Orthopaedic Surgeon
What is Hip Impingement
and a Labral Tear?
Xray of the pelvis demonstrating CAM type FAI. Image courtesy of Dr. Skelley.
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There are likely many factors that cause hip impingement. Certain activities and sports have been associated with hip impingement. Genetics may also play a role in this condition.
Bony issues around the hip that lead to impingement compress the labrum and increase the chances of having a labral tear.
What causes hip impingement
or a labral tear?
Femur
Femur
Femur
Labrum
Normal
CAM Impingement
Pincer Impingement
Graphics demonstrating the types of femoroacetabular impingement. Image courtesy of WikiCommons.
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This is a complex condition in orthopaedics and is the focus of multiple research studies. We try to treat hip impingement with physical therapy. This builds up the muscles around the hip to compensate for impingement. Some labral tears can heal on there own in very young patients. In patients with persistent pain, we may try a hip injection with steroid and pain medication to decrease inflammation in the joint.
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In cases of severe impingement with debilitating pain, some patients may be candidates for arthroscopic hip surgery. This involves placing special instruments through small holes in the hip to access the joint. These instruments can then reshape the bony abnormalities to improve the range of motion of the hip. What makes hip arthroscopy different from other joints is that the patient's leg is placed in traction in order to distract the ball and socket joint so that we may access the joint. This is necessary to treat pathology in the hip and perform labral repairs. The labrum is repaired with absorbable anchors and sutures to restore the chondrolabral junction of the hip.
How is hip impingement and
labral tears treated?
Fluoroscopic guided (with the assistance of xrays) hip injections can be therapeutic and diagnositci for problems in the hip joint. We typically inject a steroid and anesthetic medication to decrease hip pain. Image courtesy of Dr. Skelley.
The MRI image on the left is a "normal" hip. The image on the right demonstrates a labral tear indicated by the arrow. Image courtesy of Dr. Skelley.
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After the traction is applied we can gain access to the joint with xray images and special instruments.
Animated image demonstrating your position for a hip scope and how the post between your legs allows for traction with special boots around your feet.
Once access to the joint is established, portals like these are used to performed your surgery. Animated images courtesy of Nicole Wolf.
These images, from the operating room, demonstrate the operative portals used to perform a typical hip scope and what it looks like from in the hip joint using those portals.
The arrows are pointing to a repaired labral in the hip joint. Images reproduced from Skelley, NW, Conaway, W, Martin, S. Intermittent Traction as a Technique for Hip Labral Repair. Arthroscopy Techniques. June 2017.
References
1. Saadat E, Martin SD, Thornhill TS, Brownlee SA, Losina E, Katz JN. Factors Associated With the Failure of Surgical Treatment for Femoroacetabular Impingement: Review of the Literature. The American Journal of Sports Medicine. 2014;42(6):1487-1495. doi:10.1177/0363546513500766.
2. Skelley, NW, Conaway, W, Martin, S. Intermittent Traction as a Technique for Hip Labral Repair. Arthroscopy Techniques. June 2017.
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The hip joint is made of the acetabulum of the pelvis and the femoral head of the femur or thigh bone. The acetabulum can be thought of as the socket and the femoral head as the ball. Therefore, the hip is a ball and socket joint. A ball and socket joint is very congruent and has to conform well in order to provide smooth motion. If the hip has any bony irregularity, these two bones can bump into each other. This contact is known as hip impingement. The medical term for this condition is femoroacetabular impingement or FAI. If the bony problem is on the pelvis side it is commonly known as a pincer deformity. If the problem is on the femur side it is known as a cam deformity.
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The labrum is a special disc that surrounds the socket of the hip on the acetabulum of the pelvis. The labrum provides more depth to the socket and assists with hip biomechanics. The labrum in the hip is similar to the labrum in the shoulder.