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:

Sunday, 25 October 2009

hip arthroscopy recovery 15wks, 2 days.. More answers, so more questions!!

My hip arthroscopy certainly has its ups and downs, but in general I am not where I hoped I would be.
However this week some pennies have dropped and I am starting to see my problem more clearly.

I notice when in the pool, when I raise my right, operated leg to the rear, to do glute exercises, this makes my left (pre op) hip, click. Because of the nature of the pelvis been as one unit. I believe this tilts my pelvis backwards with the leg, into extreme lordosis, causing my acetabulum to hit my femur on my left, static hip. Though a different action, it recreates the contact made if I simply flex up that static leg to 90 degrees in front of me. The same bone collision is happening.

Also I have made an effort to sit properly, to avoid knackering my hamstrings at my sit bone junction. In doing so, I cause pelvis to tilt forward (increasing lordosis to normal extent), which again causes my acetabulum to crash into my femur on my left pre op side - OUCH. If I sit incorrectly, by flattening my back, it stops the bones crashing but then it really hurts my hammys and sit bones. I think, no I'm almost sure, avoiding correct posture sitting, to avoid the bone collision, has caused the damage to my hamstrings. I have unwittingly been doing it for years!

However as an experiment I have been sitting correctly for a week, which increased my sitting tolerance and reduced sit bone pain considerably, but as my theory expected now I have severe pain in my pre op hip from the bones colliding and probably catching and inflamming the labrum!!

My concern is the constant grumbling of my right hip, my post op hip and I wonder if there is enough clearance betweeen the bones now after my hip scope?
Which brought me back around to retroverted acetabulum, which causes pincer FAI. I know I have retroverted acetabulum, it was kind of loosely mentioned at a stage when I hadn't a clue what was what. I confirmed I had it on my AP X-ray and it showed inside the pelvis walls the 2 tale tale signs of the jutting in triangle protrusions into the should be empty space and the figure 8 sign over hip.
It all leaves me with a couple of questions which I need to ask my surgeon, but would also welcome any anecdotal experience..
Can a retroverted acetabulum be corrected by hip arthroscopy only? Can all cases be fixed that way? When is an open procedure necessary? How do I know if I need open surgery?

Its reassuring because it all makes sense and I can even create and remove pain by altering my posture temporarily. But I'm foxed by my rubbish recovery on my right hip and thats what is making me question retrovesion of hips causing FAI as i believe it is traditionally treated by repositioning the acetabulam through open surgery as opposed to rim trimming acetabulum through hip scope. So I question if enough has been done?

For anyone suffering persistant bum pain sitting, try sitting with your back more arched, which has your sit less on your tail bone and more on the flats of you femur, does that takeway bum pain and create groin pain? then switch back does that ease off the groin pain and bring on the bum pain? Experiment...its quite interesting!

8 comments:

  1. Thats a tough one!

    I would have thought that a pelvic osteotomy (PAO) of some sort would be needed to correct that, as its the socket that is wrongly positioned, but I don't really know much about it-sounds feasible tho,
    Kate x

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  2. Louisa,
    Sorry to hear you're having troubles!! Maybe it's just still healing and needs a bit more time. I asked my PT last week how long post op pain usually lasts and she said some people have a lot of pain up to 3 months out or more.

    Do you get to see your surgeon soon? Are you planning surgery on the other side? Do you have motorized shopping carts in the UK? haha!!

    Take care girl,
    Vanessa:)

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  3. Thanks Kate, I'm going to Q Schilders about it, I imagine he looked and thought is within ht e parameters of fixing with scope, but I'll feel better double checking.
    Vanessa, yes I think your PT's right and then some. I also know a PT who had the op and her advise altered after as she thinks its a yr recovery.
    I am thinking of the next one, yes. I think that recovery should be faster, or I mean more complete as only symptomatic for 8 months so I'm hoping less damage done.
    But its going to be planned in time for childcare, because for me thats been a bigger issue than most stuff. My help has had enough and gone and that leaves me with nursey for my almost 1 yr old and with swine flu about I do not want that. So I'm waiting until spring, summer next yr I think when less bugs about. Hope your recovery is going well and you have strong back up!

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  4. All the new stuff is greek to me ! I haven't done much research on PAO so I would need to get back to you on it.
    I find sitting with an arch definitely helps my butt but the hamstrings still pull a little. I am now sitting on a heating pad and it works wonders.

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  5. Hey Erin,
    If you have pincer FAI, it is secondary to retroverted acetabulum, almost all pincer stems from Retro Acetabulum. Retroverted acetabulum is simply the hip sockets facing slight backwards as opposed to as forwards as they should. If you picture where the sockets should be, then imagine then rolling backwards a fraction, you can see how that would cause pincer impingement. If they are very retroverted you can need open surgery to relocate the sockets peri acetabular osteotomy.
    Heat pads and water are magic aren't they!

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  6. Louisa,

    I wouldn't rush too quickly into a PAO unless you are really hampered by the pain and are pretty sure that would help. I am pretty bummed out how sore I still am at 5.5 months post-op, if it wasn't for the fact that the hip is stable and not slipping out od the socket every other step I would be questioning whether or not its the right thing to do. Although my 'good' leg is not great it is still better at the minute than my operated side,so there is no way that is going to get a PAO done.Just didn't want you to think that a PAO guarrantees pain free-when that happens tho I will let you know,lol.
    Kate xx

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  7. Thanks Kate, No I totally don't want PAO, but I want to be sure I've had the right procedure for my problem. Likely I have but then I am in a similar place to you so that brings with it some doubts and having done some research I couldn't help question. Curious mind.
    My only comforts are I can suddenly sleep on front and my limp I think has totally gone, though haven't walked for miles yet, so it could come back. I'd started limping very easily pre op though.
    Sorry your still facing tough times.. I actually thought, with your blog quiet, that you were doing really well. Its never that simple I guess!
    God I don't want a POA, just want to be sure correct, most effective treatment, esp as second hip starting to beg to be done.. I'm sure I am going t he right direction, just I don't understand the pain not leaving.

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  8. ps, XX hope that hip gathers pace for you!

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