Hip impingement surgery is a relatively recently recognised condition in orthopaedic practice.
Impingement is the abnormal contact between the femoral (ball) and acetabular (cup) parts of the natural hip joint causing damage to one or both sides of the joint. There are many causes for this including misshapen bones, abnormal movements, and lumps on the neck of the hip that develop before adulthood.
This condition has been implicated in the development of arthritis requiring joint replacement in a significant proportion of patients (10–30%). It is believed that if this condition is recognised and addressed early before arthritis develops, then the hip can be saved for many years.
Fig 1: Impingement lesion.
Patients are typically young (15–40yrs), and active in sport. It is much more common in men. They typically experience groin pain after activity, and restriction in bending and inward twisting of their hips.
Demonstration of the abnormality is not straightforward and requires specially arranged X-rays and MRI scans.
Fig 2: CT of impingement lesion of the hip.
Surgery is controversial. The Orthopaedics WA preference is not only to reconstruct the damaged soft tissue injury, but also to remove the abnormality causing the problem. We would normally carry this out through a dramatic but safe procedure requiring the dislocation of the hip joint.
Fig 3: Surgical dislocation.
More recently, the surgery can be done arthroscopically (key hole). Very rarely more extensive surgery is required to deal with the abnormality in the pelvis or femur (osteotomy).
Complications are actually rare, (nerve injury 2%, non union of the trochanter 2%). However recovery takes about six months to get back to full sporting activity. Crutches are required for the first three months to protect the repairs.
If the hip is too badly damaged by this condition, then hip resurfacing or hip replacement may be required.