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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I'm 56-years-old looking at having a hip replacement done for a problem I didn't even know I had all these years: femoral impingement. I knew things were changing because I could no long go rock hounding like I used to and my daily hike up the neighborhood mountainside slowly disappeared from my morning exercise. How come there was no sign of this happening until it was too late to do anything else except replace the joint?

It sounds like you may have a hip problem called femoroacetabular impingement or (FAI). Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs. Early diagnosis and treatment may be able to restore normal hip motion. Sometimes surgery is recommended right away. In other cases, conservative (nonoperative) care with antiinflammatories and physical therapy works just fine. Delaying surgery is possible for other patients but the long-term effect(s) of putting surgery off have not been determined. There is concern for the development of osteoarthritis without treatment or with delayed treatment. This seems to describe your situation. The first noticeable symptom of femoroacetabular impingement (FAI) is often deep groin pain with activities that stress hip motion. Prolonged walking is especially difficult. Although the condition is often present on both sides, the symptoms are usually only felt on one side. In some cases, the groin pain doesn't start until the person has been sitting and starts to stand up. There is often a slight limp because of pain and limited motion. Groin pain associated with femoroacetabular impingement can be accompanied by clicking, locking, or catching when chronic impingement has resulted in a tear in the labral cartilage. When femoroacetabular impingement and a labral tear are both present, symptoms get worse with long periods of standing, sitting, or walking. Pivoting on the involved leg is also reproduces the pain. Some patients have a positive Trendelenburg sign (hip drops down on the right side when standing on the left leg and vice versa). As is often the case, one problem can lead to others. With femoroacetabular impingement, hip bursitis can develop. The gluteal (buttock) muscles may be extra tender or sore from trying to compensate and correct the problem. The pain can be constant and severe enough to limit all recreational activities and sports participation. In your case, it sounds like the symptoms were mild enough to cause modification in your activities but not severe enough to seek medical help early on. Many people who are asymptomatic (symptom free) or nearly without symptoms look back and realize there were more indicators of a problem than they either recognized or wanted to admit. But 20, 30, 40 (or more) years later, it's time to deal with the 'what now' rather than the 'what if' of years past. Fortunately, hip replacements are available for this problem and you can look forward to resuming some of your lost activities.


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