Two of the most common causes of hip and groin pain in younger, active adults are femoroacetabular impingement (FAI) and acetabular labral tears. They are closely related, they often occur together, and — importantly — the great majority are managed without surgery. Understanding how they fit into the wider picture of hip health helps you know when, and who, to see.
Ball, Socket and the Labrum
The hip is a ball-and-socket joint. The socket (the acetabulum) is rimmed by a ring of cartilage called the labrum, which helps seal the joint, share load and keep the ball (the femoral head) stable in the socket.
Two things commonly go wrong in younger adults: the shape of the bones can cause the ball and socket to pinch against each other (impingement), and the labrum can tear. The two are linked — an abnormal hip shape is a common cause of labral tears.
When the Hip Pinches (FAI)
In a hip with femoroacetabular impingement, extra bone has formed on the ball (a “cam” shape), on the rim of the socket (a “pincer” shape), or both. During certain movements — particularly bending the hip up and rotating inward — these surfaces bump rather than glide smoothly.
FAI is common in younger, active adults, especially those in sports involving repeated deep hip flexion or pivoting. Many people have the bone shape and never develop a problem.
A Tear in the Cartilage Rim
A labral tear is damage to that cartilage rim. Tears may be associated with the shape of the hip (impingement or dysplasia), a specific injury, or gradual wear over time. As with impingement, many labral tears seen on scans cause no symptoms at all — which is why findings are always interpreted alongside the clinical picture.
Both impingement and labral tears are about a particular hip and how it's being used. Plenty of people have the shape, or a tear on a scan, and no problem at all — which is why we treat the patient, not the image.
- Dr Chien-Wen LiewHow These Conditions Feel
When these conditions do cause symptoms, they commonly include groin pain (often a deep ache around the front and side of the hip), pain with prolonged sitting, squatting, deep flexion or pivoting, and sometimes a catching, clicking or restricted feeling in the hip.
Similar pain can come from the joint surface, the tendons around the hip, or the lower back — so a careful assessment matters before assuming the labrum or impingement is the cause.
How They Are Diagnosed
Diagnosis combines your history, a physical examination (including movements that reproduce the symptoms), and imaging. Plain X-rays show the bony shape of the hip and screen for early arthritis; an MRI, sometimes with contrast (an MR arthrogram), shows the labrum and cartilage in more detail. You can read more about what arthritis looks like on a hip X-ray here.
Imaging is only meaningful when it lines up with your symptoms and examination — the picture on the scan and the person in the room have to match.
Managing It Without Surgery
For most people, the first steps are non-operative and are led by your GP and a physiotherapist: modifying the activities and positions that provoke symptoms, a targeted physiotherapy program focused on hip mechanics and core control, simple analgesia where appropriate, and — in selected cases — an image-guided injection to help with diagnosis and symptom control.
Many people settle well with these measures and need nothing more. Non-operative care is not simply a holding pattern before surgery — for the majority it is the treatment.
When Surgery Is Considered — and Which Kind
Where symptoms persist despite good non-operative care and the joint is otherwise well preserved, joint-preserving surgery may be discussed — for example hip arthroscopy (keyhole surgery) to reshape the impinging bone and manage a labral tear. This is the work of surgeons who specialise in hip arthroscopy and preservation.
My practice is limited to hip and knee replacement, so I do not perform hip arthroscopy, labral repair or other joint-preservation surgery. If preservation surgery is the right path for you, your GP can refer you to a hip-preservation surgeon.
Where This Meets Arthritis — and Where I Fit
In some people — particularly where impingement or a labral tear is long-standing — the hip develops established osteoarthritis over many years. When that happens (the joint surface itself is worn, symptoms are limiting, and non-operative measures have been exhausted), a total hip replacement in Adelaide may become the appropriate option.
That is the point at which a referral to me is appropriate. For most people with impingement or a labral tear, that point never arrives — and that is exactly the intention: replacement is for the end of the road, not the start of it. If you are wondering whether age is a barrier, this article on whether you are too young for a joint replacement may help.
Orthopaedic Surgeon, Adelaide
Frequently Asked Questions
Understanding Hip Pain in Younger Adults
A plain-English guide to impingement, labral tears, and when hip pain warrants a specialist opinion.