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Evidence is emerging that subtle abnormalities around the hip, resulting in femoroacetabular impingement (FAI), may be a contributing factor in some instances to osteoarthritis in the young patient. FAI is the abnormal contact or friction between the femoral neck/head (ball) and the acetabular margin (socket), causing tearing of the labrum and avulsion of the underlying cartilage region, continued deterioration, and eventual onset of arthritis.
Nonsurgical treatment typically fails to control symptoms.
Surgical management involves dislocation of the hip (while preserving the blood supply to the femoral head) and femoroacetabular osteoplasty. Encouraging results have been reported following femoroacetabular osteoplasty and arthroscopic treatment of femoroacetabular impingement.

1. Labral Tear (Hip)

The labrum is a pad of fibrocartilage deep in the hip joint. The hip is a ball-in-socket joint with the ball from the thigh bone (femur) and the socket from the pelvis (acetabulum). The labrum is a pad of cartilage that lies between the femoral head (ball) and the acetabulum (socket). It acts as a stabilizer and a shock absorber in the hip. Labral tears are common in athletes. When tears in the labrum occur, patients can experience pain deep in the hip joint. There are many different causes for tears. When a labral tear is symptomatic and patients have failed non-surgical measures such as physical therapy, activity modification and medication, it may be repaired arthroscopically.

2. Snapping Hip

There are three types of snapping hip: internal (iliopsoas tendon or hip flexor), intra-articular (loose bodies), and external (IT band). In most patients the snapping is merely an annoyance, but it can lead to pain and dysfunction, especially with athletic activities. When non-surgical measures have failed, these conditions can be treated arthroscopically.

3. Synovitis

The synovium is the lining of our joints. When this lining gets irritated, it can become inflamed, which may cause hip pain. The synovitis is typically secondary to an intrinsic hip problem (labral tear, FAI, arthritis) but may be due to a primary disease of the synovium (inflammatory arthritis). When indicated, the synovium can be resected arthroscopically.

Hip Arthroscopy

Hip arthroscopy is a unique, minimally invasive outpatient technique that uses fiber-optic cameras and small instruments to treat painful hip conditions that were traditionally repaired through larger open incisions. It can allow for a quicker recovery period, less scarring, and a return to pre-injury activity levels which make it an ideal technique for athletes and those under the age of 55. There are many conditions that can be treated arthroscopically when indicated.

Indications for hip arthroscopy include: labral tears, loose bodies, hip impingement (FAI), snapping hip, articular cartilage injuries, synovitis, and hip pain. Relative contra-indications for hip arthroscopy include pre-existing arthritis, obesity, infection, and regional pain syndromes (e.g. RSD, fibromyalgia).

Candidates for hip arthroscopy include:

  • Athletes with hip pain associatedwith labral tears +/- FAI
  • Athletes with snapping hip syndrome
  • Pre-arthritic patients with hip pain and labral tears +/- FAI
  • Pre-arthritic patients with hip pain associated with synovitis
  • Hip arthroscopy is not a common technique, so your surgeons experience is an important factor to consider.