Patient guide to Hip Impingement Surgical Management

Hip Impingement [Femoroacetabular impingement (FAI)], is a condition where there is unwanted contact between abnormally shaped parts of the head of the thigh bone and socket. In essence, the ball (femoral head) and socket (acetabulum) glide abnormally creating damage to the hip joint. Damage can occur to the articular cartilage (smooth surface of the ball or socket) or the labrum (soft tissue bumper of the socket).

Download our patient and exercise guidelines for surgical management of hip impingement.

FAI generally has two types:

• The Cam type describes the situation where the neck of the femur is thickened as it forms the femoral head. This causes a loss of roundness of the femoral head which contributes to abnormal contact between the head and socket.
   
• The Pincer type describes the situation where there is increased cover of the ball (femoral head) by the socket (acetabulum). This bony protrusion typically exists along the front-top rim of the socket and causes the labral cartilage to be “pinched” between the socket rim and front of the femoral head-neck junction. Often the Cam and Pincer forms exist together i.e. mixed impingement.

FAI can be associated with cartilage damage, labral tears, early hip arthritis, hyper mobility, sports hernias, and low back pain. Whilst it is common in high level athletes, it can also occur in any adult.

What does the operation involve?

The aim of femoro–acetabular surgery is to relieve symptoms arising from the hip joint. It is believed that it may also help prevent hip arthritis in later life, but there is no evidence to support this theory to-date.

The surgery is performed generally under general anaesthesia and using a special camera (called an arthroscope) inserted into the hip joint through a small incision. The number of incisions located on the lateral aspect of the hip varies from patient to patient depending upon their pathology. Each incision is approx 2cm long and is closed with either two or three sutures. These sutures are not dissolvable and need to be removed in around ten days after surgery.

Using instruments inserted through incisions, the surgeon removes some of the cartilage or bone to reshape the joint surface. With this minimally invasive surgery the hip joint does not need to be dislocated and recovery is generally quicker.

Hip labral tear repair/ debridement

The type of operation performed will depend on the type and extent of the tear present. Generally every attempt is made to preserve the existing labrum or reconstruct one if need be in special cases.

Microfracture / chondroplasty

This procedure is performed when there is presence of localised full thickness defects within the lining of the joint. This involves drilling small holes in small areas of subchondral bone thus producing a marrow clot in a bid to create new fibrocartilaginous cells responsible for the formation of new fibro-cartilage. (This is not as durable as the original hyaline cartilage however can reduce symptoms.)

Open Surgery

Sometimes it is necessary to perform open surgery, where hip joint needs to be dislocated in a safe manner. After such surgery, some hip movements will be restricted and weight bearing will be limited for the first 6 weeks.

Post Surgery

We believe commitment to a rehabilitation programme monitored closely by an experienced physiotherapist is essential to ensure the best recovery from the operation.

Do not push yourself too hard in your day to day activities and rehab in the weeks after your hip arthroscopy surgery, as recurrent micro trauma at the site may be the cause of persistent symptoms.

Why Physiotherapy?

It is important that any rehabilitation guide is modified to meet the individual needs of the patient because symptom presentation varies. Age, previous fitness and activity levels and complexity of surgery are also considered with respect to management following the operation.

Physiotherapy is essential to assist you to restore increased range of movement and strength, thus allowing you to make a better recovery from surgery and speed up your return to function.

The most common and successful sequence of treatments is to mobilise the hip joint, stretch out the tight musculature surrounding the hip, strengthen the weak muscles around the hip and pelvis and correct the faulty biomechanics and altered movement patterns which often develop.

It is important to strengthen the gluteal muscles and deep hip rotator muscles of the buttocks. Additionally the abdominal and thigh muscles benefit from strengthening because weakness of these muscle groups means the hip joint has reduced support causing excessive force/strain to be placed on the ligaments/joint capsule and cartilage of the joint.

Download our patient and exercise guidelines for surgical management of hip impingement.