Stop Ignoring Your Hip Pain

Do you have chronic hip pain? As Scott Mullen, MD, from the Sports Medicine and Performance Center explains, it may be more serious than you realize.

Dr. Scott Mullen Discusses FemoroAcetabular Impingement (FAI)
It felt pinching. And it was about an 8 out of 10. Getting out of bed would sometimes hurt. Just daily activities would bother me and that wasn't normal. She presented with pain in the front of her hip that came on first with volleyball and things like that. That's what really set it off. She actually injured her other side first. That side got better with rest and activity modification and some exercises. This side, once it started hurting, didn't get better. It started hurting her on a daily basis where she was having pain with going from the brake to the gas pedal and vice versa. Trouble climbing stairs and even walking for long periods of time was causing this this pain in the front. The first thing we do is we get plain x-rays. And we get some special views other than just a shot of the pelvis and it shot to the hip joint. We get some special x-rays and special angles that we draw these angles out on the screen and that's where we make the radiographic diagnosis. The history is really important as well, because people who have this problem generally have very characteristic complaints of the pinching-type pain and the pain in the front of the groin like we've talked about. The first thing we try to do is avoid the activities that bother it, try some anti-inflammatories to calm down the inflammation. Sometimes doing physical therapy and strengthening the muscles around the joint and getting them all firing appropriately can help relieve the pain as well. And then if all those things don't work, then we end up doing hip arthroscopy and going in and shaving down the bony bumps and repairing that labral tear. People who have this impingement, problem their socket tends to have too much bone in the front so instead of it looking like this, it tends to be turned backwards a little bit. That's exaggerated, but it tends to be turned backwards a little bit. This wavy structure here is called the labrum and it forms a gasket seal around the femoral heads for a suction seal. And so when you have these bony bumps on the socket side and then if you have one on the thigh bone side and you go to flex your hip up at a lesser degree of flexion, these two bones bump into each other repetitively and that the gasket seal the labrum gets torn from the repetitive pinching. And then once that labrum is torn, the cartilage can get injured, which is this blue covering on the bone. So what we do is we make two or three small incisions and we go in and we shave down the bony bump on the socket side and we fix that labrum and back to that healthy bone with sutures and then we go down to the thigh bone side and we recreate this taper and get rid of the bump, so that at the end of the surgery, we can flex the patient's hip up as far as possible and also internally rotate it and show that the bones no longer touch. I like driving and I like to walk upstairs for a while, so I was all for it, because I don't want to live another, like, 20 years if I can't walk upstairs, you know. And so the surgery was the best option I can already tell a good difference. Her preoperative symptoms are gone, she, of course, has some soreness, because this is a big surgery through small incisions and it's a long recovery period, but she's doing fantastic. Her prognosis is excellent. Most people end up with they go from a 50s to 60s on a hip outcome score survey to the high 80s, low 90s or mid 90s and greater than ninety percent of people have good to excellent outcomes from the surgery. So this is a very effective surgery that has track record of having very good outcomes.

What is FAI?

Femoroacetabular impingement (FAI) is a pre-arthritic condition that consists of osseous abnormalities, or bony bumps, on the acetabulum (pincer lesion) or the femoral neck (can lesion). These bony bumps collide and pinch the labrum, which leads to tearing and pain.

Who most commonly suffers from FAI?

FAI typically presents in young men, teens to 30 years old, with a femoral bump and 30- to 40-year-old women with a bump on the acetabulum. It is also identified in teenage females who have persistent groin pain with an acetabulum bump. However, it can be seen in men and women from the early teenage years to 60 years old.

What is the treatment for FAI?

These bony lesions and labral tears can be treated with hip arthroscopic surgery to shave down the bony bumps and repair or replace the labrum. Patients' hip scores usually improve from 50 to 90 after surgery, and many achieve more than 85% return to their previous level of sport or activity.

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