From the Guidelines
The recommended treatment for mild bilateral cam morphology hips is initially conservative management, focusing on activity modification, physical therapy, and non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief as needed. This approach is based on the principle of minimizing intervention while addressing symptoms, given that cam morphology alone does not always cause symptoms, and many individuals with mild cam deformities remain asymptomatic throughout life 1. Conservative management should include activity modification to avoid deep flexion and internal rotation movements that might cause impingement, physical therapy focusing on core strengthening and hip stabilization exercises, and NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain relief as needed.
Key components of the conservative approach include:
- Activity modification: Avoiding high-impact activities and positions that exacerbate symptoms.
- Physical therapy: Emphasizing improving hip range of motion, strengthening the surrounding musculature, and correcting any biomechanical abnormalities.
- Pain management: Using NSAIDs for pain relief as needed, with the option of corticosteroid injections if conservative measures fail after 3-6 months.
Surgical intervention, such as hip arthroscopy with femoroplasty to reshape the femoral head-neck junction, is generally reserved for cases with persistent symptoms despite conservative management or more severe morphological changes. The decision to proceed with surgery should be based on the individual's symptom severity, impact on quality of life, and the presence of any significant morphological changes that could benefit from surgical correction 1. Microfracture seems to be a simple and effective modality for management of chondral defects in the context of cam morphology, especially for smaller lesions, as evidenced by studies showing good outcomes with this technique 1. However, the primary approach should always prioritize conservative management to minimize risk and maximize quality of life.
From the Research
Treatment Options for Mild Bilateral Cam Morphology Hips
- The recommended treatment for mild bilateral cam morphology hips is a topic of ongoing research and debate 2, 3, 4.
- Surgical correction of cam deformity has been shown to improve clinical function and reduce cartilage degeneration in patients with symptomatic femoroacetabular impingement (FAI) 2.
- However, not all patients with cam morphology require surgical intervention, and some may benefit from nonoperative management, such as physical therapy and activity modification 5.
- A study published in 2023 found that a formal nonoperative management program combining a hip injection with structured adjunctive exercise rehabilitation was effective in improving symptoms and function in patients with symptomatic FAIS 5.
Nonoperative Management
- Nonoperative management may be a viable option for patients with mild bilateral cam morphology hips who do not have severe symptoms or advanced cartilage damage 5.
- A structured exercise rehabilitation program can help improve hip strength, flexibility, and function, and reduce pain and symptoms 5.
- Hip injections, such as corticosteroid and local anesthetic, may also be used to reduce inflammation and relieve pain 5.
Surgical Intervention
- Surgical correction of cam deformity may be necessary for patients with severe symptoms or advanced cartilage damage 2, 3.
- Femoroplasty, a surgical procedure that involves reshaping the femoral head to remove the cam deformity, has been shown to improve clinical function and reduce cartilage degeneration in patients with symptomatic FAI 2, 3.
- However, surgical intervention is not without risks and complications, and patients should carefully consider the potential benefits and risks before making a decision 2, 3.