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:

Thursday, 27 August 2009

hip arthroscopy rehab 6wks, 6 days.

Saw surgeon yesterday for my second appointment post hip arthroscopy for FAI (pincer type) and labral detachment. I'd say it went well. He went out of his way to ease my fears and to help me understand the things I didn't understand.

I'll explain the questions I asked and the answers I heard, by that I mean I am not quoting by any stretch, its my understanding of his replies..which aren't always super clear!

Q: I have the same pain as before the hip arthroscopy, but worse, why?
A: You had chronic, misdiagnosed, pain for 6 yrs, My, surgeon's, personal research on patients over the years show that if the patient had a very bad pain and lifestyle score before surgery, it takes longer to get better. Someone in less pain, or for a shorter period, usually improves immediately from operation, be doing well at 2 months, to max improvement at 6 months. However someone like me will struggle to attain good results by 2 months and in fact may get worse by 2 months, but USUALLY the 2 groups of people meet at 6 months, at the same level of improvement.

Q: How often do they 'not' get better if they haven't got arthritis or another deformity.
A: Never happened.

Q: What grade of arthritis do I have now.
A: None, you just had the wave sign, the beginning of arthritis and that's fixed now.

Q: Where there any complications during surgery?
A: Absolutely non, your surgery went just as I hoped, I was very happy with the result.

Q: What complications could cause residual pain for me?
A: Possibly inflammation within the hip capsule

Surgeon then asked my when my pain level started to increase and I said when I came off crutches and apparently this isn't too unusual, I think I am to pace myself. He did say though, to use ice and anti inflamatries and to stay active, whilst pacing myself. Inactivity is bad.

He also asked about my fall. I demonstrated (Aly McBeal moment), I think we concluded it may not be that significant, but that a further MRA at this stage post op would not be clear enough to identify any problems. I agreed not wanting to further aggravate my hip at this stage.

Q: I asked about my psoas possibly causing further impingement?
A: He concluded that as it had discontinued snapping over 50 times a day and was now only snapping once or twice it was unlikely to still be a problem.. He went on further to explain psoas impingement on a pincer impingement, but I broke the golden rule of journalism and starting thinking about the next question (not that this is an interview, just old habits die hard!), I was anxious to get through all the questions and having concluded it was no longer an issue, I wanted to line up my next Q.

Q: What is the possibility I could have retroversion, or some such thing to require further open surgery?
A: I HEARD: not a problem for you, everyone that has pincer has some level of retroversion, then he waved his arms in the air demonstration imaginary hip sockets at different angles and I think I heard blah blah retroversion blah..pincer; he was explaining but my thoughts had stalled at everyone with pincer has some level of retroversion? ...and I was thinking but it does cause some people to have bigger ops, does he just mean just I won't need a further op? ..And blah blah blah?

Q: I asked about the pointy bits in my pelvis that stick out on x-ray.
A: I HEARD Blah blah, everyone like you has them, a 'blah angle'..I was just still amazed he understood my really bad diagram I drew to demonstrate my question!

Q: Does it take a while for your muscles and tendons to catch up?
A: Yes.

Q: Can I have an x-ray to show all the impingement has gone?
A: No its not necessary, the way I work is that I test and retest your impingement in surgery until its perfect, with the angles on x-ray you might not even see the improvement. (Still really wanted an x-ray, but I wanted a steroid more and that was my next question and I didn't fancy my chances of getting both!)

Q: My left hip, my good hip is really going downhill, can I have a steroid, because I need it to support my other hip? That's why couldn't go onto one crutch as one crutch is held in the opposite arm and has you lean a little on the opposite leg, causing further pain in that hip for me.
A: Yes no problem, now?

He then tested my mechanics and was quite happy I could get my leg close up to my chest. I described the sitting pain I get that travels down my leg, a lot into my calf and occasionally toes (I blame piriformis and then it pressing on sciatic nerve, though feels like pain on sit bone)
The surgeon pressed a few spots around my sit bone and queried hamstring tendinitis where the tendon meets the bone. Additional pain source, compensatory of my hip I think. He said we could follow up that query after my holiday with an MRI (Oh NO!!!) of some sort.

I went off for lunch in a trendy bar in Shipley (ringing bupa to quickly sort out the finance and authorization) and then came back for my steroid injection.
The worst part,back in hospital, was getting locked in the loo, prior to steroid injection!
I fiddled with the door a while, was a bit stiff and in the end thought wasn't locked, so thought I better pee fast! Then, when I went to open the door it was LOCKED and would not unlock (I can't begin to tell you how claustrophobic I am, hence MRI phobia!) I hammered on the door yelling 'Help I'm locked in the loo!!' Some weird calm descended and I thought 'Yes I knew this would happen one day! Confirming my paranoia! 'I've been rehearsing for it ALL my life, stay calm'
The voices on the other side of the door said "where's the lock pointing?" I thought, breath...calm.. "nine O'clock." I said urgently, thinking wow I sound like I know what I'm talking about, like Keiffer Sutherland in a crisis, in 24!
"Okay, the voice came back, turn it the other way" I thought I've gotta get this right "which way?" I shouted back.. "Err anti clockwise or clockwise?" then voice came back again "anti clockwise." I turned it, as hard as I could, it jammed for a few moments then released and flew of of the door, straight into my nurse saviors!
"That's never happened before!" they said. I retorted suspiciously, with narrowing eyes "And yet you knew what to tell me to do!?" The girl said 'I was just guessing and hoping!' ..I nearly threw up, but opted for laughing!

By comparison the steroid injection was a breeze! No, truly I was still a big scaredy cat,because I just am, but it only was as bad as a blood test, just more intimidating. Don't ever fear a hip injection, the nerves are too dull, its not like drilling teeth, there are no sudden shocks, at worst a dull ache that you can't quite pinpoint. I've had three now, all the same.

The only thing that has freaked me out was it gave me no pain relief I think! I still had the pain down my leg part, which shocked me and made me also think more seriously about what he was saying about hamstring tendinitis ontop of FAI and labral detachment. I think I may have a pain of 2 parts, hip/groin/sacro type pain, but the bit that travels down my leg maybe part muscular, perhaps in its way trying to protect the hip? Sounds a nice, neat theory, time will tell..

A long road still to travel I think, still chasing the end of that rainbow!


  1. Hiya,

    Lol to being locked in the loo!!

    It sounds as if the appointment went pretty well and that you are where he expects you to be which is good. It is also good that he expects you to have made great improvements by 6 months. I hope you feel better for seeing him.
    I think you will find the steroid will take a few days to work (I saw improvements after 7 but full benefits after 10)Unless you have a LA as well I don't think it will have an instant effect.
    I hope you enjoy your holiday and can take his advice about doing some activity but not too much.
    Can't wait for your 6 month post when you look back and think it has all been worthwhile!
    Really pleased he is happy,
    Kate x

  2. I was going to answer the same thing, when I had my injection it took a few days to kick in but once it did it lasted for 2 weeks.
    Your coverage of the questions was great. It's nice to see their perspective on your recovery. I see Dr. Erickson tomorrow and he hasn't done any tests at all, just watches me walk. I need to also make sure everything is going as it should and that there is nothing missing from my range of motion.
    You are almost 1/3 of the way there already so stay strong and time will fly by ! Keep blogging and checking your timelines when he asks questions like "when did your pain start ?", "did anything happen, like an accident to cause this pain recently?". I found going to my blog and keeping track helps me better inform my own doctor of when I feel pain and exactly where.
    Have a great time on your holiday !!!

  3. Hi this sounds like you have more than a "hip" problem The tendinitis and piriformis are probably related to how you use your hip and pelvis and addressing this will probably save you and BUPA a lot of time and money
    Hallamshire Physiotherapy

  4. Thanks Kate, I think he did put in an anesthetic, (least I heard him say marcaine)so not sure what to think.. I'll see, the last steroid did make a difference in my other hip.. trying not to worry and jot down an account for him to make something of it. Strange though, I wasn't in pain at the time of the injection, though thought I felt calf pain as steroid going in, then it didn't leave but frankly that doesn't make sense to me.

    Erin. Thanks it actually help me remember writing down the Q & A 's and I have something to go back to.

    Hallamshire Physio... This surgery was actually a last resort for me after years of failed physio.. in fairness it was my lasted physio to even spot the problem was hip! The other physios/oesteo's/chiros over the 6 years clueless and I nearly always gave then 3 - months each to improve or fix. I got temporary relief at times, but they all missed my hip.
    I'd challenge you to improve it if I thought it possible. Then again I probably couldn't do a regular drive to Sheffield.
    Check out the v first blog, you'll see I took the complimentary road to get here, and it was jolly expensive! Thanks though.

  5. If the physio/chiros/osteopath still couldn't detect you had a hip problem after 6 years I am not surprised they failed to help you. I hope you improve within the six months as suggested. If you continue to experience pain find a physiotherapist who specialises in movement analysis and is recommended.

  6. Thank you very much for that.. I appreciate you efforts.

  7. Im a 16 year old and had hip arthroscopy for impingement on both hips. The one i had surgery on first is still hurting me somewhat worse than it was at times. I really think its common and will go away.

  8. Hi Sorry didn't see this, can you come to the front of the blog, most up to date and will try help if you give me more info. I only saw this comment by chance. Otherwise I really hope you're getting better now.

  9. I love the "blah blah blah" representation of your conversation. This is exactly what it's like talking to all the docs and trying to process while they continue on. :)