FEMOROACETABULAR IMPINGEMENT

QUESTIONS AND ANSWERS

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 one of the 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 to 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 periods of sitting
• Stiffness in the hip, groin, or front of the thigh
• Pain in the hip or groin
• Difficulty flexing the hip
• Limping
• A popping or clicking sound in 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. Today, 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.

Diagnosis

Doctors use various tests for a proper diagnosis of FAI. Generally, 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 child’s knee up to the chest and rotates it to the opposite shoulder. Consequently, if someone has FAI, he or she 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 child’s motion, muscle strength, and the way the child walks. It is how they will see if the hip joint is working properly.

Can Hip Impingement Resolve Itself?

Hip impingement typically doesn’t resolve without intervention. If left untreated, it might lead to persistent discomfort and potentially more severe issues. Here are some potential consequences of ignoring the condition:

• Ongoing Pain: Chronic hip pain can become a constant companion.
• Joint and Tissue Damage: Continuous friction in the joint can harm the surrounding tissues.
• Cartilage Degradation: Over time, the wearing away of cartilage can occur, leading to additional complications.
• Labral Tears: The increased stress may eventually result in tears to the labrum, worsening mobility issues.

While lifestyle changes like physical therapy and modified activities can help manage symptoms, professional medical advice is important for determining the best course of action and early intervention and a comprehensive treatment plan can help prevent these outcomes, ensuring better long-term hip health.

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, a child 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.

Patient Experiences with Hip Impingement Treatment

Blair Cruikshank, a national champion speed skater, battled persistent and worsening hip pain that disrupted her rigorous training schedule. After being diagnosed with femoroacetabular impingement syndrome (FAI), Blair and her family sought expert treatment. She underwent a successful hip arthroscopy procedure, which paved the way for her triumphant return to the ice. Now, she skates at full speed, free from the hindrance of her previous discomfort.

Blair’s journey highlights the effectiveness of specialized hip treatment programs in restoring athletes to peak performance. Patients like her often describe feeling renewed mobility and significantly reduced pain post-surgery, enabling them to pursue their passions without limitation. Their stories are testaments to the life-changing impact of accurate diagnosis and advanced surgical interventions in overcoming hip impingement.

Managing hip and knee pain effectively before considering joint replacement surgery involves exploring several strategies tailored to the needs of the patient. Here’s a comprehensive guide to help parents navigate their options:

Non-Surgical Methods

Physical Therapy

• Engaging in targeted exercises can strengthen the muscles around your joints, improving flexibility and reducing pain. A physical therapist can tailor a routine to suit your specific condition, emphasizing low-impact activities such as swimming or cycling.

Weight Management

• Maintaining a healthy weight reduces stress on your joints, which can alleviate pain. Consider a balanced diet and regular exercise to support weight loss efforts.

Pain Relief Medications

• Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort. For more severe pain, your doctor may prescribe medications that target inflammation more effectively.

Lifestyle Modifications

• Adjusting your daily activities can significantly reduce strain on your joints. For instance, opt for chairs with proper support, and use assistive devices like canes to improve mobility.

Joint Injections

• Corticosteroid or hyaluronic acid injections can provide temporary relief by reducing inflammation or improving joint lubrication.

Acupuncture

• This ancient practice can offer relief by stimulating specific points on the body, potentially helping to reduce pain and improve function.

Supplements

• Some people find relief with supplements like glucosamine and chondroitin. While effectiveness can vary, they are worth discussing with your healthcare provider.

Braces or Orthotics

• Using braces can provide additional support to your joints and help in redistributing weight, thereby minimizing pain.

Mindfulness and Relaxation Techniques

• Practices such as yoga and meditation can help manage pain by reducing stress, which may in turn alleviate symptoms.

Considering these options can help you manage hip and knee pain effectively, allowing you to maintain an active and fulfilling lifestyle without immediately resorting to surgery. Always consult with a healthcare professional to tailor a plan best suited to your specific needs. If conservative measures do not provide adequate relief, surgical intervention may be considered. Common surgical procedures for FAI include arthroscopic hip surgery to reshape or remove excess bone, reducing impingement and improving hip function. The specific treatment plan will depend on the child’s age, the severity of the condition, and the surgeon’s recommendations.

Surgery

Surgery can be successful in reducing symptoms resulting from impingement. Additionally, 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, 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.

After surgery, your doctor will consult about:

• How much weight can your child 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 bring your child back to the office for a post-surgery visit.

Understanding the Recovery Process

Each child’s recovery from hip impingement surgery can be unique, influenced largely by the type of procedure performed. Most children can begin walking shortly after an arthroscopic surgery, often using crutches for added comfort. However, in cases of more complex surgeries, crutches may be necessary for a longer period, sometimes extending to a few months.

Role of Physical Therapy

Physical therapy plays a vital role in the recovery journey, helping to rebuild joint strength and enhance movement. Engaging in specific exercises tailored to your child’s needs will be crucial in facilitating a smooth recovery.

Timeline for Returning to Activities

In the initial three months after arthroscopic surgery, children can typically resume low-impact activities, such as walking, stationary biking, and swimming. As recovery progresses, more intense activities like jogging and running may be reintroduced, usually after the three-month mark. For those with a more intricate surgical procedure, returning to everyday activities might extend to six months.

Ensuring Proper Healing

Your healthcare provider will schedule follow-up appointments to monitor the healing process and ensure everything is on track. These visits are essential for adjusting recovery plans and addressing any concerns that may arise.

By weaving together immediate post-surgery care instructions with a broader overview of the recovery process, you can better prepare for the journey ahead, ensuring your child has the support and guidance needed for a successful recovery.

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. Furthermore, 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.

What Should Patients Expect at an Appointment with a Hip Specialist?

Visiting a hip specialist can be a crucial step towards regaining mobility and alleviating discomfort. Understanding what to expect can ease any anxieties and help you better prepare for your appointment.

Initial Consultation and Medical History

Your appointment will typically begin with an initial consultation. During this time, the specialist will take a thorough medical history, focusing on your current symptoms, past injuries, and any previous treatments or surgeries.

Questions you might be asked include:

• When did you first notice hip pain?
• Have you experienced any previous hip injuries?
• What activities, if any, worsen your pain?

Physical Examination

Following the consultation, the specialist will conduct a physical examination. This exam will assess range of motion, flexibility, and strength in the hip area. Expect the doctor to gently move your leg in different directions to pinpoint areas of pain or discomfort.

Diagnostic Imaging

To gain a more in-depth understanding, imaging tests may be ordered. Common procedures include:

• X-rays: To view bone structures and check for any fractures or arthritis.
• MRI: Offers a detailed look at soft tissues, including muscles and tendons, which can be crucial for diagnosing tears or inflammation.

Discussion of Treatment Options

Once a diagnosis is confirmed, the specialist will discuss potential treatment options. These may range from:

• Physical Therapy: To improve movement and reduce pain.
• Medications, Such as anti-inflammatory drugs, are used to manage symptoms.
• Surgical Interventions: In severe cases, procedures like hip replacement might be considered.

Addressing Questions and Concerns

Don’t hesitate to ask questions throughout your appointment. Understanding your condition and treatment plan is vital:

• What are the benefits and risks of each treatment option?
• How long is the recovery period?
• What lifestyle changes can aid in recovery?

Leaving with a Plan

By the end of your appointment, you should have a clear understanding of your diagnosis and a personalized treatment plan to address your hip issues. Remember, the goal is to help you return to a pain-free and active lifestyle.

Final Words 

At the Medical City Children’s Orthopedics and Spine Specialists medical practice, with offices in Arlington, Dallas, Flower Mound,  Frisco, and McKinney, TX, we provide advanced care for children and tailor our treatment and care to the requirements of each child. And we always start with a thorough exam. Finally, our specialists use world-class technology 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.

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Footnote:

American Academy of Orthopaedic Surgeons: Femoroacetabular Impingement