Introduction
Hip care · Hip impingement
Hip impingement (femoroacetabular impingement, FAI) and labral tear
Specialist orthopaedic surgeon · hip problems
Dr Sean LeoOrthopaedic Surgeon, Singapore
Clinic enquiries · Not an emergency service
Illustrative image
Hip impingement is a shape problem that can tear the labrum.
Hip impingement is a shape problem that can tear the labrum.
Hip impingement is a shape problem that can tear the labrum.
- Hip impingement (femoroacetabular impingement, FAI) is a condition in which extra bone around the hip joint gives the bones an irregular shape, so they rub against each other as you move. Over time, this can tear the labrum, the firm, flexible ring of cartilage that seals the hip socket.[1][3]
- The tear can result from the impingement, so the two are assessed together. Treatment begins with non-surgical care. Keyhole (arthroscopic) surgery is considered if that has not worked.[2][3]
- Not everyone with the bony shape of hip impingement has symptoms, and exercise does not cause it.[1][3]
- OrthoKinetics is Dr Sean Leo’s professional brand. Clinical care is provided through OrthoSports Orthopaedic & Sports Surgery. Dr Sean Leo is a specialist orthopaedic surgeon who cares for hip problems.
What’s covered on this webpage
Follow the route in order, or jump to the stop you need. Stops you have read are marked.
The hip is a ball-and-socket joint, ringed by a cartilage seal called the labrum.
The hip is a ball-and-socket joint, ringed by a cartilage seal called the labrum.
The hip is a ball-and-socket joint, ringed by a cartilage seal called the labrum.
The hip is a ball-and-socket joint. The ball is the femoral head, the upper end of the thighbone, and the socket is the acetabulum, which is part of the large pelvis bone.[6]
The socket is ringed by a firm, flexible cartilage called the labrum. It works like a gasket around the socket, creating a tight seal and helping to keep the joint stable.[1] The labrum is the structure that a labral tear affects.
Extra bone makes the hip bones rub, and that rubbing can tear the labrum.
Extra bone makes the hip bones rub, and that rubbing can tear the labrum.
Extra bone makes the hip bones rub, and that rubbing can tear the labrum.
In hip impingement, extra bone grows along one or both of the bones that form the hip joint, giving them an irregular shape. Because the bones do not fit together perfectly, they rub against each other during movement.[1]
This extra bone causes abnormal contact and stops the hip bones moving smoothly during activity. Over time, this can result in tears of the labrum and breakdown of the joint’s cartilage (osteoarthritis).[1][3] That is why hip impingement and a labral tear are explained together: in this setting the tear can be a result of the impingement.[3]
Hip impingement comes from how the hip bones formed. It occurs because the hip bones do not form normally during the childhood growing years.[1] Exercise does not cause it. People who are athletic may work the hip joint harder, so they may begin to feel pain earlier than people who are less active.[1] It is not something you brought on by training.
The three shapes of hip impingement
The extra bone can be on the socket side, on the ball side, or on both. Doctors use three names for this:[1]
- Pincer: extra bone extends out over the normal rim of the socket, and the labrum can be crushed under that prominent rim.
- Cam: the ball is not round and cannot rotate smoothly inside the socket. A bump forms on the edge of the ball and grinds the cartilage inside the socket.
- Combined: both the pincer and cam types are present.
It usually causes gradual groin or front-of-hip pain, worse with deep bending.
It usually causes gradual groin or front-of-hip pain, worse with deep bending.
It usually causes gradual groin or front-of-hip pain, worse with deep bending.
Hip impingement typically comes on gradually as hip pain, often made worse by deep bending of the hip and by turning it inwards.[3] The pain is usually felt in the groin or at the front or side of the hip, and it may spread down to the thigh.[3]
Clicking, popping or catching can raise the suspicion of a labral injury. Assessment decides.[3]
These are clues, not a diagnosis. Symptoms overlap with those of other hip conditions, so they point towards the joint without confirming which structure is responsible.[3]
| What you notice | What it points towards |
|---|---|
| Gradual groin or front-of-hip pain, worse with deep bending or turning the hip inwards | The hip joint itself, which assessment can look into[3] |
| Clicking, popping or catching | Can raise the suspicion of a labral injury; assessment decides[3] |
| Pain at the point or outside of the hip | More often the bursa over the bony point of the hip, covered on the outer hip pain page[7] |
Is this hip arthritis or outer hip pain instead
Is this hip arthritis or outer hip pain instead
Is this hip arthritis or outer hip pain instead?
The same word, “groin pain”, covers more than one story. Pain deep in the groin or at the front of the hip points towards problems inside the joint, such as wear-and-tear arthritis or hip impingement.[6][3] Pain at the point or outside of the hip points more towards the bursa over the bony point of the hip.[7]
Hip impingement and a labral tear are a shape-and-pinch problem inside the joint. Wear-and-tear arthritis is a gradual wearing of the joint surfaces, and it has its own page: hip osteoarthritis. Pain at the side of the hip is covered on the outer hip pain page. The hip hub shows where each is covered.
This is a pointer, not a diagnosis. Sorting out which applies is what an examination is for, and it cannot be done reliably from a description on a webpage.
When should I get hip pain assessed
When should I get hip pain assessed
When should I get hip pain assessed?
Many people manage hip pain on their own for a while. Groin or front-of-hip pain that keeps coming back, is getting worse, or is getting in the way of your daily activities is a reasonable reason to be assessed. So is being unsure what is causing it.
Having the bony shape of hip impingement does not always mean symptoms, so it is troublesome symptoms, rather than the shape itself, that are the reason to be seen.[1][3]
This webpage is not an emergency service.
Assessment starts with the story and examination, then X-ray and MRI.
Assessment starts with the story and examination, then X-ray and MRI.
Assessment starts with the story and examination, then X-ray and MRI.
Assessment begins with your history and a physical examination. If these raise the suspicion of hip impingement, X-rays of the hip are the usual first scan. They show the shape of the bones, including the extra bone of hip impingement.[3]
An MRI scan can then look at the labrum and cartilage for possible damage. It is sometimes done with an injection of contrast into the joint, and sometimes without.[3]
A scan adds to the history and examination. It does not replace them, and which scans you need is decided at your assessment.
Non-surgical care comes first.
Non-surgical care comes first.
Non-surgical care comes first.
Treatment begins with non-surgical measures before surgery is considered. These include physiotherapy, changing your activities, and pain medication, mainly anti-inflammatory medication.[3]
Not everyone with the bony features of hip impingement develops symptoms. Some people live long, active lives with it and never have problems.[1] Having the shape does not by itself mean you need treatment or surgery.
When is hip arthroscopy considered
When is hip arthroscopy considered
When is hip arthroscopy considered?
Hip arthroscopy is keyhole surgery. It lets the surgeon see the hip joint without making a large incision through the skin and soft tissues.[2]
It may be recommended if you have a painful condition that does not respond to non-surgical treatment. Non-surgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation.[2] Keyhole surgery is a considered step after that, and it is not the first one.
It is aimed at the impingement, not at arthritis. If hip arthritis is already present, keyhole surgery for hip impingement does not address the pain from arthritis, and the arthritis is treated as arthritis.[3] The hip osteoarthritis page covers that.
Structure / Patient / Goal
Structure / Patient / Goal
Deciding together
Structure / Patient / Goal
S
Structure: what is affected?
Structure is the hip itself: the ball and socket, the labrum, and where the extra bone is, as your assessment shows it.
P
Patient: how does it affect you?
Patient means you as a whole person. Your symptoms, how active you are, the sport or work you do, your general health and your preferences all shape which options are reasonable.
G
Goal: what are you hoping to return to?
Goal is what matters to you, whether that is bending and sitting comfortably, running, playing sport, or getting through a working day. A useful plan starts from a clear purpose.
Your plan
No single factor decides the plan alone, and one scan or one symptom does not determine it. A labral tear on an MRI does not, by itself, settle what should happen next.
Keyhole surgery reshapes the extra bone and repairs or trims the labrum.
Keyhole surgery reshapes the extra bone and repairs or trims the labrum.
Keyhole surgery reshapes the extra bone and repairs or trims the labrum.
Hip arthroscopy may relieve painful symptoms from many problems that damage the labrum, the cartilage or the other soft tissues around the joint.[2]
For hip impingement, surgery can reshape the extra bone. When the labrum is torn, it can be repaired if it is reparable, or trimmed if repair is not feasible.[3]
A repair is not always possible. Surgery may relieve symptoms, but it does not promise a cure.[2][3]
Recovery is gradual and guided by your progress.
Recovery is gradual and guided by your progress.
Recovery
Recovery is gradual and guided by your progress.
Hip arthroscopy is usually done as a day procedure. If you are generally healthy, you will most likely not need to stay overnight. After surgery you stay in the recovery room for about 1 to 2 hours before going home. You need someone to drive you home and stay with you at least the first night.[2]
You can expect to use crutches or a walker for some period of time. In some cases they are needed only until any limping has stopped. After a more extensive procedure, they may be needed for 1 to 2 months.[2] Your surgeon develops a rehabilitation plan based on the procedures you needed, and in most cases physiotherapy is needed for the best recovery.[2]
Recovery is phased, and it is judged by how your hip is progressing rather than by a fixed date. The exact plan varies and is set by your treating team.[3]
What the phases look like
After surgery for hip impingement, a typical rehabilitation plan works through stages:[3]
- Early on, the hip is protected with limits on weight-bearing, and physiotherapy starts early with gentle movement.
- Weight-bearing is then advanced and active movement begins.
- Strengthening and gait training follow, then work on full hip strength, core strength and balance.
- Later, jogging, jumping and agility exercises are added, to prepare for a return to sport or other exercise.
This is one reference’s description of a typical plan. The restrictions vary between surgeons, so it is not a personal timetable.[3]
Many people return to full, unrestricted activities after arthroscopy. Your recovery depends on the type of damage that was present in your hip. Sometimes the damage is severe enough that it cannot be completely reversed, and the procedure may not be successful. For some people, lifestyle changes are needed to protect the joint, such as moving from high-impact exercise like running to lower-impact activities like swimming or cycling. These are decisions you make with your surgeon’s guidance.[2]
Risks and complications
Risks and complications
Risks and complications
Complications from hip arthroscopy are uncommon.[2] Any surgery in the hip joint carries a small risk of injury to the surrounding nerves or blood vessels, or to the joint itself.[2]
The traction needed for the operation can stretch nerves and cause numbness in the groin area, but this is usually temporary.[2] There are also small risks of infection and of blood clots forming in the legs (deep vein thrombosis).[2]
The most common complications after hip arthroscopy are a collection of blood (haematoma) and temporary nerve irritation from the traction.[3]
Repair of the labrum is not always possible.[3]
OrthoKinetics Recovery Reflection
Recovery reflection
If some people carry the bony shape of hip impingement and never have a problem, what changes when you stop treating the shape of your hip as the whole story?
The shape formed during your growing years. You did not build it, and training did not put it there. Many people carry it and never have a problem. The more useful questions are about your hip now: what it is doing, and what you want to be able to do with it.
If exercise did not cause this, what does it mean to stay curious about your hip instead of blaming the activity you love?
It is easy to search the past for something to blame. Curiosity is a gentler stance. It asks what your hip is telling you today, and what a good plan would leave room for.
A shape you did not choose is not a fault you carry. What matters is what your hip is doing and what you want to return to.
Illustrative image
With you through the seasonsMeet Dr Sean Leo
Meet Dr Sean Leo
A consultant orthopaedic surgeon whose clinical focus is the knee, sports injuries and the lower limb.
- Dr Sean Leo is a consultant orthopaedic surgeon. OrthoKinetics is his professional brand; clinical services are provided through OrthoSports Orthopaedic & Sports Surgery at Mount Elizabeth Novena Specialist Centre and Connexion, Farrer Park Hospital.
- His clinical interests include sports injuries, including those in adolescent athletes; ligament reconstruction; realignment surgery; cartilage repair and joint-preservation approaches; knee replacement; and technology-assisted hip and knee surgery.
- The consistent aim is to return people to meaningful function and activity while avoiding unnecessary downtime.
- Qualifications: MBBS, MRCS (Ed), MMed (Ortho), FRCSEd (Ortho).
More detail: Meet Dr Sean Leo
- Training and career: Dr Leo trained in medicine at the National University of Singapore and served in the Singapore Armed Forces Medical Corps from 2000 to 2012, where his work included the care of soldiers in physically demanding roles. He completed postgraduate orthopaedic training in 2009 and a one-year clinical fellowship at Royal North Shore Hospital in Sydney, Australia, before joining Changi General Hospital as an orthopaedic consultant in 2012, where he later held the positions of Senior Consultant and Director of the Hip and Knee Service. With seniority, his educational contribution has evolved towards mentorship and support for junior doctors.
Questions people often ask
Common hip impingement and labral tear questions
Common hip impingement and labral tear questions
What is hip impingement (femoroacetabular impingement)?
Hip impingement (femoroacetabular impingement, FAI) is a condition in which extra bone grows along one or both of the bones of the hip joint, giving them an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement, and over time this friction can damage the joint.[1]
What is a hip labral tear?
The labrum is a strong, flexible ring of cartilage around the hip socket that acts like a gasket, forming a tight seal and helping to stabilise the joint. A labral tear is a tear of that ring. In hip impingement, the abnormal contact between the bones can tear it over time.[1][3]
Are hip impingement and a labral tear the same thing?
They are linked but not identical. Hip impingement is the shape problem, where extra bone makes the hip bones rub. A labral tear is damage to the cartilage ring that can result over time. That is why the two are explained and assessed together.[1][3]
What is hip arthroscopy?
Hip arthroscopy is keyhole surgery. It lets the surgeon view the hip joint without making a large cut through the skin and soft tissues, and it is used to diagnose and treat a wide range of hip problems. It may be recommended when a painful condition has not responded to non-surgical treatment.[2]
Does a hip labral tear always need surgery?
Treatment begins with non-surgical measures such as physiotherapy, changes to your activities and anti-inflammatory medication. Surgery is considered if these have not worked. When the labrum is torn, it can be repaired if it is reparable, or trimmed if repair is not feasible.[2][3]
Can hip impingement be treated without surgery?
Yes, treatment begins that way. Physiotherapy, changing your activities and pain medication, mainly anti-inflammatory medication, come before surgery is considered. Not everyone with the bony shape of hip impingement has symptoms, and some people never have problems with it. Individual cases vary.[1][3]
What causes a clicking or catching hip?
Clicking, popping or catching can raise the suspicion of a labral injury. It is a clue and not a diagnosis, and symptoms overlap with those of other hip conditions. An assessment, which starts with your history and an examination, is how the cause is worked out.[3]
Is my groin pain a labral tear?
Groin or front-of-hip pain that builds gradually and is worse with deep bending is the typical pattern of hip impingement, but on its own it does not confirm a labral tear. Symptoms overlap with other hip conditions. Assessment, with an examination and imaging, is how it is confirmed.[3]
How long does it take to recover from hip arthroscopy?
Recovery is phased and gradual, so there is no single date. Surgery is usually a day procedure, crutches are used for a while, and physiotherapy is usually part of it. Many people return to full activities, but it depends on the damage in the hip and is not guaranteed.[2][3]
Does exercise cause hip impingement?
No. Hip impingement occurs because the hip bones do not form normally during the childhood growing years. Athletic people may work the hip harder and feel pain earlier, but exercise does not cause it. The cause lies in how the bones formed, and not in how much you train.[1]
Costs and insurance
Costs and insurance
Practicalities
Cost, Medisave and insurance
Ask the clinic team for current information about fees, panel status, pre-authorisation and expected payment arrangements. Insurance coverage and out-of-pocket costs depend on the individual policy and the insurer’s decision; no coverage is guaranteed.
A cost estimate for surgery can be given only after a consultation and assessment, once a surgical plan has been developed. Each individual condition is unique — implants used, time taken, and other factors contribute to the overall estimate. The estimate will be provided to you by the clinic should you decide on surgical management, and will also be used to assist in obtaining pre-authorisation from insurance where applicable.
Insurance panels. Dr Sean Leo, Orthopaedic Surgeon, is on the specialist panels of Great Eastern (GE Panel), HSBC Life (HSBC Life Shield) and Singlife (Singlife Shield), and on the Prudential Panel. AXA Insurance Singapore became part of HSBC Life in 2023, and former AXA Shield plans are now HSBC Life Shield plans.
Corporate health plans. Dr Leo is on the panels of both Alliance Medinet and iXchange, which administer medical benefits for many company health plans. If your company plan uses either panel, you can see Dr Leo as a panel doctor.
If your company uses a different panel. Some company plans still let you see a doctor of your choice outside their panel, then claim reimbursement. This varies from plan to plan, as may the co-payment, so please check your benefits with your company’s HR department.
Panel arrangements change from time to time, so please confirm with your insurer or your company’s plan administrator before your appointment.
Dr Leo is on the panels shown. If your insurer is not listed, you may ask whether co-management with an Orthosports surgeon partner on that panel is clinically and administratively appropriate. Orthosports surgeon partners are collectively on the panels of all Shield plans.
Specific benefits, pre-authorisation, reimbursement and cashless treatment depend on the individual policy and insurer approval and are not guaranteed.
Arrange a consultation: the appointment section is further down this page.
Sources
References
References
- American Academy of Orthopaedic Surgeons (AAOS). Femoroacetabular Impingement. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases–conditions/femoroacetabular-impingement
- American Academy of Orthopaedic Surgeons (AAOS). Hip Arthroscopy. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/treatment/hip-arthroscopy
- O’Rourke R, El Bitar Y. Femoroacetabular Impingement. StatPearls. NBK547699. Available at: https://www.ncbi.nlm.nih.gov/books/NBK547699/
- NHS. Broken hip. Available at: https://www.nhs.uk/conditions/broken-hip/
- NHS. Hip pain in adults. Available at: https://www.nhs.uk/symptoms/hip-pain/
- American Academy of Orthopaedic Surgeons (AAOS). Osteoarthritis of the Hip. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases–conditions/osteoarthritis-of-the-hip
- American Academy of Orthopaedic Surgeons (AAOS). Hip Bursitis. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases–conditions/hip-bursitis
Final next step
Final next step
Next step
Final next step
Reading about a problem is a starting point. An assessment brings together the history, an examination where needed and any useful tests, and helps you and your clinician decide what to do next. How much physical examination is needed is a matter of clinical judgement. It may be limited when pain makes an examination unreliable, or when imaging clearly shows a problem that matches the symptoms, such as a fracture seen on an X-ray or an MRI scan that clearly shows an injury consistent with the symptoms. The Singapore Medical Council and the UK General Medical Council both allow remote medical consultations, where a physical examination is not possible, with safeguards: the doctor must be clear about the limits of an opinion formed without an examination, and whether an in-person examination is needed, or referral to other services, is left to the clinical judgement of the attending doctor.
If a hip problem may need urgent attention, such as after a fall or if you cannot bear weight, seek urgent medical care.[4][5]
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