What is the femoroacetabular joint?
The femur (thigh bone) fits into the acetabulum (hip bone) to form the femoroacetabular joint or the hip joint. The acetabulum is lined with a thin piece of cartilage that is important for normal hip function (the labrum). The labrum seals the joint, allows for a wider range of movement, and helps keep the bones aligned.
What is FAI?
It is hip impingement, a common hip condition among professional athletes, weekend warriors, and younger amateur athletes where the hip bones do not fit together properly. This can be caused by abnormal hip formation that is revealed as a child grows, such as bone spurs that form on one or both of the hip bones (femur or acetabulum) and/or by an abnormally twisted thigh bone (femur).
The abnormal bone pinches and tears the hip cartilage (the labrum) that sits between the two bones. The deformity alters normal biomechanics, and accelerates joint degeneration. It can also cause damage to the cartilage that covers the ends of the bones causing deterioration that leads to osteoarthritis of the hip.
What are does a hip impingement feel like?
Hip impingement causes hip pain and a deep ache in the groin, stiffness, limping, and a reduced range of motion. When the cartilage (labrum) is pinched running, jumping, squatting, lunging, sitting, or standing for long periods can cause pain.
Can hip impingement cause buttocks pain?
Yes. Pain can be felt in the front of the thigh or down the buttocks. It can also cause low back pain, and sharp pain when getting into or out of a car or a chair.
What causes FAI?
Many people have a misshapen hip joint that may not cause problems until it is overused and is pushed beyond the hip’s normal range of activity. It is often misdiagnosed as hip bursitis, hip muscle strain, injury due to trauma to the hip joint, or hip dislocations.
What is the hip impingement test?
This is a test that Dr. Chahla will use when he examines you. He will ask you to bring your knee to your chest and then rotate it in toward the opposite shoulder (FADIR [flexion adduction and internal rotation]). If this causes pain, it is positive for FAI. However, diagnosis will include imaging tests to confirm the diagnosis. A comprehensive physical exam is key to determine the cause of your pain.
Does a hip impingement need surgery?
Some people live active lives, never knowing they have FAI, and don’t have any problems.
By the time symptoms develop there is usually some damage to the hip cartilage (labrum) and with repeated use, the damage will progress. The reason athletes are often diagnosed with FAI is because they overuse the joint in extreme ranges of motion, which damages the labrum more quickly and causes pain.
In mild to moderate cases, symptoms can improve with nonsurgical treatment. This involves a change in activities to avoid those activities that cause pain, including taking time off from athletics, using over-the-counter anti-inflammatory medications to reduce pain and inflammation, and physical therapy. Symptoms should resolve within several weeks. Corticosteroid injections can also help relieve pain. Chiropractic treatments can sometimes aggravate the condition.
When is surgery indicated?
When nonsurgical treatments do not relieve pain and imaging reveals severe tears, detachment of the labrum, or damage to the articular cartilage, surgery will be recommended. Surgery can be performed in a minimally invasive procedure called hip arthroscopy, which is usually an outpatient procedure. However, in some cases open surgery may be required. Hip surgery is customized for each patient because each patient’s bones and condition are different.
How long does it take to recovery from hip surgery for FAI?
Most people can recover full, unrestricted activity in 4-6 months with a good physical therapy program.
What is hip preservation?
Hip preservation refers to the use of procedures to protect and maintain the labrum (the cartilage that lines the hip bone to deepen the hip socket) to prolong the natural lifespan of the hip, to prevent arthritis of the joint, and to avoid or delay hip replacement surgery. FAI predisposes patients to premature joint degeneration. Hip replacement surgery is the treatment for advanced arthritis of the hip.
Dr. Jorge Chahla is a hip expert in Chicago, Illinois who specializes in the treatment of hip conditions. He is internationally recognized for his contributions to the field of sports medicine and is a pioneer in novel therapies. Dr. Chahla’s focus is on customized and personalized care to meet the needs of each of his patients. He uses minimally invasive arthroscopic procedures to preserve the natural joint and to reduce recovery time to accelerate his patients’ return to the activities they love.
At a Glance
Dr. Jorge Chahla
- Triple fellowship-trained sports medicine surgeon
- Performs over 500 surgeries per year
- Professor of orthopedic surgery at Rush University
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