Hip Impingement: Types, Main Causes, and Specialized Treatment Options.
The term Hip Impingement is actually very broad and covers anatomical abnormalities where the Femoral Head and Neck or the Acetabulum have a bone deformity causing abnormal friction, leading to damage of the Acetabular Ring and Labrum during certain ranges of motion.
There are three main causes:
Pincer-type Acetabular Retroversion:
The Acetabulum does not develop normally during childhood growth, pointing backwards instead of the normal forward orientation. In this case, it excessively covers the Femoral Head, restricting proper mobility and causing abnormal contact.
CAM or Cam-type Lesions:
These lesions appear at the junction of the Femoral Head and Neck, usually developing during adolescence as a prominent deformity. This prevents the head from fitting correctly into the Acetabulum, increasing stress on the upper Acetabulum and the Labrum.
Femoral Retrotorsion: Occurs when there is an abnormal position of the Femoral Neck, directed posteriorly on a horizontal plane, which can also trigger Hip Impingement.
Symptoms:
Patients with Hip Impingement feel groin pain that increases with activities involving hip flexion, such as running, jumping, or sitting for long periods. There is also a loss of internal rotation and potentially a Labrum tear over time, which increases pain and leads to Osteoarthritis.
Management:
Impingements are not the same for every patient; therefore, no single treatment plan exists. Symptoms, activity level, anatomy, and the extent of Labrum and cartilage damage must be evaluated.
For mild or moderate cases, conservative treatment including activity modification, pain relievers, physical therapy, and sometimes steroid injections may be suggested.
In more severe cases, Arthroscopy is a great option to correct the deformity, repair the Labrum, and manage articular cartilage damage.
Following surgery, physical rehabilitation is crucial; if performed correctly, the patient can return to physical activities within 6 months.
