Abnormal contact between the femoral head and acetabulum during movement, damaging the labrum and cartilage over time. Both CAM and pincer types are assessed and treated with surgical and non-surgical options.
(03) 9573 9659
Hip impingement is a pathological pattern that results in abnormal contact between the bones of the hip joint during movement. Left untreated, it causes progressive damage to the labrum and joint cartilage, which can lead to osteoarthritis. Early diagnosis is important because cartilage damage, once established, heals poorly.
Hip impingement occurs when the shape or alignment of the bones in the hip causes abnormal contact during movement. There are two main types, which frequently occur together.
CAM impingement occurs when the femoral head has an abnormal shape or when the junction between the femoral head and neck has a bony prominence. During hip flexion and rotation, this irregular shape jams against the rim of the acetabulum, damaging the labrum and adjacent cartilage. CAM morphology is more common in males and is often associated with athletic activity during adolescence.
Pincer impingement occurs when the rim of the acetabulum over-covers the femoral head, causing direct contact between the rim and the femoral neck during normal hip movement. This wears down the labrum and, over time, the cartilage on the femoral head. Pincer morphology is more common in females and may be associated with acetabular retroversion.
Impingement can also be caused by conditions such as Perthes disease, slipped upper femoral epiphysis, a misshapen femoral head, or post-traumatic deformities. It is important to note that having an abnormal bone shape on imaging does not automatically mean impingement is causing symptoms. A thorough clinical assessment is required to determine whether the morphology is contributing to a patient’s specific presentation.
The most common symptom is pain in the groin or front of the hip, during or after activities involving hip flexion such as prolonged sitting, cycling, squatting or kicking. Stiffness that limits the range of hip flexion is also common.
Early symptoms may be subtle — a dull ache after exercise, reduced athletic performance, or a limp after prolonged activity. Some patients present with back pain or pain across the lower abdomen, which can be related to the altered mechanics of an impinging hip. The attention-getter is often labral pain. The silent victim is the articular cartilage.
FAI most commonly presents in active young adults and adolescents. CAM impingement is more prevalent in males who participate in high-flexion sports. Pincer impingement more commonly affects females. Both types frequently occur together. FAI may begin at birth or develop during periods of growth. It is likely a combination of genetic and environmental factors.
Mr Balakumar diagnoses FAI following a complete history, physical examination and imaging. Standardised plain X-ray views assess the shape of the femoral head and degree of acetabular coverage. CT scanning may be used to better define three-dimensional anatomy. MRI assesses labral integrity, cartilage health and the extent of any associated damage.
Non-surgical management is always considered first. Options include anti-inflammatory medication (such as Naproxen, Meloxicam or Celebrex), activity modification, physiotherapy and cortisone injection. Mr Balakumar can perform cortisone injections under ultrasound guidance. These measures manage symptoms but do not correct the underlying bone morphology. Modifying training or activity load based on the patient’s bone profile can make a meaningful difference.
When non-surgical management has not provided adequate relief and imaging confirms that impingement is contributing to symptoms, surgery may be appropriate. Mr Balakumar performs hip arthroscopy to address both CAM and pincer impingement, reshaping the femoral head-neck junction and decompressing the acetabular rim as required. The labrum is assessed and repaired or reconstructed where needed. The aim is to restore normal joint mechanics and protect the cartilage from further damage.
In some cases, osteotomy at the femur or acetabulum may be required to correct more significant underlying deformity. The specific approach depends on the individual anatomy and the extent of the pathology.
As a general guide, if symptoms have been present for 12 months or more and have not responded to conservative management, surgery is a reasonable option to consider. There are no absolute rules. The decision is made jointly between the patient and Mr Balakumar, based on the full clinical picture.
(03) 9573 9659
Mr Balakumar is one of a small number of surgeons in Australia with formal training in both paediatric and adult hip surgery. His fellowship at Harvard’s Children’s Hospital in Boston, under some of the world’s leading specialists in hip preservation, gives him a depth of expertise that is difficult to find in a single practice.
His approach is the same whether the patient is 6 months or 65 years old – thorough assessment, honest options, and no pressure toward surgery until the clinical picture clearly supports it.
(03) 9573 9659
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Melbourne Orthopaedic Group is home to a team of experienced orthopaedic surgeons, providing comprehensive care for sports injuries and orthopaedic conditions. Whether it’s joint replacement or sports injuries, our specialists provide comprehensive orthopaedic care.
