Hip impingement, or femoroacetabular impingement (FAI), occurs when the femoral head pinches up against the acetabulum. Alex Johnson, M.D. and Brian Lee, P.A.-C. discuss the symptoms to look for when treating patients and the surgical vs. nonsurgical treatment options for FAI.
Hi, I'm Alec Johnson. I'm an orthopedic surgeon specializing in sports medicine and hip preservation. And I'm here with my name is Brian Lee and I'm a physician assistant specializing as well in sports medicine, working with Dr Alice Johnson. And we're here to talk to you today about fero, a table impingement. Now, this is a condition where there is abnormal bone growth either on the femur side for fero or asta side, which is the socket side of the hip joint. And that abnormal hip growth causes impingement between those bones as the bones move and that ultimately causes pain. A lot of it has to do with range of motion. So, impingement just by the definition of impingement means where two things encroach upon each other and they begin to lose a range of motion or kind of begin to pinch upon each other. And this is where we're talking about specifically at the hip or around the crease of your hip. So if you're thinking about when you sit down, when the crease of your hip, people tend to start to feel pain in that area. Other symptomology that will also come about is where the area of the pain is going to be at. So I've already mentioned that sometimes that pain is going to be in the growing area along the hip crease. Sometimes that pain can kind of radiate off to the side as well. And it's those two areas that kind of become problematic. And we start to see this kind of early on most of our patients. We start to see this, you know, younger populations between the ages of 14. But this can also propagate all the way to the ages of our early forties as well. So a question that comes up often is when do I see a specialist? And when you should start seeing a specialist is when the pain becomes consistent, if it progresses to a point where just walking or normal activities of daily living are starting to be affected by pain in your hip, that's when you should be coming to see us. Yeah, I agree with that. And I, you know, I think that's a lot of times that's what we're seeing is patients that they'll say, you know, I just, it just wasn't getting better and it's been maybe a few weeks for some or maybe it's months for other and, and it just continues to be a problem. So, and that's when we start talking about treatment options. Now, of course, we'll go through all the diagnosis, lots of physical exam findings to try and pin down exactly what's going on But if we get a diagnosis of a teller impingement, there are many treatment options that we have available to us from the non operative side. It really all starts with physical therapy because sometimes it can just be that the muscles around the hip joints have gotten tight that maybe there's just some mild impingement and that's just gotten the hip joint a little bit flared up and that can affect those muscles. And so you just need some work to stretch those things out to build up the strength around the hip joint to help stabilize the joint and take some pressure off of the joint itself. Usually when there's an issue when it's been going on for a long time, though physical therapy, it may not be enough to treat the condition. Then we talk about other non operative things. Brian mentioned it earlier. Um things like anti inflammatories and those can be great to help kind of cut down the inflammation inside the hip and then other pain medications like Tylenol and things like that. And sometimes again, it just, it just requires some rest a little bit of anti inflammatory and it can calm down. Um But many times it requires some more than that. And that's when we talk about injections and injections can be a little bit tricky. Um And it's very nuanced when to use an injection for fema a table or impingement and when not to, when to do that type of injection a lot of times if I'm not sure of the diagnosis. And so, you know, think that maybe this is a hip impingement. I think it's coming from the hip joint, but I'm not entirely sure that can be a great time to do an injection. Uh We have one of our colleagues that will do the injection either under ultrasound or x-ray. Uh and then put the medicine into the hip joint. If that injection takes away your pain, it makes you feel better and helps your symptoms. Then that can be a good sign that this is Femaras table or impingement or some other condition that is contained within the hip joint itself. Alternatively, if it doesn't get better, then maybe there's something else going on and maybe we need to look at the spine or the back or something like that. So yeah, things are not getting better with the non operative treatments, whether that be the physical therapy or the injections or the things that we talked about. Then that's when we talk about surgery and surgical intervention would be in the form. Most in most cases, a hip arthroscopy procedure and all that means is is that we would make some small poke holes around the hip joint and put a camera inside the hip joint to repair the structures inside the joint. Um and in most cases that can help um alleviate pain and get patients back to, to the things that they like to do, um, now Feosol or impingement surgery or hip arthroscopy surgery. I tell patients all the time that the main reason that we're doing the surgery is pain and we're trying to get rid of their pain and to get them back to doing the activities that they love. So, if they've tried all the operative things and they're still in pain and it's not getting better, then that's a reason to operate. And we've got good evidence to show in the literature that by doing this procedure, we can make their pain better and get them back to sports and activities and things like that.