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:

Tuesday, 7 September 2010

Bad news from new consultant about retroverted acetabulum being significant.

Visited a new top hip consultant yesterday..
In short, after briefly looking at my x-rays and CT scan, he concluded that I do have retroversion and that it is significant.
That my hip sockets should be facing forward, anteverted, by 15 to 18 degrees, but instead are facing backwards, retroverted by 3 degrees. This is what causes the pincer impingement. A reverse acetabular periacetabular osteotomy (PAO) is the answer, except he feels that the results from such ops are entirely unpredictable, with success rates around 60 - 70% and that perhaps had I been 20, not now 40 then it 'might' have up'd my chances of success, however I am not!

Advice was to retry pilates and exercises to help adjust pelvic tilt to help minimize the retroversion and take pain killers.

One thing of note though was that that advice would've been the same a year ago, before FAI surgery.. however I do feel that surgery, whilst not 100% successful, was indeed worthwhile.

So personally I do feel that its not quite the end of the road.. not that I want surgery, I just feel I can arrive at a better place than I'm currently at.

On the upside, surprisingly I think that my right hip is actually improving still, even 14 months post op, which I did not expect at all! Yesterday I managed a 5 hr return trip to London, combined with several hours walking around the city and that after the previous day cleaning the house top to bottom... I thought I'd be on the floor by today, but surprisingly I have some achiness this morning and had a bit of groin pain and lateral hip pain walking about yesterday and today, so that's positive.

I still need to wait a couple of weeks for this consultant to have time to work out a number of angle measurements of my hips to confirm the facts.. so whilst feeling a bit hopeless during the appointment with the lack of a solution, I don't feel this is the end of the line. I suspect there is no point until the CT is analysed and I have accurate readings and therefore full facts.

I also think I just I have not yet encountered the right surgeon for me yet, its such a specialist area, with micro pockets of speciality even under the hip FAI umbrella.

I have not mentioned this consultant's name and will no longer do so in this blog.. as things didn't go brilliantly with Ernest Schilders and I found myself in a position where I had already named Professor Schilders in thanks for a diagnosis and along the blog, before I knew what the outcome would be. I do not want to compromise my honesty and so this is the obvious solution. How did Professor Schilders miss all this?

10 comments:

  1. 3.5 weeks since bilateral hip arthroscopic surgery. Bi lateral femoral ace-tabular impingement w/bilateral labral tears. Pretty painful and hard to get around. Feel the best when I just lay down and do nothing. Surgeon is fairly sure that both my Rotator Cuffs are torn,getting a slip for that MRI soon. Doc said the problems with my lower arms and hands aren't related to the Rotator Cuff Tears, WONDERFUL! Previously before this:11/08 was bilateral meniscectomy for torn meniscus. Continued to have problems with knees, diagnosed w/Patellar Femoral Disease and torn Meniscus again, this time only right knee done so far 6/10. Bulge disk on L4 & L5 with Radiculitis.Osteoarthritis all over hinges on spine. No surgery required yet, but looking at Spinal Stimulation soon for relief. Kyphosis of Cervical, going to talk w/Doc soon about if this is affecting my lower arms and hands. I don't even have to mention my feet w/all of this,pretty messed up also. To top all of this off, I have had Myotonic Seizures since 1997 which are now happening more frequently and are more severe. I don't know, probably forgot something else that's torn or not functioning properly, but it's late. I'm just glad I found someone I can relate to about Chronic /Debilitating Pain and how it sucks soo much out of us. If I'm having a decent day w/a decrease in pain. I'm exhausted and lethargic from being beat up previously. Anyway..hang in there, that is our choice:)

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  2. Diagnosed with FAI today after arthrogram confirmed my condition. Had 12 months of back, glute, groin and hip pain. NHS physio said it was all in my head and discharged me and my private physio treated me for back pain. I got so fed up that I went private and paid to see a hip specialist. 12 days later FAI confirmed along with labral tear. He gave me 3 options:

    Option 1: Manipulation of the hip and cortizone injection. In his opinion a low risk procedure that may settle things down and help me lead a normal life again.

    Option 2: Hip arthroscopy. Massive operation and not without risk. Upto 8 hours in theatre, 8 weeks on crutches and 3 months off work.

    Option 3: Open surgery. Same as option 2 but more intrusive.

    My surgeon doesn't recommend surgery at all and has persuaded me to go for option 1 under general anaesthetic. Personally, I cannot see what this is likely to achieve. How can cortizone clear things up? I have a tear and a condition, together with early stages of arthritis. My head was spinning at the consultation so didn't really ask the pertinent questions I would have hoped to.

    I don't really have a problem walking but have constant discomfort in my hip and sharp pain in my right hip when seated for any length of time, so much so that I stand up when I can.

    My left hip is also paining me but not as intense, so wouldn't be surprised if I also had problems in that one as well.

    Not looking forward to the years ahead as FAI doesn't make pleasant reading. As it is such a new condition, the surgery doesn't inspire confidence either. My surgeon has already told me that he is not trained to carry out the necessary surgery.

    Shaun

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  3. Shaun are you on facebook? Theres a great group there called 'understanding hip impingement'. Theres almost 600 of us and growing and loads of input. US and UK and OZ

    What kind of FAI? Why do you need an anesthetic just for a cort shot? If you have it awake its not bad at all (i've had 4 times and I' a wuss, so it can't be) Also they can inject a local anesthetic at the same time and you can feel your pain disappear.
    Most important question is, as you're in the UK, who is your reluctant surgeon?? Theres literally only a handful here who are able to do this op.. though well done getting diagnosed in the first place as is near on impossible! Where are you in the UK. How old are you? Its unlikely to go away, though SOMETIMES possible to manage. Your op would be nearer 2 hrs on average, 6 weeks crutches depending on what needs doing, not sure about open.
    Sounds like you had a similar, albeit shorter, journey to myself... at one point they told me I might be depressed, when I said I didn't feel depressed they told me I prob had suppressed depression!!!??:)

    I'm not the best walking advert for this op having got a partial recovery, but there are for sure a good many people out there with full recovery and frankly given that I could only walk for 10 mins and sit for half and hour pre op, I'm doing well now, just not 100%.

    Come to facebook and find the group and if you can't, then find me and I will show you.. its a great source of help. Either way good luck Shaun and you only glean one thing from this blog its find THE BEST surgeon, theres patient choice now so you can pick.

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  4. I have to say thankyou for posting your blog. It has helped me so much :) I have the same problem - retroverted acetabulum (on both sides) causing hip impingement. And extreme pain. Luckily though I was referred to a good surgeon in London. I am due to have a hip arthroscopy in the next few weeks (after months of waiting) to remove bone fragments. He seems to be putting the PAO off ad it's quite a big op - not many sergeons do it. But I have been told if I don't have it done I will need a double hip replacement instead which would still not get rid of the pain. I hope that everything works out for you and you become pain free :)

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    Replies
    1. Hi im only 18 and I had major hip pains from the age of 10 doctors never knew what was wrong and put it down to growing pains, then a year ago I went back to have a 3rd x ray done by a specialist and finally found that I had bilateral retroverted acetabulum in both hips and pretty bad to I also got told there was only a few surgeons that could preform the op and that it was really risking. I'm still waiting to hear from them and hope that it's soon. Good luck!

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    2. Dear anonymous 18 yr old. I'm saddened to hear you've suffered so long and from such an early age. There are facebook FAI groups out there to support us and with people your age there too.
      Where are you? who are you seeing? and do you know the angle of your retroversion in degrees? I as this question as I am not clear if you have been offered a hip arthroscopy to correct the overhang or whether the retroversion is so extreme that you might need a reverse PAO. Do you know which you have been offered?

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  5. i never thought the hip impingement world had such a following haha. but i'm four months post-op from arthroscopic hip surgery to remove a cam-pincer impingement as well as to fix a labral tear.
    i'm 15 so i was supposed to 'bounce right back' and everything was going fine, but last month it all started to hurt really bad. i'm in massage therapy now, which helps, but i have a constant ache in my butt that had only occurred because of the tear in my labrum.
    any advice on butt pain? hopefully this doesn't seem too random, and thanks!

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  6. HI Maya, no its not a random Q.
    There are different theories on butt pain and to be honest I'm not certain the cause of even my own, though suspect it comes from the hip socket. You can look up contra-coup injury and piriformis syndrome.. but also in on facebook join the understanding hip impingement group there then ask that question and you'll get lots of opinions and take a look at all the points of views.
    Also try a heat patch on the side of your hip above the greater troncanter and kind of onto the glutes, it can relax muscles and sometimes help. Jacuzzi good for similar, but hook up with the facebllok group there are 600 members and happy to offer their experience too.
    ps try ease off on general activity and see if that helps as you're only 4 months out. Good luck!

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  7. Hi everyone i am new to all this website stuff but been reading the comments and its like de ja vu! I am 24 years old and have had hip pains since i was 11. Iv had several operations in diff hospitals including debridment, cyst removal, laberal tear repair, arthroacopy, arthrogram, steroid injections and even had some of the bone shaved down extra. My last op helped me for 2 yrs bt now the pain is back big time. 4 days ago i was diagnosed in london with acetabular retroversion in both hips to which left me and my family in shock! Im due to have the right hip operated on in june then my left hip a few months after. If anyone has any info or anything it would be great to here from u. My email is smiffy180905@hotmail.co.uk im also going to try and look up the facebook groups as any support would be amazing right now xx

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  8. Dear Anon, which op are you having and with whom? Come onto the group there are a good few with acetabular retro. Its a difficult condition, they assume/hope the pain generator is the extra pincer bone it causes but one other option is it can be the instability cause by the lack of bone coverage at te posterior. Addressing THAT issue is a much bigger surgery and one fairly uncommonly undertaken so an experienced consultant is a necessity to avoid being a bit of an experiment!

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