Be alert to hip impingement syndrome for hip pain

  Femoroacetabular impingement syndrome is associated with abnormal development of the acetabulum, head and neck of the femur. Normally, there is a degree of deviation between the head and neck of the femur, but some patients have a so-called “pistol-shank” type of femoral neck, with a lack of normal deviation between the head and neck of the femur. In other patients, there is excessive coverage of the acetabulum and excessive protrusion of the anterior acetabular wall.  Based on this developmental abnormality, the femoral neck may repeatedly impact with the acetabulum during hip flexion and internal retraction, resulting in glenoid labral tears or cartilage damage to the acetabulum or femoral head. This causes the patient to develop deep anterior hip pain, limited or painful internal rotation of the hip joint, and popping or discomfort in the hip joint, often worsening with activity. Walking on a level path and straight flexion may be tolerated, but impact activities (e.g., walking on inclined paths or stairs, rotational movements) usually increase the pain. Pain may occur when standing up suddenly after sitting for a long time, when putting on shoes and socks, and when cutting toenails.  These patients often have difficulty detecting minor lesions on routine orthopedic examinations and X-rays, but the location, extent, and type of injury can often be detected on specific postural X-rays, MRI (magnetic resonance imaging), or MRA (magnetic resonance angiography).  There are many causes of hip impingement syndrome, both congenital (e.g. developmental hip dislocation, ischemic necrosis of the femoral head) and acquired (e.g. slipped femoral head epiphysis). However, hip impingement syndrome occurs in young patients mainly due to abnormal development of the femoral neck or acetabulum, resulting in the impingement of the femoral neck and acetabulum within the normal range of motion, resulting in hip pain. Over time, as the impingement increases, the cartilage at the edge of the acetabulum or femoral head becomes damaged and the pain gradually increases. Since the impingement mostly occurs when the hip joint is flexed and the impingement site is mainly located in front of the hip joint, pain in the groin area often occurs, especially when the legs are squatting together. In addition, because the patient is young, the onset of the disease is not long, the location of the lesion is special, and the lesion mainly involves cartilage tissue, it is difficult to detect the presence of the lesion by ordinary X-ray examination. The usual MRI is also defective in identifying the location and nature of the lesion. A special MRI of the hip joint can help to clarify the diagnosis.  Therefore, patients with hip pain, especially in the groin area, should be examined early to clarify the diagnosis. Once the diagnosis of hip impingement syndrome is clear, surgical investigation and treatment should be performed as soon as possible. On the one hand, the impingement lesion should be repaired to reduce the chance of reoccurrence of the impingement and thus eliminate the damage to the articular cartilage. In addition, the damaged cartilage should be cleaned to prevent further expansion of the cartilage damage.  If the onset is prolonged and the extent of cartilage damage is large, the results of the surgery will be compromised. Once the timing of surgery is missed, the further expansion of cartilage damage will eventually lead to osteoarthritis of the hip joint, which will seriously affect the work and quality of life of patients. But general hospitals can not carry out! A lot of clinical work needs to be done to make it popular!