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Hip Impingement

  • If you or your teen has hip impingement, you may have many concerns and questions. It may comfort you to know that caregivers at Boston Children's Hospital offer a wealth of experience treating teens and young adults with hip impingement. We’re here to answer your questions and to support you and your family every step of the way.

    About hip impingement

    Hip impingement (femoral acetabular impingement or FAI) is a mechanical disorder of the hip. In the normal hip, there is smooth gliding motion of the round head of the thigh bone (femoral head) within the hip socket (acetabulum).

    Hip illustration Hip illustration

    Hip impingement occurs when abnormalities in the bone disturb this gliding motion. This results in friction between the femoral head and hip socket. This friction can wear away the cartilage and tear the labrum (the cushion, or seal, that lines the hip joint).

    Signs and symptoms of hip impingement include hip stiffness and pain. It can be diagnosed by x-ray and other imaging tests. If hip impingement is diagnosed and treated early, treatment can be very successful. Untreated hip impingement may lead to cartilage damage and arthritis.

    Does Boston Children’s Child and Young Adult Hip Preservation Program treat teens and adults?

    Our hip sub-specialists are part of the Orthopedic Center at Boston Children's Hospital, which U.S. News & World Report ranked best in the nation in 2014.

    Boston Children’s hip team treats patients of all ages. Many teens and young adults with hip problems need diagnostic and surgical techniques that differ from what’s indicated for older adults. Our surgeons are recognized across the globe as pioneers in hip arthroscopy for teens and young adults, and our clinicians and researchers are dedicated to finding better ways to care for adolescents and young adults with hip problems.

    Boston Children’s Child and Young Adult Hip Preservation Program offers a unique expertise—we track how the hip works in each age group, how the problems evolve and how the hip’s function changes over time in adult patients who’ve had treatment in childhood.

    Hip impingement: Reviewed by Young-Jo Kim, MD
    © Boston Children's Hospital, 2011

    Orthopedic Center
    Boston Children's Hospital

    300 Longwood Avenue
    Fegan 2
    Boston MA 02115

  • Right now, you may have many questions: How serious is hip impingement? What’s the best treatment? What do we do next? We’ve provided some answers to your questions on this site. Our hip experts can answer other questions you may have when you meet with us.

    Background: The normal hip joint

    The hip joint is one of the body's most reliable structures, providing most people with movement and support without pain or problems for a lifetime. The hip’s simple ball-and-socket anatomy—with the ball-shaped femoral head rotating inside a cup-shaped socket called the acetabulum—usually works well with little friction and little or no wear.

    The surfaces of the femoral head and acetabulum, which face each other, are lined with a layer of cartilage and lubricated by a thin fluid film.

    What is hip impingement?

    Hip impingement occurs when bony deformities disturb the hip’s smooth gliding motions. This causes friction between the thigh bone (femur) and the hip socket (acetabulum). This friction can wear away the cartilage and also damage the labrum. The labrum is the joint’s fibrous seal, which is the cushion that lines the hip joint. How common is hip impingement?

    Hip impingement is essentially a wear-and-tear condition, affecting about 20 percent of the total population. It’s more common among younger athletes—especially those in sports requiring turning, twisting and squatting motions—and physically active people.

    Who is at risk for hip impingement?

    Children, teens and adults may develop hip impingement from repetitive activities, although they may have been born with a genetic predisposition. Hip impingement is somewhat common among teen and young adult athletes. Young athletes with the condition may experience pain sooner than their less active peers.

    What causes hip impingement?

    Hip impingement is caused by the abnormal development of the bones of the hip joint that ultimately causes damage to the joint’s cartilage. Deformities of the femur bone (cam impingement), acetabulum (pincer impingement) or a combination of the two abnormalities can cause hip impingement:

    • Pincer impingement occurs when there is direct contact between the femur bone head-neck junction and the acetabular rim.
    • Cam impingement is caused by a squeezing or jamming of an abnormally shaped thigh bone head (femoral head) and head-neck junction into the socket (acetabulum) during certain types of motion.

    Hip impingement also can be caused by other conditions, including slipped capital femoral epiphysis (SCFE), a misshapen thigh bone head, an abnormally tilted femoral (thigh bone) head or post-traumatic deformities.

    What are the signs and symptoms of hip impingement?

    Signs and symptoms of hip impingement can include:

    • stiffness in the groin or front of the thigh
    • inability to flex the hip beyond a right angle
    • pain in the groin during/after the hip has been flexed, such as running, jumping or prolonged sitting

    Early diagnosis of hip impingement allows caregivers to start treatment sooner, preventing further damage. Our goal is to diagnose hip impingement as early as possible, which provides the best chance for successful recovery and return to full activities, including sports.

    How does Boston Children’s care for patients with hip impingement?

    Boston Children’s hip specialists are global leaders in hip care and offer unique expertise caring for teens and young adults with hip conditions. Although we’re recognized for our expertise in treating patients with complex hip conditions, we offer compassionate care and state-of-the-art treatment to every patient regardless of the severity of their hip problems.

    How does Boston Children’s support my family?

    Boston Children’s supports families in many ways.

    Teen Advisory Committee
    To help teenagers take a more proactive role in their care and to have their needs recognized, Boston Children’s developed the Teen Advisory Committee. The group—made up of current patients, ages 14 to 21—serves as a team of peers who can listen to other patients’ needs and ensure that their voices are heard.

    Center for Families
    You may find a hospital visit stressful. We offer services to make your child's—and your own—hospital experience as pleasant as possible. Visit the Center for Families for all you need to know about:

    • getting to Boston Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family

    Other resources

    The hip care team at Boston Children’s can connect you with resources to help you and your family cope, including:

    • patient education: From doctor's appointments to treatment to follow-up, our nurses and physical therapists will walk you through diagnosis, surgery and recovery. After you return home, we'll help you coordinate care and support.
    • parent-to-parent: Do you want to talk with someone who has been treated for a hip impingement? Our Orthopedic Center can often put you in touch with other families who've been through the same experience.
    • faith-based support: If you're in need of spiritual support, we'll connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
    • social work: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, handling stresses related to coping with illness and dealing with financial issues.
  • The first step to treating hip impingement is a timely, complete and accurate diagnosis. Our goal is to diagnose and treat hip impingement early in order to prevent further damage to the hip. Early diagnosis and treatment provide patients with the best chance for a complete recovery and return to activities, including sports.

    How do Boston Children’s hip specialists diagnose hip impingement?

    Your doctor will ask for a complete medical and family history (including any hip problems in the family). The next step is a physical exam. During the exam, the doctor may bring your knee up toward the chest and rotate it inward. Pain with this motion suggests hip impingement.

    Your doctor may order imaging tests to confirm the diagnosis:

    • magnetic resonance imaging (MRI): produces detailed images of organs and structures; shows the amount of damage to the labrum and any other parts of the hip, such as cartilage and/or ligaments
    • x-ray: can diagnose cam and pincer impingement and also rule out a fracture or other damage to the bone

    Some patients with hip impingement also have a labral tear. Our hip specialists check for this condition. They work with you to define an individualized treatment plan.

  • If you or a family member is diagnosed with hip impingement, you may wonder how it should be treated. It may reassure you to know that the Orthopedic Center at Boston Children's Hospital is the best in the nation according to U.S. News & World Report. You will receive excellent treatment and support from our team of expert hip sub-specialists.

    Your doctor will suggest treatment options based on the severity of and type of impingement. Your Boston Children’s care team will discuss options and answer any questions you may have.

    Some teens and young adults are treated non-surgically with pain medication and physical therapy. Other patients may need minimally invasive (arthroscopic) surgery; others may need open surgery.

    Your doctor will discuss specific treatment options based on:

    • age, overall health and medical history
    • the type, extent and severity of the impingement

    Conservative treatment

    Treatment may include conservative approaches such as:

    • rest
    • activity restrictions
    • anti-inflammatory and pain medications
    • exercises and physical therapy (to strengthen the muscles around the hip joint and avoid stress)

    If these don’t relieve discomfort, your doctor may suggest surgery.

    Surgical treatment

    Most teens and young adults with hip impingements that don’t respond to conservative treatment can be treated with arthroscopic surgery.

    What is arthroscopic surgery?

    Arthroscopic surgery is a minimally invasive technique. Some patients return home the same day as the surgery. Others may stay overnight for one night in the hospital. The main reason for an overnight stay is to help manage pain after surgery.

    During the surgery, the doctor makes two or three keyhole incisions. She inserts a thin scope to see the joint. Then she repairs the hip impingement. Repair may include fixing damaged cartilage or labral tear, if present. Surgery also may reduce friction between the femur head and socket.

    How long does it take to recover from arthroscopic surgery?

    Your care team will help you stand and walk with crutches after surgery. For the first two to three weeks, crutches are used to support your weight. Physical therapy to help restore muscle strength and range of motion begins after surgery. Most patients can return to full activities, including sports, three to four months after surgery.

    What is the long-term outlook for patients with hip impingement?

    For many patients, early diagnosis and treatment offer the best outcome. The hip joint is preserved, and cartilage damage does not progress.

    A complete repair and long-term recovery can be more difficult if the hip cartilage has been severely damaged.

  • Boston Children’s pioneering research helps answer the most pressing questions in pediatric orthopedics and provides patients with the most innovative care available.

    Our orthopedic research team includes:

    • full-time basic scientists
    • 28 clinical investigators
    • a team of research coordinators and statisticians

    Current studies include:

    • ongoing studies to follow patients who’ve had various treatments for slipped capital femoral epiphysis (SCFE) and hip dysplasia
    • a study investigating the effectiveness of new surgical treatments for femoral acetabular impingement (FAI)
    • a study of the long-term outcomes after Bernese periacetabular osteotomy (Bernese PAO) for hip dysplasia
    • a study of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to assess early arthritis in dysplastic hips: Read more.
    • a study of perfusion MRI as a predictor for reduced blood flow and cell death after treatment for hip dislocation. Read more.

    Boston Children’s Child and Young Adult Hip Perseveration Program is a founding member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR). ANCHOR was founded in 2006 to study surgical outcomes in teens and young adults with hip dysplasia. The goal is improved patient care, including quality of life, overall health and high levels of activity.

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO