FEMOROACETABULAR IMPINGEMENT

Femoroacetabular Impingement (FAI)

Femoroacetabular Impingement is a condition in which extra bone grows along with any one or both bones in the hip joint. It gives the bones an unusual shape. And since they do not fit perfectly, the bones rub against each other during movements. Over a period of time, this friction damages the joint, restricting activities and causing pain. If you do not treat FAI properly, it can damage the cartilage that cushions the hip. And this damage can ultimately result in arthritis or any other painful deterioration in the joints. In severe cases, children might even need surgery to recover from the damage.

Hip impingement generally becomes painful when the friction between bones damages the labrum. The labrum is the soft tissue cushioning the hip joint. And this damage is called a labral tear. Hip impingement often damages the cartilage layer in the joint, gradually leading to osteoarthritis. Sitting for prolonged periods and certain sports can cause hip impingement to become worse and more painful. Children playing Hockey, gymnastics, rugby, and other sports that involve a lot of twisting, turning, and squatting can develop problems like hip impingement. Over time, they may find training and performing increasingly painful.

Femoroacetabular Impingement Causes 

The hip joint features a ball-and-socket joint that attaches the femur to the pelvis. However, in people with FAI, there is an abnormality in the ball (the top of the femur) or the socket (the hollow space in the hip bone). This unusual shape causes friction during movement. Also, this can damage the surrounding cartilage and labrum. The abnormalities related to FAI are generally present at birth. Also, they can develop later, especially during the teenage phase. Doctors classify FAI into any one of three following categories depending on the cause:

Cam: This type is a bony growth at the head of the femur. Sometimes, physical activity can cause this growth.

Pincer: This is the extra bone growth in the hip socket. This type of growth often happens during a child’s development.

Combined: This is a condition in which both the cam and pincer types of FAI are present.

Physically active individuals may experience FAI-related pain earlier than people who are not that active. Exercise does not cause FAI in most cases.

Symptoms

Some children with FAI may not notice any symptoms. Signs of the condition will come up depending on the level of damage in the hip. If your child has symptomatic hip impingement, early diagnosis is crucial to get them the best chance of recovery and a complete return to activities and sports. The common FAI symptoms are:

• Hip pain worsens with physical activity or long times of sitting
• Stiffness in the hip, groin, or front of the thigh
• Pain in the hip or groin
• Difficulty flexing the hip
• Limping
• Popping or clicking sound of the hip

Femoroacetabular Impingement Risk Factors 

In most cases, the unusual shape has been present since birth. Also, it is possible to form this shape over time. This condition is more common in young athletes participating in sports that involve a lot of hip twisting and squatting. Also, certain conditions like slipped capital femoral epiphysis can lead to this unnatural shape.

Types 

There are basically three types of FAI: pincer, cam, and combined impingement.

Pincer – This type occurs when extra bone extends over the usual edge of the acetabulum. The labrum can compress under the rim of the acetabulum.

Cam – In this condition, the femoral head is not round. Therefore, it cannot rotate smoothly inside the acetabulum. Here, a bump develops on the edge of the femoral head that crushes the cartilage inside the acetabulum.

Combined – Here, both the pincer and cam types are present.

Diagnosis

Doctors use various tests for a proper diagnosis of FAI. Our doctors will ask about your child’s activity levels and family history. To confirm a diagnosis of FAI, our doctors often use:

Imaging tests: Tests such as X-rays and MRIs help experts identify abnormalities and any signs of damage in the hip joint.

Impingement test: The specialist brings your knee up to your chest and rotates it to the opposite shoulder. If someone has FAI, he will feel pain with this movement.

Local anesthetic: A doctor identifies FAI by injecting numbing medicine in the hip joint to check if the injection alleviates the pain.

Physical exam: A thorough physical evaluation will help specialists assess your motion, muscle strength, and the way you walk. It is how they will see if the hip joint is working properly.

Femoroacetabular Impingement Treatments 

Your child’s treatment for hip impingement will depend on different crucial factors such as the type of impingement, severity, and extent of damage, the age of your child, overall health, medical history, etc. While less severe hip impingement may not need surgery for treatment, our doctor may suggest surgery if the hip impingement of your child is severe. FAI treatment differs from person to person. It depends on the patient and the severity of the condition. The most common treatment options for FAI are:

Corticosteroids: These medicines help relieve inflammation (swelling) in and around the hip joint. Experts generally deliver this treatment through injection.

Nonsteroidal anti-inflammatory drugs (NSAIDs): These medicines reduce inflammation and are generally administered in pill form.

Physical therapy: Special exercises often help strengthen the joint and enhance mobility.

Rest: By restricting activities, you can reduce friction in the hip joint.

Surgery: Sometimes, surgeries might be necessary to repair the joint with operations such as:

• Arthroscopic hip surgery: In this minimally invasive method, an orthopedic doctor will repair or remove the damaged bone or cartilage.

• Conventional hip surgery: In severe cases, our specialists make a larger incision to repair the damage.

Results and Future Developments 

Surgery can be successful in reducing symptoms resulting from impingement. Improving the condition can prevent future damage from occurring to the hip joint. However, surgery may not completely fix the damage. It might happen, especially, if treatment is delayed and the damage is serious. Also, it is possible that other issues may develop later in life. It will rarely happen that surgery might not help. Still, it is presently considered the best way to treat painful FAI. With the improved results of surgery, specialists may recommend earlier surgery for this condition.

Post Surgery Care

After surgery, your doctor will consult about:

• How much weight your child can put on the surgical leg
• Pain medicine and possible ways to treat pain at home
• If there is any sign of infection or a lot of bleeding
• Taking care of the surgical incision
• Our doctors will tell you when you will have to return to the office for a post-surgery visit.

When to See a Doctor about Femoroacetabular Impingement

Make sure you follow all the instructions given at the hospital regarding how to take care of your child. If you notice any sign of infection as given below, immediately contact your orthopedic doctor:

• Worsening pain
• Redness and increased swelling
• Not feeling well
• Drainage
• The temperature of 101○ Fahrenheit along with other symptoms present.

Final Words 

We provide advanced care for patients, especially children, and tailor our treatment and care to the requirements of each child. And we always start with a thorough exam. Our specialists use world-class and the latest techniques for accurate diagnosis. And whenever possible, we take a non-surgical approach to treatment. However, if surgery is necessary, our surgeons are highly experienced in minimally invasive arthroscopic surgery.