Hip Impingement
A femoracetabular impingement (FAI) is a condition where the bones of the hip are abnormally shaped and there is an abnormality in the way the ball of the femur (thighbone) and the acetabulum (hip socket) fit together. A cam impingement is a type of FAI where the ball of the femur is misshapen and does not move smoothly within the hip socket. The friction creates a protrusion on the ball of the femur that places pressure on the cartilage in the joint and damages it. As a result, bone spurs may develop, causing joint damage and pain. This condition is caused by hip bones that do not form normally during the years of growing and development in childhood.
Symptoms of Cam Impingement
Patients with a cam impingement typically experience pain around the hip area that may be dull and persistent. In some cases, sharp, stabbing pain sometimes occurs with sudden movement such as twisting or turning. Pain may occur in the groin area or toward the outside part of the hip.
Diagnosis of Cam Impingement
A cam impingement is diagnosed through a review of the patient’s medical history as well as a a physical examination of the hip and surrounding joints. Additional tests may include:
- X-ray
- CT scan
- MRI scan
The doctor may also perform an impingement test by moving and rotating the knee towards the chest and opposite shoulder, to see if these movements recreate any pain. If symptomatic pain is recreated with these movements, the patient will test positive for an impingement.
Treatment of Cam Impingement
Cam impingement may respond to conservative treatments such as limiting certain physical activities and taking non-steroidal anti-inflammatory medication. Physical therapy may be helpful in restoring range of motion and strength to the muscles around the hip joint. In severe cases, if the symptoms do not improve, arthroscopic surgery may be recommended to remove any damaged cartilage and trim the bony protrusion of the hip socket and femur. The goal of the procedure is to trim the bones enough to prevent the impingement from occurring.
Labral Debridement
The labrum is a protective layer of cartilage in the hip joint. It provides this relatively shallow ball-and-socket joint with more stability and cushioning, allowing for a full range of motion. Tears in this cartilage, known as labral tears, are often caused by either trauma to the hip or chronic overuse. Such injuries are more common in individuals who play sports which require repetitive twisting or pivoting motions, such as golf or hockey. Tears of this type may also be the result of excessive wear on the labrum due to anatomical abnormalities. Labral tears can lead to pain, stiffness and a catch or click within the joint during movement.
Diagnosis of a Labral Tear
To diagnose a labral tear, the physician will perform a physical examination and take a thorough medical history. Labral tears are frequently misdiagnosed because their symptoms are similar to those of a number of other ailments or conditions. To confirm a suspected diagnosis, an injection of anesthesia may be administered to help pinpoint the area in which the pain originates. Testing may include X-rays or an MRI scan to provide a precise view of the internal structures of the hip joint.
The Labral Debridement Procedure
While some labral tears can be treated by managing pain symptoms with a combination of medication and physical therapy, many cases require surgical treatment. The goal of a labral debridement procedure is to trim back the torn area of the labrum in order to lower the risk of further tearing. The procedure is often performed arthroscopically, using very small incisions and special surgical tools. This minimally invasive approach reduces trauma to the area and generally takes about one hour to complete.
After anesthesia is administered, the leg is placed in traction to maximize access to the hip joint. The surgeon makes tiny incisions near the hip and inserts the arthroscope and surgical tools. The arthroscope provides a clear view of the joint so the surgeon can precisely evaluate which portion of the labrum to trim back. Once the debridement is complete, the incisions are closed with sutures.
Labral debridement is a less extensive surgery than a labral repair procedure. Labral repair involves the implantation of anchors that must be drilled into the bone. In contrast, labral debridement focuses only on the shaving down of an area of the labrum and requires the use of no fixation devices. Both procedures have high success rates, reduce pain in the hip and improve the range of motion in the joint. The determination as to which procedure is better for each individual patient’s condition is dependent on several factors, primarily the extent of the damage.
Risks of a Labral Debridement
Labral debridement is considered a safe procedure, but, as with all forms of surgery, it does carry some risks. The risks associated with labral debridement may include damage to the cartilage of the hip, nerve injury and swelling around the treatment site.
Recovery from a Labral Debridement
After a labral debridement procedure, patients are typically able to return home the same day. There may be some residual pain as the joint heals, but this generally resolves on its own within a few weeks. Patients may need assistive devices such as a walker, crutches or a cane temporarily to avoid placing too much weight on the hip as it heals.
