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:

Saturday, 26 November 2011

Scar Tissue and Hip Arthroscopy for Hip Impingement.

There seems to be a trend building of scar tissue issues after hip arthroscopy to treat labral tears and hip impingement/FAI.  Because hip arthroscopy surgery is in its early stages its hard to know if high rates of adhesions are down to current surgical techniques, or just that some people are more prone to scar tissue than others. Only time will tell, but there does look to be an increasingly high proportion of hip arthroscopy patients complaining of recurrent issues and having revision hip arthroscopy surgeries to combat scar tissue.

What can you do to help yourself? Well...inflammation that is out of control causes scar tissue to build, so post hip arthroscopy take the anti inflammatories prescribed by your surgeon. Do not push yourself too hard in your day to day activities and rehab in the weeks after your hip arthroscopy surgery, as recurrent micro trauma of the site may encourage scar tissue to build. It is said scar tissue can start building as early as 2 hours post surgery.

You need to insure you keep a good range of motion so that the scar tissue is not allowed to limit this. Do listen to your physio regarding types of stretches and exercises that can can help you with regaining your ROM, as well as your strength.

Icing the site is a cheap and easy option which can be done several times a day. Ice helps combat inflammation and has no systemic downside.

There are also some supplements that can help and can be taken in tablet form, if you feel unable to incorporate them into your diet.. you will find turmeric, omega 3's and bromelain (from pineapple) can help you fight inflammation. Do check first though with your healthcare provider that there are no problems with you taking such supplements.

I am posting a link to a site here which advises on anti inflammatory foods to help relieve the swelling. Never under estimate the power of the fuel we fill our bodies with, it is an unfortunate truth that sugars and alcohol are true irritants and pro inflammatory to our bodies. I'm not so unrealistic as to say you can't have a bit of the bad stuff, just try in rehab to tip your diet more towards the anti inflammatory foods, even if it means subtle changes like switching cola for a pineapple juice and regular potatoes for sweet potatoes. There is more you do to help yourself than you might think.
It also explains the inflammation to scar tissue process.

Monday, 26 September 2011

Hip Arthroscopy FAI - campaign for UK NHS funding & Campaign for Aetna funding in the US

Hip arthroscopy is not yet funded by all PCT's nationwide in the UK. In the US there are also issues with Aetna refusing to fund Hip Arthroscopy. These two are huge issues for FAI patients in need of surgery.

There are two new campaign groups starting out on facebook, gathering patients together who are struggling with hip arthroscopy funding issues, whether in the UK or US.

These groups will allow people to meet and discuss their cases, compare notes and hopefully find a way ahead. For the UK campaign there is also a councillor who is looking to gather FAI sufferers together and launch an appeal with the NHS for funding for hip arthroscopys for FAI sufferers. Her details are on this site and she is hoping you will make contact with her and add weight to her argument. Also there is a surgeon becoming involved and keen to help with the lack of Nationwide NHS funding. There is also a petition available to sign.

The UK campaign is at facebook groups, type in: "Hip Arthroscopy FAI" - campaign for nationwide NHS funding in the UK.

The US campaign is at facebook groups, type in: "Hip Arthroscopy FAI" - campaign for Aetna funding.

Sorry I am unable to provide links, unfortunately facebook currently block links.

News in Dec 2011:
Delighted one of the members of the facebook groups is doing brilliant work raising awareness over the Aetna row, please follow this link and joint the petition: Well done Ryan Herring Carroll! http://news.change.org/stories/why-im-asking-aetna-to-cover-my-surgery

UK: Bradford PCT will now fund hip Arthroscopy. However there are still many counties that don't... yet!

More brilliant news, I will quote Ryan here as a campaigner for FAI with Aetna:

Ryan Herring Carroll Aetna members... aetna just changed their policy!!! They now consider FAI surgery "medically necessary" if certain criteria are met. The petition campaigned I started on Change.org has recieved over 1000 signatures. In addition, I sent all of the research I had done to most major news outlets, TV shows, the American Medical Association, American Association for Ortgopedic Sugeons, senator, the governor, the Va Insurance Commision, etc. I also reminded Aetna of a similar law suit they were involved in back a few years ago. They "settled" in that situation, but in the settlement they outlined what the term "medically necessary" means. Anyway, Im so glad that everyone can have this now :)

Monday, 12 September 2011

hip arthroscopy recovery exercises

Hip arthroscopy recovery/rehabilitation is heavily dependent on the correct exercises to regain strength, after surgery for FAI and labral tears. The 2 rehab programmes below are FAI recovery life savers!

Aqua exercises now available on this site at physiocure. Highly recommend aqua exercises, brings your hip strength back without having to weight bear and helps corrects gait after 6 weeks on crutches. Phased 1-4 especially for your recovery.


For regular hip arthroscopy rehab exercises I would also strongly recommend the Damian Griffin site, see link on this page here:



Friday, 22 July 2011

Hip Injections for hip labral tears and hip impingement (MRI ARTHOGRAMS and STEROID INJECTIONS)

Had bi lateral hip injections this morning, anesthetic (good bit) and steroids injected into both hips. I can honestly say I had a more painful blood test yesterday, hand on heart.
I'd just say that hip injections either for MRI- arthograms or steroids are more intimidating because of the setting, all the shiny steel objects. The overhead x-rays and TV screen with your live x-ray hip on and the fact that there were several staff in lead outfits, if you're already nervous, then this setting alone can increase your heart rate!

However, I had a jovial consultant radiologist, who explained every action, making the odd joke and lovely nurses to hold my hand. Its the idea of a needle going into your hip socket that is terrifying. There was a 'tiny' pinch feeling as the needle pierces the actual hip capsule, but seriously nothing like my blood test yesterday.
Keep in mind that there are 'very few' nerve endings in the hip socket... so the sensation is kind of woolly and distant, you are aware something is happening, but nothing sharp or sudden. Piecing your finger tip, with all its nerve endings would sooner have me run a mile on the pain stakes.

I think back on how I was almost not diagnosed with a hip labral tear and hip impingement altogether, just because of my fear of needles and the sound of an MRI arthogram. I am a true fainting, scardey-cat, so if I can do it and come out smiling, you can!

Below is a video of a hip steroid injection. Looks 'way' worse than it feels, but if you're just one of those people that feels the need to see for yourself first, then here it is. I asked if I could film my hip steroid injections today, but whilst the consultant would have been willing, hospital policy wouldn't allow, so this is the best I could do "a short clinical video tutorial on how to administer a hip steroid shot" Forward the video to 5 mins in, as the first example is a shoulder shot.
Note these ARE NOT my hairy legs!

Friday, 28 January 2011

New consultant

I met with my new consultant last week. In the same day, prior to meeting him, I had a double MRI, a CT, a series of x-rays and met with his physio for ROM and pain tests. The wait for this new consultant was long, but worth it. He appears to run late because he makes time to go through everything with each patient in turn. You can't however complain then when the same consideration is applied to your case. He took an hour and a half to discuss my hips and the way forward.

He surmised that my case was indeed complicated and that at first glance results, I have bi lateral FAI and (I didn't know this bit) possibly some pubic symphasis from my second child, 2 years ago. The course of action was to have a local anesthetic injection, mixed with steroid, into my hip sockets. This I had done yesterday.

The procedure was smooth and well ordered. You arrive to a lovely room and super helpful nurses. Later I was checked by a physio for ROM and pain inducement, Then some hours after I was sedated and injected with the dye, anesthetic and steroids into my hip socket. Once awake I was fed (hurray!) and re-tested soon after by the physio.

I had mixed results though, as only some symptoms were gone. The impingement seemed more obvious on left unoperated hip. I must say though, I felt anxious knowing so much would depend upon the outcome of these tests and could scarcely think clearly to answer my pain in numbers. I find it hard to quantify pain, esp the fleeting kind induced and find I almost question my own answers. Still it seems a better exploratory process than I have experienced before.

Here's the additional consideration, I desperately want a third child, which I've left and left because of the drawn out situation with my last consultant. Now the clock is ticking, or might have stopped ticking altogether, for all I know! How do I fit this in? A decision I have been agonizing over for months. Do I do one hip, hope it heals fast, then try squeeze in a baby, then fix my other hip? What to do?

Before you leave the hospital the consultant revisits you with a course of action.
He arrived, calm and considered well thought out as ever.
He said he would give me 2 options and said which-ever I choose, he is fine with.
Option one: go away and have that 3rd baby, then come back and he will do his best to fix my hips. Or 2: we take what most likely will be the best part of a year, to get both hips fixed and that's the best case scenario... if all goes well.
I knew my decision the minute he finished his sentence!

He also wants to monitor how the steroids work in both hips in the coming weeks and months. He said there is nothing shocking on my scan to make him think a disaster is imminent. So if I can manage the pain, then to take the time out, as its most likely my last opportunity to try have a baby.

He also said mine is not a straight forward case, as there is pain inside and outside the joint and he can't be sure which is the most troublesome. He thought my left hip had more evidence to suggest bone impinging issues on anesthetic test, but wanted to collate all the information before drawing any final conclusions.
He did seem to suggest my hips wouldn't be easy to fix, I think for anatomical reasons, as well as the pain symptoms pointing to multiple issues... Yet for some reason I am more encouraged by that attitude, than by the 'no problem lets get in there' approach. I think this is because I feel that with my hips they are complicated and I am reassured he can actually see the hurdles.

He refuses to discuss all my scans thus far, (believing I'm a tad fixated with angles and percentages, where would he get that idea from?!) and saying he treat's patient's pain, rather than simply corrects their scans. He told me I have a 3 page detailed letter coming, so I can have my "fix" very soon!

I haven't had any surgery yet with this new consultant, but everything he says is so considered, honest and appears well thought out. This new consultant seems thorough with military precision, which appeals to my well organized personality type... He appears kind and thinks about you as a whole. I wish I'd seen him long ago.
I will, without doubt, be going back to him!

Wednesday, 19 January 2011

FAI hip arthroscopy on the horizon, no.2

With another hip arthroscopy on the horizon, I will be having a double MRI hip scan on the hip's soft tissue, a CT of the pelvis, a series of x-rays to view hip angles; and seeing a brand new hip consultant (OS) on Thursday. My new consultant will remain nameless in my blog and will be known only as my consultant.

Thank you for the many emails asking why I have not updated this blog in a long time, I have simply had little new to say.
I have ongoing bilateral hip issues, FAI impingement caused by pincer. My right hip, operated on over 18 months ago, has had some improvement to pre-op. However as I suspected from day 7 post op, surgery did not fully work... I have ongoing sitting pain, walking pain and over-doing it pain and can't swim as many as 20 lengths without pain and I still have night pain. All the same symptoms, just to a lesser degree... I can do everything for a bit longer, but ultimately the pain returns and I still have issues with muscle spasms.
As some of you know, I did follow all protocol with exercises and physio and then some, for over a year, to little avail.
My old consultant appeared to lose interest and I gave up asking him questions, as I felt it served only to irritate him, rather than engage his urge to consider what went wrong.

My left hip has deteriorated and I have almost identical symptoms on my left hip now, pain on flexing hip, sitting, walking and the resulting muscle spasms in the surrounding hip flexors, glutes and anterior thigh too. Wuhoo lucky me!

I am very much looking forward to seeing this new consultant and hoping this is a new dawn on my hip story. The journey has not been one I forecast. I genuinely thought I'd have both hips done and dusted by Christmas 2009, but hey-ho life doesn't always follow your ideals! Onwards and upwards. I will let you know the outcome from this Friday's consultation.