What Happens If Hip Impingement Is Left Untreated?

What Happens If Hip Impingement Is Left Untreated?

Untreated hip impingement can lead to labral tears, cartilage damage and, in some people, early arthritis. Learn why impingement without symptoms does not need surgery and when treatment should not wait.

What happens if hip impingement (femoroacetabular impingement, or FAI) is left untreated depends very much on the person. Bone shape variations that cause no symptoms and are found only on imaging may never cause trouble. A painful impingement that keeps recurring with movement, however, can over time lead to a labral tear, cartilage damage and, in some people, early arthritis. So the real question is not simply "do I have impingement?" but "is it causing symptoms and damaging the joint?"

This article explains what untreated impingement can do to the joint over the long term, who faces a higher risk of arthritis, why impingement without symptoms does not need surgery, which findings mean treatment should not be delayed and how treatment options are approached.

A quick reminder: what is hip impingement?

The hip is a ball-and-socket joint formed by the head of the thigh bone and the socket in the pelvis (the acetabulum). In FAI, a shape variation in one or both of these causes the bones to meet too early, especially when the hip is bent and turned inward:

• Cam type: Extra bone where the femoral head meets the neck. More common in young men and athletes.
• Pincer type: The socket covers the femoral head more than usual. It may be seen more often in women.
• Mixed type: Both variations together, which is common.

Repeated contact stresses the labrum that rims the socket and the joint cartilage. You can read more about types and causes on our femoroacetabular impingement page.

What can happen to the joint if symptomatic impingement is ignored?

In symptomatic impingement, change is usually gradual and varies widely between people. Over time the following may develop:

1. Labral tear: Repeated contact can detach or tear the labrum. At this stage catching, locking and sharp groin pain often become more noticeable.
2. Cartilage damage: Particularly in cam impingement, the bump on the femoral head can push into the socket cartilage with every movement and peel it away from the underlying bone (delamination).
3. Joint space narrowing and arthritis: As cartilage damage progresses, the joint space narrows, bone spurs form and the picture can evolve into hip osteoarthritis.

This sequence does not run to the end in everyone. Some people keep their symptoms under control for years with activity changes and exercise. But cartilage has limited capacity to repair itself once damaged, so treatment options narrow when assessment comes late.

Does impingement cause arthritis? Who is most at risk?

Research shows that a pronounced cam shape in particular is associated with a higher likelihood of developing hip osteoarthritis later. This is an increased probability, not a certainty: many people with impingement morphology never develop arthritis. Factors that matter include:

• The size of the bony bump and the degree of impingement
• Whether symptoms are present, how long they have lasted and whether pain is becoming more frequent
• An existing labral tear or early cartilage damage
• Sports and jobs that force the hip into deep flexion and rotation, such as football, hockey, martial arts and ballet
• Excess weight and a family history of early hip arthritis

Our article on whether hip pain is arthritis or impingement explains how the two are told apart.

Does impingement without symptoms need surgery?

No. Finding a cam or pincer shape by chance on an X-ray or MRI taken for another reason is common, and these shapes are also found in people with no pain. Based on current knowledge, operating on an impingement shape that causes no symptoms simply to prevent future arthritis is not recommended. Usually, information, strengthening of the hip muscles and reassessment if pain begins are enough.

The decision to treat depends on symptoms, examination findings and whether the joint is being damaged, not on the shape seen on a scan. This distinction matters both for avoiding unnecessary surgery and for not delaying treatment that is needed.

When should treatment not be delayed?

Non-surgical care is tried first for symptomatic impingement, but the following situations call for prompt assessment so that options are preserved:

• Groin pain that has not eased after several months of physiotherapy and activity changes
• Catching, locking or sudden sharp pain in the hip
• Increasing loss of hip movement, especially internal rotation
• Pain that clearly limits sitting, driving or sport
• An MRI showing a labral tear or early cartilage damage

Assessment while the joint space is still preserved allows your surgeon to judge whether joint-preserving treatment is suitable. Once arthritis is advanced, surgery aimed at impingement offers much less benefit.

Which tests show the condition of the joint?

Alongside the examination, imaging helps show whether impingement is damaging the joint. Each test answers a different question:

• X-ray: Shows bone shape, the degree of cam or pincer morphology and, most importantly, whether the joint space is preserved. Narrowing suggests arthritis has begun and directly affects treatment choice.
• MRI or MR arthrography: Assesses the labrum, cartilage and bone marrow. When a labral tear is suspected, MR arthrography with contrast injected into the joint can give more detail.
• CT scan: Shows the location and size of the bony bump in three dimensions and may be used for surgical planning.

Imaging findings are never interpreted alone; they are matched against symptoms and examination. A minor labral irregularity on MRI, for example, does not necessarily mean it is the source of the pain.

How is hip impingement treated?

Non-surgical treatment

• Reducing deep squats, long periods in low chairs and other positions that bend the hip excessively
• Physiotherapy focused on strengthening the hip and core muscles and improving movement control
• Short courses of pain relief and anti-inflammatory medication
• In selected cases, an injection into the joint, which can also help confirm whether the pain comes from inside the hip

Non-surgical care does not change bone shape; its goal is to reduce symptoms and manage the movements that stress the joint. Many people achieve a meaningful improvement in daily life this way.

Hip arthroscopy

For patients whose symptoms persist despite non-surgical care, whose examination and imaging point to impingement as the source of pain and whose joint space is preserved, hip arthroscopy may be considered. In this keyhole procedure the extra bone is reshaped, the labrum is repaired if needed and cartilage damage is addressed. The aim is to reduce pain and improve function; research into how far arthroscopy prevents arthritis in the long term is ongoing, and results vary between individuals. For details of the procedure, see arthroscopic treatment of femoroacetabular impingement.

At Prof. Dr. Gökhan Polat's clinic, the treatment decision is based on symptom severity, examination findings, the condition of the joint on X-ray and MRI, age, activity level and personal goals.

When should you see an orthopedic surgeon?

• Groin pain lasting several weeks that is worse when sitting, driving or squatting
• Catching, locking or a feeling that something is pinching in the hip
• Recurrent groin pain and loss of performance in sport
• A previous impingement diagnosis with pain becoming more frequent or movement becoming more limited

Seek urgent care if: you cannot bear weight after a fall or knock, or you have hip pain with fever and cannot move the joint. These suggest serious causes other than impingement and need prompt assessment.

In summary

• An impingement shape without symptoms is common and is not a reason for surgery on its own.
• Symptomatic impingement that is ignored can lead to labral tears, cartilage damage and, in some people, early arthritis.
• Treatment usually starts without surgery; hip arthroscopy is considered when symptoms persist and the joint space is preserved.
• Assessment while the joint is still healthy helps keep treatment options open.

This article is for general information only; diagnosis and treatment decisions are made individually after examination and the necessary tests.