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 April 2010

improvement steroids or reality

Well, in general, I think I am doing better! Hurray!!

My hip held up REALLY well for me yesterday, during a 4 and half hour stint in a stately home and its play park on a hill (the things you do for your kiddies!) Frankly, I would've thought I'd have been a write off, after that amount of walking and standing! I was very aware of my hip etc, but no pain for a wonderful change and I had enough good sense to lay down for an hour when I got home!
I am really not sure if its the steroid (which typically takes 3 weeks to kick in for me always) or whether it could be ... that I am.. in fact.. SLOWLY... getting better???

The thing I am struggling with still is sitting and laying on my back esp, which brings on pain in the butt and sciatic pain! Possibly that is the hammies or some other annoying reactionary muscle group, though its still possibly ongoing intrarticular hip joint irritation.

My PT did loads of trigger point massage work on my tight adductors this week (OUCH!) and ouch for a good day after, but now fine. I think it could be that they, the TFL and Illiotal band, that are causing thigh and 'new' knee pain - peculiar pain patterns with hip problems.

Anyway in summary, whilst not out of the woods yet, I am also not saying 'ouch', 'shit', 'for god sakes', 'bloody hell' and 'leave me alone!' as much... So, on reflection, I would, say quite possibly, that I am improving now - only 9 months post op!! Grrrrr

Saturday, 17 April 2010

Answers from FAI expert

 I have pretty much copied in my latest correspondence between my Surgeon and myself, via his secretary..
I can't say I am too clear about where I am at, other than I'll probably be having another MRI soon.

Hi Louisa,

I have had a response to your questions from surgeon, as follows:

Q: What dose of anaesthetic and steroid was given and was this a “stronger” dose? - The two injections in the past have not affected the pain experienced when she sits down and this one did. Why? Also, why did the pain she gets when she sits down never go away after her hip arthroscopy?
A: 2ml Depo-medrol 80mg and 8ml of Marcaine. I wouldn’t call that a strong dose but a normal dose for a hip injection. I am not sure if Louisa is referring to the two previous hip injections that she has had in the past or to the hamstring injections. If she is referring to the hamstring injections then I would conclude that the hamstrings are not causing the problem. If I knew exactly why the original pain had never completely disappeared I would be able to treat it, but unfortunately her response is not a typical response that is seen in the majority of the hip arthroscopy patients with this type of pathology and therefore more difficult to pin down.

Q: Louisa’s range of motion is quite good. Would this be expected if she has developed scar tissue?

A: The number of patients that I have treated so far with adhesions post hip arthroscopy is very small. But in the group with this problem I didn’t feel that a reduction in ROM was the problem. Because we are talking about 1-2% of the hip arthroscopies as a group it is too small to see patterns and be able to identify possible causes for residual problems.

Q: The effect of the recent injection lasted no more than 4 hours. You said it would possibly last for 5-6 hours. Is this because Louisa’s pain is now so chronic and nothing will have a longer-lasting effect?
A: Each patient’s reaction to an anesthetic is individual. If I specify 5-6 hours then this means that this can be expected in the majority of patients, but it can last a shorter or longer amount of time as well and we have no way of knowing this with each patient. Chronic pain is unfortunately much more difficult to resolve because the permanent stimulus to the nerve roots telling the brain that there is pain might still continue even though the original problem has been solved.

Q: Louisa said that the injection took away the pain she feels when she sits down and was replaced by a sensation of deep-seated “itching” within her hip. Does this tell you anything?

A: It tells me that there could be an intra-articular cause which is at least partially responsible for her pain.

Q: Do you feel that Louisa has some residual impingement, or has she likely developed scar tissue?

A: That I can’t answer at this moment. As I discussed with her, if we felt that the injection gave her a positive response (i.e. blocked the pain), which I think she has had, at least partially, it would probably be a good idea to re-scan her hip.

I would say that the diary of symptoms over the past week is what could be expected from the effect of the local anesthetic firstly, and then subsequently, when the steroid kicks in, her symptoms start to improve again.

Q: Louisa has noticed that her gluteus on the right side seems to increase and decrease in size and she is able to induce “impingement” symptoms in the right hip herself in some positions. Can you explain this?

A: What Louisa is able to induce is pain, but there is no evidence at present that this is “impingement” and this should not automatically be assumed.

Q: Louisa seems quite convinced that there is some residual impingement remaining. Is this a possibility?

A: We have discussed in clinic how I treat a pincer abnormality and I have confirmed that she doesn’t have a coxa profunda, which is the more global-type of over-coverage.
I assessed the zone where Louisa had a wave sign and then decompressed the acetabulum in the area of unstable cartilage followed by a labral repair. Assessment of the impingement is done dynamically during the operation.

Can there still be residual impingement? - nothing is impossible; however her outcome scores and assessment do show that she is deviating from the pattern that the standard group of patients with this type of pathology follow (call it disproportionate symptoms) and we therefore have to start to look realistically at would could be achieved with further surgery if permanent stimulus to the nerve roots continues.


I hope the above information is of some help. If you are amenable to a re-scan I can ask the MRI department to arrange an appointment with you. I know you said that you were not keen on another arthrogram, but your surgeon would not consider a second arthroscopy without a scan, as the results of the scan will be important in deciding further appropriate treatment options if something does show up. I understand it is difficult and frustrating for you not to have a definitive answer, but I think he has been as informative as he can at this stage. If you have a think about things over the weekend and let us know if you would like an MRI scan arranging.

Thursday, 1 April 2010

Appointment with the consultant

Saw Professor Schilders yesterday.
Whats its not:
He thinks its not arthritis as on X-ray there looks to still be good distance within the socket and in surgery whilst there was a wave sign, the arthritis was categorized as grade 2, mild.
He says its not coxa - profunda? (big sockets) as I still have a teardrop sign. I didn't think it was though.
He says that there is retroversion because of the crossover sign, but says that its not, in his experience, the problem and that in arthroscopy he had a good view of my posterior socket and it was problem free. So the retroversion is mild.
He said it was not posterior impingement and I insisted on a physical test for that, which he did and it was pain free. He also said that again, during surgery no visible damage was there at the posterior hip capsule.

What it could be:
He said, according to his stats, pain could be caused by scar tissue. My only real bug bear with Proff Schilders, is that I feel he prefers to use his history stats, rather than listen to the individual. I'm sure he does both.. but I do feel like saying 'there's no point referring to your stats, as I'm never the average!'

I also showed one way I can illicit the pain, by laying on my side with my right leg on top, causing it to fall into an internal rotation. This made him say it was possible that there could be some residual impingement.

My question though its if its caused by scar tissue, which builds with time, why did the pain never go away and then return? It simply stayed, which has my money on residual impingement.

Alternatively the problem could be tendons etc.

So the inevitable arrived, the best test to rule in or out my actual hip socket was an anesthetic injection into my hip joint, yay! Actually for the 1st time in four of these, it actually hurt!

Anyhow, afterwards my sit pain disappeared, which I wasn't expecting, as once before I had the same shot and the sit pain didn't disappear.... so I wonder.. It could still be my hip causing all this pain. I could also more clearly feel other factors at play like a really tight, sore hamstring and a bit of discomfort around the SI, but these weren't that all encompassing pain and with that gone, I think I was able to distinguish other niggles. Does that sound weird?
Also where and when I would feel pain (like sitting) instead I simply felt like a deep itch that couldn't be reached, but not pain. I wonder too, if that's normal?

So this morning I need to know 2 things, could any anesthetic go into the local muscles, as that could skew the consequence of no pain on sitting after a hip socket injection and did he give me a stronger shot of anesthetic, so that this time it could stop the pain?
I feel a phone call to his secretary coming on!

ps The anesthetic should've lasted 5 to 6 hours, but felt to last 3 to 4 before the pain broke back through.

PPS We exchanged on our house yesterday, yippee so its legal and on May 10th I can move out of this stair hell, though lovely house, and move to my easy stair house!!

PPPS Note to self, the marker pen they use to draw all over your hip, prior to injection, doesn't just wash off.. not even with a shower.. and exfoliater. Might delay swimming, as it looks like I've been drawn up for liposuction!