Will cam impingement lead to arthritic degeneration?

One of the most common concerns I’ve heard from people who have been given the FAI diagnosis is that their cam impingement (or pistol grip deformity) means they are doomed to arthritic degeneration and then, eventually, a more serious hip surgery.

The basic theory is that the misshapen femoral head causes extra wear and tear. Perhaps your femoral head is “football” shaped. Or it has an “extra” growth near the acetabular rim. This sounds scary. It also sounds very convincing that pistol grip deformity could cause you pain, discomfort, and serious problems…which makes surgery seem like your only option.

This study done in 2009 should give you something much more hopeful to think about.

Predictors of progression of osteoarthritis in femoroacetabular impingement examined 43 patients with cam impingement and followed them for 10 years to see if their cam impingement caused their arthritis to get worse.

It didn’t.

The conclusion of the study:

The results of this study suggest that mild to moderate osteoarthritis in hips with a pistol-grip deformity will not progress rapidly in all patients, with one-third of them taking at least ten years to manifest, although we have no evidence that it will ever do so…A hip with cam impingement is not always destined for end-stage arthritic degeneration.

Your cam impingement does not doom you to progressively severe arthritis, so you do not have to panic and make a rushed decision when weighing your options.

An even bigger point to be made here, though, is that blaming pain on arthritis doesn’t make sense either.

Signs of arthritis are actually not a useful predictor of pain or mobility problems. In fact, studies like this one done on over 1000 people demonstrate that there is no correlation between how arthritic a joint appears on an x-ray and how much pain and stiffness a person experiences.

In fact, it appears research studies that muscles play a bigger role in joint mobility and comfort than the way a joint looks in an X-ray.

And that is why the FAI Fix focuses on your muscles, not your cam impingement, not your pincer impingement, not your labrum, and not your arthritis.

stuart dI am 45 years old and a competitive triathlete. I have had minor hip pain for years. I played water polo growing up, and I had a ski injury 24 years ago on my left hip. I was diagnosed with arthritis 20 years ago in the joint, that was not progressing and was probably a result of the ski injury. About 3 years ago, my left hip started bothering me much more frequently.

As a result, I decided to start doing yoga. As I started yoga, I found that my low lunge, with my left leg forward, was not working well. For 2.5 years, I did yoga and forced it. I stretched and stretched. It got worse. It turns out that I simply stretched my back and shredded my labrum, which I found out later. This spring, in March, I was skiing in Colorado on my annual “guys’ trip”. One of the guys I was with had invited a friend, an orthopedic surgeon and competitive cyclist. Desperate, I asked him in the kitchen to tell me what the hell is wrong with my left hip. He had me do a couple of tests on the spot, and checked my range of motion, and he told me “Google FAI” and to make an appointment with him to get a workup when we got back to Texas. I googled FAI.

My first inclination was to get the surgery ASAP to shave the cam lesion from my femur, which was clearly visible on my x-ray I got from my chiropractor showing my “mushroom” femur hip joint. Then I found you on Youtube, and spent probably 40 hours researching FAI and treatment options. What you said resonated with me. I had an appointment a couple of weeks later with the doctor, who ordered an MRI and x-rays. I went to him and expected to argue about surgery. Much to my surprise, he told me that I should not have the surgery, but that I should attack it using the approach that you are recommending. I was so happy. He is a cyclist, and told me about how I need to modify my bicycle fit for my time trial bike, so that I do not injure the impinged area, which I have done (I recently took 4th place overall in a local triathlon). He also told me that I should expect to have total hip replacement in 10 years – not so happy.

Since that time, I have hired a personal trainer twice per week, focused on the exercises that strengthen my “hinge”, and I have attacked the glutes. I roll out the adductors and quads and TFL every other day.

I have found that my constant dull pain in the joint is simply gone. I have seen my range of motion on my left leg when I raise my knee to my chest has now improved to 95 degrees, up from 90 degrees, but more importantly, it is without any pain. I can also ALMOST squat down to the ground – so close, but then I fall on my butt. 95 degrees still sucks, but I’m in it for the long haul, and I keep telling myself that this is a 2 year process. I am hopeful that one day I will have full mobility on both sides.” ~Stuart D.

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