Bone & Joint Surgery
The younger patient chronic hip pain must remind of femoroacetabular impingement (FAI), especially if the patient is athletic, also if it has been lasting for a long time and if many other diagnoses have been given such as tendonitis, repetitive muscle tears, pubalgia and adductor problems.
This condition is well known today, and especially so since the use of arthroscopic hip surgery has increased.
For this condition to develop and become painful, the concerned young athlete has to have a light anatomical hip abnormality: either at the femoral head (more often than not) or at pelvis level (retroversion of The acetabulum).
Without practising sports and especially without the repetition of hip bending movements, such anatomical abnormalities would not give pain.
In addition to impairing pain, this condition leads to a gradual joint degradation with the appearance of early osteoarthritis (the damaged cartilage is called osteoarthritis) and eventually hip labral tear. After a few years, if athletes can resist the pain and continue their activity, arthritis has finally developed so that resorting to hip replacement will be inescapable. For the medical profession this is then considered a failure because fixing a hip replacement very early in life will put an end to a high level sportive activity and inevitably lead after about 20 years to a replacement of this hip prosthesis i.e. a risky procedure whose outcome may often be disappointing.
Everything must obviously be done to prevent this from happening, so how osteoarthritis should be kept from forming? To achieve this, it is necessary to operate on femoroacetabular impingements in patients who want to continue to practise their sporting activity.
When the femoroacetabular impingement is related to an abnormality of the femoral head, it is called « cam » effect; a pelvis abnormality is known as « pincer » effect.
To make it simpler, we will only show and speak here of the cam effect because it happens to be much more frequent than the pincer effect.
Hip Surgery Video: Femoroacetabular impingement under arthroscopic exploration – Cam effect
(Beware! Some scenes not for the faint-hearted!)
The aim of the surgical procedure is to remove the abnormality (cam effect) located on the femoral head and thus prevent this bone « bump » from damaging the hip joint by creating pain at every move.
This procedure can be carried out by making a wide incision into the hip, using a minimally invasive procedure or the least traumatic technique, namely arthroscopy which is performed with adapted instruments introduced through two small incisions such as for the knee arthroscopy which is better known and more prevalent.
This operation is most often done on an outpatient basis, walking is permitted within the clinic with two cane crutches as a precaution for a few days; restarting the sporting activity should be very gradual though, and one can rarely expect recovery at best level before 3 to 6 months, which is a long but mandatory period.
If one wants to compare this type of hip surgery procedure to arthroscopic knee surgery, we may say that cruciate ligament surgery is most similar to it, in terms of recovery time required before restarting the sportive activity.
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