Hip Impingement (FAI)

Cam Impingement

The hip is a ball and socket joint. The ball is spherical, attached to the top of the femur (thigh bone) by the femoral neck. The femoral neck is usually slim to allow a good range of motion in the joint.

Some patients are born with or develop a swelling or 'Cam' deformity on the ball (illustrated in pink on the right) and/or on the femoral neck.

Hip with a Cam Impingement

Deformity of the spherical ball can result in an oval shape that fails to fit in the socket correctly causing damage to the hip with movement. The femoral neck is wider than usual; this reduces the range of movement in the hip and causes impingement or catching within the joint.

Healthy Hip JointHealthy Hip Joint
Hip with a Cam ImpingementCam Impingement

Pincer Impingement

The hip is a ball and socket joint. The socket is essential to the optimal performance of the joint. The majority of the socket is made from bone with an articular cartilage surface but also is deepened by the labrum. In most individuals the position of the socket is such that the ball is stable within the socket, distributes load evenly and provides a good range of movement.

Patients with Pincer impingement have a deep socket and patients with a shallow socket have Hip Dysplasia. Range of movement of the hip is reduced with a deep socket or 'Pincer' (illustrated in pink on the right).

The femoral neck impinges or abuts on the rim of the socket often causing a Labral Tear or articular cartilage damage (see video clip below).

In young adult life the body can compensate for the damage caused by these conditions. Patients may have minimal symptoms of mild pain after exercise or restriction in range of movement of their hip or hips noticed for example by the inability to sit crossed legged. Over time the symptoms can restrict activities such as running, sitting for prolonged periods and getting out of a car. Sometimes an injury to the hip can precipitate a Labral Tear with a subsequent sudden deterioration of symptoms.

Healthy Hip JointHealthy Hip Joint
Hip wih a Pincer ImpingementHip wih a Pincer Impingement

Mixed Picture Impingement

It is common for patients to have both 'Cam' and 'Pincer' deformities. This is referred to as a 'Mixed Picture' Impingement. It is important that both deformities are looked for and corrected at the time of Hip Arthroscopy.

Cam Impingement
Hip wih a Pincer ImpingementPincer Impingement

What signs and symptoms suggest I may need hip surgery?

You will know when you are ready. The hip will be painful and affecting your quality of life enough to accept the small risks of complication from the operation. Often patients describe struggling with a lack of sleep, reduced walking distance, and pain killers become less effective.

You can struggle to work, have difficulty participating in social and family life, and even struggle or be unable to put on shoes, socks or cut toe nails.

Your questions answered

Why might I need a hip replacement?

Over time, the surfaces on the hip joint can start to wear. This can be caused by osteoarthritis – a condition that causes joints to become painful and stiff, - or from a previous injury to the hip, such as a sporting injury.

Osteoarthritis can become painful as joints become inflamed when lining between them gets damaged or wears away.

Without the protection of this lining, the rough surfaces of your bones rub together as you move, causing pain during everyday tasks such as walking or getting dressed.

When should I have a hip replacement?

Total Hip joint replacement is intended for use in individuals with severe joint disease resulting from degenerative and rheumatoid arthritis, avascular necrosis, fracture of the neck of the femur or functional deformity of the hip.

You will know when you are ready. The hip will be painful and affecting your quality of life enough to accept the small risks of complication from the operation.

Often patients describe:

  • Lack of sleep
  • Reduced walking distance
  • Pain killers becoming less effective
  • Inability to work or work being compromised by hip symptoms
  • Difficulty participating in social and family life
  • Unable to put on shoes, socks or cut toe nails

What type of hip problems affect the younger patient?

The hip is a ball and socket joint. Some patients are born with or develop a swelling deformity on the ball and/or on the femoral neck, causing impingement or catching within the joint and pain.

Others experience hip impingement (a deep socket which may require trimming) whilst a shallow socket can cause hip dysplasia, a condition in which many cases are only diagnosed during adolescence or adulthood, and again impacts on movement.

The labrum, a cartilage ring that runs along the rim of the hip socket, can tear after a single injury such as a fall or as a result of repetitive injury. It is a common cause of hip pain felt in the groin, back, knee or lateral (side) aspect of the hip.

It has been reported that 66% of patients with mechanical symptoms including clicking, catching, popping or feeling of giving way reveal a labrum tear.

There is good evidence to support repair of the labrum in the case of a tear, but it is a challenging procedure and requires surgical expertise and experience. A sound repair however will preserve the integrity and function of the hip joint.

This type of surgery is performed through key hole or hip arthroscopy surgery.

In some young patients the condition has progressed to degeneration or osteoarthritis of the hip. The option to have a hip replacement even when young can have a dramatic positive effect on the ability to continue work and enjoy a social life. Mr Conroy can explain the modern advances that have led many of his young patients to choose the benefits of a hip replacement whilst being reassured about the future of their hip if it wears in the future.

Should I consider a resurfacing hip replacement?

Resurfacing hip replacements may have a role in men under 55 years of age with active lifestyles. Mr Conroy along with a large proportion of hip surgeons have chosen not to perform hip resurfacing in any of their patients due to concerns about metal on metal bearing surfaces and higher than expected failure rates. Patients with resurfacing hip replacements often have to undergo annual blood cobalt and chrome levels to monitor the performance of the hip and some private insurance companies won’t cover patients choosing resurfacing implants.

Can I have both hips replaced at the same time?

Yes you can. You have to be physically fit for the anaesthetic and be prepared for the challenge of a difficult recovery in the first couple of weeks after surgery.

The benefits are less time away from work or social life and a single anaesthetic.

I am only young but in pain, should I wait or act now?

In young adult life the body can compensate for the damage caused by many conditions. Patients may have minimal symptoms of mild pain after exercise or restriction in range of movement of their hip or hips noticed for example by the inability to sit crossed legged.

Over time the symptoms can restrict activities such as running, sitting for prolonged periods and getting out of a car. Sometimes an injury to the hip can precipitate a labral tear with a subsequent sudden deterioration of symptoms.

Continued advancements in treatment and a new generation of hip implants and techniques means we are helping an increasing number of younger people who need surgery but don’t want to wait or to live with pain.

In younger patients potential complications need to be discussed fully as the demands on a hip replacement are far greater than in the elderly population.

We now have more confidence and knowledge about the wear rate of new prosthetics, which allows us to be less restrictive on an age basis as people are now keeping active longer than ever before.

What are my options?

At the Yorkshire Hip Clinic we pride ourselves on providing a comprehensive service across all aspects of specialist hip treatments including:

Robotic assisted hip replacement

Yorkshire Hip Clinic uses state-of-the-art robotic assistance aids to ensure consistent and accurate positioning of implants.This accurate placement is predicted to give optimal performance of your new joint replacement. Our aim is to give you the best functional outcome and longevity for your hip or knee replacement.

The state-of-the-art Mako™ robotic arm system works alongside the surgeon from the pre-surgery planning stage through to assisting in the surgery itself in order to improve the accuracy and precision of the procedure.

Learn more on our ‘Robotic-assisted surgery’ page.

Key hole or arthroscopic surgery of the hip

Mr Conroy provides over ten years of expertise in hip preservation surgery. Performing regularly over 150 hip arthroscopy surgeries per annum he treats a variety of sports injuries and femeroacetabular impingement surgery including labral repair the hip. Patients are generally younger in age from 14 years upwards.

‘Revision’ or ‘Re-do’ joint surgery

If you have concerns about a poorly performing hip replacement Mr Conroy has the experience and current knowledge to advise on the option of revision surgery or simply reassure you that further surgery is not required.

Revision surgery is more complex than standard hip surgery. It requires the ability to deal with complex problems of bone loss, fractures around the prosthesis and an understanding of hip biomechanics. Mr Conroy performs complex hip or revision procedures on a weekly basis.

Minimally invasive surgery (MIS)

If you would like a small scar and potentially quicker recovery then ask about minimally invasive surgery. Mr Conroy is faculty on MIS hip courses teaching other Consultants about the technique. His preferred approach is the Direct Superior Approach as he believes it reduces some of the risks associated with the Direct Anterior Approach such as femoral fracture. MIS is not always the best option if the overall success of the hip replacement is compromised due to limited visualisation during the procedure.

Robotic assisted surgery is complimentary to the MIS technique in ensuring accuracy of hip placement during the procedure. Click here to learn more

Type of hip replacement

Patients have choice of hip replacement types. These include cemented or uncemented hips and differing bearing surfaces including ceramic. The type of hip for you depends on a variety of factors and it is best to have this discussion wth Mr Conroy at your consultation.

Mr Conroy generally uses Stryker products including the uncemented Accolade II / Trident or cemented Exeter hip replacement.

Call us: +44 (0) 113 388 2129

Make an enquiry click here

Professional Memberships

Leeds

Leeds Nuffield Hospital
2 Leighton Street
Leeds
LS1 3EB

c Jayne Thompson
t 0113 3882129 / 0113 3882067
e leeds@yorkshirehipclinic.co.uk

Harrogate

BMI The Duchy Hospital
Queens Road
Harrogate
HG2 0HF

cJanette Hall
t 0808 101 0337 / 01423 567136
e harrogate@yorkshirehipclinic.co.uk