Femoroacetabular impingement
Femoroacetabular impingement is common in athletes and young adults. It involves pain that is exacerbated by sports and certain positions, sometimes associated with cracking or locking of the hip. Athletes have often been unsuccessfully treated for psoas or adductor tendinitis, or even for pubalgia.
Diagnosis
Making a diagnosis of hip impingement relies on a thorough patient history and examination, which can reveal symptoms of mechanical coxopathy, triggered by certain movements, especially during sports activities.
Diagnosis confirmation is based on radiographs, which may sometimes be interpreted as normal but show a sphericity disorder (bump) at the level of the femoral head (cam effect impingement). Sometimes the acetabulum is responsible for the impingement due to a pincer effect (retroversion, coxa profunda). CT or MRI of the hip shows a lesion of the acetabular labrum (hip rim) and/or of the cartilage. A bone cyst is usually present on the femoral cam.
Treatment
The interventional treatment of hip impingement is based on hip arthroscopy. Three small incisions allow for the introduction of an optical device and miniaturized instruments, then the lesions are repaired (labrum) or excised (cartilage). The cause of the impingement is addressed by removing the femoral cam (femoroplasty) or excess coverage of the acetabulum (acetabuloplasty).
Hip arthroscopy is a dynamic examination, which allows, at the end of the procedure, to visually check for the absence of residual impingement.
After hip arthroscopy, walking is resumed the day after the procedure. Rehabilitation will be undertaken in the following weeks. Sports activities will be gradually allowed, once the joint has healed.
Hip arthroscopy for the treatment of impingement provides excellent results when the diagnosis is made early. If left untreated, hip impingement progresses to early coxarthrosis and requires the implantation of a total prosthesis.