Impingement syndrome of the hip joint: consequences of development, surgery

Impingement syndrome in medicine is interpreted as a mechanical conflict that occurs between the femoral head or neck and the edge of the acetabulum of the hip joint. This phenomenon in the joint is scientifically called femoroacetabular (FAI) and femoroacetabular (FA) impingement. Its source is a unilateral or bilateral defect in the anatomy of the hip bones of congenital or acquired etiology. In another way, this process can be characterized as follows: a pathological collision of the bone components of the joint during movement due to the discrepancy between their shapes.

Femoroacetabular impingement syndrome, which should not normally occur, causes abnormal bone friction. Osteophytes form around the femoral head or along the periphery of the acetabulum (AC). Bone protrusions prevent the sliding of interacting segments, and at a certain point of movement they collide. As a result, the acetabular lip, which borders the pelvic cavity at the top, constantly experiences chronic trauma. Over time, this problem leads to its rupture, as well as abrasion and destruction of the cartilaginous covers of the articulating bones of the hip joint. As a result, to progressive motor-support disorders and increasing pain.

Impingement syndrome very often acts as a stimulator of pain in the hip joint and a provocateur of the early appearance of coxarthrosis in young people.

Causes of impingement syndrome

Predisposing factors to the development of impingement between the femur and pelvic bone are congenital and acquired anomalies of the structure of the hip joint.

Common birth defects that can cause FAI include:

• ellipsoidal head of the femur;
• protrusion (tubercle) of the bone body in the area of ​​the neck-head junction;
• shortened femur bone;
• defective configuration of the acetabulum.

Acquired pathogenesis often results from injuries and diseases, such as:

• epiphysiolysis (Salter-Harris fracture);
• osteochondropathy of the femoral head (Perters disease);
• infarction of the bone tissue of the femoral head (avascular necrosis);
• local fractures, bruises, sprains, tendon ruptures, other types of injuries;
• inflammatory pathologies of the synovial bursa (bursitis, etc.);
• atrophy of the muscles surrounding the joint;
• unsuccessful surgical interventions on the joint.

Note that severe endocrine diseases can cause a vicious ratio of articular bones and, as a result, impingement syndrome. People suffering from diabetes are at high risk, since poor metabolism and problems with blood circulation negatively affect the morphology of bone and cartilage tissue. The risk category includes people who regularly experience heavy physical stress on the pelvic girdle and lower limbs. Possible causes of FAI also include primary and secondary diseases of the musculoskeletal system and connective tissue, for example, arthritis of the hip joint, gout, scoliosis, lumbar hernia, etc.

Types and degrees of impingement

There are two main types of impingement syndrome: anterior and posterior.

Anterior impingement is mainly a consequence of traumatic injury to the ligaments of the ankle. Any instability of the joint, even if it is very weakly expressed, contributes to its injury in the position of extreme extension.

According to statistics, athletes mostly suffer from anterior impingement. In them, the disease is provoked by frequent high load on the front part of the joint, which causes permanent damage. First of all, with this disease, the amplitude of extension of the joint decreases.

Posterior impingement is often associated with the anatomical features of the ankle structure and injuries. The posterior type of impingement is characteristic mainly of ballet dancers. Indeed, during this dance, a person is forced to walk a lot on his toes, which leads to strong flexion of the ankle joint in the back and, as a result, to injury.

The existence of posterior impingement is often forgotten, although in fact the disease can lead to serious impairment of joint function.

The disease can also be divided into several degrees:

• I degree – characterized by the presence of a spur up to 3 mm in size on the tibia, called the synovial degree;
• II degree – osteochondral, the size of the spur exceeds 3 mm;
• III degree – exostoses with or without fragmentation can be identified, a spur also appears on the talus;
• IV degree – changes characterizing arthrosis develop.

Types of femoroacetabular impingement

The so-called “impact conflict” during the motor act of the TB joint is classified according to localization into 3 main types of FAI:

• acetabular, or pincer type;
• femoral, or cam type (cam);
• mixed look, or mixed.

1. Pinser type
   . The cause of the impact is an anatomical failure in the form of an increase in the coverage of the acetabulum with a normal proximal femur. Occurs 3 times more often in women than in men. The age range of patients is 40-57 years. On radiographs in anteroposterior and lateral projections, the following can be seen:

• increasing the depth of the cavity, its protrusion;
• signs of cross-over;
• central-edge angle G. Wiberg more than 39°;
• VP roof inclination angle is less than 0°;
• symptom of the posterior edge of the pelvic cavity;
• linear depression of the bone in the neck area.

1. Cam-type
   . The primary source of impingement is the abnormal shape of the femur in the proximal part with loss of sphericity with an unchanged acetabular socket. This problem occurs 14 times more often in male patients. The age group of patients is 21-50 years. X-ray images in the direct and lateral planes show:

• deformation of the metaepiphysis of the femur like a “gun handle”;
• neck-shaft angle less than 125°;
• horizontal epiphyseal plate symptom;
• ∠α (alpha angle) from 50° or more;
• abbreviated cervical offset – below 8 mm, offset index less than 0.18;
• posterior deviation of the femoral neck (retrotorsion).

1. Mixed type.
   The clinical picture is observed simultaneously on two bone components of the articulation: the acetabular cavity and the femur. In 90% of cases this type is diagnosed.

Impingement syndrome of the hip joint (femoroacetabular impingement syndrome)

As an image to introduce this article, we wanted to put a photo of the Stockholm street Mårten Trotzigs gränd (Morten Trotzigs grand). This is the narrowest street in Stockholm - only 90 centimeters wide at its narrowest point. The street is loved by tourists, and if two groups entering the street from opposite ends meet, impingement will inevitably occur. Impingement or impingement syndrome in traumatology and orthopedics is an impact that interferes with movement. Of course, impingement can only occur in a narrow place, but for impingement one bottleneck is not enough: there must still be movement. Therefore, impingement syndrome is a joint problem. As an example to illustrate this point, we can recall the narrowest street in the world: Spreuerhofstrasse. It is located in Germany. Its width is only 31 cm and this street is listed in the Guinness Book of Records. However, there are almost no tourists on Spreuerhofstrasse, and “impingement syndrome” is rare on this street.

The word impingement itself is a tracing paper from the English impingement, which just means impact. Strictly speaking, it would be more correct to say simply impingement, rather than impingement syndrome (in fact, there is no syndrome, i.e., “symptoms running together,”).

Anatomy

The shape of the hip joint can be imagined as a ball located in a deep round socket. The pubic symphysis and sacroiliac joint are inactive, and in the ball-shaped (or, more precisely, cup-shaped) hip joint, which simultaneously provides stability of the body and mobility of the leg, a large range of movements is possible. The hip joint is one of the largest joints in our body. Due to the fact that man, as a result of evolution, stood on two legs, the hip joint is the main supporting joint and bears a significant load when walking, running, and carrying heavy loads.

The socket of the hip joint is formed by the pelvic bone and is called the acetabulum. Along the edge of the cavity is the acetabulum , a fibrocartilaginous formation. It increases the depth of the socket by 30%, increasing the contact area of ​​the femoral head and acetabulum and thus promoting joint stability. But the main function of the acetabular labrum is the synthesis of synovial (articular) fluid, which evenly lubricates the articular cartilage of the femoral head and nourishes it. By creating a suction effect, the acetabular lip strengthens the hip joint. In addition, the acetabular labrum contains nerves that determine the position of the femoral head in space. You can read more about the anatomy of the hip joint in the general article on the causes of pain in the hip joint.

The structure of the hip joint: in order to show the acetabular labrum, the head of the femur in the picture is “dislocated” from the joint

Transverse section of the hip joint: the acetabular labrum, bordering the acetabulum, increases the area of ​​contact with the head of the femur

The hip joint is designed in such a way that it is possible, up to a certain limit, for the unhindered sliding of the head of the femur in the acetabulum: lateral abduction and adduction, flexion and extension. In addition, rotational movements in the hip joint are also possible. All this is possible thanks to the spherical shape of the hip joint. Movement in the joint is limited by the joint capsule, into which the ligaments are woven. It is the tension of the capsule and ligaments that determine the maximum amplitude with which movements in the hip joint are possible.

What is impingement syndrome or femoroacetabular impingement syndrome?

Femoral-acetabular impingement syndrome (impingement syndrome) is one of the anomalies of the hip joint in which impingement or collision of articular structures occurs during movement. It is called femoroacetabular because impingement during movement is possible due to the collision of a part of the femur (usually the femoral neck or the edge of the femoral head) with the edge of the acetabulum (where the cartilaginous acetabulum is located).

Normally, impingement is impossible, but if a tubercle appears on the neck of the femur, or if the edge of the acetabulum and its lip are uneven, thickened, or stand too strong, then it is these tubercles or thickenings that will collide during movements in the joint. In this case, a vicious circle will arise: the impacting formations will become inflamed during movement, swell, become even larger in size and collide even more strongly. The exact reasons why these irregularities occur, leading to impingement syndrome, are unknown.

Sometimes this syndrome is also called femoro-acetabular impingement (from the Latin words femur - femur and acetabulum - acetabulum).

Some scientists believe that impingement syndrome is the cause of early arthrosis of the hip joint.

There are two mechanisms of impingement that can exist in the same hip joint at the same time:

1) eccentric impingement caused by the non-spherical shape of the head and the presence of deformation at its base on the femoral neck. This option is sometimes called cam impingement, from the English word cam - cam mechanism.

2) pincer impingement caused by excessive coverage of the acetabulum. The name comes from the English word pincer - tongs.

Before we talk about the signs, diagnosis and treatment of hip impingement, let's discuss the principle of eccentric impingement or cam impingement. The best thing here, in our opinion, is an animated picture of the operating principle of the internal combustion engine, which is installed in most cars.

There is a special part in the engine - it is dark green in the diagram. This is precisely the cam mechanism, which, with its protrusion, when torsionally pushes up another part (valve).

Hip joint, top view. a - normal hip joint, nothing interferes with the movement of the head in the acetabulum; b — pinser impingement (the acetabular lip interferes with movement); c - cam impingement, in which movement is hampered by deformation at the base of the femoral head, where it passes into the neck of the femur; d - combined impingement (cam-pinser-impingement)

With cam impingement (eccentric impingement), the femoral head has an aspherical shape due to a more gradual transition of the femoral head to the femoral neck, which can be described as a protrusion or tubercle. When the hip joint is flexed, this protrusion (the aspherical part of the femoral head) compresses the acetabular labrum and cartilage over a relatively large area, which almost always leads to avulsions of the acetabular labrum. In this case, the protrusion pushes the lip outward, tearing it away from the underlying cartilage of the acetabulum.

With pinser impingement, the impact involves a smaller part of the acetabulum but a larger part of the acetabulum (a narrow strip around the circumference of the acetabulum impacts). This option is more common in cases of too deep acetabulum (coxa profunda). In the case of a deep position of the head in the acetabulum, there is too much coverage of the head with the acetabular lip, which can even curl inward during movements. In addition, retroversion of the acetabulum (excessive posterior tilt; normally, the acetabulum is tilted anteriorly by 10-15 degrees) also contributes to pincer impingement.

a — diagram of cap impingement (eccentric impingement) of the hip joint; b - diagram of pinser impingement of the hip joint

Diagnosis

The main symptom of hip impingement is pain that occurs in certain positions. With cam impingement, as a rule, this is flexion and external rotation (rotation around an axis). It is in this position that impingement most often occurs, i.e. collision. With pinser impingement, which is based on the deep position of the head in the acetabulum, the impact occurs in a wider range of movements (flexion, extension, abduction and their combinations).

An important role in diagnosis is played by an examination by a doctor, who will use tests to determine the position in which the pain occurs. It is worth noting that signs similar to the symptoms of hip impingement can occur with other injuries and diseases that cause pain in the hip joint, for example, a rupture of the acetabular labrum can give a similar picture.

To clarify the diagnosis, radiographs are taken, which must be taken not only in the standard anteroposterior projection, but also in the axial one, i.e. lateral. The fact is that a mild cam deformity is often not visible on a traditional anteroposterior radiograph, but it can be clearly seen on an axial radiograph. Bone changes in impingement syndrome are not always pronounced, so sometimes it is necessary to take control radiographs of the opposite, healthy hip joint.

X-ray of the hip joint with cam impingement (eccentric impingement). On the left is an anteroposterior projection, on the right is an axial projection. The head of the femur is aspherical in shape: note that the head extends beyond the white circle (white arrows). This variant of the shape of the head and neck of the femur is sometimes called the pistol grip symptom: the smoothed anterosuperior part of the femoral neck appears abnormally convex and, together with the head of the femur, resembles a pistol grip. Bone cysts may be visible in this convex part of the neck.

X-ray of the hip joint with pinser impingement. On the left is an anteroposterior projection, on the right is an axial projection. In this case, there is a deep location of the femoral head in the acetabulum. The head has a clear spherical shape in both projections (in contrast to cam impingement). In this image, attention is drawn to the ossification (i.e. ossification) of the acetabular lip, which is injured during movements.

Both computed tomography and magnetic resonance imaging can be helpful in diagnosis and can help identify other causes of hip pain that are not due to impingement.

Unfortunately, doctors are rarely aware of the problem of hip impingement syndrome and are often misdiagnosed, while the true cause of the pain remains unattended.

Treatment

Conservative treatment does not eliminate the cause of impingement, so it is rarely effective. However, with unexpressed pinser deformities, it can be useful in view of the vicious circle we have already mentioned: the impact causes inflammation, the pinched and inflamed acetabular lip swells, increases in size and is even more involved in impingement. In this case, unloading the joint, taking paracetamol, non-steroidal anti-inflammatory drugs (ibuprofen, ortfen, etc.), avoiding movements that lead to impingement can help cope with the exacerbation, but will not solve the problem in principle.

Conservative treatment for camp impingement does not affect the cause of the disease in principle, but one must remember that even in this case, with a mild impact, unloading the joint and painkillers can help survive the period of exacerbation of pain.

The only way to get rid of the cause of impingement is through surgery, but this does not mean that any impingement should be operated on. First of all, you should focus on the degree to which the existing impingement interferes with life, work, and sports. Mild cam and pinser deformities can be treated arthroscopically: a video camera and instruments are inserted into the joint cavity through 1-centimeter punctures. Using a special arthroscopic drill, the bony protrusion on the femoral neck at the base of the femoral head is resected (removed) in case of cam deformity and/or part of the acetabular labrum is resected in case of pinser impingement. As we have already noted, very often these two types of impingement exist simultaneously, so during the operation it is necessary to correct both the femoral neck and the acetabular labrum. It is worth noting that arthroscopic surgery for impingement is not always technically possible; moreover, the world's leading experts on this problem prefer to perform traditional open surgery rather than arthroscopic surgery.

Often, impingement is accompanied by ruptures of the acetabular labrum, which are treated according to the same principle as traditional ruptures due to trauma or degenerative changes.

Impingement syndrome is the cause of the development of arthrosis of the hip joint, which is a progressive disease. When the leading cause of pain and a significant decrease in quality of life becomes not impingement, but arthrosis itself, then hip replacement may be required.

Materials used when writing this article:

Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg [Br] 2005;87-B:1012-18.

The author of the article is Candidate of Medical Sciences Sereda Andrey Petrovich

Symptoms of hip impingement syndrome

Characteristic clinical signs are pain and limited mobility. These criteria are relative, as there are exceptions when a person does not notice any discomfort at all. He lives in peace and is not even aware of the existing problem. Therefore, everything is individual, but in the majority of people, the painful condition still makes itself felt with the following symptoms:

• pain, its frequent localization is the groin area, buttock area, lower back;
• sudden onset of pain in the hip joint during its extreme positions of internal rotation, ghosting, flexion;
• persistent limited range of motion in the joint;
• the lesion is usually localized in one of the hip joints;
• increased pain after a long stay in the “sitting” position;
• increasing discomfort after prolonged or intense physical activity;
• pain relief at rest.

We would like to point out that similar symptoms manifest themselves in many diseases not only of the hip joint, but also of other components of the musculoskeletal system. Therefore, with complaints of this nature, it is important to reliably determine whether the symptoms originate from the hip joint. In addition, whether they are provoked by impingement, what type and origin it is, how strong the femoroacetabular conflict is and whether it is combined with any other diseases of the joint. A competent differentiated approach to diagnosis will help you avoid making mistakes in choosing treatment tactics.

Prevention and prognosis

To prevent the occurrence of impingement syndrome, you should minimize the risk of joint injury, use special protective equipment or bandages during professional sports or prolonged physical activity, and carefully treat any damage or injury in the shoulder or knee area with antiseptics.
The prognosis for life and ability to work depends on the stage of the disease. In the first degree, when only conservative treatment is required and the changes are potentially reversible, the prognosis is favorable. In later cases, the prognosis is questionable or unfavorable, since complications may develop - the inability to move the limb.

Impingement syndrome is a pathological condition that occurs when the soft tissues of the shoulder, knee or hip joint are pinched. The disease is not life-threatening, but it is better not to neglect it, but to treat it in a timely manner to prevent complications. The medical association “New Hospital” employs neurologists, rheumatologists, therapists, radiologists, ultrasound doctors and other specialized specialists necessary for a thorough diagnosis and treatment of this pathology.

Clinical examination, diagnosis

For patients, diagnostic measures begin with functional tests of the hip. They consist of assessing the functions of flexion, extension, adduction, abduction, and rotation of the problem joint. The doctor tests the patient's limb in different physiological trajectories of movement.

A specialist can make a preliminary conclusion about the diagnosis, for example, based on the “log rolling” test. To do this, the patient lies on his back, after which the doctor rolls his leg from the outside in and back. If during such an experiment a peculiar crunch occurs locally, then this is highly likely to indicate damage to the labrum.

To identify a bone conflict, the tactics of bending the limb at the hip joint to a right angle are used, then the leg is brought in and rotated inward, then outward. If pain occurs at the end point, the test is considered positive. More often, such pain indicates a collision of the anterosuperior acetabular area and the surface of the femoral neck.

The region of interest can also be tested for Drehmann's sign and the C sign. In the first case, the diagnostic criterion is the ability to bend the leg at the joint exclusively from the position of external rotation, which indicates torsion of the femur according to the retroversion type. In the second, pain occurs when grasping and compressing the supratrochanteric part with the thumb and forefinger, forming the letter “C”. A certain C-symptom indicates a distorted morphology of the acetabular element.

No good specialist will make a diagnosis or prescribe treatment based solely on functional tests. The next stage, which allows us to confirm or reject initial assumptions about the problem and extract maximum information about the anatomical disharmony of the joint, is instrumental diagnostics. It is based on the implementation:

• radiography;
• magnetic resonance imaging;
• computed tomography.

First there was impingement, and then arthrosis developed.

Despite the existence of highly promising methods for obtaining cross-sectional images of the joint, standard radiography remains the first and mandatory diagnostic method in this diagnostic chain. The diagnostic information value of classical radiography for determining BVI is quite high: 90% and above. It is possible to make a correct diagnosis based on X-ray results only if images are taken in all of the following projections:

• anteroposterior (standard);
• according to Launstein (laying in the “frog” position);
• lateral;
• in the position of hip flexion at angles of 90°, 45°;
• “false” profile (oblique projection technique, Lequesne’s false profile).

Tomography methods (CT, MRI) are used when a complicated generalized form of pathology is suspected, requiring a more in-depth assessment of the structural components of the hip joint. The best picture of the condition of soft tissues will be provided by magnetic resonance imaging using a high-power MRI machine. This type of diagnosis determines pathologies of articular cartilage, synovial membrane and lip, well visualizes cysts, muscle tendinosis, joint synovitis, bone marrow edema.

Diagnostics

To suspect this diagnosis, in most cases the doctor will only need the patient’s specific complaints and an external examination.
However, there are diagnostic tests that can help confirm the presence of impingement syndrome. When performing the Hawkins test, the patient needs to bend the arm at the shoulder and elbow joint and slightly rotate it inward. The pain occurs due to narrowing of the subacromial space between the humerus and the coracoacromial ligament.

The doctor may also ask the patient to raise his outstretched straight arm up. If discomfort occurs at an angle of 60-120°, pathology can be judged. Pain occurs due to contact of the head of the humerus with structures above the glenohumeral joint.

When performing the Nira sign, the doctor fixes the patient’s scapula, performs internal rotation of the shoulder, while simultaneously raising the arm up. The pain occurs due to the collision of the humerus with the “roof” of the shoulder joint.

There is also the Neer test, in which painkillers are injected subacromially. The disappearance of pain after injection further confirms the presence of impingement syndrome. Among non-invasive additional diagnostic methods, ultrasound is widely used. With its help, you can indirectly see inflammation of soft tissues in the form of their thickening, the appearance of exudate, and changes in tendons. Bone structures can be assessed using radiography. In the pictures you can see signs of arthrosis, ossification of ligaments and other changes. MRI of the shoulder joint is also informative in this disease. It reflects the condition of the rotator cuff, all muscles and ligaments. The method is highly sensitive.

Basic principles of treatment for FAI

In the treatment of patients with hip impingement, depending on the severity of the clinical case, either conservative or surgical treatment is used. Today, due to incomplete knowledge of the natural course of the femoral-acetabular conflict, it is impossible to predict the success of non-surgical therapy.

After operation.

Regarding prognosis after surgical interventions, we note that in patients with severe secondary arthritis, treatment results are worse. Surgery has a good effect if the joint space is narrowed by no more than 1/2 of the normal values, that is, the width of the gap is not less than 2 mm when the norm is 4 mm. The patient's young age and the short period of time from the onset of FAI to the patient seeking medical attention significantly increase the chances of success of the operation. help.

Recovery period

After almost all hip joint surgeries, the person is allowed to get out of bed the very next day. At first, he moves with crutches and loads the operated limb only 50%. After arthroscopy this period lasts 1.5-2 weeks, after open surgery - 3-5 weeks.

The duration of rehabilitation after arthroscopic surgery is 3-4 months, after open surgery – 5-6 months. During the recovery period, the patient engages in physical therapy and undergoes physical procedures. This allows him to quickly return to his usual lifestyle.

Rehabilitation is an important part of surgical treatment. Lack of medical care during the recovery period increases the risk of complications.

Rehabilitation is the most important part of treatment.

Conservative treatment tactics

A conservative approach involves prescribing complex treatment, including:

• limiting physical activity that causes pain;
• temporary immobilization of the joint (with severe inflammation, swelling)
• physical therapy aimed at increasing the range of movements and strengthening the muscles that stabilize the joint apparatus;
• physiotherapy procedures (ultrasound, laser, magnet, electrophoresis);
• drug treatment - the use of painkillers from the NSAID series; for unbearable pain, blockades with intra-articular administration of corticosteroids (diprospan, hydrocortisone, etc.) are used.

Injections of steroids and hyaluron are justified if there is a proven fact of the presence of a lesion in the cartilaginous formation attached to the edge of the acetabular bed along the circumference. The pathogenesis associated with lip damage can only be confirmed by MRI. Purely on the basis of x-rays that simply prove the presence of a nosocomial infection, injections of hormones and hyaluronic acid are not prescribed.

If the symptoms of a pathological phenomenon cannot be stopped conservatively, it is advisable to perform surgical intervention to eliminate the causes of pathogenesis. Remember, an unfavorable pathogenetic mechanism can progress, causing a serious disease of the entire hip joint - deforming arthrosis. Often such complications require total joint replacement with an endoprosthesis.

If non-surgical treatment fails within 3-4 months, it is important for people of working age, athletes and adherents of an active lifestyle to undergo surgical intervention as soon as possible.

Treatment

At the first signs of impingement syndrome, conservative methods of therapy are used.
In more advanced cases or when drug treatment is ineffective, surgery is used. For conservative therapy it is recommended:

• limit movement and reduce stress on the affected area;
• taking non-steroidal anti-inflammatory drugs (in the absence of contraindications);
• GCS injections into periarticular soft tissues;
• physiotherapy.

When irreversible stages 2 and 3 of the disease occur, surgical treatment is required. Subacromial decompression with bursectomy is usually performed. The scope of the operation includes resection of part of the acromion, coracoacromial junction and inflamed bursa.

Surgery for hip impingement syndrome

We emphasize that impingement is not always a reason for operating on a patient. The first thing that draws attention is how much FAI interferes with a person in everyday life (at work, in sports, at home). So, surgical treatment is carried out using open or arthroscopic approach technology. The surgical session is aimed at removing exostoses (bone growths), which will eliminate the pathomechanical factor of the components of the joint hitting each other.

An open operation is performed through a standard incision, about 8-10 cm. Interventions with a wide opening of the articulation are prescribed, for example, for the posterior cam type, a generalized increase in the area of ​​the acetabular covering, acetabular retroversion of idiopathic etiology. Open intervention is accompanied by cutting off the greater trochanter and dislocation of the hip. Next, taking into account the indications, the necessary manipulations are performed (resection, plastic reorientation interventions, etc.) that will help restore the shape of the proximal metaepiphysis of the femur and/or the glenoid cavity.

Reducing buildup.

Arthroscopic procedures are performed using the optical instrument of an arthroscope, but with impingement not clearly visible on radiographs. The arthroscope tube is inserted into the joint through a small skin incision, the size of which is approximately 1 cm. During arthroscopy under video control, the surgeon performs a simulating resection: clears the acetabular and femoral components of excess bone growths. If lip injuries are discovered during the session, the defects are corrected by anchor refixation, autoplasty or mechanical (sometimes plasma) debridement.

How much does the operation cost?

The cost of surgical treatment of hip impingement in Russia starts from approximately 15 thousand rubles, the maximum can reach 100 thousand rubles. The estimated price for arthroscopy of a simple level of complexity in Moscow is 20-25 thousand rubles. Orthopedic clinics in Israel and Germany offer promising prospects for complete, safe, low-traumatic removal of impingement. The price of an operation for this problem in medical institutions in Israel is from 14 thousand dollars or more, in clinics in Germany - at least 10 thousand euros.

Cost of surgery in Russia and abroad

In most Moscow clinics and hospitals, prices for arthroscopic treatment start at 35,000 rubles. In addition to the operation itself, you will have to pay for preoperative examination, consultations with specialists, hospital stay, anesthesia, consumables and rehabilitation. As a result, the cost of treatment will not be cheap. At best, the total you will pay is rubles.

State Clinical Complex "Bulovka" (Czech Republic).

If you intend to receive treatment abroad, think about the Czech Republic. Hip arthroscopy costs about euros there. Czech clinics are equipped with modern equipment and are staffed by qualified European specialists. There you will not only be operated on, but also given full rehabilitation.

In clinics in Israel and Germany, you will pay more for the same surgical intervention - about a euro. The cost of treatment there does not include rehabilitation. You will be discharged from the hospital in a few days, and you will have to recover on your own. If you decide to get help from a rehabilitator, you will need to pay an additional tidy sum.