Hip impingement, also known as femoroacetabular impingement (FAI), is a condition where abnormal bone growth causes the hip bones to rub against each other during movement.

The hip joint is a ball-and-socket joint, consisting of the femoral head (the ball) and the acetabulum (the socket) of the pelvis. FAI occurs when there is extra bone along one or both of these bones, leading to friction and damage to the joint.

There are two main types of FAI:

Cam Impingement – where the femoral head is not perfectly round and causes friction.

Pincer Impingement –  where extra bone extends over the normal rim of the acetabulum.

Often, both types can occur together. This abnormal contact can damage the articular cartilage and the labrum (the ring of cartilage that follows the outside rim of the socket), leading to pain, reduced range of motion, and, if left untreated, arthritis.

Today, we’ll explore this condition through the case study of a patient named Sarah, diving into her medical history, symptoms, diagnosis, treatment, and recovery.

Case Study: Sarah’s Journey with Hip Impingement

Medical History

Sarah, a 29-year-old avid runner and yoga enthusiast, had been experiencing hip pain for about a year. Initially, she attributed the discomfort to overuse and minor muscle strain. Despite reducing her activity level and incorporating rest periods, the pain persisted and gradually intensified, affecting her daily life and exercise routines.

Symptoms and Patterns of Pain of Hip Impingement

Sarah reported the following symptoms:

• Pain Location: Deep pain in the groin area, occasionally radiating to the outer hip and thigh.
• Pain Trigger: Sharp pain during hip flexion activities like running, sitting for long periods, and yoga poses that require deep hip movements.
• Pain Duration: The pain was initially intermittent but became more constant over time.
• Other Symptoms: Stiffness and a limited range of motion in the affected hip.

Clinical Assessment and MRI Findings

Sarah’s physical examination revealed:

• Limited Range of Motion: Notable restriction in hip flexion and internal rotation.
• Positive Impingement Test: Pain and discomfort during the FADIR (Flexion, ADduction, Internal Rotation) test.

To confirm the diagnosis, an MRI was performed, revealing:

• Cam Impingement: Negative – the shape of the femoral head was normal.
• Pincer Impingement: Excessive bone growth along the acetabulum.
• Labral Tear: Damage to the cartilage lining of the hip socket, likely caused by repetitive impingement.

Surgical Treatment

Given the severity of her symptoms and the impact on her quality of life, Sarah and her orthopaedic specialist decided to proceed with arthroscopic surgery.

The procedure involved:

• Pincer Resection: Removing the excess bone from the acetabulum to prevent further impingement.
• Labral Repair: Reattaching and stabilising the torn labrum to restore joint function and joint stability.

Post-Operative Outcomes

Sarah’s post-operative care included a comprehensive rehabilitation program:

• Immediate Post-Op: Initial rest and limited weight-bearing for a few days to allow healing.
• Physiotherapy: Gradual introduction of gentle range-of-motion exercises, followed by strength training and functional exercises tailored to her activity level.
• Return to Activity: After several months of dedicated rehabilitation, Sarah gradually returned to her running and yoga routines, with modifications to prevent recurrence.

Sarah’s surgery and diligent rehabilitation led to significant improvements:

• Pain Relief: Substantial reduction in pain and discomfort.
• Improved Mobility: Enhanced range of motion in the hip.
• Quality of Life: Ability to resume her favourite activities without limitations.

Expert Care at London Bridge Orthopaedics

Sarah’s successful treatment was overseen by Prof. Venu Kavarthapu, who runs the regional young adult hip surgery service, including hip arthroscopy and minimally invasive hip replacement surgery at King’s College Hospital in London, and a key specialist at London Bridge Orthopaedics.

Prof. Kavarthapu is renowned for his surgical expertise in hip arthroscopy and the treatment of complex hip conditions like femoroacetabular impingement. His extensive experience and commitment to patient care ensure that individuals receive the highest standard of treatment, from diagnosis through to postoperative recovery. Under his guidance, patients benefit from cutting-edge surgical techniques and personalised rehabilitation programs designed to restore function and improve quality of life.

Conclusion

Hip impingement is a challenging condition that can significantly impact an active lifestyle. However, with accurate diagnosis, appropriate surgical intervention, and a structured rehabilitation program, patients like Sarah can achieve excellent outcomes. If you experience similar symptoms, consult with a specialist hip consultant to explore the best treatment options tailored to your needs.

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