Femoral-Acetabular Impingement and Surgery
Orthopaedic Faculty with this Specialization
Christopher L. Peters, M.D.
University Orthopaedic Resources:
Questions and Answers
Q) What is Femoral-Acetabular Impingement?
A) Impingement occurs when the ball (femoral head) doesn't have full range of motion in the socket (acetabulum). This is caused by too much bone around the femoral head and/or the socket turned backwards (retroversion) and the femur bumps into the rim of the acetabulum and causes pain and possibly damage over time.
Q) What are symptoms common with impingement?
A) Impingement can present at any age between 20-50 years old. Most of the time, people will start to get pain in the front of their hip (groin) after prolonged sitting or walking. Walking uphill can also be difficult. Sometimes they feel a dull ache in the groin, other times catching or popping.
Q) What happens inside a hip with impingement?
A) When the extra bone on the femoral head and neck (ball) hits the rim of the acetabulum (socket) the cartilage and labrum can be damaged. These tissues are the cushion between the ball and socket (clear space on x-rays), and when damaged can cause pain and start to degenerate (get small tears and form arthritis). If left untreated, pain and arthritis continues and usually a hip replacement (total hip arthroplasty) is needed at some point.
Q) What does Retroversion; mean?
A) Retroversion is a form of acetabular dysplasia where the socket is facing more backwards than it normally would, which can cause the femur (thigh bone) to bump into it when you flex your hip. This happens because the front of the socket (anterior wall) is lower than the back of the socket (posterior wall). It can be seen by subtle shadows on x-ray. Anteversion means facing forward and this is normal.
Q) How do I know if I need surgery?
A) Pain that is in the anterior groin (front) that affects daily activities and prevents you from doing the things you want to. If x-rays show extra bone around the head/neck with early degenerative changes (mild arthritis) but still evidence of good cartilage, you may be a candidate for a femoral-acetabular debridement. Usually flexion of the hip with turning your leg in or out correlates with impingement. If there is retroversion of the acetabulum (socket) and that seems to be contributing to the impingement, you may need a Periacetabular osteotomy with or without a femoral head debridement.
Q) What is involved in a Femoral-Acetabular Debridement?
A) Usually it is through an incision over the side of your hip where we carefully dislocate the hip after saving the blood supply to the head (Greater Trochanteric Osteotomy). After exposing the femoral head and acetabulum, extra bone that contributes to the impingement can be cut away. After thorough removal of bone and damaged tissue, the Greater Trochanter is replaced to the femur with 2 screws.
Q) What is involved in a Periacetabular Osteotomy (PAO)?
A) The surgeon goes through an incision over the front of the hip, then with x-ray guidance (fluoroscopy) carefully cuts through the three pelvic bones (ischium, pubis, ilium) around the acetabulum to free it from its original position. Then once we are happy with its new location (facing the right direction with good coverage), we fix it there with screws (usually 3-6). From this same incision we can access the hip joint to debride extra bone from the head/neck as needed.
Q) Will I need a blood transfusion?
A) You may. We recycle the blood you lose at surgery and give it back to you if there is enough. But sometimes you will need a transfusion of 1-2 units after surgery. You may donate your own blood if you are able, but if not, the blood bank is very safe and we can use that if it's needed.
Q) How long will I be in the hospital?
A) Usually, the hospital stay is 2-3 days after surgery.
Q) What physical therapy do I have to do?
A) Starting the day after surgery you will have Physical Therapy twice a day that includes gentle exercises, learning to sit, stand and walk with partial weight-bearing and crutches. You may take a few steps the first day around your room, and then into the hallway on the second day, and so on. After you leave the hospital, the important therapy you have to do is walk, rest and let your surgery heal.
Q) What are the major risks to the surgery?
A) Blood clot: we reduce risk of this by using a blood thinner, T.E.D. hose (compressive stockings) and compression boots on your feet to increase circulation.
Infection: you are given IV antibiotics before surgery, which is continued for 1 day after, then keep a close watch of the incision for redness or drainage.
Failure to heal: this is uncommon but always a concern, especially if you smoke. If the bone doesn't heal, the screws can break and the bone can move. An additional surgery to increase bone healing could be needed, but very rarely.
Avascular Necrosis: this is uncommon, but possible. If the blood supply to the femoral head is damaged, the bone may collapse and die. This could speed up the need for a total hip, if it were to happen.
Nerve Palsy from PAO: a sensory nerve called the lateral femoral cutaneous nerve is right where we do surgery. We do our best to identify it and protect it but there is a 50% chance you will have some numbness over the front of your thigh, over time sensation usually returns.
Q) What happens when I leave the hospital?
A) If you have family at home - you will usually need 24 hour help for a week. Or if you don't have adequate help at home, we could consider a Rehabilitation center. The final plans will be made while you are recovering in the hospital.
Q) What do I do at home while recovering?
A) For the first 6 weeks: finish taking blood thinners (aspirin for 6 weeks); wear T.E.D. hose; walk with 2 crutches (partial weight bearing); keep wound clean.
For the next 6 weeks: transition to 1 cane or crutch as instructed by your physician until three months after surgery; may start gentle stretching or strengthening exercises; walk;
After 3 months: return to work part time or full time as tolerated (2-3 months from surgery), continue to walk, and return to gentle exercise.
After 6 months: You may return to full activity (when the bones are completely healed) except for running/jumping activities. The best lifelong activities are walking, swimming, biking to preserve your hips health.
Q) How long do I take narcotics?
A) Only as long as you need to, about 7-21 days from surgery. Be aware that sometimes anti-inflammatories (NSAIDS) can slow down bone healing, but Tylenol doesn't.
Q) When can I drive?
A) Usually 3-4 weeks after surgery.
Q) When do I see my doctor after surgery?
A) You will probably have staples and should see your doctor in 2 weeks, then again 6 weeks after surgery for x-rays, then 3 months, 6 months, 1 year, and every year or two so we can see how your hip progresses.
Q) Who do I call if I'm having problems after surgery?
A)The nurse/MA who works with your surgeon. Call the orthopedic clinic and ask for her voicemail, she will get back to you within a day (m-f) otherwise, call the orthopedic resident on-call.
Q) How long will it take to fully recover from surgery?
A) Debridement or Periacetabular Osteotomy: You will be walking within a couple days of surgery, on 1-2 crutches for 3 months, and it usually takes 9-12 months to feel fully recovered.
Q) How long with the surgery last? Will I need another surgery?
A) We hope to prolong the time between now and when you need a hip replacement. But the exact time in years is unknown, and on an individual basis, based on the amount of arthritis in your hip already.
Q) What lifelong activities can I do or not do?
A) We advise patients to resume what they can tolerate, especially walking, swimming and bicycle riding. We discourage repetitive jumping, running and heavy manual labor and lifting. These activities tend to wear out the hip faster.
The information provided may be useful for patients to become more knowledgeable about their specific injury, surgery or condition. It is provided for informational purposes only, and does not replace the advice of a physician.
