The Doctor
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Just as a tire on a car wears down over time, so can the hip joint

Hip pain can sometimes be more than a nuisance. Being aware of these signs can be important in maintaining your physical health. 

A femoroacetabular impingement (FAI) hip condition is similar to a tire on a car being out of alignment. The hip labrum is a rubbery like lining of the hip socket which acts like a gasket providing suction seal to the ball and socket while maintaining stability of the joint. An FAI ailment occurs when additional bone forms along either the ball or socket of the hip joint causing a mismatch. This irregularity can cause the bones to rub together producing damaging friction to the hip joint. An FAI condition can also lead to destruction of the hip joint resulting in labrum tears, separation of cartilage as well as arthritis. 

Symptoms of an FAI hip ailment

In some FAI cases, symptoms are evident. Symptoms of FAI can include anterior groin pain, lateral and posterior hip pain. Some patients describe a catching, clicking or locking sensation within the hip. For other patients, labrum tears present without pain symptoms.

Diagnosis of an FAI hip ailment

Digital medical illustration: Anterior (front) x-ray view (orthogonal) of human hip. With pain zone in hip

Diagnosing an FAI disorder requires a physical examination with past history taken into account. Imaging including X-rays to view the shape of the bones and to identify arthritis may also be recommended. High-quality 3T MRI (magnetic resonance imaging) is a non-invasive imaging technology and effective tool in diagnosing a hip labrum tear, early arthritis and possible stress fractures within the hip bone. In some cases, an injection into the hip joint to pinpoint the source of pain may be needed. 

Types of Hip Impingement

  • Cam impingement – Excess cam bone spur prohibits the ball end of the femur (femoral head) from moving efficiently within the acetabulum (hip socket). The cam bone spur on the femoral head grinds with cartilage within the acetabulum causing joint damage and pain. 
  • Pincer impingement – Additional bone growth at the perimeter of the acetabulum causes the hip socket to become deeper than usual. The extra bone can also cover the femoral head affecting and possibly preventing the ball from rotating properly within the joint. These occurrences can impinge the neck of the femur bone and cause hip labrum tears. 
  • Combined impingement – Combination of both cam impingement and pincer impingement conditions within the hip.  

Non-Surgical Approach (Therapy) – 

In some FAI ailments, physical therapy can help to strengthen the muscles and provide stability within the hip joint. Physical therapy should be doctor supervised. 


Hip Preservation Surgery –

If non-surgical treatments for FAI fail to relieve pain, hip surgery may be recommended by your doctor. Hip arthroscopy or hip preservation surgery aims to provide treatment for the arthritis, repair the labrum and return the bone within the hip socket to normal shape. During arthroscopic surgery, small incisions provide the pathway for an arthroscope or small camera the surgeon will use to view the hip joint and instruments to perform the procedure. 


The priority in recovery within the first month after hip arthroscopy focuses on protection of the labrum repair and hip capsule (ball and socket of the hip joint). Wearing a hip brace may be recommended to prevent certain motions, allowing the hip joint to heal properly. Crutches for balance and control may also be needed for several weeks post-surgery. Post-operative rehabilitation and physical therapy will be prescribed in a quick time frame after hip surgery. A full return to all activities after hip arthroscopy surgery can take between four-to-six months. Patient-reported outcomes (PRO) at one-year post-operatively in the athletic population after hip arthroscopy surgery have shown over a 90 percent return to pre-injury levels. 

Just as a faulty or unbalanced tire needs maintenance over time due to wear and tear, so may your ailing hip ailment. If hip pain is affecting your quality of life, you should be seen by a trained orthopedic surgeon and sports medicine specialist who can help with non-surgical, physical therapy or surgical options to provide treatment for the hip condition. 


Dr. Jonathan Hersch is a board-certified orthopaedic surgeon and sports medicine specialist. His areas of interest include shoulder, elbow and knee surgery, sports medicine and arthroscopy, fracture care, adolescent and adult care and hip arthroscopy. Dr. Hersch’s office is located in Boca Raton, FL.


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