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, 1 October 2009

Advise please??? Canada FAI experts?

Someone has approached me for advice. They NEED a top FAI specialist, has anyone got a name for FAI/Labral tear hip specialist in Calgary or close, Canada. I'm pretty sure have heard of one there in the past but can't remember?

PS Been suffering all night with MUCH discomfort, I'm almost sure from my hamstring though and it feels swollen. Good to ID the pain though!

Be very grateful for any Canada recommendations or Canada people connections.

42 comments:

  1. I am still looking fr one in Canada .. but the closest I found was Washington.

    Philip R Downer MD
    First Hill Orthopedic Clinic
    2409 N 45th St
    Seattle, WA 98103
    (206) 633-8100


    Keith A Mayo MD
    Orthopaedic Center:
    1112 6th Ave # 300
    Tacoma, WA 98405
    (253) 272-2224

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  2. My hamstring was what really caused most of my pain for nearly a month. You will have to stretch that one religiously to get it to losen up. The best stretch so far that helps me is laying on my belly, pillow underneath, pulling my pelvis inward while concentrating on my spine and then doing a kegel. Once your in this position, lift your leg off of the bed/floor. Once you get the hang of it you add the arm that is on the same side at the same time.
    Takes some concentration but if you visualize yourself stretching the hamstring you can pinpoint the place you need to lift to.
    I have started to link those on my blog as well .. check the left hand side under links.

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  3. Found one ...
    Dr. Nick Mohtadi, an orthopedic surgeon at the University of Calgary who has performed about 80 of the operations.

    "So far, only a few doctors in Canada are performing the operation, which is not recognized by provincial health insurance programs. Some jurisdictions lack a fee code, which means doctors need to get special permission every time they do it"

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  4. Thanks Erin , you're a star! Vanessa was saying some people also travel to Dr Phillipon in New York. And Jess and Vanessa said the the yahoo Fai group is good to join for advice too ...So Lyndsey theres a fair few links that I hope help. Feel free to email again if you want any further help from this mad collection of hippy bloggers!

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  5. Hi Louisa!!! Not sure I have any advice for you! They can keep coming south to Colorado and see Philippon...he is the best in the world!

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  6. I've started to worry about my hamstrings. Glad to see Erin's tip, but other than that, what can you do to stretch them while recovering? I'm wondering this early in recovery if I'll even be able to do that one. Have a PT appt tomorrow, guess I'll ask. What is the hamstring problem you're having? I've always had a weird snapping a little above the backside of my knee.
    --Vanessa

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  7. I feel that but it also hurts at the insertion point to my hip. It was so tight I couldn't bend the leg to walk. There is another one where you lay down on your back, cross the leg (post-op leg) over the other side of your body and try to let it rest on the floor (opposite side). Like when you try to pop your back and cross the leg over your belly. You can start pulling the leg up closer towards the chest when it losens a little bit.
    I actually am not sure what's going on with mine. You can see my update for more details.

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  8. Just remembered about Kelly, who is in Canada...she had a hip scope a while ago...this is her news article http://www.cbc.ca/health/story/2007/01/15/hip-arthroscopy.html

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  9. I know from MRI scan that my hamstrings have inflammation and eodema, on ultra sound it didn't look severe, but was still quite apparent and in both hammys. They've been injected with steroid which I'm hoping will have some effect (normally takes me 3 weeks for steroids to work)
    My hammy symptoms are pain from butt to calf, main pain on sitting or laying on bottom and pressing on hammy. I think my sciatic nerve runs a bit to close and either swelling or compression can irritate it. I think before the op it caused me never to straighten this leg when standing, always bent at the knee for comfort. Worse on right with worse hip.

    I'm having trigger point massage on it as of yesterday, very effective. I am sure I re-injured it lifting Izzy 2 days ago, I think that I have had these 2 things going on 6 yrs together and that my dodgy hips knocked my glutes out and then the hammys took over and its bursitis due to chronic over or misuse.

    I keep coming across others the same and my specialist says the hip can have this knock on effect.
    Vanessa for you I'd put up with it at the mo and though it doesn't look big from insertion points, you don't want to do any manovre that might ruin your hip work. Ask your physio if there's a 'gentle' exercise for hammys. Then go for it when you've a few weeks between you and you hip Arthroscopy! Keep in mind resting is one of the most effective tools in calming hammys and you're doing that post op.
    My physio warned me be careful of the bridge exercise re hammys, though it never hurt and I did it over and over. Stairs aren't great either!
    Noell, Jess again thanks for your help. I'll let Lyndsey know of all your replies.

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  10. Lyndsey said thanks you all!

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  11. Thanks so much for all your help everyone.

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  12. Dr. Ayeni at McMaster Hospital in Hamilton, Ontario. I'm day 19 post-op from surgery for FAI, labral tear and a debridement... I've been back to work since day 9-10 post-op... No crutches before the 1st week was over... and I wore the Bledsoe-Philippon hip brace for 2 weeks. I've been going to PT and have full range-of-motion now. I have little to no discomfort now...

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  13. I have a hip labrum tear diagnosed by MRI arthrogram. Am waiting to see specialist in Vancouver, Dr. Mike Gilbart - am told it could take up to 3 years - yikes! Anyone know anything about him? Am wondering about provincial x-border rules. I understand Dr. Mohtadi deals with this diagnosis. How long does it take to get into him? Any other suggestions? I really don't want to wait 3 years for a consult! Jo

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  14. I am in the same boat as "Anonymous" above. I also have a hip labrum tear diagnosed by MRI anthrogram. I live in Abbotsford, and I too am waiting to see Dr. Mike Gilbart. He does see patients privately with no wait time, but I don't know the cost of the surgery yet. I have been looking into other options and would love to share information with you, as it may help us both to get in somewhere faster. Post back on this site if you are interested.

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  15. Hi there in Abbotsford - Here's what I ended up doing. You can see Dr. Gilbart privately at the Specialist Referral Centre (www.specialistclinic.ca) in Vancouver for the consult ($500). If you have had all your diagnostic tests done then you'll get in in 1-2 wks. He sent me for some different x-ray views first. (I'd already had the MR arthrogram done privately). Then you can go back to his public practice for the surgery, which is currently about a 4 month wait or so. The long wait to see him publicly is to get the consult. The cost of the surgery privately (generally in 2-4 wks) is around $10,000. So, to me, the $500 bucks was well spent! Dr. Gilbart has no problem with patients flipping between his private and public practices. Good luck! Jo

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  16. Thanks Jo! That is exactly the route that I have been proceding with. I have all my testing done and am just waiting on an appt time with Dr. Gilbart privatley. I didn't realize though thtat you could jump back to the public system at that point, so that is great news and will possible save me from looking at other provinces etc. So are you waiting for your surgery now? TK

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  17. Hi TK: You'll be glad to get the consult and get on with it! There's a 4 month wait for surgery. I don't have a date but his office sounds confident that it will be mid-April. I'd love to keep in touch with you and compare notes! You've probably seen him by now... how did it go? Jo

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  18. TK: There's a web forum for hip arthroscopy and labral tears that I participate in - mostly Americans but lots of good info and learning from each others experiences. http://community.active.com/community/sports/running/injuries
    Maybe I'll see you on that site? Jo

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  19. Thanks for the link! I started reading through and found one of your posts. I did have my appointment and am booked in for surgery most likely in May. I really liked Dr. Gilbart and he spend a lot of time answering all my questions. I don't have a ton of hip pain, although it seems to be getting worse. I was in a car accident and broke my femur, so I also have a bone contusion in my knee which is still acting up. So it is hard for me to know what is from the knee and what problems are caused by the labral tear. I love activity though and now that I am mostly better I am eager to do whatever it takes to get back to 'normal', so I think I will go ahead with surgery, especially if I am still having troubles in May. Thanks a lot for your help! It saved me a lot of time and energy. I will check out the link as well. How did you injure yourself and what are your symptoms? TK

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  20. That's good news, TK! I am so glad it's all working out... wonder what happens to patients who aren't so good at researching and advocating for themselves though. My tear is "degenerative", no one single incident caused it. I've had on again/off again hip/SIJ/low back pain for years (I've been an avid triathlete since 1983), and I haven't been able to balance well on my left leg for a long time. I've gone through periods where it clicks and clunks. Then since Oct 2009, after doing an Ironman, I've never been able to get back to running or cycling comfortably. I don't have much pain if I am not very active, occasional twinges and aches, but I don't want to be really limited in my activity for the rest of my life! I finally started doing my own research (I am a physio, but not an orthopedic/sports specialist) and decided I probably had a labral tear, went to my dear GP, told her what test I needed (MRA), paid privately for that to avoid 8 month wait, got the diagnosis confirmed. A local orthopod recommended Dr. Gilbart. Given the wait was going to be forever for the consult, I started looking at other options (provinces/U.S.), etc. Somewhere in my internet research I discovered Dr. Gilbart worked at Cambie as well! I was elated to say the least! He's not sure till he gets in there just how much repair work he will have to do, so the post-op period could be relatively easy or pretty long and arduous. Some of the U.S. docs have very detailed post-op rehab protocols on their websites, which Dr. Gilbart doesn't - so I wonder whether he gives more detail to you after the surgery or leaves it up to the physio you choose. My concern with that is that most physios won't have seen any/many of us! So if he doesn't have his own specific protocol I may ask if he recommends someone elses protocol (eg. Dr. Brian Kelly). There are lots of protocols out there, and they vary considerably! I will keep posting on the active.com web forum through my surgery and post-op, which is supposed to be in April, so about a month ahead of you I imagine. Good luck TK, and hope to see you on the forum! Jo

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  21. Dr Ayeni - McMaster university Hamilton ON. If you have FAI and/or labrum tears you must see him. I had to travel from Newfoundland to Hamilton for my proceedure - would do it a hundred times again to get the results Dr. Ayeni gave me. I was almost 4 years in pain ...could not get a diagnosis here in NL. Was eventually suspected for labrum tear and refered to Dr. Ayeni in Hamilton. Long story short I saw Dr. A and his team in August 10 - was diagnosed with impingement and tear - given surgery appointment in Feb 11. The Dr. and his staff were amazing - the entire hospital was incredible with my care and treatment. The very next day after surgery I knew the pain was gone ( was sore from proceedure of course). Every day since has been a constant improvement..... I am pain free and have my Life back. It has only been 8 weeks and I feel awesome. If you can see this Dr. do what you must to do so. Take my word for it you won't be dissappointed. Good luck

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  22. I get my hip arthroscopy in a few days, April 15, by Dr. Gilbart in Vancouver. Yikes! Am getting nervous! I'm encourage and happy for you that it has gone so well! Will post after my surgery to let you know how it goes. Jo

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  23. Had my arthroscopy with Dr. Gilbart at UBC 4 days ago and so far so good! Just had a labral repair with anchors (no FAI)and was doing really well, down to just tylenol xtra str and advil for pain. But the ride home yesterday (we took 9-1/2 hrs to do a 5-1/2 hr drive with several breaks) did me in and am back on the dilaudid last night/today. Having said that, it's not as much pain as I had anticipated pre-op. Have started doing a few exercises, riding an ex. bike, icing, CPM, short outdoor walks (am only feather weight bearing with crutches). I feel like this is going to work and once over the surgery I'll be fine! Jo

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  24. Had my 5 wk post-op visit with Dr. Gilbart - he was pleased with my recovery. Had a few ups and downs along the way, learning what my limits are. But am getting smarter about following his guidelines "let pain be your guide" seems to be the mantra! And take it slow with the progression of exercises and activities. Am mostly not using crutches around the house now (was feather wt. bearing for 4 wks), but often 1 or 2 when I go out if much walking is involved, otherwise I just get achy. He says the symptoms now are mostly the result of the area still being easily irritated due to the traction during surgery. So I am feeling very positive about the long term recovery picture and glad I had the surgery. Will see him again in a couple months.
    Jo

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  25. Hi Jo:

    Thanks for the updates. I had my surgery yesterday. He smoothed out my tear, as it was quite small, but there was a lot of damaged cartilage and inflammation from my car accident that he also tried to smooth out. He is hoping that it gives me some relief. I feel good so far, and am happy to have it done, although not too sure what the results will be like, as I think there are several issues around my hip/knee to contend with because of the femur break. Will continue to look for you here :)

    TK

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  26. Hey, good to hear from you TK! That's unfortunate about the damaged cartilage...sure hope you get some improvement! Are you toe-touch/feather wt bearing for 4 wks? Or is he letting you do more sooner? Don't be surprised if you have lots of ups and downs during the recovery...I hope you can avoid the "downs" but apparently this is common. The traction during surgery seems to be the cause. I didn't have much problem initially, but have had several episodes of deep aching in my butt and low back, and my SI joint "catching". He wasn't at all surprised, which was reassuring, and said it will go away. I have days where I feel fabulous and think I could do anything I want (but don't)...and then days where I can't get comfortable anywhere. The trend, however, is I am definitely getting better week by week. Let me know how you make out! Jo

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  27. Hi Jo:

    I just had my 6 wk followup and am doing well. I can go back to all activity except running, which I can not do anyway. I certainly am up and down, but overall feel better than before surgery. My last major problem is sharp pain under my knee cap, which make my knee give way when going down the stairs, and doesn't allow me to activate my quad in the same way, so it is still atrophied a bit. But I am happy to be back hiking and biking! How are you doing?

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  28. Hi TK: I'm so happy you are having a great recovery! All worthwhile then! Me, not so much,yet. Saw Dr. G. July 28, 3-1/2 mo. post-op, and concerned that I am getting a lot of aching deep in my hip. Can't do very much in the way of exercise or walking without flaring it up. He was surprised, because at 5 weeks I was on track for a good recovery. He says it's inflamed and has put in on Celebrex and told me to take it easy. It does seem some improved, but not brilliant yet. If not better in September he'll give me a cortisone shot to kickstart this thing into settling down. He assures me it will get better as the surgery itself was really straightforward - no impingement no arthritis. So I am confident it will be great eventually. Just frustrating in the meantime! Are you a Canucks fan? Same surgery Ryan Kesler just had! (I posted yesterday, but it doesn't seem to show up today, so am reposting...) Happy further healing! Jo

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    1. Jo
      Just wondering how your recovery is going. I have a labral repair with FIA 6 weeks ago with Dr. G, and am axiously looking for some success stories, as I had a painful pinching sensation in my groin last week and am still very tender in my groin area.

      Andrew

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  29. Thanks to Louisa for pointing me to this page! It is so strange to see other people finally talking about Canada for surgeries! :)

    For me, I FINALLY got properly diagnosed in FAI in late October through Dr. Masri who took one look at my films and said "You need to go see Dr. Gilbart". Dr. Masri put in the request to have my MRI-Arthrograms done in advance in prep for my appointment (I tell you, Dr. Masri is a complete genius, arrogant, but a genius).

    I got my first MRI-A in early November on my left hip (always ask them to send the requisition EVERYWHERE!) and had the right scheduled the week after, but unfortunately I had to travel back home to deal with my dad passing away. While I was there, I got a call from Dr. Gilbart's office to book my appointment for the 16th of December and got my MRI-A for my right hip around that same time.

    Then, and I don't know how things worked so well, but I got a call a week or two after and got my surgery scheduled for January 17th. Took all of 3 - 4 weeks from my first appointment and I had surgery done.

    Unfortunately it's now been 8 months and the surgery has done me no good. If anything, it's made things a bit worse off. My labrum was completely torn and according to the follow up X-rays I've still got a significant amount of impingement throughout my left hip.

    So I've been spending the last 8 months trying to chase the solution. I went back to see Dr. Masri who told me that he wasn't willing to do a THR on me, but instead told me that he wanted me to go see Dr. Ackermann in Kamloops... a 4 hour drive from where I live... as he's the only surgeron who does the OPEN procedure in all of BC. So I've gone to see him for my first visit, which was on the 12th of September, but I have to go back in November to have another MRI-A on my left now done by him, by his hospital and also do an X-ray exam. He's confirmed he'll be able to help me, but by what... I don't yet know.

    I'd love to hear from anyone else. As far as surgery times, be as flexible as you can. And if you're young (I'm in my 30's) that will certainly help, it seems they're more flexible and willing to work with speeding things up. Maybe I just got lucky with my surgery times, who knows. But I'm waiting again, hopefully it won't be terribly long after my November appointment until I get my left hip all fixed... although, ugh, then there's the right to deal with too!

    But one thing at a time. I'm happy for anyone to get in touch with me, send a message to andsoitgoes then add the numbers 42 after that, and it's at gmail :) Or find me on the Hip Impingement group on Facebook :)

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    1. Hi Nick! my name is Elizabeth I'm 22 years old and I need to have the same surgery you have had. I've been doing a lot of research and have come across many cases like yours where after having surgery with Dr. Gilbart, patients have found either no relief or that their pain is worse. I was wondering if you'd be kind enough to share your story with me. My personal email is e.rostamabadi@hotmail.com. I hope you don't feel obligated although I have to say I'd be overjoyed if you did choose to share your story with me.

      sending love and positive thoughts and hoping to hear from you

      -E

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  30. Hi Nick,
    was you surgery arthroscopic? I had a failed scope surgery for FAI and it backfired so bad I'm pretty much disabled at the moment...and I'm 28. I've had a few failed surgeries now, so like you, I wanted a THR. Of course, as soon as they hear my age it's an absolute no. I've been told to try to get into an open-hip surgeon as well because open-hip surgery is still the gold standard and allows an accurate assessment of the hip...MRI-A lie, as I know all too well :) It may not help you but Dr. Carlo Panaro in Edmonton, Alberta does open-hip surgeries and specializes in hip problems in us younger folks. Good luck and hang tight!
    Pam (also in the Hip Impingement FB group)

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  31. Some of you may be interested in this

    http://findarticles.com/p/articles/mi_7346/is_6_16/ai_n55422927/

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  32. Not sure if anyone is still checking out this tread, I am booked for FAI surgery with Dr. Panaro this Feb/Mar. Can't say I am super excited. I am looking to chat with someone my age (33) who has had this surgery with Dr. Panaro. We are starting with the left and then the right maybe next year.

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    1. Hi Lee, yes but come to this page
      https://www.facebook.com/groups/BestHipSurgeonsReviews/

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    2. HI Lee, I am curious as to how your surgery went with Dr. Panaro?? I too am in Edmonton, and have recently been referred to him.

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    3. Wow, can't believe it has been a year since I last posted or check this blog. I am booked for another surgery in Feb. for my right hip. Had my left hip done last Feb. I hiked Chilkoot Pass and surfed in the surfer. My left hip, once weak, is now perfectly stable and strong - very minimal pain, if I forget to stretch every day. The surgery is major and manageable. It was more difficult on my partner I think then me (e.g,. physio appts). I am going to check out this facebook page . . . How are you Carmina?

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    4. Hi Carmina and Lee... I am not sure if you will check this since it is almost 2 years old but I have been referred to Panaro as well. Have anteverted hips and torn labrum. Pain for almost 2 years now getting progressively worse. Would like to know more about your surgery(ies) and how they went?

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    5. Hi Carmina and Lee... I am not sure if you will check this since it is almost 2 years old but I have been referred to Panaro as well. Have anteverted hips and torn labrum. Pain for almost 2 years now getting progressively worse. Would like to know more about your surgery(ies) and how they went?

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  33. Anyone had this surgery done in Ontario and/or with Dr. Whelan in Toronto?

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  34. I'm also considering surgery for FAI & a labral tear with Dr.Whelan in Toronto. I'd love to hear from anyone who's had a successful surgery with him and get more information regarding the procedure and rehab. Any idea how he compares to Dr. Ayeni in Hamilton (# of arthroscopic surgeries for FAI performed per year, etc.) ?

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    1. I'm also waiting for my first appointment with Dr. Whelan...the waiting time is six months to see him and six to eight months for surgery. Anyone have surgery done by him?

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