WEBVTT 00:00:00.000 --> 00:00:02.899 Imagine this for a moment. You're active, maybe 00:00:02.899 --> 00:00:05.040 really dedicated to a sport, perhaps football, 00:00:05.179 --> 00:00:06.879 running, dance, whatever it is, or maybe you 00:00:06.879 --> 00:00:10.400 just love being active. And then, this ache starts, 00:00:11.039 --> 00:00:13.199 deep in your hip, maybe you're groin, not from 00:00:13.199 --> 00:00:16.120 a specific injury, it just creeps up. Sometimes 00:00:16.120 --> 00:00:18.260 it's sharp, especially after activity or even 00:00:18.260 --> 00:00:20.000 just sitting for a while. It's a very common 00:00:20.000 --> 00:00:21.800 story, unfortunately. And you live with it for 00:00:21.800 --> 00:00:24.100 months, maybe years, adjusting how you move, 00:00:24.339 --> 00:00:27.469 hoping it'll go away. but it often doesn't. Well, 00:00:27.670 --> 00:00:30.170 that nagging pain, that mechanical niggle might 00:00:30.170 --> 00:00:34.469 be femurocetabular impingement or FAI. Indeed. 00:00:34.729 --> 00:00:37.070 It affects a huge number of symptomatic athletes, 00:00:37.409 --> 00:00:40.729 maybe 55%. But it's also present, often silently, 00:00:41.090 --> 00:00:44.049 in about 10, 15 % of the general adult population. 00:00:44.690 --> 00:00:47.810 Today, we're diving deep into FAI. I'm your host, 00:00:47.850 --> 00:00:49.609 here to navigate through the complex details, 00:00:49.729 --> 00:00:52.189 and I'm joined by our expert, Jest. He has this 00:00:52.189 --> 00:00:55.090 fantastic ability to take really complex medical 00:00:55.090 --> 00:00:57.170 information, see the patterns, and explain it 00:00:57.170 --> 00:00:58.789 all in a way that makes sense. It's great to 00:00:58.789 --> 00:01:01.130 be here. The hip joint really is an incredible 00:01:01.130 --> 00:01:03.329 structure, designed for both power and subtle 00:01:03.329 --> 00:01:06.299 movement. But yeah. even small changes in its 00:01:06.299 --> 00:01:08.620 shape can cause significant problems like FAI. 00:01:09.120 --> 00:01:11.359 Absolutely. And that's our mission today to really 00:01:11.359 --> 00:01:14.920 get under the skin of femurocetabular impingement. 00:01:15.319 --> 00:01:17.340 We'll look at what it is, the different types, 00:01:17.480 --> 00:01:20.060 who gets it, why they get it, and crucially, 00:01:20.219 --> 00:01:22.359 how it's diagnosed and what the latest treatment 00:01:22.359 --> 00:01:24.959 options look like from physio right through to 00:01:24.959 --> 00:01:28.579 surgery and what it all means for long term hip 00:01:28.579 --> 00:01:32.939 health. So let's get stuck in. OK, let's start 00:01:32.939 --> 00:01:35.819 right at the beginning. Femoral acetabular impingement, 00:01:36.079 --> 00:01:38.760 FAI. What exactly is it? It doesn't sound like 00:01:38.760 --> 00:01:41.260 a typical disease, does it? More like a physical 00:01:41.260 --> 00:01:43.219 fit issue. That's a very good way to put it, 00:01:43.219 --> 00:01:45.859 actually. It's not a disease like an infection. 00:01:46.019 --> 00:01:47.920 It's what we call a pathomechanical process. 00:01:47.980 --> 00:01:49.879 It's half a mechanical, right? Yeah. Think of 00:01:49.879 --> 00:01:52.140 your hip as a near -perfect ball and socket joint. 00:01:52.519 --> 00:01:54.180 You have the femoral head, the ball at the top 00:01:54.180 --> 00:01:57.079 of your thigh bone, fitting snugly into the acetabulum, 00:01:57.400 --> 00:01:59.689 which is the socket in your pelvis. Normally, 00:01:59.829 --> 00:02:03.189 they glide smoothly. In FAI, that smooth gliding 00:02:03.189 --> 00:02:06.810 is disrupted. You get abnormal contact, basically. 00:02:07.230 --> 00:02:10.250 The femur and the acetabulum repeatedly collide 00:02:10.250 --> 00:02:12.469 or rub against each other incorrectly during 00:02:12.469 --> 00:02:14.689 movement. A collision. Exactly, a mechanical 00:02:14.689 --> 00:02:17.610 collision. And this isn't gentle. It's often 00:02:17.610 --> 00:02:21.439 a forceful pinching or grinding. Over time, this 00:02:21.439 --> 00:02:24.599 constant abnormal contact starts to cause damage. 00:02:24.699 --> 00:02:27.379 Damage to what, specifically? Well, typically 00:02:27.379 --> 00:02:29.300 the first structure to suffer is the labrum. 00:02:29.419 --> 00:02:31.460 That's a ring of strong fiber cartilage around 00:02:31.460 --> 00:02:33.180 the rim of the socket. Right. Think of it like 00:02:33.180 --> 00:02:35.740 a gasket or a seal. Okay. the rubbing damages 00:02:35.740 --> 00:02:38.879 it, causes tears, then the articular cartilage, 00:02:39.099 --> 00:02:41.159 that incredibly smooth white lining in the bone 00:02:41.159 --> 00:02:43.520 surfaces that lets them glide, that gets injured 00:02:43.520 --> 00:02:45.719 too. Right, the slippery stuff. Precisely. And 00:02:45.719 --> 00:02:48.099 this ongoing damage, this mechanical insult, 00:02:48.500 --> 00:02:50.500 is what leads to the progressive hip pain and 00:02:50.500 --> 00:02:52.639 stiffness that people experience. So yes, fundamentally, 00:02:52.699 --> 00:02:54.719 it's a problem of shape and mechanics. That makes 00:02:54.719 --> 00:02:56.900 sense. And you mentioned different types, that 00:02:56.900 --> 00:02:59.900 this extra bone or abnormal shape shows up in 00:02:59.900 --> 00:03:02.879 distinct ways. That's right. Although the underlying 00:03:02.879 --> 00:03:05.680 issue is this abnormal bone shape causing the 00:03:05.680 --> 00:03:08.400 collision, where that abnormality is located, 00:03:08.680 --> 00:03:11.219 defines the type, and often correlates with who 00:03:11.219 --> 00:03:13.599 tends to get it. We generally talk about two 00:03:13.599 --> 00:03:15.939 main types, though very often people have a mix 00:03:15.939 --> 00:03:18.860 of both. OK. The first is cam impingement. The 00:03:18.860 --> 00:03:22.039 name comes from engineering, like a camshaft 00:03:22.039 --> 00:03:24.860 that isn't perfectly round. Ah, OK. This is a 00:03:24.860 --> 00:03:27.219 femoral based disorder. The problem is on the 00:03:27.219 --> 00:03:29.840 ball side, the femur. We tend to see this more 00:03:29.840 --> 00:03:33.159 in young athletic males. Young men, okay. Yes. 00:03:33.740 --> 00:03:35.879 Essentially, the femoral head, or usually the 00:03:35.879 --> 00:03:37.819 junction between the head and the neck, isn't 00:03:37.819 --> 00:03:41.379 perfectly spherical. It's a bit aspherical or 00:03:41.379 --> 00:03:44.379 too broad, often with a characteristic bump on 00:03:44.379 --> 00:03:46.599 the front outer side. A bump on the ball. Exactly. 00:03:46.879 --> 00:03:48.639 We're talking about a decreased head -to -neck 00:03:48.639 --> 00:03:51.800 ratio or offset. Basically, the smooth contour 00:03:51.800 --> 00:03:54.280 is lost. Now imagine this non -spherical ball 00:03:54.280 --> 00:03:56.280 trying to move fully within the socket. It's 00:03:56.280 --> 00:03:59.539 gonna jam, isn't it? Precisely. As a hip flexes 00:03:59.539 --> 00:04:02.699 and rotates inwards, that bump, the cam lesion, 00:04:03.139 --> 00:04:05.159 effectively levers against the rim of the socket. 00:04:05.860 --> 00:04:08.539 This creates a shearing force right where the 00:04:08.539 --> 00:04:11.639 cartilage meets the labrum. Ouch. Yes. Instead 00:04:11.639 --> 00:04:15.020 of gliding, it peels the cartilage away from 00:04:15.020 --> 00:04:17.459 the bone that's cartilage delamination, and it 00:04:17.459 --> 00:04:19.779 can tear the labrum, causing labral separation. 00:04:20.270 --> 00:04:22.509 On x -rays, you might see what's called a pistol 00:04:22.509 --> 00:04:25.029 grip deformity because of the shape. Pistol grip. 00:04:25.189 --> 00:04:26.949 Got it. So that's cam. What's the other type? 00:04:27.269 --> 00:04:29.329 The second type is pincer impingement. This is 00:04:29.329 --> 00:04:32.189 an acetabular -based disorder. The issue lies 00:04:32.189 --> 00:04:34.250 with the socket, the acetabular. So the socket's 00:04:34.250 --> 00:04:36.649 the problem this time. Correct. We tend to see 00:04:36.649 --> 00:04:38.850 this more frequently in active middle -aged women. 00:04:39.569 --> 00:04:42.329 Here, the socket rim has too much coverage, an 00:04:42.329 --> 00:04:44.069 overhang, usually at the front and top part. 00:04:44.149 --> 00:04:47.129 Too much socket. In effect, yes. It might be 00:04:47.129 --> 00:04:48.949 because the socket itself is angled slightly 00:04:48.949 --> 00:04:51.589 backwards, it's acetabular retroversion, or it 00:04:51.589 --> 00:04:53.430 might be just generally too deep, what we call 00:04:53.430 --> 00:04:56.129 acetabular protrusia or coxoprofinda. So with 00:04:56.129 --> 00:04:59.029 pincer, when the hip flexes, instead of the bump 00:04:59.029 --> 00:05:01.949 shearing things, the overhanging rim of the socket 00:05:01.949 --> 00:05:05.170 directly pinches or crushes the labrum against 00:05:05.170 --> 00:05:07.550 the femoral neck. Crushing the seal. Exactly. 00:05:07.850 --> 00:05:10.230 This often causes tearing within the substance 00:05:10.230 --> 00:05:13.269 of the labrum itself. And interestingly, You 00:05:13.269 --> 00:05:15.509 can get what's called a contracoup cartilage 00:05:15.509 --> 00:05:18.449 injury. Contracoup? Like in head injuries? Similar 00:05:18.449 --> 00:05:20.750 principle. As the front of the neck hits the 00:05:20.750 --> 00:05:23.350 overhanging socket rim, it levers the back of 00:05:23.350 --> 00:05:25.290 the femoral head against the back wall of the 00:05:25.290 --> 00:05:27.930 socket, damaging the cartilage there opposite 00:05:27.930 --> 00:05:31.430 the main impingement site. Wow. Okay. Any specific 00:05:31.430 --> 00:05:34.129 signs on x -ray for pincer? A classic one, especially 00:05:34.129 --> 00:05:37.209 with retroversion, is the crossover sign on a 00:05:37.209 --> 00:05:39.300 pelvis x -ray. where the front and back walls 00:05:39.300 --> 00:05:41.600 of the socket seemed to cross over. Right, CAM 00:05:41.600 --> 00:05:43.519 and PINCER. But you said people often have both. 00:05:43.680 --> 00:05:45.500 Yes, absolutely. It's really important to stress 00:05:45.500 --> 00:05:48.439 that. Combined impingement, a mix of both CAM 00:05:48.439 --> 00:05:50.879 and PINCER features, is actually the most common 00:05:50.879 --> 00:05:53.019 scenario we see in symptomatic patients, perhaps 00:05:53.019 --> 00:05:56.319 up to 80 % of cases. So often, we need to address 00:05:56.319 --> 00:05:59.310 both aspects surgically. OK. That's clear. These 00:05:59.310 --> 00:06:01.910 aren't just minor anacomical quirks then. They 00:06:01.910 --> 00:06:04.649 cause real mechanical problems. And it sounds 00:06:04.649 --> 00:06:06.769 like this isn't just about the immediate pain 00:06:06.769 --> 00:06:09.470 of that collision. It sets off a kind of chain 00:06:09.470 --> 00:06:11.629 reaction, doesn't it? Leading to bigger problems 00:06:11.629 --> 00:06:14.149 down the line. Precisely. That's the critical 00:06:14.149 --> 00:06:16.250 thing to understand about the long -term picture. 00:06:16.910 --> 00:06:19.029 The immediate pain is from the pinching and rubbing, 00:06:19.269 --> 00:06:22.899 yes. But it's the chronic, repetitive nature 00:06:22.899 --> 00:06:25.899 of that mechanical collision that does the real 00:06:25.899 --> 00:06:29.259 damage over time. This constant friction, whether 00:06:29.259 --> 00:06:31.420 it is shearing from a cam lesion or crushing 00:06:31.420 --> 00:06:34.579 from a pincer, leads to progressive labral degeneration 00:06:34.579 --> 00:06:37.420 and tears. The labrum just isn't designed to 00:06:37.420 --> 00:06:39.839 withstand that kind of abuse, so it wears down 00:06:39.839 --> 00:06:42.980 phrase tears. And the cartilage too. And the 00:06:42.980 --> 00:06:45.779 cartilage, too. That smooth gliding surface suffers 00:06:45.779 --> 00:06:48.740 significant cartilage damage. It might soften, 00:06:49.040 --> 00:06:51.300 fray, develop blisters, or even full thickness 00:06:51.300 --> 00:06:53.920 tears or flaps. And the trouble with articular 00:06:53.920 --> 00:06:56.839 cartilage is its very limited ability to heal 00:06:56.839 --> 00:06:59.160 itself. It doesn't repair well. Not really, no. 00:06:59.920 --> 00:07:03.819 So over time, this relentless wear and tear transforms 00:07:03.819 --> 00:07:06.579 localized damage into broader joint degeneration. 00:07:07.439 --> 00:07:10.519 which is why FAI is now recognized as a major 00:07:10.519 --> 00:07:13.480 known risk factor for the development of osteoarthritis 00:07:13.480 --> 00:07:16.379 of the hip. Ah, so it leads to arthritis earlier. 00:07:16.600 --> 00:07:18.779 It certainly seems to accelerate the process, 00:07:19.180 --> 00:07:21.879 yes, leading to hip dysfunction and potentially 00:07:21.879 --> 00:07:24.779 the need for hip replacement surgery much earlier 00:07:24.779 --> 00:07:27.220 in life than we might otherwise expect. It's 00:07:27.220 --> 00:07:30.360 a pathway from subtle shape difference to significant 00:07:30.360 --> 00:07:32.519 joint failure, potentially. That's quite sobering. 00:07:32.540 --> 00:07:34.540 So if these bone shapes are the root cause, what 00:07:34.540 --> 00:07:36.800 causes them? Is it something you're born with? 00:07:36.920 --> 00:07:39.259 Is it genetics, or does activity play a role? 00:07:39.519 --> 00:07:41.579 You mentioned athletes. It's a really key question. 00:07:41.699 --> 00:07:43.459 And the honest answer is we're still figuring 00:07:43.459 --> 00:07:45.620 out all the details. But the current thinking 00:07:45.620 --> 00:07:47.779 points towards a combination of factors. It's 00:07:47.779 --> 00:07:50.740 rarely just one thing. Firstly, there does seem 00:07:50.740 --> 00:07:53.740 to be a genetic predisposition. Research suggests 00:07:53.740 --> 00:07:57.240 genetic factors may contribute. Specific small 00:07:57.240 --> 00:08:00.720 variations in our DNA, things called SNPs, single 00:08:00.720 --> 00:08:03.819 nucleotide polymorphisms, tiny genetic differences, 00:08:04.360 --> 00:08:08.389 some. like variants in genes called GDF5, FRZB, 00:08:08.509 --> 00:08:12.370 DI02, HOX9, have been linked to particular hip 00:08:12.370 --> 00:08:15.689 shapes, both on the femur and socket side, and 00:08:15.689 --> 00:08:18.529 also to an increased risk of developing osteoarthritis. 00:08:18.850 --> 00:08:21.009 So your genes can literally shape your hip in 00:08:21.009 --> 00:08:23.470 a way that makes FAI more likely. It seems that 00:08:23.470 --> 00:08:26.269 way, yes. It sets the stage, potentially. Interesting. 00:08:26.550 --> 00:08:28.509 And the athlete connection, does playing sport 00:08:28.509 --> 00:08:30.899 cause it? That's the athlete paradox, as you 00:08:30.899 --> 00:08:33.500 called it. We definitely see more FAI, particularly 00:08:33.500 --> 00:08:36.899 the cam type in athletes. But, and this is really 00:08:36.899 --> 00:08:39.720 crucial, exercise does not cause FAI in a normal 00:08:39.720 --> 00:08:41.639 hip. Okay, that's important. Yes. The leading 00:08:41.639 --> 00:08:43.399 theory is that during adolescence, when the bones 00:08:43.399 --> 00:08:45.820 are still growing and developing, the increased 00:08:45.820 --> 00:08:47.919 stress along the great plate of a hip from high 00:08:47.919 --> 00:08:50.639 intensity sports, think repetitive deep flexion, 00:08:50.659 --> 00:08:53.580 rotation, like in football, hockey, martial arts, 00:08:53.940 --> 00:08:55.960 might trigger a sort of stress reaction. The 00:08:55.960 --> 00:08:58.759 bone reacts to the stress? Exactly an increased 00:08:58.759 --> 00:09:01.980 stress reaction bone formation the body adapts 00:09:01.980 --> 00:09:04.399 by laying down more bone But in this area it 00:09:04.399 --> 00:09:07.940 can result in that cam deformity that bump So 00:09:07.940 --> 00:09:10.120 intense activity during those key growth years 00:09:10.120 --> 00:09:12.980 and someone perhaps already predisposed might 00:09:12.980 --> 00:09:15.000 lead to the shape forming So activity doesn't 00:09:15.000 --> 00:09:16.940 cause it from scratch, but it can contribute 00:09:16.940 --> 00:09:19.059 to the shape developing, or at least make an 00:09:19.059 --> 00:09:22.139 existing shape symptomatic earlier. Precisely. 00:09:22.500 --> 00:09:24.980 If you already have that subtle anatomical difference, 00:09:25.539 --> 00:09:27.580 vigorous activity involving lots of hip movement 00:09:27.580 --> 00:09:29.960 will provoke the impingement more often and more 00:09:29.960 --> 00:09:33.059 forcefully, leading to symptoms sooner. It unmasks 00:09:33.059 --> 00:09:35.080 the problem. Right. Are there other factors? 00:09:35.440 --> 00:09:38.320 Childhood conditions? Yes, definitely. Childhood 00:09:38.320 --> 00:09:40.639 influences are important. A history of slipped 00:09:40.639 --> 00:09:44.779 capital femoral bypasses or SEFE is a major one. 00:09:45.139 --> 00:09:47.059 That's where the ball part slips off the thigh 00:09:47.059 --> 00:09:49.169 bone at the growth plate during childhood. Even 00:09:49.169 --> 00:09:51.769 after it's fixed surgically, the residual shape 00:09:51.769 --> 00:09:55.210 change, the deformity, can directly cause impingement 00:09:55.210 --> 00:09:57.970 later in life. Other conditions like perthase 00:09:57.970 --> 00:10:00.269 disease, which affects blood supply to the hip 00:10:00.269 --> 00:10:03.049 in childhood, and hip dysplasia, where the socket 00:10:03.049 --> 00:10:05.809 is too shallow, are also linked to a higher chance 00:10:05.809 --> 00:10:08.870 of developing FAI. So it's often multifactorial. 00:10:09.389 --> 00:10:12.029 Genetics, developmental stress, maybe previous 00:10:12.029 --> 00:10:14.649 hip issues. OK, that makes sense. But then... 00:10:14.620 --> 00:10:16.960 If these shapes are actually quite common, as 00:10:16.960 --> 00:10:18.919 you said earlier, why do some people have terrible 00:10:18.919 --> 00:10:21.500 symptoms while others with the same x -ray findings 00:10:21.500 --> 00:10:24.830 feel Absolutely fine. It's confusing. It is confusing 00:10:24.830 --> 00:10:27.049 and it's a huge area of research You're right. 00:10:27.070 --> 00:10:29.149 The prevalence of the bone shapes is surprisingly 00:10:29.149 --> 00:10:31.710 high We mentioned 10 15 percent in the general 00:10:31.710 --> 00:10:34.289 population having the morphology But remember 00:10:34.289 --> 00:10:36.750 that study the meta -analysis by Frank at all 00:10:36.750 --> 00:10:40.409 They found cam deformity in 37 percent and pincer 00:10:40.409 --> 00:10:43.330 deformity in a massive 67 percent of asymptomatic 00:10:43.330 --> 00:10:45.929 volunteers people with no hip pain at all 67 00:10:45.929 --> 00:10:48.970 percent Wow Exactly. So a huge number of people 00:10:48.970 --> 00:10:51.429 are walking around with these FAI bone shapes 00:10:51.429 --> 00:10:54.730 without any symptoms. The morphology itself doesn't 00:10:54.730 --> 00:10:57.590 automatically equal pain. We also see those gender 00:10:57.590 --> 00:10:59.970 differences in prevalence can more in men, pincer 00:10:59.970 --> 00:11:02.950 more in women. But again, many are asymptomatic. 00:11:03.190 --> 00:11:05.289 So what's the tipping point? Why do symptoms 00:11:05.289 --> 00:11:07.590 start for some people? The general consensus 00:11:07.590 --> 00:11:10.190 is that symptoms develop when the mechanical 00:11:10.190 --> 00:11:12.929 collision finally starts causing significant 00:11:12.929 --> 00:11:15.549 damage to the cartilage or the labrum. It's when 00:11:15.549 --> 00:11:17.789 those soft tissues, which have nerve endings, 00:11:18.190 --> 00:11:20.029 start to break down under the repetitive strain. 00:11:20.169 --> 00:11:22.870 Ah, so it's the damage, not just the shape. Exactly. 00:11:23.090 --> 00:11:26.789 The onset of pain, clicking stiffness that usually 00:11:26.789 --> 00:11:29.110 signals that the pathological process is now 00:11:29.110 --> 00:11:31.710 actively injuring the joint structures. And once 00:11:31.710 --> 00:11:34.129 that happens, if the impingement continues, the 00:11:34.129 --> 00:11:36.570 condition is likely to worsen. The damage progresses. 00:11:37.169 --> 00:11:39.289 Having the shape is one thing. Having symptoms 00:11:39.289 --> 00:11:41.690 means the joint is now suffering. Right. Which 00:11:41.690 --> 00:11:44.269 brings us neatly to diagnosis. For someone with 00:11:44.269 --> 00:11:46.490 that nagging hip or groin pain, what are the 00:11:46.490 --> 00:11:49.110 telltale signs? How do doctors start to suspect 00:11:49.110 --> 00:11:52.190 FAI specifically, given hip pain can be so vague? 00:11:52.509 --> 00:11:54.889 It can be very vague, you're right. That's why 00:11:54.889 --> 00:11:57.250 a careful history and a thorough physical exam 00:11:57.250 --> 00:11:59.730 are absolutely paramount. What do patients typically 00:11:59.730 --> 00:12:02.970 report? Usually a gradual onset of hip pain. 00:12:03.629 --> 00:12:06.529 It's often not a sudden thing. The location is 00:12:06.529 --> 00:12:08.970 most commonly deep in the groin area, but as 00:12:08.970 --> 00:12:11.350 we said, it can radiate to the thigh, buttock, 00:12:11.370 --> 00:12:14.970 outer hip, even the back. The C sign? Yes. Often 00:12:14.970 --> 00:12:17.250 they'll use that characteristic C sign, cupping 00:12:17.250 --> 00:12:18.970 their hand around the side in front of the hip 00:12:18.970 --> 00:12:21.509 to show where it hurts. That's quite suggestive 00:12:21.509 --> 00:12:23.909 of something inside the joint. Okay. And what 00:12:23.909 --> 00:12:27.629 makes it worse? Classically, pain is exacerbated 00:12:27.629 --> 00:12:30.909 by hip flexion and internal rotation. So activities 00:12:30.909 --> 00:12:33.450 involving those movements, high intensity sports, 00:12:34.090 --> 00:12:36.840 squatting, getting in and out of cars, driving, 00:12:37.059 --> 00:12:39.340 even just sitting for prolonged periods. Makes 00:12:39.340 --> 00:12:41.679 sense that position forces the joint together. 00:12:41.879 --> 00:12:44.600 Exactly. They might also report mechanical hip 00:12:44.600 --> 00:12:46.799 symptoms, things like clicking, catching, locking, 00:12:47.039 --> 00:12:49.799 or a popping sensation. That strongly suggests 00:12:49.799 --> 00:12:52.240 a labral tear is involved. And during the physical 00:12:52.240 --> 00:12:55.039 exam, what are you looking for? We look for restricted 00:12:55.039 --> 00:12:58.190 movement. Often there's limited hip flexion and 00:12:58.190 --> 00:13:00.649 particularly limited internal rotation, especially 00:13:00.649 --> 00:13:03.450 when the hip is flexed to 90 degrees. Sometimes 00:13:03.450 --> 00:13:05.450 internal rotation is less than five degrees. 00:13:05.610 --> 00:13:09.070 Wow, very restricted. Yes, and the key provocative 00:13:09.070 --> 00:13:12.769 test is the anterior impingement test or FEI 00:13:12.769 --> 00:13:15.870 or test. We gently flex the hip to 90 degrees. 00:13:15.980 --> 00:13:18.059 bring it across the body slightly, adduction, 00:13:18.480 --> 00:13:20.580 and then rotate it inwards. And if that hurts? 00:13:20.720 --> 00:13:22.820 If that reproduces their specific pain, it's 00:13:22.820 --> 00:13:25.820 a positive test. It's highly sensitive, positive 00:13:25.820 --> 00:13:29.279 in about 88 % of patients with FAI. It really 00:13:29.279 --> 00:13:32.100 hones in on that specific conflict zone. OK. 00:13:32.620 --> 00:13:34.799 So history and exam give a strong suspicion. 00:13:35.200 --> 00:13:37.759 Then comes imaging, presumably, to confirm it 00:13:37.759 --> 00:13:40.159 and see the extent of the problem. Absolutely. 00:13:40.720 --> 00:13:42.659 Imaging is essential to confirm the bony shapes 00:13:42.659 --> 00:13:45.360 and, critically, to assess the state of the labrum 00:13:45.360 --> 00:13:47.960 and cartilage. It completes the picture and guides 00:13:47.960 --> 00:13:50.100 treatment. What imaging do you start with? We 00:13:50.100 --> 00:13:52.139 always begin with radiographs, standard x -rays. 00:13:52.759 --> 00:13:54.860 A specific set of views is needed. a standing 00:13:54.860 --> 00:13:57.279 AP pelvis view, an AP view of the affected hip, 00:13:57.419 --> 00:13:59.480 and a good lateral view of the hip. What do these 00:13:59.480 --> 00:14:01.379 show? They allow us to assess the bone structure, 00:14:01.740 --> 00:14:04.000 looking for those cam and pincer lesions. We 00:14:04.000 --> 00:14:06.820 look for the pistol grip deformity for cam, signs 00:14:06.820 --> 00:14:08.799 of over coverage, like the crossover sign for 00:14:08.799 --> 00:14:12.340 pincer, or maybe a deep socket protrusio. And 00:14:12.340 --> 00:14:14.639 you measure things on the x -rays? Yes. Precise 00:14:14.639 --> 00:14:17.320 measurements are key. The alpha angle, usually 00:14:17.320 --> 00:14:19.379 measured on a special lateral view, like a dun 00:14:19.379 --> 00:14:22.720 or frog leg view, quantifies the cam deformity. 00:14:23.049 --> 00:14:26.210 An angle over 50 -55 degrees is generally considered 00:14:26.210 --> 00:14:29.110 abnormal. We also measure acetabular coverage 00:14:29.110 --> 00:14:31.610 with things like the lateral center edge angle. 00:14:32.110 --> 00:14:34.809 An angle below 25 degrees might suggest dysplasia. 00:14:35.039 --> 00:14:37.120 not enough coverage, which is different from 00:14:37.120 --> 00:14:40.019 FAIs over coverage. Different views like the 00:14:40.019 --> 00:14:42.139 done view are best for seeing the cam lesion, 00:14:42.340 --> 00:14:44.759 while a false profile view helps assess coverage 00:14:44.759 --> 00:14:47.159 at the front. So x -rays give the bony blueprint. 00:14:47.419 --> 00:14:50.500 What about CT scans? CT scans can be a useful 00:14:50.500 --> 00:14:53.000 adjunct. They give incredibly detailed views 00:14:53.000 --> 00:14:55.279 of the structural abnormalities and allow for 00:14:55.279 --> 00:14:58.340 amazing 3D reconstructions. These are fantastic 00:14:58.340 --> 00:15:00.059 for preoperative planning, letting the surgeon 00:15:00.059 --> 00:15:01.860 really visualize the shape and plan the bone 00:15:01.860 --> 00:15:04.590 resection. The downside is the higher radiation 00:15:04.590 --> 00:15:07.690 dose. Right. And for the soft tissues, the labrum 00:15:07.690 --> 00:15:11.429 and cartilage. For that, MRI is the gold standard. 00:15:11.929 --> 00:15:14.470 Specifically, MR arthrography is often preferred. 00:15:15.049 --> 00:15:17.129 Arthrography. That involves an injection, doesn't 00:15:17.129 --> 00:15:20.250 it? Yes, exactly. An intraarticular contrast 00:15:20.250 --> 00:15:22.690 injection, a special dye, is put into the hip 00:15:22.690 --> 00:15:25.669 joint just before the MRI scan. This dye leaks 00:15:25.669 --> 00:15:28.309 into any tears or defects in the labrum or cartilage, 00:15:28.669 --> 00:15:31.490 making them show up much more clearly. It's the 00:15:31.490 --> 00:15:34.289 best modality to evaluate for articular cartilage 00:15:34.289 --> 00:15:37.250 and labral damage. It makes sense. MRI also shows 00:15:37.250 --> 00:15:40.110 the bone shape well, without radiation, and it's 00:15:40.110 --> 00:15:42.070 excellent for ruling out other causes of hip 00:15:42.070 --> 00:15:45.970 pain that might mimic FAI. like a vascular necrosis, 00:15:46.230 --> 00:15:48.669 stress fractures, or various types of tendonitis. 00:15:48.929 --> 00:15:51.330 So MRI is really comprehensive. Is there anything 00:15:51.330 --> 00:15:54.149 else diagnostically? One other tool is a diagnostic 00:15:54.149 --> 00:15:56.570 intraarticular injection of local anesthetic. 00:15:56.970 --> 00:15:59.470 We numb the hip joint directly. If the patient's 00:15:59.470 --> 00:16:01.830 pain significantly improves, even temporarily, 00:16:02.309 --> 00:16:04.269 it strongly confirms the pain is coming from 00:16:04.269 --> 00:16:06.850 inside the joint, likely the FAI. It can be very 00:16:06.850 --> 00:16:08.490 helpful when the picture isn't perfectly clear. 00:16:08.620 --> 00:16:10.840 That's a really thorough diagnostic process. 00:16:11.259 --> 00:16:14.580 So once FAI is confirmed, surgery isn't automatically 00:16:14.580 --> 00:16:17.120 the next step, is it? What about conservative 00:16:17.120 --> 00:16:19.759 approaches? No, absolutely not. Non -surgical 00:16:19.759 --> 00:16:21.940 management is always the first port of call, 00:16:22.259 --> 00:16:25.700 especially for patients who are minimally symptomatic 00:16:25.700 --> 00:16:28.299 or don't have those definite mechanical symptoms 00:16:28.299 --> 00:16:30.700 like locking. What does that involve? It's usually 00:16:30.700 --> 00:16:34.659 a combination approach. Firstly, activity modification. 00:16:34.960 --> 00:16:37.960 This means identifying and reducing or temporarily 00:16:37.960 --> 00:16:41.100 stopping activities that provoke the pain. Not 00:16:41.100 --> 00:16:43.379 stopping everything, but being smarter about 00:16:43.379 --> 00:16:46.360 movement. Avoiding the triggers. Exactly. Secondly, 00:16:46.539 --> 00:16:49.399 and crucially, targeted physical therapy. A good 00:16:49.399 --> 00:16:52.080 physio will assess movement patterns, look for 00:16:52.080 --> 00:16:54.220 weaknesses or imbalances in the kinetic chain, 00:16:54.740 --> 00:16:56.980 and work on improving hip range of motion and 00:16:56.980 --> 00:16:59.399 strengthening the surrounding muscles, glutes, 00:16:59.519 --> 00:17:01.980 core muscles. To support the joint better. Precisely. 00:17:02.080 --> 00:17:04.660 Better control, better mechanics can sometimes 00:17:04.660 --> 00:17:07.940 reduce the stress on the impingement zone. Thirdly, 00:17:08.119 --> 00:17:10.779 pain management, mainly with NSAID's non -steroidal 00:17:10.779 --> 00:17:13.539 anti -inflammatory drugs to reduce pain and inflammation. 00:17:13.819 --> 00:17:16.740 Like ibuprofen. Yes. And as we mentioned that, 00:17:17.019 --> 00:17:19.299 intraarticular injection of local anesthetic 00:17:19.299 --> 00:17:22.160 and steroid can be used therapeutically too. 00:17:22.619 --> 00:17:25.059 The steroid reduces inflammation inside the joint, 00:17:25.599 --> 00:17:27.559 providing pain relief that can last weeks or 00:17:27.559 --> 00:17:30.519 months, making physio more effective. But these 00:17:30.519 --> 00:17:33.079 don't fix the underlying shape, do they? No, 00:17:33.240 --> 00:17:35.660 and that's the critical limitation. Conservative 00:17:35.660 --> 00:17:38.099 measures manage the symptoms, they manage the 00:17:38.099 --> 00:17:40.539 inflammation, they might improve mechanics around 00:17:40.539 --> 00:17:43.019 the problem, but they don't change the bone shape. 00:17:43.279 --> 00:17:45.859 They don't stop the collision happening. So if 00:17:45.859 --> 00:17:49.240 these don't provide... lasting relief. Then surgery 00:17:49.240 --> 00:17:52.140 becomes the next consideration. If symptoms persist 00:17:52.140 --> 00:17:54.180 despite a good trial of conservative management, 00:17:54.339 --> 00:17:56.900 usually three to six months, or if mechanical 00:17:56.900 --> 00:17:59.119 symptoms are prominent, then we discuss addressing 00:17:59.119 --> 00:18:01.779 the underlying anatomy directly. Right. So tell 00:18:01.779 --> 00:18:03.740 us about the surgical options. What's the aim? 00:18:04.259 --> 00:18:07.519 The aim of surgery is to reshape the bones, the 00:18:07.519 --> 00:18:10.160 femur, the acetabulum, or both, to eliminate 00:18:10.160 --> 00:18:13.059 the abnormal contact, the impingement, basically 00:18:13.059 --> 00:18:15.900 to restore normal hip mechanics and allow smooth, 00:18:16.119 --> 00:18:18.410 pain -free movement. They're two main approaches. 00:18:18.690 --> 00:18:21.109 The most common approach now is arthroscopic 00:18:21.109 --> 00:18:24.470 osteoplasty. This is minimally invasive, done 00:18:24.470 --> 00:18:27.349 through small keyhole incisions using a camera, 00:18:27.670 --> 00:18:29.509 the arthroscoge, and specialized instruments. 00:18:29.630 --> 00:18:32.569 Keyhole surgery for the hip. Exactly. The surgeon 00:18:32.569 --> 00:18:36.130 can see inside the joint on a screen and precisely 00:18:36.130 --> 00:18:39.509 trim the bony rim of the acetabulum, if it's 00:18:39.509 --> 00:18:42.869 a pincer lesion, or shave down the bump on the 00:18:42.869 --> 00:18:46.259 femoral head or neck for a cam lesion. That's 00:18:46.259 --> 00:18:48.460 the osteoplasty part reshaping the bone. And 00:18:48.460 --> 00:18:50.519 they can fix the labrum at the same time? Yes, 00:18:50.660 --> 00:18:52.940 a huge advantage is that arthroscopy allows the 00:18:52.940 --> 00:18:55.640 surgeon to thoroughly assess and repair or clean 00:18:55.640 --> 00:18:58.339 out any damage to the labrum and articular cartilage 00:18:58.339 --> 00:19:01.079 as well. Studies show it gives equivalent results 00:19:01.079 --> 00:19:03.339 to open hip surgery, but often with a quicker 00:19:03.339 --> 00:19:05.759 return to activity. That sounds promising. What's 00:19:05.759 --> 00:19:08.200 the open surgery option? The alternative is open 00:19:08.200 --> 00:19:10.640 surgical hip dislocation. This is the previous 00:19:10.640 --> 00:19:13.059 gold standard. It involves a larger incision 00:19:13.059 --> 00:19:15.380 and a technique where part of the hip bone, the 00:19:15.380 --> 00:19:17.960 greater trochanter, is temporarily detached to 00:19:17.960 --> 00:19:20.000 allow the surgeon to safely dislocate the hip 00:19:20.000 --> 00:19:22.619 joint and get a wide direct view of the femoral 00:19:22.619 --> 00:19:25.019 head and socket. Sounds quite major. It is a 00:19:25.019 --> 00:19:28.039 bigger operation, yes, but it's designed very 00:19:28.039 --> 00:19:31.720 carefully to preserve the blood supply to the 00:19:31.720 --> 00:19:35.019 femoral head. So the risk of a vascular necrosis 00:19:35.019 --> 00:19:39.079 or AVN is very low. It provides excellent exposure, 00:19:39.380 --> 00:19:42.119 which can be really useful for significant femoral 00:19:42.119 --> 00:19:45.500 deformity or complex cases. Return to play rates 00:19:45.500 --> 00:19:48.359 for athletes after open surgery are historically 00:19:48.359 --> 00:19:51.680 very high, over 85 -90%, provided they don't 00:19:51.680 --> 00:19:54.039 already have significant arthritis. Okay, and 00:19:54.039 --> 00:19:55.740 regardless of the approach, dealing with the 00:19:55.740 --> 00:19:57.680 labrum is key, you said. Absolutely critical. 00:19:57.819 --> 00:20:00.279 If there's a labral tear, which there usually 00:20:00.279 --> 00:20:03.180 is in symptomatic FAI, it needs to be addressed 00:20:03.180 --> 00:20:05.720 repaired or sometimes reconstructed at the same 00:20:05.720 --> 00:20:08.259 time as the bone is reshaped. Just cleaning out 00:20:08.259 --> 00:20:10.440 the labral tear, isolated labral debridement, 00:20:10.720 --> 00:20:12.940 without fixing the underlying bony impingement 00:20:12.940 --> 00:20:15.059 simply doesn't work long -term. Because the cause 00:20:15.059 --> 00:20:17.299 is still there? Exactly. It's a major cause of 00:20:17.299 --> 00:20:19.200 treatment failures. You have to address both 00:20:19.200 --> 00:20:21.339 the bone shape and the soft tissue damage it's 00:20:21.339 --> 00:20:23.599 caused. Right. Are there other surgeries sometimes 00:20:23.599 --> 00:20:26.940 needed alongside? Occasionally, yes. If there's 00:20:26.940 --> 00:20:30.299 significant hip dysplasia or etabular retroversion, 00:20:30.759 --> 00:20:33.839 a more complex operation called a periocetabular 00:20:33.839 --> 00:20:36.720 osteotomy might be needed to reorient the socket. 00:20:36.940 --> 00:20:39.000 And if the joint is already badly worn out with 00:20:39.000 --> 00:20:42.039 end -stage arthritis, then hip arthroplasty, 00:20:42.319 --> 00:20:44.559 a total hip replacement, becomes the necessary 00:20:44.559 --> 00:20:46.839 solution. It really depends on the individual 00:20:46.839 --> 00:20:50.420 case. Okay. Now, surgery always carries risks. 00:20:50.619 --> 00:20:52.579 What are the potential complications people should 00:20:52.579 --> 00:20:55.940 be aware of with FAI surgery? And what's a realistic, 00:20:55.940 --> 00:20:59.079 long -term outlook? That's a crucial conversation 00:20:59.079 --> 00:21:01.480 to have with patients. While generally safe and 00:21:01.480 --> 00:21:03.599 effective, complications can occur. What are 00:21:03.599 --> 00:21:05.740 the main ones? Major, though thankfully rare, 00:21:06.019 --> 00:21:07.859 complications include things like femoral neck 00:21:07.859 --> 00:21:09.900 fracture, particularly during the bone reshaping 00:21:09.900 --> 00:21:12.400 for a cam lesion. Surgeons are very careful to 00:21:12.400 --> 00:21:14.599 limit how much bone they remove, generally less 00:21:14.599 --> 00:21:17.920 than 30 % of the femoral neck diameter, to minimize 00:21:17.920 --> 00:21:20.920 this risk. With arthroscopy, very rare risks 00:21:20.920 --> 00:21:23.880 include things like abdominal compartment syndrome 00:21:23.880 --> 00:21:26.559 from fluid leaking where it shouldn't, or nerve 00:21:26.559 --> 00:21:29.099 injury. Other potential major issues, though 00:21:29.099 --> 00:21:33.440 uncommon, are blood clots, DVTPE, deep infection, 00:21:33.880 --> 00:21:37.279 or dislocation after surgery. A vascular necrosis 00:21:37.279 --> 00:21:39.619 is a risk, though minimized by careful technique. 00:21:39.700 --> 00:21:42.480 And minor complications. These are more common, 00:21:42.539 --> 00:21:44.910 but usually manageable. Things like heterotopic 00:21:44.910 --> 00:21:47.329 ossification where extra bone forms in the soft 00:21:47.329 --> 00:21:50.789 tissues afterwards. We often give endocides like 00:21:50.789 --> 00:21:52.990 endomethacin post -operatively to help prevent 00:21:52.990 --> 00:21:56.230 this. Temporary nerve irritation or praxious 00:21:56.230 --> 00:21:58.970 causing numbness maybe in the thigh or perineal 00:21:58.970 --> 00:22:01.650 area from traction during arthroscopy can happen 00:22:01.650 --> 00:22:04.309 but usually resolves. Superficial infection or 00:22:04.309 --> 00:22:06.849 bruising are also possible. Okay and the long 00:22:06.849 --> 00:22:10.359 -term prognosis. Does surgery stop arthritis? 00:22:10.700 --> 00:22:12.299 That's the million dollar question, isn't it? 00:22:12.440 --> 00:22:14.700 We know the natural history of untreated FAI 00:22:14.700 --> 00:22:17.500 likely leads to early onset hip dysfunction and 00:22:17.500 --> 00:22:19.720 arthritis. Surgery definitely needs to change 00:22:19.720 --> 00:22:21.640 that course. It's very successful at reducing 00:22:21.640 --> 00:22:23.839 symptoms and improving function in the short 00:22:23.839 --> 00:22:26.619 to medium term, and it can prevent future damage 00:22:26.619 --> 00:22:29.619 by stopping the impingement. But... The current 00:22:29.619 --> 00:22:32.420 scientific evidence is still unclear whether 00:22:32.420 --> 00:22:35.779 it will definitively delay or prevent the development 00:22:35.779 --> 00:22:38.759 of hip arthritis in the very long run, say 15, 00:22:38.779 --> 00:22:41.039 20 years or more. So it might still happen later. 00:22:41.359 --> 00:22:43.480 It might. Patients need to understand that while 00:22:43.480 --> 00:22:45.700 surgery aims for joint preservation and symptom 00:22:45.700 --> 00:22:48.460 relief, they may still develop arthritis in the 00:22:48.460 --> 00:22:50.960 future and potentially need a hip replacement 00:22:50.960 --> 00:22:53.980 eventually. The goal is to push that possibility 00:22:53.980 --> 00:22:56.750 as far down the road as possible. or lessen its 00:22:56.750 --> 00:22:59.109 severity. That's important expectation setting. 00:22:59.650 --> 00:23:02.069 And after surgery, rehab is vital, I imagine. 00:23:02.230 --> 00:23:04.910 Absolutely essential. Post -operative rehabilitation 00:23:04.910 --> 00:23:07.730 is just as important as the surgery itself. It's 00:23:07.730 --> 00:23:10.970 a structured, progressive process guided by physical 00:23:10.970 --> 00:23:13.170 therapists. What does it involve? It starts with 00:23:13.170 --> 00:23:15.130 a period of protected weight -bearing, using 00:23:15.130 --> 00:23:17.440 crutches for maybe... two to six weeks depending 00:23:17.440 --> 00:23:19.940 on the surgery. Early passive range of motion 00:23:19.940 --> 00:23:21.759 starts almost immediately to stop stiffness. 00:23:22.160 --> 00:23:24.460 Then comes active range of motion followed by 00:23:24.460 --> 00:23:26.680 intensive strengthening exercises for the hip 00:23:26.680 --> 00:23:29.759 and core and gait training to normalize walking. 00:23:29.880 --> 00:23:32.400 Getting back to sport. That comes later usually 00:23:32.400 --> 00:23:35.460 after 12 weeks or so with gradual reintroduction 00:23:35.460 --> 00:23:39.279 of jogging, jumping and agility exercises. It's 00:23:39.279 --> 00:23:41.720 a careful progression tailored to the individual. 00:23:42.059 --> 00:23:45.359 The physio's role is absolutely critical in guiding 00:23:45.359 --> 00:23:48.019 this safely. It sounds like a long process. It 00:23:48.019 --> 00:23:49.799 requires patience and commitment, definitely. 00:23:50.400 --> 00:23:52.980 Finally, looking ahead, what's new in the world 00:23:52.980 --> 00:23:55.920 of FAI? Where is the research heading? It's a 00:23:55.920 --> 00:23:58.519 very active field. The number of scientific publications 00:23:58.519 --> 00:24:01.460 on FAI has exploded in the last 15 -20 years. 00:24:02.039 --> 00:24:04.519 We're seeing advancements like computer -based 00:24:04.519 --> 00:24:07.220 navigation systems being developed to help surgeons 00:24:07.220 --> 00:24:09.460 perform the bone resection even more accurately 00:24:09.460 --> 00:24:12.309 during arthroscopy. Improving precision. Exactly. 00:24:12.809 --> 00:24:14.650 But there's also an acknowledged need for more 00:24:14.650 --> 00:24:16.829 high quality research. We need more mechanistic 00:24:16.829 --> 00:24:19.369 studies to really understand why the damage occurs 00:24:19.369 --> 00:24:21.690 at a cellular level. And critically, we need 00:24:21.690 --> 00:24:24.250 more long -term outcome data studies following 00:24:24.250 --> 00:24:27.009 patients for many, many years to truly understand 00:24:27.009 --> 00:24:30.329 the natural course of FAI and the real long -term 00:24:30.329 --> 00:24:32.789 impact of non -surgical and surgical treatment 00:24:32.789 --> 00:24:36.450 on preventing arthritis. So still learning? Always 00:24:36.450 --> 00:24:39.539 learning, yes. but we've come a very long way 00:24:39.539 --> 00:24:41.460 in understanding and treating it effectively. 00:24:41.599 --> 00:24:43.619 This has been incredibly informative. It really 00:24:43.619 --> 00:24:46.599 drives home how complex hip pain can be stemming 00:24:46.599 --> 00:24:49.339 from these underlying mechanical issues. Just 00:24:49.339 --> 00:24:51.420 to summarize the key takeaways for everyone listening. 00:24:51.720 --> 00:24:54.650 Firstly, FAI isn't just pain, it's a mechanical 00:24:54.650 --> 00:24:57.650 clash in the hip caused by abnormal bone shapes, 00:24:58.029 --> 00:25:01.109 cam, pincer, or usually combined. Bone hitting 00:25:01.109 --> 00:25:03.730 bone where it shouldn't. Secondly, it's a clear 00:25:03.730 --> 00:25:06.529 risk factor for developing early hip osteoarthritis, 00:25:06.730 --> 00:25:09.529 especially in active people whose movements can 00:25:09.529 --> 00:25:12.119 accelerate the wear and tear. Correct. Thirdly, 00:25:12.420 --> 00:25:14.700 diagnosis hinges on specific clinical tests, 00:25:15.200 --> 00:25:18.000 like that FADR impingement test, combined with 00:25:18.000 --> 00:25:20.900 imaging x -rays for the bone shapes, MRI, often 00:25:20.900 --> 00:25:23.339 with dye to see the laboring and cartilage damage. 00:25:24.039 --> 00:25:26.099 Yes. Fourth, treatment starts conservatively 00:25:26.099 --> 00:25:28.920 with activity changes and physio, but precise 00:25:28.920 --> 00:25:32.400 surgery, often keyhole arthroscopy, can reshape 00:25:32.400 --> 00:25:34.740 the bones and repair soft tissues to fix the 00:25:34.740 --> 00:25:37.369 mechanical problem. That's the pathway. And finally, 00:25:37.589 --> 00:25:39.549 while surgery is good for symptoms and function 00:25:39.549 --> 00:25:41.789 now and can prevent further immediate damage, 00:25:42.250 --> 00:25:45.029 its ability to completely stop arthritis developing 00:25:45.029 --> 00:25:48.029 decades later is still being studied. It's about 00:25:48.029 --> 00:25:50.730 long -term joint preservation. Well summarized. 00:25:51.410 --> 00:25:53.569 If you found this deep dive helpful, we'd really 00:25:53.569 --> 00:25:55.509 appreciate it if you could take a second to rate 00:25:55.509 --> 00:25:57.470 the show or share it with someone who might find 00:25:57.470 --> 00:25:59.210 it useful, maybe someone you know dealing with 00:25:59.210 --> 00:26:01.910 persistent hip issues. And a final thought to 00:26:01.910 --> 00:26:04.849 leave you with. Just consider how these seemingly 00:26:04.849 --> 00:26:07.190 small variations in our anatomy, things we might 00:26:07.190 --> 00:26:10.049 not even know we have, can have such a huge impact 00:26:10.049 --> 00:26:12.630 on our movement, our quality of life, and our 00:26:12.630 --> 00:26:15.309 long -term joint health. It really highlights 00:26:15.309 --> 00:26:17.089 the importance of listening to our bodies and 00:26:17.089 --> 00:26:19.509 seeking answers when things don't feel right.