Our insurance policy just changed to increase our family deductible to $2000.00. At the same time, our 15-year-old daughter was diagnosed with something called femoroacetabular impingement. The surgeon thinks it may be possible to correct the problem with arthroscopic surgery. An X-ray, a CT scan, and maybe an MRI will be needed. Can we dispense with any of these tests to help save money? They already know what the problem is. Can’t they just fix it?

Femoroacetabular impingement occurs in the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

The diagnosis begins with a patient interview and history. Then comes a physical exam. The physician looks at pelvic and hip motion and palpates muscles and tendons for areas of tenderness.

There may be a telltale snapping of the iliopsoas tendon as the patient moves the leg from one position to another (flexion to extension, external rotation to internal rotation). Several other tests can be done to identify what’s going on.

As is often the case, one problem can lead to others. With femoroacetabular impingement, hip bursitis can develop. The gluteal (buttock) muscles may be extra tender or sore from trying to compensate and correct the problem.

The clinical exam is followed up by imaging studies including X-rays, MRIs, and CT scans. X-rays show the presence of any extra bone build up as well as the position and alignment of the bones and joint. Using different X-ray views, the radiologist and orthopedic surgeon can see the shape of the femoral head and look for any asymmetries (i.e., where the head is no longer an even round shape).

MRIs can show any damage to the labrum but not necessarily to the surface of the hip joint. The presence of edema (swelling) under the bone may show up and requires further evaluation to decide if it is from femoroacetabular impingement or some other cause (e.g., cyst, tumor, stress fracture). Using MRI with a dye injected into the joint (called magnetic resonance arthrography or MRA) provides greater detail of the joint surface and may be needed.

CT scans help show the exact shape of the bone and reveal any abnormalities in the bone structure. CT scans might be the most helpful when arthroscopic surgery is planned. It gives the surgeon a better idea of what needs to be done to reshape the bone. If the procedure is going to be done with an open incision, then the CT scan isn’t necessary. The surgeon will see everything once the area is opened up.