Hip Impingement / Femoroacetabular Impingement (FAI)

Definition

The hip joint is formed by the articulation between the head of the femur and the acetabulum, or socket, of the pelvis. This is a classic ball-and-socket joint (the head of the femur forms the ball; the acetabulum creates the socket). Normally, the femoral head is perfectly round, sitting in the perfectly round acetabular socket. Femoroacetabular impingement (FAI) is caused by abnormal contact between the femoral neck and the acetabular rim as the hip moves through its physiologic range of motion. Bony abnormalities can occur on either the femoral side (cam impingement) or the acetabular (Pincer impingement) sides, but most commonly occur together (mixed- or combined-type FAI). The abnormal bony lesions lead to tearing of the acetabular labrum, which lines the acetabulum rim, causing pain in the hip and the development of osteoarthritis over time, if left untreated.

*The term “cam” comes from camshaft, where the cam is attached to a cylinder (think: femoral neck), creating a cylinder with a rotating irregular shape. (Link)

*The term “pincer” is more self-explanatory, in that the abnormal anatomy resembles a crab’s claw.  

Anatomy

The proximal femur and acetabulum typically articulate without abutment through a physiologic range of motion (ROM). However, the required ROM differs from patient to patient, depending on their activity, and the ROM will be dependant and related to the boney native anatomy of the hip. A sedentary patient will require less range of motion, whereas an extreme range of motion might be required for activities such as dance, ballet, and ice hockey, for example. Normally, the acetabulum is anteverted 12 to 16.5 degrees and covers the femoral head to a depth that avoids both impingement (overcoverage) and instability (dysplasia or undercoverage) with a horizontal, thin sourcil (the weight bearing zone). The proximal femur normally has a spherical, concave head-neck contour and appropriate offset between the head and neck that allows for impingement-free ROM. Typically, the angle of the femoral neck-shaft angle is 120 to 135 degrees, and the femoral neck is normally anteverted 12 to 15 degrees. As mentioned above, the rim of the boney acetabular cup is lined by a fibrocartilaginous structure called the labrum (similar to the glenoid labrum of the shoulder). The acetabular labrum functions to create a fluid pressurization seal with the femoral head. It also occurs in continuity with the articular cartilage liner of the joint. As a result, tears of the acetabular labrum eventually begin to extend into the cartilage lining the joint, resulting in “chondral delamination” of the joint and, eventually, osteoarthritis.

Pathogenesis

Femoroacetabular impingement is categorized into three different subtypes:

A. Pincer-type Impingement: Contact between the abnormal acetabular rim and femoral head-neck junction.

A pincer lesion is usually the result of a deep acetabulum (coxa profunda), focal anterior overcoverage, acetabular retroversion, or, less commonly, posterior overcoverage. This leads to labral bruising and degenerative tearing which may ultimately result in ossification of the labrum and a contrecoup posterior acetabular chondral injury. Pincer-type impingement is predominantly found in middle aged women.

 B. Cam-type Impingement: Contact between the acetabular rim and an abnormal femoral head-neck junction. The abnormal femoral head–neck junction is typically secondary to an aspherical anterolateral head–neck junction but also can be secondary to a slipped capital femoral epiphysis (SCFE), femoral retroversion, coxa vara, a malreduced femoral neck fracture, and, less commonly, posterior femoral head–neck abnormalities. A CAM-type impingement causes a shearing stress to the anterosuperior acetabulum, with predictable chondral delamination and labral detachment and tearing. CAM-type impingement is predominantly found in young, male athletes (90%).

C. Mixed- or Combined-Type Impingement: The most common form of FAI involves a combination of BOTH cam and pincer lesions, creating an abnormal articulation between the acetabular rim and the femoral head-neck junction.

D. Extra-Articular Sources of Impingement: Recently, Anterior Inferior Iliac Spine (ASIS) Impingement has been recognized as a form of Femoroacetabular Impingement. The AIIS is the origin of the head of the rectus femoris muscle, and impingement can occur secondary to a prior avulsion fracture or pelvic osteotomy, or can develop in the event of acetabular retroversion. Although rare, Ischiofemoral Impingement is a noted type of proximal-femoral based impingement that occurs between the lesser trochanter and ischial tuberosity. As a result, the quadratus femoris muscle can be compressed because it occupies this space between the LT and ischial tuberosity. Normal distance between the lesser trochanter and ischial tuberosity is 20 mm. However, with ischiofemoral impingement, the space between these sites can decrease, causing this form of impingement. Women are at greater risk for ischiofemoral impingement due to their wider pelvis and resultant lateralization of the ischial tuberosities.

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pincer.png

Natural History

There is no known evidence that confirms that a patient with untreated FAI will undoubtedly develop osteoarthritis, due largely to a paucity of longitudinal long-term data. However, clinical correlation with over 600 surgical dislocations of the hip in patients with FAI has depicted a strong association of this disorder with progressive acetabular chondral degeneration, acetabular labral tears, and progressive osteoarthritis of the joint. Patient with symptomatic FAI will, however, develop a progressive chondral and labral injury which could then lead to progressive osteoarthritis of the joint, if left untreated and allowed to progress. One population study suggests that there is a 15% to 19% prevalence of a deep acetabular socket (pincer lesion) and a 5% to 19% prevalence of pistol grip deformity (cam lesion) of the hip. This population had a relative risk ratio of developing hip osteoarthritis of 2.2 to 2.4, illustrating the association between FAI boney abnormalities and arthritis.

It is well known that there is a high prevalence of FAI imaging findings in asymptomatic patients (Arthroscopy 2015, Euro J Radiol 2016, AJSM 2015). This should emphasize the importance of both the patient history and physical examination in overall assessment of the patient.

Patient History

Typically, patients are young to middle aged and present with a variety of symptoms ranging from predominantly anterior groin pain to lower back or buttock pain. Anterior groin pain is the most common presenting symptom. The symptoms are typically aggravated by activities such as running, skating, yoga, sitting for extended periods of time, standing up from a seated position, putting socks and shoes on, sitting with legs crossed, and getting in and out of vehicles. Patients often complain that their symptoms are beginning to affect their sleep at night and not being able to get into a comfortable position in bed, often resulting to sleeping with a  pillow between their legs (a pillow between your legs will help prevent the adducted, internally rotated position that typically worsens FAI symptoms and anterior groin pain). Symptoms may also be present or mild in the contralateral hip. Patients have often been (mis)diagnosed with other conditions such as chronic lower back pathology, hip flexor strains, and sports hernias/athletic pubalgia and may have had past surgeries for pain relief, often misdiagnosing or completely missing their pathologic hip condition.

This study by Clohisy et al (CORR 2009) illustrates the variety of presenting symptoms in patients with symptomatic FAI and some of the common dilemmas of misdiagnosed hip pain in patients suffering from FAI: “The average patient age was 35 years and 57% were male. Symptom onset was commonly insidious (65%) and activity-related. Pain occurred predominantly in the groin (83%). The mean time from symptom onset to definitive diagnosis was 3.1 years. Patients were evaluated by an average 4.2 healthcare providers prior to diagnosis and inaccurate diagnoses were common. Thirteen percent had unsuccessful surgery at another anatomic site. On exam, 88% of the hips were painful with the anterior impingement test. Hip flexion and internal rotation in flexion were limited to an average 97 degrees and 9 degrees, respectively. The patients were relatively active, yet demonstrated restrictions of function and overall health. 

Physical Exam

The physical examination is critical in the diagnosis of FAI, which aims to classify the subtype of impingement through a series of tests that exacerbate the patient’s symptoms by putting the hip into vulnerable positions and motions that may reproduce the impingement, causing discomfort.

  • ROM tests: Global ROM restriction generally suggests advanced osteoarthritis.

  • Anterior Impingement Tests: FADIR (Flexion, Adduction, Internal Rotation)

  • Posterior Impingement Tests

  • FABER Distance Test: Flexion, Abduction, and External Rotation of the hip. An increased distance from the lateral knee to the examination table may indicate femoroacetabular impingement. (Reference: Trindale et al. KSSTA 2018)

  • For subspine impingement, the physician may examine for pain with straight flexion, restricted flexion, and, more likely than not, tenderness to palpation of the AIIS that recreates the flexion-based discomfort.

  • For ischiofemoral impingement, the physician may examine for pain with extension, adduction, and external rotation (ER).

  • Evaluation of femoral version/torsion and acetabular version

Imaging

Radiographs (X-rays) should be taken of the anteroposterior (AP) pelvis, a frog-leg lateral, 45-degree and 90-degree modified Dunn views, and false-profile view.

An MRI (Magnetic Resonance Imaging) or MR-Arthrogram may be ordered to evaluate the following:

  • Labral and chondral pathology

  • Acetabular version

  • Femoral head-neck junction deformity

  • Femoral neck version: Impingement may be caused by retroversion or torsion (anteversion and torsion can result in instability)

  • Synovial herniation pits/impingement cysts at the femoral head

  • Occasionally, an anesthetic agent (lidocaine combined with corticosteroid) can be included with the gadolinium to verify the hip joint as the source of pain.

A Three-Dimensional CT Scan can be helpful in order to:

  • Further assess the boney morphology of the hip joint

  • Increase accuracy and understanding of the joint

  • Assess the hip joint for complex revision cases

  • Confirm subtle cases of FAI

  • Evaluate femoral version/torsion and acetabular version

AP Radiographs of the left hip illustrating a CAM lesion (A) pre- and (B) post-resection.

AP Radiographs of the left hip illustrating a CAM lesion (A) pre- and (B) post-resection.

Differential Diagnosis

  • Sports hernia/athletic pubalgia/core muscle injury

  • Osteoarthritis of the hip

  • Femoral neck stress fracture

  • Lumbar spine pathology

  • Gynecologic or urologic pathology

  • Intra-abdominal pathology

  • Hip flexor pathology or iliopsoas snapping

  • Iliotibial band (ITB) pathology or snapping

  • Other extra-articular myotendinous pathology

  • Abductor/gluteus medius/minimus pathology

  • Pelvic stress fracture

  • Apophysitis or apophyseal injury in the developing skeleton

  • Intra-articular pathology not related to FAI

  • Extra-articular hip impingement

  • Neurogenic disorders

Nonoperative Management

Nonoperative management approach to FAI included stretching, activity modification, and physical therapy focusing on core and abduction strengthening and ROM. Other options include medications such as anti-inflammatories and analgesics. Intra-articular hip injections are aimed to decrease inflammation within the joint rather than cure the underlying pathology, and may include corticosteroids, platelet-rich plasma (PRP), or mesenchymal stem cells (BMAC).

Operative Management

The primary indication for surgery in FAI is failure of a course of conservative management and exacerbation and progression of symptoms despite conservative management. Dr. Dold treats FAI through hip arthroscopy, utilizing 2 to 3 keyhole incisions around the hip. An arthroscope is utilize to visualize the joint pathology, while small instruments are used to remove the boney lesions and repair the acetabular labrum.

To set up a hip consultation with Dr. Dold, click here.

YouTube of Dr. Dold’s arthroscopic labral repair and osteochondroplasty technique can be viewed here.

Dr. Dold’s article on post-operative considerations following hip arthroscopy can be found here.

Visit Dr. Dold’s YouTube channel for more surgical technique videos:

https://www.youtube.com/c/AndrewDoldMDOrthopedicSurgeon

   

Acetabular Labral Tears

Definition

The acetabular labrum of the hip is a fibrocartilaginous structure that surrounds the rim of the acetabulum. It is contiguous with the transverse acetabular ligament (TAL) across the acetabular notch in inferomedially. The labrum is widest in the anterior hat and thickest in the superior half. It is contiguous with the articular highland cartilage that lines the socket of the acetabulum and asked to cushion the hip joint. It is attached to the edge of the bony acetabulum via a fin segment of bone that extends into the tissue via a zone of calcified cartilage and it inheres directly to the outer surface of this bony extension without a zone of calcified cartilage. Importantly, the labrum is separated from the hip joint capsule by a narrow synovial-lined recess.

The labrum functions to enhance the stability of the hip joint by maintaining the negative intra-articular pressure within the joint as well as by increasing congruity between the femoral head and the acetabular socket. It has also been shown that the labrum functions to decrease contact pressures within the hip and to decrease cartilage surface consolidation. Via its “joint sealing” effect, the labrum acts to maintain articular fluid in contact with the weight-bearing cartilage to help protect the cartilage and dissipate pressure during weight bearing exercises and activity. Tears of the labrum have been shown to closely correlate with cartilage disease (chondral delamination) of the hip, potentially leading to progressive osteoarthritis.

hip-anatomy - DOLDMD.png

 

Diagnosis of Labral Tears of the Hip

Presentation

The clinical presentation of patients with an acetabular labral tear is often variable and as a result of the diagnosis is often missed initially. Patients commonly state that they have been treated by a number of previous physicians for other diagnoses, including an adductor tendon strain (groin strain), athletic pubalgia (sports hernia), or back pain. This study by Burkett et al (JBJS 2006) looked at the clinical presentation of 66 patients with an arthroscopy-confirmed acetabular labral tear. The initial presentation was insidious in 40 patients, was associated with a low-energy acute injury in 20, and was associated with major trauma in 6. Moderate to severe pain was reported by 86% of patients, with groin pain predominating (61 patients; 92%). 91% of patients had activity-related pain and 71% of patients had night pain. On examination, 39% of patients had a limp, 38% had a positive Trendelenburg sign, and sixty-three (95%) had a positive impingement sign. The mean time from the onset of symptoms to the diagnosis of a labral tear was twenty-one months. A mean of 3.3 health-care providers had been seen by the patients prior to the definitive diagnosis. Surgery on another anatomic site had been recommended for eleven patients (17%), and 4 had undergone an unsuccessful operative procedure prior to the diagnosis of the labral tear.

This landmark study by Clohisy et al. (CORR 2009) documented the typical presentation of patients with hip impingement.

This landmark study by Clohisy et al. (CORR 2009) documented the typical presentation of patients with hip impingement.

Imaging and Diagnostic Studies

A series of standard radiographs are critical as part of the initial assessment to evaluate the patient for osteoarthritis, femoroacetabular impingement (FAI), and hip dysplasia. The imaging modality most commonly used to confirm a labral tear is an MRI or MR-Arthrogram (an MRI with intra-articular contrast/dye). Multiple studies have demonstrated the superior accuracy of MR-arthrography as compared with standard magnetic resonance imaging for the diagnosis of labral tear. Intra-articular gadolinium has been shown to improve the sensitivity of diagnosing labral pathology.  However, recent advances in standard magnetic resonance imaging, including the use of 3-Tesla magnets, has improved the accuracy in diagnosing acetabular labral tears with standard non-contrast MRIs.

In cases where the diagnosis of a labral tear is equivocal or in which a tear has been diagnosed by MRI but it is uncertain whether the patient’s symptoms are related to the tear, an intra-articular injection of local anaesthetic (lidocaine) combined with corticosteroid can be a useful diagnostic tool. If the patient’s symptoms improve with this injection, it can be assumed that the intra-articular pathology (ie. the labral tear) is responsible for the patient’s pain and symptoms.

MR-arthrogram showing a labral tear

MR-arthrogram showing a labral tear

labral tear 2 MRA.jpg

Surgical Indications

The primary indication for elective surgery is ALWAYS based around patient symptomatology and a failure of conservative modalities. In most cases, patients presenting with labral pathology have tried various forms of conservative treatment, including physical therapy, NSAID medications, activity modification, and rest, and have failed to improve. Furthermore, their hip symptoms have started to affect their ability to take part in activities they enjoy and might be starting to affect their day-to-day lives including their ability to sleep at night.

Indications include:

  • Persistent pain in the groin with weight bearing exercises and activities that has failed conservative management.

  • Mechanical symptoms with rotational activities

  • Concomitant femoral acetabular impingement (FAI) with a repairable acetabular labral tear.

Surgical Technique

Dr. Dold performs hip arthroscopy through 2 to 3 keyhole size incisions around the hip. He is one of the first physicians in Texas to utilize a post-free hip table for arthroscopy. Previously, a post was placed between the patient’s legs to distract the hip from the joint – this was associated with increased post-operative pain and a risk of nerve injury and post-operative numbness in the groin.

Arthroscopic instruments are used to remove the pathologic bone responsible for the impingement, re-contouring the acetabular rim and femoral head-neck junction to restore normal anatomy and repair the torn labral tissue. A video of an acetabular labral repair can be found here.

Recovery from hip arthroscopy ranges from patient to patient. Typically, patients reach a clinical improvement between 3 and 6 months post-surgery. However, clinical improvement can continue up to two years post-surgery.

Paper: When Do Patients Improve After Hip Arthroscopy for Femoroacetabular Impingement? A Prospective Cohort Analysis (AJSM 2018).



   

Avascular Necrosis (AVN) of the Femoral Head (Hip Osteonecrosis)

Definition

Avascular necrosis (AVN) literally translates to “death caused by no blood supply”. In this case, death is of the bone making up the femoral head of the hip joint (AVN can also affect the knee and the proximal humerus of the shoulder, most commonly). AVN of the femoral head (also termed “hip osteonecrosis”) is a pathologic process that results from interruption of blood supply to the bone. AVN of the hip is poorly understood, but this process is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation and blood supply of the proximal femur. The condition is more common in males and accounts for roughly 10% of all total hip arthroplasties performed each year. In 80% of patients, both hips are involved, with approximately 3% having “multifocal” disease, meaning that AVN also affects other parts of the body.

Anatomy

The blood supply to the femoral head is complex and varies from patient to patient. In approximately 60% of patients, the two main arteries supplying the femoral head (the medial and lateral circumflex arteries) originate from the profunda femoris artery. Most of the blood supply of the femoral head comes from the lateral femoral circumflex artery, which gives rise to three or four retinacular vessels which supply the cartilaginous border of the head. In AVN, the blood supply to the femoral head is obstructed or impaired. As a result, the underlying bone supporting the cartilage layer of the hip joint begins to die (“necrosis”), resulting in progressive degeneration of the femoral head with eventual collapse and flattening of the head.

The medial and lateral circumflex arteries supply blood to the femoral head keeping the bone healthy. In avascular necrosis, this blood supply is impaired, resulting in death of the bone in the femoral head. As a result, the femoral head begins to collapse, losing its round contour.

The medial and lateral circumflex arteries supply blood to the femoral head keeping the bone healthy. In avascular necrosis, this blood supply is impaired, resulting in death of the bone in the femoral head. As a result, the femoral head begins to collapse, losing its round contour.

Risk Factors / Causes

The risk factors for developing AVN are divided into direct and indirect causes.

Direct causes:

  • Irradiation (ex. prior cancer treatment utilizing radiation therapy)

  • Trauma (ex. femoral neck fracture)

  • Hematologic diseases (ex. leukemia, lymphoma)

  • Dysbaric disorders (decompression sickness, "the bends") - Caisson disease

  • Marrow-replacing diseases (ex. Gaucher's disease)

  • Sickle cell anemia

Indirect causes:

  • Chronic steroid use

  • Chronic alcoholism

  • Hypercoagulable states

  • Systemic Lupus Erythematosus (SLE)

  • Viral infections (CMV, hepatitis, HIV, rubella, rubeola, varicella)

  • Protease inhibitor medications (ex. Ritonavir) – used to treat HIV (Study)

Symptoms

Patients typically present with insidious onset of hip and anterior groin pain that is worse with activity. As mentioned above, the disease is bilateral is approximately 80% of cases, so patients often complain of similar symptoms in the contralateral hip. If left untreated, the disease progresses in a predictable fashion through six stages, culminating in advanced osteoarthritis typically requiring joint replacement. In order to prevent to requirement for joint replacement, the disease needs to be treated in the “pre-collapse” stages.

Classification

The progression of AVN in the femoral head is classified according to the Steinberg Classification (a modification of the original Ficat and Arlet classification). The disease progresses through six distinct stages, terminating with advanced degeneration and osteoarthritis of the hip joint.

Steinberg et al: How do radiologists evaluate osteonecrosis? (Skeletal Radiol. 2014)

Steinberg Classification of AVN of the hip (a modification of the Ficat and Arlet classification). AVN progress through six stages, culminating in advanced osteoarthritis of the joint (Stage VI) if left untreated.

Steinberg Classification of AVN of the hip (a modification of the Ficat and Arlet classification). AVN progress through six stages, culminating in advanced osteoarthritis of the joint (Stage VI) if left untreated.

Ideally, AVN of the hip is recognized and treated before Stage III (subchondral collapse of the bone). Core decompression can help prevent the progression of the disease to advanced osteoarthritis.

Ideally, AVN of the hip is recognized and treated before Stage III (subchondral collapse of the bone). Core decompression can help prevent the progression of the disease to advanced osteoarthritis.

Treatment

Non-operative

Bisphosphonates have shown to be effective in treating “pre-collapse” AVN (Stages 0 to II), as shown in this study by Lee et al:

The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study.

However,  new literature seems to cast doubt on the efficacy of bisphosphonate treatment in pre-collapse AVN with medium to large lesions. The authors suggest that the reported success seen in treating smaller lesions might be due to the natural history of these lesions which often do not progress to collapse even in the absence of any treatment.

Operative

Various surgical options are available for the treatment of AVN. The treatment is largely dictated by the stage of the disease. For early AVN, prior to collapse of the femoral head, core decompression with bone grafting has become the treatment of choice.  In core decompression, Dr. Dold uses a drill to remove diseased tissue from inside the femoral head. This procedure relieves pressure within the femoral head, increasing blood flow and allowing new vessels to form. As an augment to this procedure and a step to replace the diseased tissue in order to support the cartilage layer of the head, a bone graft is combined with the patient’s own mesenchymal stem cells (derived from their bone marrow during surgery and concentrated to induce a regenerative effect in the bone) and delivered directly into the femoral head. The procedure is done through a small incision in the lateral aspect of the thigh.

Core Decompression of the femoral head aims to relieve pressure within the head, allowing for re-vascularization of the diseased bone.

Core Decompression of the femoral head aims to relieve pressure within the head, allowing for re-vascularization of the diseased bone.

Once AVN has progressed to advanced osteoarthritis, the disease is considered irreversible and typical requires a hip replacement. Ideally, AVN is diagnosed and appropriately treated in the early stages to prevent the need for a hip replacement.

Dr. Dold currently treats patient suffering from AVN of the hip through a novel technique utilizing core decompression and mesenchymal stem cell transplantation to regenerate normal tissue. If you are suffering from AVN, please contact our office for an appointment.

Studies

Osteonecrosis of the Femoral Head. Orthop Clin North Am 2019.

Core decompression for early osteonecrosis of the hip in high risk patients. (CORR 1997).

Radiographic predictors of outcome of core decompression for hips with osteonecrosis stage III. (CORR 1998).

Surface replacement hemiarthroplasty for the treatment of osteonecrosis of the femoral head. (JBJS 1998).

Osteonecrosis of the humeral head treated by core decompression. (CORR 1998).

Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. (JBJS 1999).

Evaluation of core decompression for early osteonecrosis of the femoral head. (Arch Orthop Trauma Surg. 2000)

Cementoplasty in the treatment of avascular necrosis of the hip. (J Rheumatol 2009).

Staging of hip avascular necrosis: is there a need for DWI? (Acta Radiol 2011).

Osteonecrosis in systemic lupus erythematosus. (Reumatol Clin 2015).

Management of non-traumatic avascular necrosis of the femoral head-a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting. (Musculoskeletal Surg 2017).

An MRI showing advanced AVN of the patient’s left hip. You can easily see the difference between the two hips, with the left hip showing loss of sphericity and collapse/flattening of the femoral head.

An MRI showing advanced AVN of the patient’s left hip. You can easily see the difference between the two hips, with the left hip showing loss of sphericity and collapse/flattening of the femoral head.

   

Hip Conditions

We Treat the Following Issues:

  • Hip Impingement / Femoroacetabular Impingement (FAI)

  • Acetabular Labral Tears

  • Avascular Necrosis (AVN) of the Femoral Head

  • Osteoarthritis of the Hip

  • Gluteus Medius tears

  • Gluteal Tendinopathy

  • Greater Trochanter Bursitis

  • Hip Fractures

  • Proximal Hamstring Tears and Avulsions

  • Hip Pointer (Iliac Crest Contusion)

  • Hip Flexor Stains

  • Snapping Hip (Coxa Saltans) – Internal and External

  • Trochanteric Bursitis

  • Adductor/Groin Strain

  • Hamstring Muscle injuries

  • Muscle Tears and Contusions

  • Iliotibial Band Syndrome (ITB Syndrome)

  • Stress Fractures of the Hip & Osteoporosis

  • Transient Osteoporosis of the Hip

  • Osteitis Pubis

  • Athletic Pubalgia

  • Anterior Superior Iliac Spine (ASIS) Avulsion

  • Anterior Inferior Iliac Spine (AIIS) Avulsion

  • Piriformis Muscle Syndrome


Stress Fractures of the Hip & Osteoporosis

Content Pending



   

Hip Conditions

We Treat the Following Issues:

  • Hip Impingement / Femoroacetabular Impingement (FAI)

  • Acetabular Labral Tears

  • Avascular Necrosis (AVN) of the Femoral Head

  • Osteoarthritis of the Hip

  • Gluteus Medius tears

  • Gluteal Tendinopathy

  • Greater Trochanter Bursitis

  • Hip Fractures

  • Proximal Hamstring Tears and Avulsions

  • Hip Pointer (Iliac Crest Contusion)

  • Hip Flexor Stains

  • Snapping Hip (Coxa Saltans) – Internal and External

  • Trochanteric Bursitis

  • Adductor/Groin Strain

  • Hamstring Muscle injuries

  • Muscle Tears and Contusions

  • Iliotibial Band Syndrome (ITB Syndrome)

  • Stress Fractures of the Hip & Osteoporosis

  • Transient Osteoporosis of the Hip

  • Osteitis Pubis

  • Athletic Pubalgia

  • Anterior Superior Iliac Spine (ASIS) Avulsion

  • Anterior Inferior Iliac Spine (AIIS) Avulsion

  • Piriformis Muscle Syndrome


Transient Osteoporosis of the Hip

Content Pending