What is Femoroacetabular Impingement?
Femoroacetabular Impingement is a pathological condition of the hip in which there is growth of an extra bone within the bones of the hip joint which give the hip an irregular or deformed shape.1 Femoroacetabular Impingement causes the two bones to rub against each other with movement which over time due to increased friction between the bones causes pain and a decrease in functional activity of the individual.
The bone overgrowth seen in Femoroacetabular Impingement is termed as bone spurs usually develop around the femoral head in the hip or the acetabulum. This extra bone is in constant contact with the hip bones and prevents them from moving smoothly and swiftly with any movement of the hip and causes pain. If left untreated, labral tears or osteoarthritis of the hips which is a complex condition to treat may be caused due to Femoroacetabular Impingement.
What are the Different Types of Femoroacetabular Impingement?
There are basically three types of Femoroacetabular Impingement namely Pincer Type, Cam Type, and the Combined Type.1
Pincer Type Femoroacetabular Impingement
This type of Femoroacetabular Impingement occurs when the bone overgrowth extends over the acetabulum causing the labrum to be compressed within the rim of the acetabulum.2
Cam Type Femoroacetabular Impingement
This type of Femoroacetabular Impingement occurs when the femoral head comes out of round and is not able to rotate smoothly within the acetabulum.3 This results in formation of a bump at the femoral head-neck junction which starts to damage the cartilage within the acetabulum.
Combined Type Femoroacetabular Impingement
This type of Femoroacetabular Impingement occurs when there is present of both the Cam type and the Pincer type of Femoroacetabular Impingement present in an individual.
What Causes Femoroacetabular Impingement?
Femoroacetabular Impingement usually occurs in the childhood and in the growing years of the child as a result of the hip bone not developing normally. Because of the abnormal development of the hip bones there is formation of bone spurs which ultimately cause pain and damage to the hip joint.
Once the shape of the bones gets deformed that is when the development of Femoroacetabular Impingement takes place. Usually people may face no problem with Femoroacetabular Impingement until the bone spurs start to cause damage to the cartilage within the acetabulum or the labrum gets compressed beneath the rim of the acetabulum.
This is the time when people with Femoroacetabular Impingement start to develop pain which starts to interfere with their regular activities of daily living. It is also seen that people with Femoroacetabular Impingement who tend to be more active start to experience symptoms first than people who are less active.
What are the Symptoms of Femoroacetabular Impingement?
Some of the symptoms of Femoroacetabular Impingement include:
- Persistent and severe pain in the hips, especially with any movement
- Stiffness of the hip joint
- Difficulty ambulating can be a symptom of Femoroacetabular Impingement
- The pain in the hips radiating to the groin area
- Pain with twisting, squatting, and turning which tends to sharp and excruciating can be a symptom of Femoroacetabular Impingement.
How is Femoroacetabular Impingement Diagnosed?
In order to diagnose Femoroacetabular Impingement, the treating physician will first take a history of the patient and inquire as to the location and severity of the symptoms. If there is suspicion of an impingement then an impingement test will be done in which the physician will bring the knees up towards the chest and will rotate the knees in either direction. If there is reproduction of pain in the hip then it will confirm that impingement in the hip is causing the symptoms.
To confirmatively diagnose Femoroacetabular Impingement, the physician will conduct radiological studies in the form of x-rays, MRI and CT scans. MRI done with contrast medium will clearly show the deformed shape of the hips and the status of the labrum and acetabulum confirming the diagnosis of Femoroacetabular Impingement.
The physician may also conduct an anesthetic test in which the physician will inject a local anesthetic into the hip joint and if there is relief of pain temporarily then the diagnosis is confirmed of Femoroacetabular Impingement.
How is Femoroacetabular Impingement Treated?
Femoroacetabular Impingement can be treated both surgically as well as with conservative approaches.
Conservative treatment approach for Femoroacetabular Impingement involves patient being asked to maintain certain lifestyle changes and advised to avoid activities that may aggravate the symptoms.
The patient will also be given NSAIDs in the form of ibuprofen or Tylenol to deal with the pain caused by Femoroacetabular Impingement. The patient will also be sent to physical therapy to strengthen the muscles of the hip and to improve range of motion of the hip so as to relieve some pressure on the labrum and cartilage that is being put as a result of Femoroacetabular Impingement.
In case if the above approaches are unsuccessful in alleviating the symptoms of Femoroacetabular Impingement then the physician may opt for a surgical solution to the problem in which a surgical procedure to remove the bone growth and reconstruction of the hip joint may be done so as to relieve the pain symptoms and treat Femoroacetabular Impingement.