Hip

Femoroacetabular Impingement: What to do With Chronic Hip Pain?

By Last updated on April 5th, 2020 Last updated on April 5th, 2020 No Comments

Femoroacetabular Impingement

Femoroacetabular Impingement is a condition in which tissues in the hip joint are pinched and begin to express pain. As the condition progresses, the pain may escalate and leave an individual permanently debilitated.

Though there are many treatment options to consider, it may be helpful to learn more about which portions of the hip are involved, how the condition manifests itself, and the options available to those who suffer from it.

Anatomy of Femoroacetabular Impingement

The hip is what’s known as a “ball and socket” joint where the “ball” is made up of the rounded head of the femur (upper portion of the thigh bone) and the “socket” is made up of the cavity formed by the pelvic bone (known as the acetabulum).

The head of the femur is held in place by a sleeve of very powerful ligaments that connect to the pelvis. These ligaments provide stability and help ensure the femur stays within a certain range of motion.

Both the femoral head and the pelvic cavity are covered by a smooth layer of cartilage which helps to cushion the movements within the joint. This cartilage ensures that the bones slide smoothly against one another with minimal friction.

In addition to the cartilage and ligaments, a layer of rubber-like fibrocartilaginous tissue forms a rim around the “socket” in the pelvis, increasing its depth, and in turn, the stability of the femoral head within the pelvic cavity. This rim is called the labrum and it acts as an o-ring or gasket to help secure the femoral head within the pelvic cavity.

If even one of these components does not function properly, this limits the range of motion of the femoral head within the cavity of the pelvis and leads to Femoracetabular Impingement (FAI).

Femoracetabular impingement is simply the name given to the act of the two hip joint bones colliding with one another and pinching the labrum. As the head or neck of the femur collides with the socket in the pelvis, the labrum is compressed and an individual begins to feel pain.

Signs and Symptoms of Femoroacetabular Impingement

An individual may have FAI for quite some time before the symptoms begin to manifest as pain typically doesn’t occur until the latter stages of the condition.

As FAI develops, an individual may begin to experience:

  • Aches and pain in the inner hip or groin area
  • Locking or “catching” of the hip joint
  • Pops, clicks, and other noises and sensations
  • Pain after sitting for long periods of time
  • Difficulty walking up hill
  • Reduced range of motion for the leg
  • Weakness at the outer limits of leg movement
  • Hip instability

These symptoms typically manifest overtime. Strenuous activity may make them more apparent at first, but over the course of a few years, the symptoms will manifest with more subtle activities. As the condition progresses, it may cause a range of other issues such as osteoarthritis.

Causes of Femoroacetabular Impingement

When doctors examine a patient for FAI, they will look for two probable causes – a deformity of the ball or a deformity of the socket of the hip.

Femoral Head (Ball) Deformity

A deformity of the ball of the hip joint causes a condition known as “cam impingement”. If the shape of the head of the femur is irregular, this abnormality can cause a jam as a person bends at the hip. The abnormality will snag on the cavity in the pelvis and cause reduce the range of motion of the hip. Activities such as riding a bike or

Acetabulum (Socket) Deformity

A deformity of the socket of the hip joint causes a condition known as “pincer impingement”. If the rim of the acetabulum (cavity of the pelvis) extends out too far, the neck of the femur (the portion just below the femoral head), may collide with the rim of the hip socket and pinch the labrum.

Both of these abnormalities cause the labrum to become pinched and will eventually lead to a diagnosis of FAI. Additionally, these deformities are not unique to each other and may occur simultaneously, causing much worse problems and more rapid development of FAI.

Diagnosing Femoroacetabular Impingement

A preliminary examination will begin with a scrub of a patient’s medical history and general health. The doctor will be on the lookout for any history of issues with the hip and use this information to prepare the most accurate examination plan.

If FAI is suspected after examining a patient’s medical records, the doctor will proceed with a physical examination involving an FAI test or use imaging technology to take a closer look at the structure of the hip joint.

FAI Test

If FAI is suspected, the doctor will add an impingement test to a patient’s physical examination. The patient will lay on their back as the doctor bends their leg. The doctor will rotate the leg within the hip joint in order to test its range of motion. Depending on the position of the leg when a pain occurs, the doctor may be able to diagnose the FAI right then, if not, they will continue with imaging tests.

Imaging Tests

Doctors will use a range of medical imaging technologies to check the structures within the hip joint.

These include:

  • X-rays
  • Computer Tomography (CT) scans
  • Magnetic Resonance Imaging (MRI) scans

Each of these tests is aimed at producing images of the hip joint for the doctor to examine. Depending on the test, a doctor will be able to view the bones, muscles, tendons, ligaments, or soft tissues of the hip in order to more accurately diagnose a patient.

With the tests concluded and the results positive, the doctor will recommend a course of treatment.

Conventional Treatments for Femoroacetabular Impingement

Nonsurgical treatments should be the first considerations for treating FAI. Oftentimes, the pain from FAI can be resolved with a few hours of rest, over-the-counter anti-inflammatory medication, and physical therapy. These conservative approaches can help manage a person’s FAI enough to help them continue their life at a comfortable functional level.

Medication

Typically, medications such as ibuprofen, naproxen, and acetaminophen will be recommended if FAI pain is minimal. These medications help to reduce inflammation and increase blood flow to thereby reducing the compression around the nerves within the hip.

If these over-the-counter remedies are not effective enough for an individual to reach their functional goals, doctors may prescribe higher dosages of the same medication or alternatives meant to block the body’s response to pain.

Steroidal Injections

If medication fails to reduce inflammation to the point that a patient is satisfied, doctors may recommend steroidal injections. While these procedures help to reduce inflammation, they do come at a cost. Over time, steroid injections have been shown to break tissues down, and prolonged use may lead to complete dysfunction of the joint. It’s best to approach steroidal injections with caution.

Physical Therapy

Adding a physical therapy routine is a recommended practice for any joint issue. Massage, exercise and stretching, hot/cold treatments, or any treatment which involves a physical element all fall into this category of treatments.

The benefit for patients here is that they may recreate these therapies within their own home via self-massage, yoga, hot pads, or other physical aids. If they are not satisfied with the results from self-administered physical therapy, they may reach out to their doctors for a professional consultation.

As a last resort patient may be referred for surgical treatment. Surgery for FAI is typically non-invasive and involves the use of a tool called an arthroscope.

Arthroscopy

After the anesthetic has been administered, arthroscopy will begin will a small incision near the hip. The arthroscope use a small camera along with a set of tools at the end of the scope in order to shave off and extract pieces of the abnormal bones in the hip.

The doctor will recommend that a patient rest for 2 weeks to reduce the weight on the recovering hip. After this, it may take 6 months or more for the patient to experience a reduction in their pain and swelling.

Additionally, a physical therapy and medication routine may also be lumped in with the surgery in order to increase the chances of success.

While these conventional treatments are the most popular, they come with long recovery periods and may be ineffective. If these treatments do not return enough functionality to the hip joint after FAI has begun to run its course, there are alternatives to consider.

Regenerative Therapy for Femoroacetabular Impingement

Regenerative therapies offer an alternative to the long recovery periods and minimal effectiveness of conventional treatment options. By using tissues found naturally in the body, regenerative therapies such as Platelet Rich Plasma (PRP) and Stem Cell Therapy can help control inflammation, reduce pain, and increase the functionality of the hip joint.

Both stem cell and PRP therapy involve the extraction of tissues from a patient’s body followed by processing of the tissues and reinjection of those processed tissues.

PRP uses platelets isolated from a patient’s blood as an active ingredient. Once re-injected into the site of FAI, the platelets send out chemical impulses in order to reduce the inflammation within the hip. Additionally, the PRP helps to reconstruct any tissues which may have been lost over the course of the FAI progression.

Stem Cell Therapy processes a patient’s fat and bone marrow into pseudo-stem cells known as mesenchymal stem cells. These stem cells are mixed with a solution of growth factors and then readministered into the hip. Once near the site of injury, the cells form a protective environment meant to call on the body’s natural healing factors to restore cartilage and reduce inflammation.

The added benefit of regenerative therapy over conventional treatments is that they not only treat the pain but the source of it as well. If the labrum is degraded, there is only so much that conventional treatments can do. They may be able to help a patient avoid inducing pain, but they will not be able to help stop the progression of FAI. Regenerative therapies do.

Conclusion

Femoroacetabular Impingement is a progressive condition that can leave individuals debilitated from pain. If the condition is allowed to develop, there are many treatment options to consider. While conventional treatments may help reduce the pain, they do not help to treat the source of it. Regenerative therapies offer an alternative in a simple out-patient procedure which helps treat both the pain and its source.

If you are considering alternative treatments to your FAI pain, contact Cellaxys today to set up a consultation or learn more about how regenerative therapy may be right for you.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni