created gif

User login

Hip Impingement

Like so many other words, the term "hip impingement" was borrowed from the English although it was coined by the Swiss professor Reinhold Ganz.

Hip impingement means nothing other than "jamming of the hip" and is a painful condition. Different structures of the hip may be involved: the labrum, bony structures, cartilage, scar tissue, and in rare cases, the pubofemoral ligament. Sometimes it is not possible to determine the precise site of origin of the pain.

Two main types of hip impingement have been described: cam impingement and pincer impingement. At OZM, it is our opinion that there is a third, distinct type, namely, traumatic hip impingement. We define the third type as a purely traumatic labral injury, i.e. a traumatic labral tear, in an otherwise completely normal hip. If diagnosed early, the torn labrum can be repaired arthroscopically. The great advantage to this is that once healing is complete, the hip is "really healed", that is, there is no specific risk of early degeneration or arthritis of the hip. 

Two main types of hip impingement have been described: cam impingement and pincer impingement. In my opinion, there is a third type existing as an entity separate from the other two types, namely, traumatic hip impingement. The third type, in my opinion, is a purely traumatic labral injury, i.e. traumatic labral tear, in an otherwise completely normal hip. If diagnosed early, the torn labrum can be repaired arthroscopically. Once healing is completed, the hip is "really healed", that is, there is no specific risk of early degeneration or arthritis of the hip.

In pincer impingement, there are degenerative changes mainly in the acetabulum, which slips forward, clamping the neck of the thigh bone (femur) like the pincers of a crustacean.

A typical case of pincer impingement is shown on the image above. Note the cysts on the acetabular rim, which juts forward, jamming against the neck of the femur, particularly during hip bending movements. The animated graphic demonstrates well how impingement (jamming) damages the labrum and, consequently, the articular cartilage.

Dr. M. Tannast, Orthopaedic Surgery, Inselspital, University of Bern, Switzerland

In cam impingement, the degenerative changes occur mainly on the neck of the femur. Bumps form on the neck of femur, causing it to jam against the acetabulum.

As shown on this MRI image, the femoral neck is much wider than normal and does not taper like the one on the opposite side. This results in impingement mainly during hip bending movements. However, the mechanism of impingement is completely different from that in pincer impingement.

Dr. M. Tannast, Orthopaedic Surgery, Inselspital, University of Bern, Switzerland

This animation demonstrates nicely how impingement leads to progressive joint damage.

Most patients have combined forms of cam and pincer impingement in which degenerative changes occur in both the acetabulum and the neck of the femur. These conditions are always associated with labral tears of variable severity.

This poses the question of whether the labral tear might have occurred first before the osseous bumps developed mainly on the acetabulum or femoral neck depending on the stress load over time. This theory is supported by the fact that many of our patients state that they have had occasional stabbing pain in the groin region for many years, which is most probably caused by a labral tear. Unfortunately, hip impingement is frequently misdiagnosed as "groin pain" in men and as "ovarian problems" in women. These misdiagnoses can delay proper treatment for several years.

There must not always be a long way to find the correct treatment.

Hip impingement syndrome can be treated arthroscopically, that is, through arthroscopic repair of the acetabulum and/or neck of the femur, as needed. This can be performed as a minimally invasive procedure: conventional open surgery is no longer necessary. Successful arthroscopic surgery requires a doctor with expert surgical experience. We have performed more than 2000 hip arthroscopies since 1998, making us one of the largest and most experienced hip arthroscopy centres worldwide.

If the procedure is performed correctly and at the right time, a complete return to sports activity is generally possible (see Patient Testimonials). As these forms of hip impingements are always associated with an increased risk of arthritis, exceptions of this general rule sometimes apply.