Public health campaign needed on costly impact of hip impingement

There’s a disorder that touches more Americans than diabetes, cancer or asthma. It particularly hits young, healthy, active people – athletes – but knows few boundaries: up to two-thirds of the general population may live with it, according to a 2015 study in The Journal of Arthroscopic and Related Surgery, whether they know it or not (likely not). It’s called hip impingement.

Officially called Femoral Acetabular Impingement (FAI), hip impingement (which is a structural abnormality in the hip ball or socket) is often misdiagnosed by healthcare professionals, despite effects that can be severe. These can include debilitating pain in the lower back, knee, groin and hip and the possibility of a labrum (hip cartilage) tear. For many older Americans, osteoarthritis is likely linked to FAI. So why is no one talking about it?

{mosads}One answer is that FAI is a fairly new diagnosis – it has only been around since 2003 and what we know about the disorder is still emerging. But more importantly, no one has tried to educate the public or work with physicians to develop prevention guidelines, as has been done for heart disease and stroke through federal organizations such as the bipartisan Congressional Heart and Stroke Coalition.

A similar congressional coalition devoted to hip impingement – which oversees prevention funding, advocacy and research, while supporting­ policies that promote better access to quality care – would make huge strides in improving the quality of life for the two-thirds of Americans who may unknowingly be suffering from the disorder.

Consider the case of 17-year-old track runner Deja Bryant of Illinois: Two years ago, Bryant felt something “weird” pop in her hip during a race. She figured it was a minor strain and kept running. Over the next couple of months the pain got worse and began radiating down her hip into her knee, which caused doctors to think she had pulled her IT band.

Soon “whenever I would run in a meet, the next day I wouldn’t be­ able to go to school, because I couldn’t get out of bed it hurt so much… Every time I went to doctors, they would say ‘Oh, it’s your knee’ or ‘Oh, it’s just inflamed.’ They didn’t think anything was wrong with it.”

This went on for a year before anyone even looked at her hip as a cause of pain. When they did, her school’s athletic trainers assumed her hip flexors were tight and that stretching would relieve her symptoms. It didn’t.

Hearing of another athlete’s success with surgery, Bryant found her way to Shane Nho, a surgeon at Midwest Orthopaedics at Rush in Chicago, who is one of the nation’s experts in FAI. (Nho has authored numerous studies on FAI, including the one mentioned above.) He was able to fix her FAI and labrum tear, which the impingement had caused. She was back on the track pain-free within six months of her operation.

Others are not so lucky. The blogosphere is full of stories of those whose pain lasted for years before they were diagnosed with FAI.

 “FAI has always been there – it just wasn’t understood,” explains Tom Ellis, a surgeon at Orthopedic One in Dublin, Ohio. He’s been exploring hip impingement as a cause of mysterious pain for more than 15 years. “In the 80s and 90s, if you saw someone with hip impingement, you didn’t know how to diagnose it,” he says.

But today, Ellis says FAI is one of the most talked about topics among orthopedists. The conversations just haven’t filtered out the rest of us, including our elected representatives.

The population it generally affects is young and healthy. On average, men are found with the problem in their 20s and women in their 30s. Ellis says it’s not unusual for him to operate on patients in their teens. He has even operated on children as young as 12.

Nho also treats many youth and says there seems to be a strong correlation between competitive, repetitive motion athletics (such as soccer, hockey, running and gymnastics) and people who present with FAI symptoms. Yet physicians hesitate to conclude that the issue is developmental rather than congenital.

For one thing, people can have FAI even if they don’t have symptoms, says Nho. So untold numbers of people may be suffering from FAI, fruitlessly trying multiple types of interventions without relief. There’s no reason for this.

As we see modeled by the Congressional Heart and Stroke Coalition, bipartisan efforts to prioritize widespread education and further research have been incredibly effective. A congressional coalition on FAI could be similarly successful by providing another way for our nation to improve health care while simultaneously curbing the cost of ineffective, expensive treatments resulting from misdiagnosed cases of hip impingement.

Lofton is a freelance journalist.