Femoroacetabular Impingement:
Hip Impingement Surgery
in Houston, TX

Film X ray of an individual with femoroacetabular impingement. Our hips are relatively simple ball-and-socket joints where the ball of the femur fits tightly into the socket. Without play in the joint, the ball should glide smoothly within the socket, allowing pain-free movement. But when the hip joint develops extra bone it causes the bones to rub together. This is hip impingement, clinically known as femoroacetabular impingement.

Dr. Adickes can treat femoroacetabular impingement, typically using arthroscopic methods.

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What is femoroacetabular impingement?

Femoroacetabular impingement (FAI) is an unusually shaped hip joint that causes two bones in the hip to rub together. The pressure causes friction between the top of the femur (thighbone) and the acetabulum (the hip socket). This bone on bone contract will eventually lead to pain and will begin to limit motion.

What are the symptoms of femoroacetabular impingement?

When this occurs, it doesn’t usually instantly display symptoms to the person. The bone abnormalities are usually present from childhood, but there may not be any symptoms or pain. Eventually, there will likely be some of these symptoms:

Mature man with lower back pain at the hospital

  • Pain or aching (usually located at the inner hip, or groin area), usually after walking, or prolonged sitting (as when driving)
  • A locking, clicking, or catching sensation in the joint
  • Pain when sitting for long periods
  • Difficulty walking uphill
  • Low back pain
  • Pain at the sacroiliac joint on the back of the pelvis, the buttock, or the side of the hip
  • Difficulty putting on socks and shoes
  • Pain when sleeping on your side with the impinged hip

What causes femoroacetabular impingement?

FAI generally occurs as two forms (or a combination of the two): cam and pincer. The cam form occurs when the femoral head and neck are not perfectly round. This is a deformity of a cam bone spur. When the hip goes through its normal range of motion, this bone spur creates abnormal contact between the head and the socket.

The pincer form occurs when there is extra bone growth in the hip socket. There is now over-coverage. This typically exists along the front top rim of the acetabulum/socket. This causes the labral cartilage to get pinched between the rim of the socket and the front part where the femoral head meets the femoral neck.

These abnormalities in the bones that allow cam or pincer impingement are usually present in childhood, and there isn’t anything that can be done to prevent eventual FAI. Some people, especially if they aren’t active athletically, may never have problems. However, the increased work of the hip joint involved with athletic endeavors will often lead to that person experiencing pain earlier. Exercise is not the cause of FAI, but it will exacerbate the abnormal bone contact.

How is femoroacetabular impingement diagnosed?

Dr, Adickes has several tests to diagnose FAI. He’ll discuss your family history and your overall activity levels. He’ll probably have a good idea of your condition simply through a physical exam that assesses a range of motion, muscle strength, and the way you walk. To confirm his diagnosis, he may use these tests:

Imaging tests

A female patient entering a mri scan while technician standing and looking at her.X-rays and MRIs will show abnormalities in both the bone and the soft cartilage in the socket and on the femur head. A special type of MRI called magnetic resonance arthrography (MRA) may be used. For MRA, a contrast dye is injected into the joint space to help make the images clearer. Dr. Adickes will often add local anesthetic to these injections to help determine if your pain is coming from inside the joint.

Impingement test

Dr. Adickes brings your knee up to your chest and rotates it toward your opposite shoulder. If you have FAI, this will normally cause some degree of pain.

What are the non-surgical treatments for femoroacetabular impingement?

The underlying problem with FAI is the abnormal bone shape, and this will not change with physical therapy or rest. Of course, it’s not the bones themselves that are causing your pain; it is the labrum or articular cartilage that is causing your pain as they come in contact with the abnormal bone. That limits the potential for improving your condition without surgery. Still, these are nonsurgical treatments that are the first option:

  • Lifestyle changes — If you’ve been very active, you can decrease your level of activity, or you can avoid certain activities that really work your hip joint.
  • Non-steroidal anti-inflammatory medication — Prescription-strength ibuprofen and other medications can reduce pain and inflammation.
  • Physical therapy — Strengthening the muscles that support your hip and exercises that improve your range of motion can relieve some of the stress on the injured labrum or cartilage, but these can also cause more pain in some people.

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What are the surgical treatments for femoroacetabular impingement?

Traumatology orthopedic surgery hospital emergency operating room prepared for arthroscopy operation photo of nurse scrubbing doctor putting hands insterile plastic gloves.Dr. Adickes can treat many FAI problems with arthroscopic surgery. He generally uses two portals into the joint. These are small incisions, one typically on the side and the other on the front of the hip. The arthroscope is inserted through one portal to provide visuals of the inside of the joint. Dr. Adickes inserts the tools he needs through the other portal.

To gain access into the hip joint, space needs to be created, as the joint is quite tight. This is called “distraction,” and it involves using traction to create enough space in the joint to be able to perform the necessary repairs. This is not dislocation of the hip.

For these surgeries, Dr. Adickes can repair or clean out any damage to the labrum and articular cartilage. He can correct the abnormal boney areas by trimming the bony rim of the acetabulum or by shaving down the bump on the head of the femur.

If the patient has more severe issues, open surgery may be necessary. This requires a large incision, from 7-10 inches, and makes for an involved recovery. Arthroscopic options are pursed if at all possible.

Who would be a candidate for hip impingement surgery?

Anyone experiencing pain associated with femoroacetabular impingement is a good candidate for this surgery with Dr. Adickes. As mentioned above, the bony abnormalities will not correct themselves with physical therapy or any other treatment. If you want to continue to be active, arthroscopic surgery is probably your only true treatment option.

That said, it’s wise to not wait too long to have this procedure. The longer you wait, the more cartilage damage will occur. At some point, this will not be repairable.

What is recovery like after arthroscopic hip impingement surgery?

Senior Patient and physical therapist in rehabilitation walking exercises, she is helping him along the barsYou’ll be on crutches after your surgery. These arthroscopic procedures are outpatient, and you’ll return home the same day. You’ll walk with crutches for 1-2 weeks, and you’ll have six weeks of physical therapy. Six weeks is the typical recovery time, but this varies. It may take between 3 and 6 months before you don’t have pain after physical activity. If your damage is more severe, this procedure could be a bridge to postpone the future necessity of hip replacement surgery.

What happens if I leave my femoroacetabular impingement untreated?

If you don’t address femoroacetabular impingement, it will usually lead to damage in the cartilage that cushions the hip joint, both in the socket and on the tip of the femur. This is osteoarthritis and will continue to degrade the hip. At some point, continued damage will likely lead to the need for hip replacement because once the cartilage is seriously damaged there is no way it can be repaired.

See what our patients are saying…

“Dr. Adickes performed bilateral hip labrum repairs on me this December and February. He is one of the most competent doctors I have ever worked with and am grateful I had the opportunity for him to perform the surgeries on me. Of course, he is also my top choice to fix my two torn rotator cuffs as well – he is skilled in many major joints! I’m back to running and would recommend him to anyone – near or far! – Charlotte E.

Dr. Adickes has great bedside manners. I thought he was very friendly and easy to talk to. He understood my condition and ended performing arthroscopic repair. I am still taking PT, but I am healing well. I had another injury while healing and he also addressed it during one of my follow-up visits. His staff has always been friendly and helpful, even when I call and ask questions over the phone. The check-in desk is always busy but seems efficient. I’ve never had to wait too long to see him, but on one visit he was running a little behind. I would recommend Dr. Adickes to anyone I know needing care under his specialty. – D. Smith

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If you’re interested in learning more about femoroacetabular impingement please contact us for a consultation at (713) 464-0077  or fill out our contact us form. We will discuss your needs and concerns, and determine your best course of action.

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