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Hip Impingement (Femoroacetabular Impingement, FAI) and Labral Tears

by Amir Jamali, MD

Date last updated 01/01/2017

Hip Impingement

Hip impingement is a disease in which the femoral head and acetabulum (hip socket) abnormally contact each other thereby injuring one or both structures. It has been subclassified into a Pincer type and a Cam type impingement. In the Pincer impingement, the hip socket is excessively deep with walls that protrude outward. The walls abnormally contact the neck of the femur damaging both the neck as well as the soft-tissue structure around the hip socket known as the hip labrum. Cam impingement is the condition where the femoral head is excessively large to fit into the hip socket and causes a shearing injury to the articular cartilage at the edge of the socket. The large head can be secondary to a malformation of the femoral head seen in some individuals. Professor Reinhold Ganz and his collaborators are greatly responsible for the recognition and treatment of hip impingement in its current form. They have developed a surgical technique for safe surgical dislocation of the hip joint to allow evaluation and correction of both the abnormalities of the hip socket and the femoral head. Recently, surgeons familiar with arthroscopic treatment of the hip have also made progress in the correction of morphological abnormalities of the femoral head by using intraoperative x-ray and motorized arthroscopic instruments.

Labral Tears

The hip labrum is a soft-tissue structure located at the edge of the hip socket or acetabulum. It is highly innervated meaning that when it is damaged, it can lead to a high degree of pain. The labrum can be injured from a severe twisting injury to the hip or simply as a result of abnormal contact against the head of the femur. The labrum has a relatively poor blood supply and therefore has a limited healing potential. Although there have been reports of labrum tears slowly healing, most cases require surgery consisting of hip arthroscopy. Hip arthroscopy is a recently available procedure for the treatment of certain abnormalities of the hip.

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