A problem like osteoarthritis does not seem like it would be a concern for young athletes. They are active and typically not overweight. They excel beyond anything most would ever dream of accomplishing. However, if they push themselves beyond what their own bodies can handle, even they can break down.
Hip and/or groin pain in a young athlete is often signals a problem. One of the most common causes of hip pain in this group is a condition known as femoroacetabular impingement or FAI. Early detection is critical in preventing serious hip problems later in life.
When a young athlete experiences FAI, the condition involves an abnormal hip anatomy that flares up when the hip is subjected to repetitive movement. These morphologic irregularities may include:
- Femoral head that is not perfectly round
- Off-center placement of the hip in the hip socket
- Irregular hip socket
- Bent or twisted femoral neck
- Os acetabulum, a piece of bone located along the front of the hip socket
With impingement, the soft tissues around the joint get caught between the femur and the hip socket. There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.
The fibrous rim of cartilage around the hip socket, called the labrum, is the area most likely to suffer the impingement, or pinching. When the pinching occurs continuously, as it does with repetitive movements, the labrum tends to fray and tear. For this reason it is important to address FAI hip problems as soon as possible. Not only will this head off more serious problems in the future, it will allow athletes to safely return to the field more quickly.
Can too much physical activity at a young age be the problem? Some high-level athletes with abnormal hip joints never develop problems. The question of who develops FAI and how to predict if and when it should be treated are areas where further study is needed.
For now, arthroscopic surgery may be the most effective way to deal with this issue. When pain prevents participation in sports, athletes are eager to find ways to get back in the game. Conservative, non-surgical care may be tried first, however if that fails to eliminate pain, restore motion and improve function, it may be necessary to look inside the joint to see what can be done.
Using an arthroscope, the surgeon can enter the joint without making a large incision. A tiny TV camera on the end of the instrument projects a picture on a screen for the surgeon to see. Any areas of damage to the labrum can be smoothed down and repaired. If necessary, the rim of the acetabulum and the head of the femur can be reshaped. Reshaping the area where the femoral head and neck meet requires significantly more skill but may be helpful, too.
In a recent study of 200 athletes who had arthroscopic surgery for FAI, 92 percent were able to return to full participation in the sport of their choice. Whenever possible, the surgeon repaired the labrum instead of removing or shaving it off. This approach may account for the good results.
Soccer players, runners, football players, and basketball players made up the majority of the patients, which also included wrestlers, ice hockey players, weight lifters, swimmers, dancers, golfers, and even two bull riders. All of the patients had this arthroscopic treatment of FAI.
Due to some complications (e.g., temporary nerve damage, bone formation within the hip capsule) the results weren't perfect. One athlete ended up getting a total hip replacement and four others had to have a second surgery due to continued problems with hip pain.
The surgeon who conducted the study noted that by the time the athlete comes in for surgery, there is often some damage to the joint that simply can't be reversed. He advocates for earlier diagnosis in order to help prevent some of the unavoidable consequences of this problem in active, young athletes.
Arthroscopic surgery is currently the most effective way to treat painful FAI. The earlier it is detected and treated, the more likely FAI hip problems will not develop into major issues later in life. According to American Academy of Orthopaedic Surgeons information on Femoroacetabular Impingement, Surgery can successfully reduce symptoms caused by impingement. Correcting the impingement can prevent future damage to the hip joint. However, not all of the damage can be completely fixed by surgery, especially if treatment has been put off and the damage is severe. It is possible that more problems may develop in the future.”
As an experienced orthopedic surgeon on the Reconstructive Orthopaedics team, I am skilled in the diagnosis and treatment of a variety of hip issues, and perform all procedures related to hip arthroscopy.
Dr. Kevin Shaw
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