Femoroacetabular impingement refers to a painful narrowing of the hip joint space. Young athletic people are particularly affected by the syndrome.
What is femoroacetabular impingement?
Medical professionals also refer to femoroacetabular impingement (FAI) as hip impingement. This refers to the presence of a narrowing between the acetabulum and femoral head. Due to the narrowing, the bones collide during strong bends. This in turn creates the risk that structures close to the joint, such as cartilage or the joint lip, are pinched or affected. This results in severe pain in the groin area. A distinction is made between two forms of femoroacetabular impingement. These are pincer impingement hip (pincer-FAI) and cam impingement hip (cam-FAI). In pincer-impingement hip, there is a normal configuration of the femoral neck, while the acetabulum is deformed and resembles a pincer. In this way, the femoral head is literally “pincered”. Because the femoral head is therefore more covered, this easily leads to the acetabular roof and femoral head colliding. Pincer impingement hip is most commonly seen in women between the ages of 30 and 40. Cam impingement hip is when the natural waist of the femoral head, which provides more range of motion, is no longer present due to a growth. A bone bulge causes the joint space to narrow, promoting painful rubbing of the acetabular roof and femoral neck head. This happens especially in young men who are active in sports. Soccer players in particular suffer from this form of FAI.
Causes
Femoroacetabular impingement occurs mostly because of a bony deformity of the acetabulum (acetabular roof). The pelvic bone (os ileum) forms a socket that resembles a cup. Together with the femoral head, it forms the hip joint. If the formation of bone spurs takes place at the bony parts of the hip joint, this not infrequently leads to mechanical narrowing. Young people who are active in sports often suffer from femoroacetabular impingement because they often subject the hip joint to increased physical stress. However, the exact cause of many cases of cam impingement and pincer impingement has not been clarified. However, the bony structural changes in the majority of patients can usually be proven. A conceivable explanation for the development of femoroacetabular impingement is considered to be growth disorders in adolescence that cause defective closure of the growth plates.
Symptoms, complaints, and signs
In many cases, the symptoms that result from femoroacetabular impingement are gradual. Occasionally, they manifest as hip joint sporadic pain. In this case, the pain radiates into the thigh. The complaints are further aggravated by exertion. Many patients also have problems when driving a car, when they assume a sitting position, and when climbing stairs. If the bent leg is turned inward, this also often results in pain, which often leads sufferers to adopt a protective posture by turning the painful leg in the outward direction. In some cases, patients also suffer from dull hip pain during sexual intercourse or restricted movement of the hip when it is bent. If the affected person stands or walks for a long time, this can also result in pain. In the late stages of femoroacetabular impingement, coxarthrosis sets in for most patients. Similarly, early wear and tear of the hip is possible in younger people.
Diagnosis
If femoroacetabular impingement is suspected, the affected person should consult an orthopedist. He or she will first look at the patient’s medical history and want to know what sports the patient participates in, what movement restrictions occur, and whether the pain was triggered by an injury. Following the medical history, the doctor performs a physical examination. To test hip mobility, the patient must place his or her leg in different positions. If the orthopedist presses the leg against the acetabular rim, this usually results in pain.Another important examination is the taking of X-rays. The images allow precise detection of structural changes in the bone. Magnetic resonance imaging (MRI) also allows accurate visualization of the soft tissues surrounding the hip. About 70 to 80 percent of femoroacetabular impingement cases take a positive course. After about 6 to 12 weeks, light sporting activities can usually be resumed. However, about 15 to 20 percent of all patients suffer residual symptoms.
Complications
Femoro-ccetabular impingement occurs primarily in young people who are active in sports. In most cases, the diagnosis is delayed because the symptoms are ambiguous and increase in severity and frequency over time. In most cases, however, sporadic pain at the hip joint is apparent, which can also occur without exertion in the form of pain at rest. If the affected person puts additional strain on the respective areas, the pain increases even more and can thus greatly affect the patient’s life, so that many postures of the body lead to pain. This includes, for example, climbing stairs or sitting while driving a car, which is why the affected person suffers from severe movement restrictions. Many people also suffer from psychological discomfort if the movement restrictions occur at a young age. The pain can be treated with the help of painkillers, with no further complications. However, patients should avoid long-term use of painkillers. Likewise, exercises and therapies help with the symptoms and can combat the condition. However, many patients suffer from residual symptoms and minor pain even after treatment. It is often no longer possible to perform sports activities.
When should you see a doctor?
Since this disease usually does not heal itself and the symptoms continue to increase in most cases, a doctor should always be consulted in this case. This can prevent further complications or even permanent movement restrictions. A doctor should be consulted if the affected person suddenly suffers from severe pain in the hip joint for no particular reason. This pain can occur in the form of pain at rest or pain on exertion and can have a very negative effect on the quality of life and everyday life of the affected person. Especially when sitting, the pain can occur. Furthermore, the doctor should also be consulted if there are restrictions in movement. This causes the hip to wear out more quickly, which can lead to further complications. Usually, the condition is diagnosed and treated by an orthopedic surgeon. Some sufferers require surgical intervention, although most symptoms can be limited with exercise and therapy. Sports activities should be limited when the condition occurs. Usually, this does not reduce the life expectancy of the affected person.
Treatment and therapy
To correct the cause of femoroacetabular impingement, surgical intervention is usually required. In the early stages, conservative methods are primarily used to relieve the pain. For this purpose, the patient is given painkilling drugs such as ibuprofen or acetylsalicylic acid. Electrotherapy, baths, the application of mud packs and the performance of targeted physiotherapeutic exercises are also considered helpful. As part of surgical therapy, a hip arthroscopy (hip joint endoscopy) is usually performed. With this procedure, the structural changes of the bone can be eliminated. If the operation succeeds in eliminating the mechanical narrowing, this leads to an improvement in pain in most cases. Hip arthroscopy is especially recommended for young patients because it can reduce the risk of joint stiffness.
Outlook and prognosis
In a large number of patients, femoroacetabular impingement shows a favorable disease course and a good prognosis. Most patients can be discharged from treatment as cured within three months. Nevertheless, restructuring of usual physical activities is often necessary. The disease mainly occurs in people who are very active in sports.In order to prevent a recurrence of the complaints, the activities or the exercise of individual movement sequences should be changed and optimized. This may result in a discontinuation of the exercise of the usual sports. Slightly more than twenty percent of sufferers complain of long-term consequences despite considerable efforts to recover. They do not experience a complete recovery of their symptoms. Their prognosis is less favorable. There is a risk of a chronic course of the disease. In addition, the restrictions on their daily routines are significantly increased. Pain at rest and the necessary changes in life can trigger complications in these patients. There is a threat of psychological complaints that can trigger secondary diseases. Thus, the overall prognosis for the patient is worsened. In exceptional cases, the patient receives a poor prognosis. If it becomes apparent within the treatment that a stiffening of the joint is necessary, healing can no longer take place. This step takes place when the symptoms continue to spread or increase despite adequate treatment.
Prevention
To prevent discomfort caused by femoroacetabular impingement, it is advisable to engage in sports activities in moderation. While sports are not the cause, they often evoke the associated pain.
Aftercare
In most cases, there are no measures of aftercare available to the affected person for this disease. In this case, the affected person is primarily dependent on a rapid and, above all, an early diagnosis and subsequent treatment, so that further complications or a worsening of the symptoms can be avoided. The main focus of this disease is therefore on early detection and further treatment. The earlier it is detected by a doctor, the better the further course of the disease usually is, since it cannot heal itself. The treatment of this disease is primarily carried out by taking medication. In any case, the affected person should pay attention to a correct dosage and also to a regular intake. However, a long intake of painkillers should be avoided. Furthermore, physiotherapy measures often have a positive effect on the course of the disease. The affected person can also perform many exercises from such a therapy at home and thus increase the movement of the muscles again. The life expectancy of the affected person is usually not reduced by this disease.
What you can do yourself
Despite reluctance, the patient should basically pay attention to the needs of his body and react accordingly. If pain occurs, sports activities or strong physical activities should be reduced as well as stopped immediately. Resting the body is important to avoid triggering further complications. In many cases, it is helpful to seek help to stabilize the psyche. Cognitive methods for realigning existing attitudes and relaxation techniques have proven effective. Methods such as yoga, autogenic training or meditation can be used to reduce stress and establish an inner balance. Discussions with therapists, mentors or relatives often help to gain new impulses for dealing with the disease. In forums or self-help groups, experiences are exchanged and advice is given on how to cope with the challenges of everyday life. The patient should maintain a positive basic attitude. Although beloved activities can no longer be performed, new opportunities arise that also contribute to a strengthening of well-being. Adequate protective clothing should be worn when engaging in sports activities. Knee pads, elbow pads and bandages stabilize the body and have a positive effect on health. If swelling occurs, the affected person should immediately cool the region with gel pads. Cooling ointments, such as aloe vera gel, are also helpful.
