Hüftverletzungstypen erklärt: Labrumrisse bis AVN

Labrumriss

The acetabular labrum is a ring of fibrocartilage that deepens the hip socket and provides a suction seal for joint stability. Labral tears cause groin pain, clicking, catching, and stiffness, often worsened by prolonged sitting or hip flexion activities. They commonly result from femoroacetabular impingement (FAI), trauma, or hip dysplasia. MRI with arthrogram is the gold standard for diagnosis. For conservative management options, see our article on labral tear healing without surgery.

Femoroacetabuläres Impingement (FAI)

FAI occurs when abnormal bone morphology of the femoral head or acetabulum causes premature contact during hip motion. Cam-type impingement involves an aspherical femoral head, while pincer-type involves excessive acetabular coverage. Most patients have a combination of both (mixed type). FAI leads to labral tears and cartilage damage over time and is a major risk factor for early hip osteoarthritis. Activity modification and physiotherapy are first-line treatments, with hip arthroscopy for refractory cases. Learn how these morphology changes appear on MRI in our hip MRI reading guide.

Bursitis trochanterica

Now more accurately called greater trochanteric pain syndrome, this condition involves inflammation of the bursa and often coexistent gluteus medius or minimus tendinopathy. It causes lateral hip pain that is worse with lying on the affected side, climbing stairs, and prolonged walking. Treatment includes activity modification, physical therapy focusing on hip abductor strengthening, and corticosteroid injection for refractory pain. True gluteal tendon tears may require surgical repair in severe cases.

Stressfraktur

Hip stress fractures most commonly affect the femoral neck, particularly in runners, military recruits, and patients with metabolic bone disease. They present with groin pain that worsens with weight-bearing activity. Femoral neck stress fractures are classified as tension-side (lateral, higher surgical risk) or compression-side (medial, generally treated conservatively). MRI is essential for early detection as X-rays may be normal for weeks. Prompt diagnosis prevents progression to complete fracture.

Avaskuläre Nekrose (AVN)

AVN of the femoral head occurs when blood supply to the bone is disrupted, causing bone death and eventual joint collapse. Risk factors include corticosteroid use, alcohol abuse, sickle cell disease, and hip trauma. Early stages are asymptomatic and detectable only on MRI, making screening important for high-risk patients. Early AVN may be managed with core decompression surgery, while advanced collapse typically requires total hip replacement.

Zusammenfassung

• Labrumrisse und FAI sind eng miteinander verbunden und sind Hauptursachen für Hüftschmerzen bei jungen Erwachsenen
• Das Trochanter-major-Schmerzsyndrom umfasst häufig eine Glutealsehnenpathologie, nicht nur eine Bursitis
• Schenkelhals-Stressfrakturen erfordern ein dringendes MRT zur Früherkennung und angemessenen Behandlung
• AVN wird am besten frühzeitig im MRT erkannt, wenn knochenerhaltende Behandlungsoptionen noch verfügbar sind

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