Hip impingement, or femoroacetabular impingement syndrome, happens when the bones of the hip joint are shaped in a way that makes them not fit together perfectly.

Over time, this poor fit can cause the ball (femur) and socket (acetabulum) to rub against each other. This can damage the soft tissues in the hip, including the labrum and cartilage. When this happens, it can cause pain and limit activity.

A variety of factors contribute to the development of hip impingement. Genetics and activity during bone growth can affect how the bones form.  Certain activities, such as hip flexion, can contribute to symptoms.   

Three types of hip impingement

Extra bone formation can occur on one or both sides of the joint. Each type is classified by the reason the hip doesn’t fit together correctly: 

1. Cam impingement: Extra bone grows at the ball of the femur bone.
2. Pincer impingement: Extra bone grows on the hip socket.
3. Combined impingement: Extra bone grows at both the ball of the femur bone and the hip socket.

What hip impingement feels like: Symptoms and diagnosis

Pain may feel like a constant ache in the hip. It may get worse with certain activities, positions or long periods of sitting. 

Primary symptoms include pain:

• In the groin.
• In the front and around to the side of the hip.
• That radiates to the back or hamstring.

“Symptoms can vary between individuals,” says orthopaedic surgeon Justin Greiner, MD. “Some patients experience more pain with activity, while other patients may have pain worsened with sitting activities.” 

Three things must be present for a diagnosis:

1. A history of consistent, ongoing symptoms.
2. A physical exam with movement and range-of-motion tests that reproduce the pain.
3. Specific X-rays, MRI and sometimes CT scans. 

“X-rays are critical for a diagnosis of hip impingement,” adds Dr. Greiner. “Specific x-ray views are needed to pick up subtleties of bone morphology that allow me to quantify if impingement is present.”

Treatment options

Initially, you can try treating hip impingement at home. Conservative treatments are the first course of action. These may include:

• Modifying activities to limit the movements that cause pain.
• Over-the-counter anti-inflammatory medications for pain and inflammation relief.
• Prescription anti-inflammatory medications or cortisone shots into the hip joint.
• Physical therapy to address pain, address hip weakness, and improve mechanics.

If symptoms persist, surgery may be an option. Hip arthroscopy is a minimally invasive procedure used to reshape the bone and repair any soft-tissue damage. This type of hip preservation surgery is primarily used for patients under age 45.

“This surgery isn’t recommended for people with arthritis or bone spurs that indicate arthritis has already developed,” adds Dr. Greiner. “Hip arthroscopy is a way of preserving the hip joint by preventing future development of cartilage and labrum injury, which contributes to the development of arthritis.”

Recovery after surgery

Recovery varies from person to person, but typically includes: 

• Using crutches for two weeks, then without crutches for one month.
• Activity restrictions lifted after three months.
• Return to full activity or sports after six months.

The Nebraska Medicine comprehensive hip program

As the only hip arthroscopy surgeon in the Nebraska Medicine system, over 50% of Dr. Greiner’s practice involves treating patients with hip impingement.  

He is part of a multidisciplinary hip preservation program that treats a variety of hip conditions, including hip impingement. Care may include nonoperative treatments, modalities, minimally invasive hip arthroscopy and open hip surgery.   

This means patients have access to the newest treatment options. 

“Our team is the only one in Nebraska offering a combined hip arthroscopy and periacetabular osteotomy (PAO) for complex cases involving both impingement and dysplasia,” adds Dr. Greiner. “Our comprehensive approach provides the full range of non-operative and surgical treatments for various hip pathologies.”