Hip arthroscopy

What is surgery for mismatch between the hip ball and socket?

Mismatch or abnormal shape of the hip (femoro acetabular impingement or hip impingement), is an abnormal shape of the hip. It can be common amongst individuals who take part in sporting activities.

There are two types of hip impingement, 'Cam' and 'Pincer' and you can get a combination of both. Normally the hip glides and moves smoothly as the ball shaped head of the thigh bone (femur) moves in the cup shaped hip socket (acetabulum).

Cam Impingement is caused by a jamming or squeezing of an abnormally shaped head of the thigh bone (femoral head) and head-neck junction into the hip socket (acetabulum) during certain hip movements. Cam impingement typically occurs in young, athletic males.

Pincer Impingement occurs when there is direct contact with the head of the thigh bone (femoral neck or head-neck junction) with part of the edge of the hip socket (acetabulum edge and labrum). The hip socket (acetabulum) appears to be 'over deep. 'Pincer impingement is more commonly seen in middle aged females.

The presence of both types is referred to as mixed impingement.

Symptoms include restriction of movement, ‘clicking’ of the hip joint, and pain. Symptoms may occur or increase during hip flexion activities (sometimes described as when the knee comes toward the chest) resulting from sporting activity, although many patients experience pain whilst sitting.

Management of hip impingement usually includes a trial of conservative measures, including activity modification to reduce excessive motion and loading on the hip.

Patients who do not improve with conservative treatment, may be considered for surgical management to improve range of movement and reduce pain may be required.

Treatment

The three surgical approaches commonly used are:

  • Open dislocation surgery involving dislocation of the hip joint
  • Arthroscopy (a surgical procedure that allows doctors to view the hip joint without making a large incision (cut) through the skin and other soft tissues) OR
  • Arthroscopy with a limited open approach.

Compared to open surgery, there is evidence that the more limited open arthroscopic surgery is just as effective for reducing pain and improving function and quality of life for patients. It is also associated with lower rates of further operations being required.

Patient eligibility criteria

This is a very specialised procedure and needs to ONLY be undertaken by those who are undertaking a number of these procedures on a regular basis and have the clinical specialism and the Multi-Disciplinary Team (MDT - e.g. doctors, specialist nurses, physiotherapist) to support the patient in place.

The CCG has commissioned certain hospitals with suitably qualified staff to undertake the procedure and the MDT in place to support the patient prior to, during and following surgery.

Advice and guidance

  • For more information, search for femoroacetabular impingement at www.nhs.uk
  • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

Treatment policy for patients covered by NHS Birmingham and Solihull CCG