Hip Pain in the Young Active Patient

By: Chetan Deshpande, MD, FACS

Hip arthritis in the elderly is a common and well-recognized problem with a consistent and successful treatment algorithm. However, diagnosing and treating hip pain in the young athlete can be a difficult challenge. In recent years, femoral acetabular impingement has become a more widely recognized pathology, and treatment options for young patients with hip pain are steadily improving.

Femoral acetabular impingement (FAI) is an anatomical mismatch between the femoral head and acetabulum. This leads to abnormal contact within the hip joint during physiologic range of motion. During athletic activities, the increased loads and wider range of motion can result in significant and sometimes irreversible damage to the structures of the hip joint, most importantly, the cartilage surface. This can lead to early degenerative changes and the need for arthroplasty, which can significantly limit the younger patients’ activities.

If recognized early, FAI can be managed in such a way that these degenerative changes can be prevented. Patients will often complain of groin pain and sometimes buttock pain, which is worse during athletics. Typically motions requiring deep squatting will also accentuate the symptoms. In later stages, patients will even have trouble getting in and out of a car or sitting down in a low chair. Initial management will consist of activity modification, physical therapy, and medications. If these fail surgical decompression of the hip along with the repair of damaged structures is possible through both arthroscopic and open approaches. When treated early and aggressively, many patients can be returned to their pre-injury activity levels.

See Chetan Deshpande, MD, FACS speak at the GAPA 2020 Summer Conference in Sandestin, FL.

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