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:

Monday, 1 March 2010

7 and a half months post a FAI op - anyones guess!

much to same, good and bad days.. but more bad days since last week when I woke with my leg/hip internally rotated and turn it into external rotation, as I did this I heard a VERY loud grinding noise... Also its still very stiff, wonder sometimes if I should lay off the exercises and see what happens. Still not convinced I am properly better..I wonder if:

1) Its possible my left hip that still needs an op can be affecting my right post op hip detrimentally?? Is that possible?

2) Hoping my fab physio is right and that actually its ongoing inflammation caused by the relentless stairs in this 3 story house, that I am due to move out of in the coming months.

3) The remaining pain is muscular, but then why does it have the power to wake me up every night? ..And I exercise my glutes all the time and in a targeted way too. My right glute though is still flatter, no mater what I do!?

4) Fearing that my surgeon is wrong and that my acetabular retrovertion is in fact the main pain causing factor that needs addressing. Without CT, I'm unsure how he can have such confidence it isn't. Especially given the poor view of the posterior of the acetabulum, via front portal arthroscopy when doing FAI surgery.
Also it concerns me that he insisted no-one suffers posterior impingement, when there is a clear body of evidence suggesting otherwise.

I wish I could be sure of my right's recovery, as my left is screaming out for the op. The problem is, until the right one is fixed, I don't have the confidence to address the left one, for fear it is the wrong op! I know its my hip causing pain, but which is the correct hip surgery, depends on the accuracy of diagnosis and due to ongoing pain, I have lost some confidence in that!

I'm banking on it settling after the move, though think that IS optimism. Still, until then, my head is planted firmly in the sand, unless pain dictates otherwise.

PS set up a 'How to move, improve and extend without going mad' blog, hence the alteration of 'about me'!

8 comments:

  1. Hey Louisa, sorry things have gone downhill again. It sounds as if you have lost some confidence in your surgeon, so perhaps its time to think about getting a second opinion from someone who does PAOs as well as scopes? That way you can be sure they have considered all options and not be left wondering what if. I know you have the house move coming up, but maybe going to the GP to get the wheels in motion now or even if you can, see someone privately for an opinion.

    I took off my fentanyl patch on friday and back to the tram - having been stood on ward round all morning, then did hydro, I am now suffering a lot. Stupid hip - seeing surgeon thurs.
    Sam xx

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  2. Sam did you recover fast from past ops? Its so uphill isn't it!
    I'm kind of in denial until after the move, when I can test out the stairs theory.. I did 328 stairs yesterday and half of those I wouldn't in a normal house.
    I know no matter what or when I can't see me doing POA, what is the cut off age for POA when they go for THR instead, do you know?? Might hang on. Can it be done on retroversion? Have you heard of Mr Witt?
    Keep strong xx

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  3. Hi Louisa, sorry to hear that the pain continues. Perhaps Sam is right, getting a couple of opinions on other procedures before going into another scope that might not help. Some people have voiced concerns over having scopes too many times and can cause more problems (but then, many have their hip issues sorted after one scope!). I'd get yourself a referral to one of the top surgeons for hip problems in younger people and see what they say. London and Birmingham are the places to find the top dogs. No harm comes of talking and having a few scans (to see the joint properly).

    PAO cut off is relative I think, mostly done in those under 55. Resurfacing is better for younger people too if you do have to go down that route (but like THR, your joint would have to be in a bad state, arthritic, significant loss of cartilage - which I don't think your joints are in judging from your blog). A good surgeon would be able to implant a hip prosthesis on a retroversion joint - you'll have to do your homework on the surgeon if that time comes. I didn't take my first or second consultants as both weren't experienced enough for dealing with my bad dysplasia. Third time lucky for me!

    It's all so overwhelming I know. I stuck my head in the sand for a fair while there, then I just got fed up and decided to attack back!

    Take care,
    Bex x

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  4. Thanks Bex, Who did you use?

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  5. Hey Louisa,

    My PAO was for retroversion, so yes they do them, but its much rarer (I think I was numbers 1 and 3 for my surgeon) for that than for normal dysplasia. Its backwards to a normal PAO but with the same pelvic cuts. I was told by my surgeon that if I had a THR with the retroversion, it would fail very quickly as I had no posterior coverage at all really, so it would dislocate out or the prothesis would become loose very quickly. Now both sockets are in the correct place to receive THRs I will need in later life (as my surgeon keeps helpfully telling me each time I see him...).

    The age cut off is variable, as it depends on your individual damage and degree of dysplasia/retroversion as Bex says. By the sound of things, IF you were to need it, you would probably be suitable from a damage point of view as you don't have severe arthritis yet. But, equally, you may be fixed with a scope or perhaps an open debridement instead?!

    Don't base it too much on me, although I have retroversion, I know mine was severe and couldnt be fixed any way but the PAO, but that IS unusual. The surgeon said I had the weirdest pelvis he had ever seen (I also have anterior tilt, which makes my xrays look like they took them wrong!)

    Kate was operated on by Mr Witt and she thinks he is very good, and Dee had her THR done by him and again, highly recommends him. I'm not sure if he does open debridements, so it might be worth finding someone who does all options - I can recommend my surgeon Mr Fern, but he is based in cornwall, so might be a huuuuuuuuuge trek for you. I have heard good things about damian griffin (I know he scopes but not sure what else is in his remit - he has a private website).

    My open debridement recovery was just as slow (I needed screw removal 14 weeks postop and a steroid injection 12 weeks postop to get anywhere) and to be honest, I don't think its right yet, as I still get aching and pain daily. But I think it would be liveable with if my left wasnt complaining so much and as my left deteriorated so rapidly, I havent had a chance since the op last march to try it out and see what it can do!

    Sam x

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  6. Thanks Sam, IS THR possible with less severe retroversion? I'm going to sound childish now, but I really can't face these ops, people seems to recover sooo slowly, I don't what to not be involved in my kids growing up, I REALLY DON"T and without a doubt with these slow recoveries thats what it means. I hope and hope I can have a THR should my scope never settle, but I think I will go for a second opinion as Schilders doesn't seem to think I need a CT, and that retroversion isn't the issue judging from the surgery (can he tell with too tiny anterior portholes?).. and I would be convince but for his surgery appears not to have fixed me... we'll see what happens once I escape the stairs

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  7. my comments on my blog notwithstanding Louisa, I think you have to look on it as being only potentially 8-12 weeks for a PAO (THR is 6 weeks) which in the grand scheme of things is nothing - I know it seems like a lot but it really isn't if it gave you the freedom to run around after the kids with no hip problems going forward - I guess you have to weigh up whether if you do it now how much would you be able to do.

    There are lots of examples too on hipwomen of girls who have had fast recoveries so it's not a foregone conclusion that it's months and months.

    I would say for any hip related op the first 2-3 weeks are really the worst and then you can manage to do things after that.

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  8. I am a new comer to the blog, but I'm 31 in the U.S. and had THR on one hip last year and I can't tell you how much of a difference it has made in everything, least of all taking care of young kid (2.5 years old now) I had severe retroversion (I think), but they took care of it during the THR. The other hip is holding up after an osteotomy earlier in life at age 2. I also live in a 3 story house and I can tell you that it did lead to having the first THR but that was also due to congenital hip issues as well. Take care, and do know that THR may help, it is a life saver for me, really.

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