What is Hip Impingement?

Hip impingement is a grouping of disorders in which there is limited space within the hip for the soft tissues that line the bones. This can be due to irritation of the cartilage, tearing of the labrum (deepening cartilage), or limitations in the motion. This spectrum of diseases can affect day-to-day life or sports. Typically, pain occurs during activity. These disorders can often be treated with hip arthroscopy.

This is NOT arthritis. Arthritis or wearing away of the cartilage is typically painful at all times including rest and sleep. Hip arthroscopy is not an effective treatment for hip arthritis.

Hip impingement comes in three common varieties: cam, pincer, and combined. Cam impingement is an extra “bump” of bone on the ball of the hip joint. (See large arrow, Figure 1) This decreases the smoothness of rotation of the hip. Pincer impingement is an extra boney lip on the cup of the hip socket. (See small arrow, Figure 1) This creates a pinching effect of soft tissues in certain motions during activity. The most common type, however, is a combination of both of these entities.

Figure 1: Cam lesion near ball of hip (large arrow), Pincer lesion (small arrow)

The combination of these changes around the hip can cause pain, tear cartilage, and limit motion. There is also concern that these changes and the symptoms created may lead to the acceleration of arthritis. Surgery can be helpful in eliminating symptoms and hopefully, create a more normal hip to diminish the risk for arthritis.

Figure 2: Hip labral tear arrow with extra bone on the acetabulum (socket) of the hip joint

Hip arthroscopy is an outpatient, minimally invasive surgery that can help with these changes. (See figures 3 and 4) Cartilage or labrum tears can be repaired, and extra bone can be eliminated. These changes can improve symptoms and increase activity through small incisions compared to the large incisiontechnique of the past. Smaller incisions typically equate to shorter recovery to previous activities.

Figure 3: Cam lesion being excised during surgery

Figure 4: Excising Cam lesion on x-ray

Recovery after hip arthroscopy is variable but typically consists of an outpatient or same-day surgery. Most patients are on crutches 1-5 weeks depending on the type of procedure done. Therapy begins the day after surgery and usually lasts 3-4 months with decreasing frequency. Most patients are able to get back to more normal activities including running and other sports around the 4-8 month mark after surgery depending on the problems that are encountered during surgery. Like any surgery, hip impingement surgery has risks that must be considered and discussed with the surgeon.

If you have questions please feel free to contact me, Eric Pifel, MD