FAI Hip Impingement (Femoro-acetabular Impingement)

FAI Hip Impingement Awareness facts - It is estimated that approximately 15% of the young, adult population have hip impingement, so who do you know that might have it?
Hip impingement causes painful labral tears within the hip socket.
Hip FAI symptoms are misleading to the average medical professional, as FAI hip impingement pain frequently presents as low back pain and interesting only 10% of back pain is ever clinically diagnosed and cured... Which begs the question what percentage is actually caused by hip FAI or hip impingement, as its otherwise known.
The more active you are, the more likely you are to trigger hip impingement symptoms, so busy mums and gym bunnies beware... but at least you're in good company as many premiere league football players have also suffered FAI hip pain.
Hip impingement is diagnosed through x-ray and labral tears are diagnosed through MRI arthograms - but both need to be read by hip consultants specifically trained in FAI hip impingement.
There are 60,000 hip replacements every year in the UK and it now appears that FAI hip impingement, over the years, could be the leading cause of hip osteoarthritis. A silent epidemic.
Hip arthroscopy can reduce the hip impingement and reattach the torn labrum to the hip socket. This surgery can eliminate the pain and disability caused by FAI hip impingement and divert the need for hip replacement in later life.

Also please feel welcome to join in our help and advice forum for support. We have 3 advising FAI expert hip surgeons, 3 PT/physios and a sports medicine doctor as well as the largest international FAI hip impingement forum on the net:

Saturday, 27 June 2009

Hip arthroscopy - what is it?

What is a hip arthroscopy? ...Well hopefully I'll be nicely under so as not to recall, but my understanding is: they lay you on your back and put a padded post between your legs, pull the offending side leg down by 1 cm or so, to dislocate the joint, then they make 4 x 2cm incisions within which they insert a camera to view the miserable, grumpy hip thats been ruining your life for however long and give it a good talking to! ..no sorry, they view the damage and do their best to cut away the ruined parts of the labrum and re-anchor it back to the acetabulum. If though the labrum is so shredded through injury, be it traumatic or repetitive, there is no alternative but to remove it. They call that debrideing.
If you also have FAI pincer type they then get out the black and decker and 'TRIM' (what a illusionary nice word,) away acetabular rim until it recedes enough, that on re-test bone no longer hits bone and the impingement is gone. Or if you have the cam version or bony abnormalities they shave those down, so as to no longer impinge. Stitch you back up and bob's yer uncle! IF ONLY!

Here's how I imagine mine will go, with the scary bits they don't tell you! What is it like to have a hip arthroscopy??? So few people know..
From my point of view, as I steer towards 10th July 2009, I veer all over the place trying to google answers...hence why I am writing this, as no doubt there will be someone a few steps behind me.. you poor thing you!

I know this much, its the stuff that will happen whilst I am still awake that will get me! I will turn up shakily to hospital on the 10th July and beg for a pre-med (else risk bolting out!)

I believe I will then be led to theatre, terrified and intimidated by all the shiny technology and sterile green surgical uniforms. I will feel vulnerable wearing bugger all below my ridiculous bum flashing gown. I will be positioned on the bed, possibly with a hideous post between my legs, which they will later use to dislocate my hip (ok I shouldn't be thinking in this much detail I'm starting to breath too fast again, pass me a paper bag someone!) Then they will hack away for a good 5 mins as they try to get a needle into my hand or arm. I only have one available vein for that, which they never believe and insist of trying more convenient veins. They will persist and roll their eyes at each other before then relenting and using the advised vein in my right arm.

Then I know I will panic and say to my surgeon "Seriously please try keep the labrum, don't remove it, cos I've read the recovery isn't nearly as successful if debrided." Followed by a few more pleas to make me better after 6 years of suffering! Then I'll plead with the anesthetist to pay attention to keeping me alive and reel off that I might have a heart attack, or forget to breath and finally I'll say please make sure I'm ok, cos I really love been a mummy or some ridiculous statement, hopefully followed swiftly by 10, 9 zzzzzzzzzzzzzzzzz
And I prey when I wake (or that I do wake!) that I am not in too much pain, or too freaked out.

I came round from a sedation a few months ago, after a steroid procedure, well I didn't come round exactly, because they couldn't knock me out, as I was so wired! But as I 'came round' I could hear people groaning and really distressed in the recovery room, coming round from anesthetics... scary stuff..
I asked the nurse tending me for any tips re anesthetics and he said 'REALLY TRY to fall asleep with nice thoughts and feelings as you tend to wake in the same way you go to sleep'. I thought great! I'll probably wake screaming, sit bolt upright and try make a dash for it ending up flat on my face forgetting I can't walk after surgery!

hmmm normally I feel better after writing this, like I've off-loaded, but this time I feel all wound up!

BUT the other thing is in the states, you know where its 'really' 2009 as opposed to the UK where technology filters so slow its more 1989, the have ALL SORTS for rehab. They have pressure inflating leg wraps to avoid DVT, here its "can you just wiggle your toes regularly please".
They have you on CPM machine 6 hrs a day or so for passive motion, to keep the joint moving and boots to wear in bed to force your legs straight....here, NOTHING ...and that worries me!
I asked what was my aftercare and was told I'd be given a folder of exercises to keep me REALLY busy and see a physio intensively, twice a week? I call that casual!
SO, the aftercare looks a bit patchy here in jolly old bloody blighty!

Let me tell you this, I don't yet know how bad or good the surgery is, nor the long, long, long rehab, but I can tell you the actual waiting for the op is utter torture. If you're 'slightly' scared of hospitals and all they mean, like me its got to be the worst part, hasn't it??!

Thursday, 25 June 2009

Hip arthroscopy - bring it on!

Well after several days of normal activity I have managed to really bring on my hip pain symptoms in technicolour! So much so it reminded me I have no chance of resuming a normal life/activity level above that of a couch pototoe with any kind of conservative treatment.
...And so much so I actually called my surgeon's secretary to see if she had any surgery cancellations, not so I'm afraid. Apparently due to the enormity of the recovery people rarely cancel, having had to make all sorts of arrangements to function in the weeks post op.

Yesterday I actually cried when carrying my 8 month old chubster daughter (21lbs) I was faced with the stairs to the first floor and it look my a lifetime to climb them carrying Izzy. I live in a 3 story house, the ground floor I see as a useless obstacle now and only houses the laundry room and shower room and the garden room, so I have to climb a flight of stairs just to get into the main part of the house, the the lounge, kitchen, diner, then another flight for the bedrooms and bathrooms. I'm trying to work out which floor to stay on post hip arthroscopy, with crutches, as despite having 3 bathrooms, none are on the middle, living floor! My husband keeps joking about putting a portaloo out on the lounge balcony, but its starting to become appealing! Sometimes I can 'DO" stairs, but on bad hip pain days of which there are increasingly many, I have to drag myself up, last night I tried crawling and that worked quite well, but not whilst carrying a baby I suspect!

I HAVE to give this hip arthroscopy a shot, I've tried every treatment going, but to no avail and owe it to myself, my long suffering hubby and to my toddler and baby. I see 60yr olds more agile than myself! ..and before this, I was super active, its like been a prisoner inside a mutinous body!

Don't get me wrong, I am terrified. I've already listed my anxieties, though 2 new ones are what if the house sets on fire and I can't get the kiddies and myself out on crutches; and (more minor) what if a huge spider runs across the floor and I can't get it and I'm trapped in a room with a monster spider!!

But I see no choice as I stoically plod towards 10th July 2009 with fear buried in the pit of my stomach (sounds bit melodramatic) but its pretty accurate!

No more pain, I can take no more, but I know its a bloody long road ahead as IF my right hip fixes well, then I still need my left hip fixed. Both hips have hip impingement, the right hip more severe impingement than the left hip. I believe the hip degree range should be between 20 and 37 degrees and my right hip is at 50 degrees and my left hip 40 something...I think I blanked out at the second hip measurement explanation.. a bit like in the TV show "SCRUBS" ..I could here my own voice saying "my God BOTH hips, I knew it! ... but OMG, that means TWO operations, SHIT!"
It makes a change though, as usually in these medical appointments with consultant types (prior to hip diagnosis) My 'SCRUBS voice' was saying in my head " You really have noooo idea, do you ...how old are you? ..24? I get it, you've just qualified, oh my God yes, you're only a house officer, Jesus why have they given me a house officer, can't they see I've been in agony for years.... arrhhhhh!"

Saturday, 20 June 2009

Hip arthroscopy FAI - pre op panics

I have scheduled my hip arthroscopy to repair femoral acetabular impingement (FAI) and labral tear, on my right side for Friday 10th July 2009 with the surgeon. I can't believe I have actually done it!

I am almost physically sick with worry and pretending not to be, as most people don't really get what I'm dealing with anyway.. Ironically having spent a week laying on a sun lounger my hips are feeling much better as they do with less activity. The downside is I want them to hurt as normal, as some days I would fearlessly check myself into surgery there and then, due to the pain!
Positive, positive, stay positive!!! arrrhhh...
I can not imagine what state I'll be in by the 8th or 9th of July, I'll probably be on the run with a bottle full of diazapam. Well I'm going to go into Harrogate shopping to:
1. Buy hospital stay over stuff.
2. Walk around enough to bring on all the symptoms and begin limping again.
3. Test how many pre op panic attacks I can bring on for sport!

Breath, breath... calm..

Tuesday, 9 June 2009

FAI and hip labral tear - coming to terms

Met up with a fellow sufferer today, who is lovely and has also been suffering for 5 + yrs before being diagnosed, bless her. She has dysplasia (shallow hips) which seems to be the opposite end of the same spectrum as FAI (deep hips). She was also lucky enough to have the same fab sports physio as myself and so was discovered.

Its definitely good to have someone to talk to who can relate to what seems to be a relatively unique experience. Though the more research I do, the more I suspect this condition is less unique than drastically under diagnosed.

Having recovered from the elation of a diagnosis, I've now hit the reality come down! It is still amazing to know why I am in so much pain and know there is an operation to improve or hopefully cure symptoms. BUT it is truly daunting to know I face two separate hip operations, each requiring a 3 - 6 month recovery. It is going to take a year to be back to what I should be and I'm juggling a baby and preschooler too!
In fact I'm utterly riddled with anxiety about the whole thing:

1 Anesthetic for hip arthroscopy (if I wasn't so scared of anesthetics I would've had a boob job by now!!)
2 Traction to open up hip socket during hip arthroscopy...ewwww
3 If hip socket is worse than anticipated when they open me up, if there is much arthritis as a result of the FAI and labral tear injuries, then there is less chance of the operation working.
4 Hip pain when coming round from hip arthroscopy.
5 How I'm going to cope on crutches for at least 4 weeks.
6 Childcare.
7 What if the hip arthroscopy doesn't work for me (there are 'many' stories of this, though mainly as under qualified surgeons only addresses the labral tear and not the underlying cause, fai)
8 All of the possible complications.
9 Even if the whole process is awful I still have to go back and have 2nd hip fixed!

....But on the other hand I keep seeing adverts for Stanner Stair lifts and thinking hmmmm, when can I book in??
So I have booked for mid July, but asked Professor Schilder's secretary to keep me on a cancellations list as the less time I have to the build up the better, trust me on that one! This is worse than waiting to go into labour!

Ok, no, writing negative lists isn't going to help, so lets try for 9 positives?????

1 My consultant inspires confidence with high success rates etc.
2 Hospital drugs are usually great fun.
3 I'm covered by Bupa so I'll have the luxury of a private room.
4 I should come round from the anesthetic in time to watch loose women!
5 I like school dinner type meals.
6 Been on crutches might elicit some sympathy, whereas now I look normal and people don't understand.
7 I'll not have to change any nappies for at least 4 weeks.
8 I'll get quality time with me!!! (any mum will understand that!)
9 ...and finally...I might 'just' get my life back!

OK I feel a lot better now I've given myself a pep talk! Better dash, nappies to change!

Monday, 8 June 2009

A diagnosis - FAI and hip labral tear is the cause of back pain and hip pain symptoms

Femoral Acetabular Impingement (FAI) Pincer type and Labral Tear.

Meaning hip, back and groin pain caused by hip sockets been too deep, hitting bone on bone when flexed and tearing own hip lining, or in short "OUCH!"

Labral tear and FAI hip impingement - there it is, just like that a diagnosis after 5 years and 6 months of pain and partial disability. Its taken over 20 health professionals to finally arrive at the door of a consultant who is knowledgeable enough to spot what is wrong with me!
THANK YOU lord!  I have FAI hip impingment (pincer type) in both hips and at least one labral tear.

Its has been a long journey to this diagnosis. I have seen EVERYONE from top consultants to chakra alignment spiritualists and spent thousands, probably over £20,000. I have seen doctors, physios, osteopaths, chiropractors (lots), acupuncturists, prolotherapists, spiritualist healers (anything when desperate!) and 6 consultants and for what it was worth may as well have consulted one of the checkout girls from Waitrose! At best I had temporary pain reduction and worst I was mislead down the wrong route with foundation-less diagnosis.

My FAI hip symptoms: (10 of the symptoms below are typical FAI hip pain symptoms, I've starred them for you.)
1. Deep ache mainly in right buttock.*
2. Pain down leg. (common complaint on hip impingement forums)
3. Pain around sacroiliac area and just above.*
4. Groin pain.*
5. Hip pain.*
6. Muscular spasm pain (lots). Mainly in QL and buttocks, multidifidus and also feels locked in thigh with tense TFL and iliotal band.*
7. Pain intermittent, worse on activity.*
8. keeps me awake most nights.*
9. Really hurts to sit.*
10. More recently limits walking to half hour on a good day.*
11. Hip clicks when flexed.*

Had to give up job as journalist/producer and curtail almost all sitting activities, driving (live in a village so hard to stop), cinema, meals over hr long at best, most social activities; and sport...as if, no more horse riding, swimming etc. and can't lift heavy stuff well.

Misleading diagnosis I have had:
in date order.

Sept 03 GP: muscular back pain. Told pain back as hip pain can't refer into back, but back can refer into hip - Here begins a trend!

Oct 03 physio: mild muscular spasm lower back. Told do pelvic floor. Surprised as pelvic floor strong... I thought!

Oct 03 GP: postural problems

Feb 04 GP: suppressed depression, when I said I wasn't depressed!?

March 04 Osteo: bit out of alignment. Do pelvic floor.

April 04: consultant neurologist:
MRI shows nothing bar "very mild dehydration at L5, unremarkable MRI" and so mild myelitis diagnosed.

May 04 chiropractor: (quote) you've got real problems. Told back pain refers into hip and groin hence symptoms! Do pilates.

July 04: Fell pregnant for 1st time, and in the absence of any cure, sort good bed as a cure.
In the space of 6 months bought a firm cheapish mattress, followed by a tempur 20inch, followed by an inflatable £18.99 mattress from Argos that I could alter night by night to help. Sleep on the Argos mattress for 3 and a half years - yes v sexy!
Was for some reason generally better during and shortly after 1st pregnancy, though did resume some tablet taking post pregnancy.

July 04 acupuncture: Low energy.

March 05: 1st baby born.

May 06: Symptoms suddenly much worse (prob from carting weight of 28lb toddler around.)

May 06 GP: Same old, "who knows, but take some of these" approach, (given up with GP now)

May 06 Osteo: questions twisted pelvis, v temp relief.

July 06 Pilate's tutor: back too curved, but Pilate's makes it worse.

Sept 06 muscular skeletal specialist: mild anterior pelvic tilt, glutes not firing, otherwise unremarkable. Told do Pilate's/pelvic floor (yawning now!) Have 2 caudal epidurals, cause more pain. Refers me to pain specialist.

Sept 06 Pain consultant: *Its my discs, so performs discography, but I'm fine.
*So it must be my facet joints, so have steroid injections. *Not sure if have some relief, so think best action is denervation (burn the nerves away) of area. Am in agony for weeks!
*Must be sacroiliac joint, steroid injections. Again didn't seem to work.
*Check for inflammatory illness high ANA's come back, told bad news, now scared, more tests, takes week to finally come back and is negative.
Am so glad will not be dying within next 10 yrs pain pales! Told can't be fixed, told don't know why got pain in groin, told to learn to live with it at pain clinic.

Feb 07 Podiatrist:
Twisted pelvis, lower back too curved refers to Chiro before treatment.

Feb 07 Chiropractor: Twisted pelvis, though eventually thinks back 'too flat'. Stay with this chiro for 18 months as temporarily helps and he keeps trying and trying. Told can't be my hips as hip pain doesn't refer into back. told do pelvic floor.

March 07: consultant muscular skeletal: Told sacroiliac dysfunction need prolotherapy in ligaments. probably 3 sessions of 20 odd injections. But I have 11 sessions over many months = about 250 injections. Means I can now sleep on a flatter bed as all ligaments accidentally support hip area I now think. Told to walk for 2 miles each day, I do for one yr; and do pelvic floor, but PFE doesn't help as doing pelvic floor exercises always hurt.

Jan 08: fall pregnant again, but this time at around 26 weeks I lose ability to walk for more than 10 mins, told symphasis pubis. I accept that and start seeing lady chiro

July 08: Lady chiro: says pubic symphasis and pelvic girdle pain been the problem all along even though started before ever pregnant. Does a lot work on hip flexors, TFL and illiotal band, but insists, as all others, can't be hip problem. Says twisted pelvis, do pelvic floor.

Oct 08: Have baby and symptoms worsen considerably. Now struggle to shuffle round 3 or 4 isles in Waitrose. Can't sit again. Leg gives way whilst shopping. Desperate.

Nov 08 Obs Physio: post baby. Says hips stiff, recommends Pilate's and pelvic floor. I point out everyone says that and it hurts to do PF exercises, I ask for internal check rather than blind diagnosis of pelvic floor. To her surprise and not mine she finds pelvic floor in spasm and abs pinged back, says must be compensation for back. Refers me to pain clinic.

Dec 08 new Chiro: the best: Says maigne syndrome and twisted pelvis, do pelvic floor arrrrgggghhh! Says back too flat and told legs uneven length due to twisted pelvis. I ask for standing xray and I do have 8mm discrepancy, but is actual, not pelvis related. Had been told many times previously about leg length, hence my insistence to clear it up.

Jan 09 Another post baby physio: internal work to relax pelvic floor, obturator internus real problem. Given hip strengthening exercises..

Jan 09 new physio: (for external stuff) Does trigger point work, gives relief of muscular pain, starts to question hips and triggers reoccurring. Start getting pain both sides now, identical.

[march 09 my baby daughter has leg length discrepancy, I google and decide she qualifies as hip dysplasia, I take her to my chiropractor for confirmation as doc appointment a week away. They say sacroiliac/pelvis twisted no dysplasia. As does Doc, but this time I insist on scan! Scan confirms hip dysplasia.. she is treated with 12 wks in pavlik harness and it works, just... but I am now furious at how it was nearly missed and the subsequent consequences; and doubt both doc and chiro have a clue!]

April 09 physio: writes to my new Doc (one that listens) asking for her to refer me to hip specialist and to MRI whole area. Physio suspects labral tear, as despite working on me for a few months I do not improve (at last someone picking up on my symptoms). Thank you Louise Grant at Cookridge Hall, Leeds, Physiocure. She also looks further into labral tear/hip problems and literally finds that 5 more of her patients with vague, changing unrelenting pain have this problem. She is proved right within subsequent weeks as these patients undergo MRA scans. I later wonder if there is a silent epidemic! (Adding this 2 years on and Louisa Grant at Physiocure has now found over 100 patients with FAI, within a small suburb, within the city of Leeds... it is a silent epidemic and I wonder how many people are out there misdiagnosed and suffering like I was.)

April 09 specialist pain consultant: (this NHS appointment arrives 2 days before my private hip diagnosis) : Told not sure of my diagnosis, but that it CAN'T be a hip problem as I'm too flexible. So it must be my sacroiliac joint, even though when pushed he told me I don't test positive for sacroilliac problems, however this must be the problem as he can find nothing else?? To live with condition and medicate with stronger stuff, anesthetic patches or try coccyx steroid injection for sitting disability.

April 09 Consultant private hip specialist in labral tears: Thinks most symptoms match labral tear symptoms. Says xray completely normal, but MRA shows labral tear (MRA not actually painful to have, just uncomfortable, I'd been dreading it so much I almost didn't go ahead with it!). I don't remember a tearing incident, but he says many don't. I'm grateful at last for a diagnosis.

May 09: I raid google 'labral tear' sites and look for top top top specialists as I learn 3 things:

1. Get THE best specialist you can - and there's only a small handful in the UK.
2. Find the cause of tear - else you'll likely re-tear and need revision surgery.
3. Rehab, rehab, rehab

I seek out the best consultant in my area. 
From my X-ray alone he sees I have Femoral Acetabular Impingement (pincer type)  Hips should be around late 20's/30 degrees, (average presenting patient at 37 degrees) but my bad hip is at 50+ degrees, good one at 43 degrees and of course one labral tear on tested side,  a suspected tear on other.  Thank you lord, I am home!

...But I am not am I?! I have all this hip arthroscopy surgery ahead of me, so this is where I am at and how I got here.. Its an end in one sense, as I have a diagnosis at last, but here begins the cure (I HOPE!) and I will be blogging as I juggle life, my kids, crutches in a 3 story house, my frustrated, but ever patient husband and these scary ops and believe me I'm scared!
So feel free to follow this recovery blog and I hope in some way I can help, because I know out there are many more people suffering like I am with FAI hip impingement, that don't even have their diagnosis yet it!

Updated from 2013:
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