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Hip pain in young individuals and athletes: symptoms, causes and treatments

Every time you walk, run, ride a bike, play sports, or sit in front of the computer, your hips are involved. In particular, certain types of sports such as soccer, dancing, or martial arts, put a lot of strain on this part of the body. A problem with this joint can result in a sensation of stiffness and recurring pain during specific movements in one’s daily life.

An accurate diagnosis, combined with a surgical intervention such as hip arthroscopy when appropriate, can help alleviate the symptoms of a painful hip. The main cause of hip pain in young and athletic patients is femoroacetabular impingement with associated acetabular labral tears.

What is the femoroacetabular impingement?

Femoroacetabular Impingement (FAI) is a hip pathology caused by the conflict between the femoral head and/or the acetabulum, a conflict that occurs during the normal movement of these two joints. It can be either an occasional episode following a sports performance or a consequence of congenital or acquired hip pathologies.

The deformities resulting from this conflict can be distinguished into two different types:

  • Pincer: acetabular deformity, which mainly affects females, causing the femoral head to be pinched like a clamp.
  • Cam: mainly affects males and occurs when the femoral head is not perfectly spherical, causing the eccentric part to contact the acetabular rim.

What do acetabular labral lesions consist of?

Femoroacetabular Impingement (FAI) involves a lesion of the acetabular labrum, which is a kind of seal of the joint that lines the edge of the acetabulum. Following the labral injury, there is a disruption of the synovial fluid homeostasis, which normally provides nourishment to the articular cartilage. This alteration initially leads to delamination of the acetabular cartilage, and over the years, it can progress to hip arthritis.

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Which are the symptoms?

Pain in FAI and labral lesions usually manifests subtly in the groin, but sometimes pain may be referred to the buttock or characterized by complex radiations. Typically, symptoms are felt after physical exertion, not necessarily of great magnitude, such as standing for many hours to attend an event or due to professional requirements.

Initially, this discomfort occurs only during certain activities, but over time, it can affect physical activity or normal daily movements.

What tests should I undergo to determine if I have this impingement?

  • A clinical examination aimed at finding clinical signs of the disease through specific tests (FABER-FADIR).
  • A pelvic X-ray, as well as hip X-rays in Dunn projection at 45° and 90°.
  • An MRI of the hip.

How is femoroacetabular impingement treated?

Conservative treatment (non-surgical) should always be considered first when dealing with FAI, and often it can result in reduced hip pain and stiffness, although it may not always prove to be the best course of action. Here are the behaviors to follow:

  • Rest
  • Modification of one’s behavior
  • Physical therapy
  • Treatment with anti-inflammatory drugs

Surgical treatment through hip arthroscopy is a minimally invasive procedure that, through small incisions (1 cm) and appropriate instruments, identifies and treats some pathologies associated with hip pain. This procedure is performed on an ordinary hospital stay (one night in the hospital). Here are the various phases that characterize the treatment:

  • General anesthesia
  • Gradual traction of the hip to increase the joint space in order to introduce arthroscopic instruments
  • Making a skin incision, introducing an arthroscopic camera connected to an external monitor to examine the condition of the operated joint
  • Execution of a second small incision, introduction of surgical instruments suitable for treating the diagnosed pathology.

Here’s what can be done through surgical intervention: depending on the damage found at the time of arthroscopy, it may be possible to repair or totally remove the damaged labrum; transplant the damaged labrum; repair mild chondral lesions; reshape the femoral head and/or acetabulum to eliminate the impingement once and for all.

Which patients benefit the most from hip arthroscopy?

Patients who respond best to hip arthroscopy are young and active individuals with hip pain, where the joint cartilage is still healthy at the time of diagnosis. For patients who have already experienced significant cartilage loss, a more definitive treatment such as hip replacement is more suitable.

Scientific studies have shown that 80% of patients who undergo hip arthroscopy return to sports and other physical activities at pre-pain levels (from femoroacetabular impingement). The majority of patients are significantly better, but it is still unclear to what extent the procedure halts the progression of arthritis.

Hip arthroscopic surgery has the advantage of being a minimally invasive procedure that allows for the treatment of hip pathologies with minimal tissue trauma and post-operative pain, as well as rapid recovery and return to sports.

In order to address issues such as hip pain in young individuals, the MiniHospital “Sandro Pertini” relies on specialist experts in the field of surgery and collaborates with a senior medical officer from the Rizzoli Orthopedic Institute in Bologna, Dr. Mariotti, who specializes in conservative and minimally invasive arthroscopic surgical treatment of the most common hip pathologies, with a significant case history of surgical interventions.

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