Trauma / Fracture Service

Hip Impingement
Laurence E. Dahners, MD

My interest is in the care of a newly-recognized cause of hip pain, described as hip impingement.  Impingement occurs when the ball (femoral head) doesn’t have full range of motion in the socket (acetabulum) due to bumps of bone around the femoral head and/or the socket being turned backwards (retroversion).  This causes the femur to bump into the rim of the acetabulum or to “impinge” on the front of the socket and causes pain and damage to the cartilage and labrum over time causing arthritis.

Open femoroacetabular debridement is a 2-4 hour procedure that entails making an incision over the side of hip so that the hip can be carefully dislocated while preserving the blood supply to the head (called a “surgical dislocation”).  Once the femoral head and acetabulum are exposed, the extra bone that is contributing to the impingement can be cut away.  After thorough removal of the impinging bone and damaged cartilage, the hip is reduced.  The patient is usually in the hospital 2-3 days after such surgery and must be on crutches for 1-2 months.  We’ve recently become successful in carrying out these debridement operations arthroscopically. Although arthroscopic treatment of hip impingement remains a long procedure of about 3 hours, the patient can go home that day, does not have to use crutches, and the risks of surgery are much lower. In addition, the patient usually feels better much sooner.

It is believed that relieving impingement of the hip, either with open surgery or arthroscopically, not only relieves pain but can substantially delay the need for a hip replacement.  The procedure usually allows the patient to resume normal activities such as walking, swimming, cycling, basketball, tennis, and gymnastics with significantly less pain. [watch video...]