Joint, Ligament and Muscle Disorders

Femoral Acetabular Impingement (FAI) & Labral Tear of the Hip

Anatomy

The hip is a ball-and-socket joint. The socket is formed by a part of the large pelvis bone (acetabulum). The ball (femoral head) is the upper end of the thighbone (femur). A slippery tissue (articular cartilage) covers the ball and socket, providing a smooth, low-friction surface that allows the bones to glide easily across each other.

A strong fibrocartilage (labrum) rings the acetabulum and forms a gasket around the socket, creating a tight seal and helping to provide stability to the joint.

Description

When bones of the hip are abnormally shaped and do not fit together perfectly, the hip bones may rub against each other and cause damage to the joint. The resulting condition is femoroacetabular impingement (FAI), which is frequently seen along with a tear of the labrum.

There are three types of FAI:

• Pincer— Extra bone extends prominently, out over the normal rim of the acetabulum, potentially crushing the labrum.
• Cam—The femoral head is not round enough to rotate smoothly inside the acetabulum; a bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum.
• Combined impingement—Both pincer and cam types of FAI are present.

Symptoms

Symptoms usually include pain in the groin area, which is sometimes located toward the outside of the hip. Sharp stabbing pain may occur with turning, twisting and squatting, or you may just experience a dull ache.

Nonsurgical Treatment

• Activity changes—Your doctor may first recommend simply modifying your daily routine and avoiding activities that cause or aggravate symptoms.
• Nonsteroidal anti-inflammatory medication (NSAIDS)—Drugs such as ibuprofen can be provided in a prescription strength to help relieve pain and inflammation. However, whether in over-the-counter or prescription-strengths, these medications must be used carefully. Taking them for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.
• Physical therapy—Specific exercises or a hip conditioning program can improve the range of motion in your hip and strengthen the muscles that support the joint.

Surgery

If tests indicate joint damage caused by FAI and your pain is not relieved by nonsurgical treatment, your physician may recommend arthroscopic surgery to repair or clean out any damage to the labrum and articular cartilage. During this hip arthroscopy, your orthopaedic surgeon can trim the bony rim of the acetabulum and shave down the bump on the femoral head to correct the FAI.

With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.