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, 29 January 2012

FAI (Hip Impingement) surgery success rates

There is a lot of talk of FAI / hip impingement surgery success rates. Some studies (short and medium term) have been done by eminent surgeons around the world with success rates as high as 96%... however the forums are full of failure, in part that is the nature of forums, in that the failed surgeries often cluster together for support and advice. 
However having been a member of such forums for a number of years now I have also seen many newly diagnosed FAI patients come to such a forum for advice on their hip impingement diagnosis and prognosis and stay throughout their surgery and rehab... but then not recover.

I was responding to one such newcomer's question this morning, who wanted to know if anybody did ever get better after surgery and I thought I would copy the reply I gave to her here also, as I was asked the same question on here only last week and it is the best advice I feel I could give to any newly diagnosed person with FAI:

I think success is MUCH dictated by surgeon selection, there are a LOT of learner FAI surgeons out there and they won't tell you that, pick VERY, VERY wisely. 

Success is also dictated by the 'surgeon's patient selection'... in that a straight forward case of FAI appears to have fairly good success rates, what can really muddy the water is FAI surgery on patients who 'also' have dysplasia, or accelerated cartilage damage, or hyper-mobility issues or extreme versions such as global retroversion... these complications can drop the success rates significantly. And to complicate things further it is often the more experienced surgeons who know when 'not' to operate as they are 1. more experienced and 2. not so keen to get another FAI surgery under their belt for surgery numbers.

Another factor in FAI surgery success is that the longer you have had 'symptomatic' FAI, the more muscular and tendon adaptations you evolve and this adds significant time onto rehabbing, correcting worn in patterns of movement can take some undoing. 

There is one other factor that I am aware of causing post op, frequent complications and that is scar tissue. We are told to rehab fairly intensely, yet some of the people that religiously do so still build scar tissue inside the hip capsule. Intense levels of physio (or activity) can cause inflammation, which in turn can cause scar/adhesions. So basically on rehab if it irritates your hip, simply take it more gently. Do persist with the physio rehab because you need to strengthen and stretch those incorrectly working muscles, but do also listen to when your body says slow down. 

However I am not convinced so many scar tissue problems relate to our post op behaviour and suspect that it is possible that surgical technique (how the surgeons open the hip capsule during a scope) could be significant to the formation of adhesions and hip instability. Some of the US surgeons are just now finding that patients having wide capsulotomys during keyhole are more likely to develop adhesions than in techniques using smaller incisions through the hip capsule to access the joint. Theory been less disruption causes less scar. There were a couple of reports I read online from ISHA winter 2011 which I will locate and post up, one by Christopher Larson revealing this... and I do believe early style surgical technique to be a significant factor in the formation of scar tissue... 

Anyhow my point is that this can be a wonderfully successful procedure, but that much depends upon 'your' surgeon selection and 'his' patient suitability selection and the best advice I can give is for you to be mindful of these factors, your 'exact' condition and choose your surgeon wisely and NEVER be afraid to seek a second or third opinion, or forth opinion, it is your body... settle for any surgeon in haste, repent at your leisure!

See list of best FAI surgeons here:
http://myfaihippain.blogspot.co.uk/2013/04/how-to-find-best-fai-hip-surgeons.html

78 comments:

  1. This is very interesting. I find, after going through all of is and discussing much along the way with fellow FAI sufferers, that everyone's uniques situation is just that. No two hips are alike. Thankfully, I choose wisely in terms of Doctors but that isn't the end of the story.

    The body adjusts how it can after surgery and during physical therapy. My Doctor put it perfectly, he said "With this condition in hips it can always be a bit tricky." of course I have heard the wonderful out comes and also the terrible. For me, it was a combination of prolonged symptomatic FAI ( a dreaded triple impingement) and hicccups (probable micro trauma) during recovery which have left me in pain still after the traditional alloted recovery time. jury is still out about scar tissue, which my Dr. did mention as a possible cause. But the whole 3-6 months to a year are all approximations as to recovery, again we are all different in terms of healing.

    At the end of the day, thought it has been frustrating, I have my OWN hip still (and being young that is important) and thought I still struggle with pain, Doctors know much more about this then they used to and that leaves me with hope.

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  2. Absolutely true, all hips are different and one of the things I notice frequently is people on forums comparing their hip arthroscopies like for like, yet one persen could've have a simple labral repair (not recommended :) ) and the other could've had labral repair, bone work, a micro-fracture and some ligaments repaired. Two entirely different hip surgeries, but both coming under the umbrella of hip arthroscopy, so often these 2 patients comparing recoveries and not realising that their surgeries are worlds apart. There are so many different conditions even within hip impingement.
    I would say in reply though that SOME doctors know so much more than they used to, specialists within the field, but there is still a void of knowledge with GP's, certainly within the UK, who really haven't heard of this condition.. word is spreading but not fast enough for my liking, when I think of all the people out there currently misdiagnosed with either a 'low back condition' or some new fangled 'pelvic tilt/ pelvic misalignement/core disfunction' wishy washy nonsense syndrome, or more accurately a symptom of the cause ( a young hip problem) I despair, but slowly we're getting closer to a the medics been better informed of this condition.
    Hope you keep improving, improvements can continue I'd say up to 2 years post op, although I think most is done within the first year. All the best Louisa Weeks - Browning

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    1. Louisa,

      You said 'yet one persen could've have a simple labral repair (not recommended :) )'

      Why is this?

      I am considering exactly this operation.

      Lars

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    2. Hi Lars,
      Generally (and I emphasize that word) a torn labrum is a symptom... and by only addressing the symptom and not the cause (generally FAI) you're more prone to tear again. However if you had a traumatic event, car accident/thrown off a horse etc then it is possible you tore your labrum this way and would likely not encounter a reoccurrence of a tear once repaired.
      If you haven't had a trauma, it might be worth asking your surgeon's thinking behind only a labral repair. Has FAI been identified in your case and is your consultant an FAI expert?

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    3. what a wonderful informative forum !!!! thank you !!! i just read a girls BLOG re her FAI surgery recovery ANd she scared the hell out of me !!some people need a licence to discuss their medical problems :) all she talked about was her pain which i think was over the top !! she didnt answer any of my questions in my mind .... i intend to sit down on my days off work and read through this forum As i am having a left hip scope Lab Repair The hip bump ground down ( excuse my lack of proper terminology) umm the osteo arthritis cleaned up etc etc ..does anyone know what a capsule repair means ? is this the cartilage cleaned up ??..i have had the labral tear for 5 ( caused by FAI ) so the damage to my hip will be extensive :( I have a wonderful orthopaedic surgeon here in Australia ..A MR Parminder Singh ..he specialises in key hole surgery ...I have this done in 8 days !!!! 16th of October 2012 !! a long 5 year wait i tell you !! my knees ache so much as i am still working 9 hour shift on my feet :( ...any way my QUESTION ??? as i wont discuss this with my surgeon until after the operation WHEN CAN I RETURN TO MY JOB ??? MY SHIFTS ARE 7/8 HOUR SHIFTS ON MY FEET AND MOVING AROUND A BUSY VENUE ALL DAY ...IM TOLD I HAVE TO BE ON CRUTCHES FOR A MINIMUM 2 WEEKS ..NO WEIGHT BEARING AT ALL and extensive physio but i really want to know how soon i can return to work but i cant find any answers ..thanks for reading to whom ever has taken the time to read my story ...

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  3. Great post...I agree 100%. When I had surgery for FAI in 2010, I was told that the surgery could make things better, worse, or not change a thing. I was also told that there is no telling what the long-term effects of the surgery could be. In the words of my surgeon, "you could develop OA in 6 months, 10 years, or never." My surgeon recognized that FAI correction wouldn't be a 'simple' fix in my case. I was born with severe dysplasia (complete dislocation) and I am extremely flexible with greater ROM than normal. My surgeon was hesitant to perform surgery but in the end we had no choice when the entire labrum tore and needed to be removed.

    Although I became much worse after my surgery, I don't regret it and I wouldn't dissuade others from trying it. Maybe those of us who never got better were never good candidates for the surgery to begin with. Maybe by studying who gets better/who doesn't surgeons will be able to define better selection criteria for future patients. I also think there isn't much standardization among surgeons who perform these surgeries. My entire labrum was removed and left that way by one surgeon; yet others say that's a huge no-no and if it can't be repaired it must be reconstructed.

    I guess the point I'm getting at is that these surgeries are still in an experimental stage and essentially, we're the guinea pigs. At this point, there's no way to determine who may benefit and who won't. There's no real way to know which surgical method is better than others - yet. With more surgeries performed and more surgical experience gained and by following-up the long-term effects of patients, hopefully the success rate can be improved.

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  4. Thank you and I think you're right, that we're the experiments paving the way for the future, I wish things could be more advanced at this stage, however I am also very grateful I wasn't born 20 years earlier and would've been written off and drugged up...
    Have you subsequently been offered a PAO? That's normally the next stage for hip dysplasia.

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  5. Hi Louisa, my hip was surgically realigned when I was a child. It's as fixed as it's going to be :) Right now, my surgeon is contemplating labrum reconstruction surgery and has referred me to a colleague of his for a second opinion. Hopefully it helps!

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  6. Man, reading this doesn't make me feel better... has hip arthroscopic surgery 2 weeks ago, because of sharp pain in my groin when walking. They did check the spinal cord first but I was told that it can not come from there so the Orthopedic Doc said it could be a tear in the lumbar. Did the MRI with the die (contrast something) and poof I was on the table 2 weeks later and operated on. So two weeks after the operation all that pain around the area vanished and I started feeling better and poof, the original pain is back - same area. Was wondering if anyone had a similar problem. Will be at the doctors office tomorrow... see what he has to say (sorry about the English)

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    1. Hi Birgit,
      your surgery is quite recent so you might still be feeling effects of the surgery as well as some annoying scar tissue. After my first arthroscopic surgery I felt great but the old pain came back suddenly a few months later. Turns out the cartilage tore again. However, you mentioned you had lumbar treatment - I have no idea what that entails. Sorry I couldn't be of much help and hope you feel better soon:)

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  7. P.S. according to my doc I also had some labral repair, bone work done including the lumbar trear

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  8. Lambada, my daughter (age 3) has hip dysplasia and is fixed as of last year after treatment, however they continue to monitor her yearly as things can change, in fact I think (though don't quote me on this) that our pelvis doesn't lock solid until we're 25. Often dysplasia and FAI co-exist been a 3D joint it can be deficient in some areas and have over coverage, or an odd shaped femoral head elsewhere. I would say for you fixing the labrum alone could be a temporary fix though as as far as I understand it the joint of a dyslastic hip is unstable because of under-coverage and that increases in joint 'instability', so then allows the labrum to tear. If that be the case, I'm not sure you're in for a long term fix. Can you ask your surgeon about that factor?

    Birgit, I am sorry if this post has left you feeling worse, it certainly isn't my aim and unless you have the above mentioned conditions, 'dysplasia, hyper mobility or extensive arthritis' it shouldn't, as if you also have a GOOD surgeon your chances should be VERY POSITIVE indeed.
    However I am not clear on why your first hip arthroscopy failed and your terminology, I understand you have had a labral repair and some bone work done? ...but a lumbar tear leaves me in the dark as that sounds like a back procedure. Does you surgeon do back surgery, or hip, or both. Either way I don't imagine both in the same procedure.
    That aside and I second Lambada, 2 weeks is NO TIME and you can't judge the outcome at this stage. I am not convinced you can accurately judge it at only 2 months out. Feeling the same pain initially seems a common sensation both with hip arthroscopy success's and hip arthroscopy failures.
    Try find out what you've had done, you may have surgery notes and please don't feel disheartened at this early stage.
    All the best Louisa Weeks-Browning.

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  9. Back in December 2011 I had a MRI scan done on my right hip which showed features of cam type FAI,chondroladral erosion,cyst ,non displaced labral tear and degenerative change to the attachment of the lidamentum teres. Firstly sorry to bore/scare people with the medical terms but I have tried to summarize this as best I can. I have been to many sports physicians and physiotherapist with this information and none of them have explained to me what this all means, so i kept training in my martial arts braziillian jiu jitsu and constantly seeker treatment for my hip flexes adductors,back,core etc. Three days ago I had very bad pain in both my hips especially the right and the back was up and down from average to bad. Went and saw my recent physiotherapist and she explained to me that I should watch my training and not over do it because it will accelerate my need for a hip replacement!
    Yeh, so I have been researching FAI and i finally have a understanding to what has been causing most of my pain and injuries. I'm 38 in a month I love playing sport and cannot see myself not participating in competitive sport, but I don't want to end up in a wheel chair, I have 2 beautiful girls and wife that loves me dearly.
    I am at the early stages of trying to accept and understand this disability and working out my next step. Brazil Ian jiu jitsu is definitely on hold as I can barely walk let alone grapple but I do want to continue with sport as sport and my family keeps me alive.
    Thank God for blogs like this as without them I would still be wondering what was wrong with me.

    George G

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    1. George,
      I am also a Brazilian Jiu Jitsu practitioner and am about 4 and a half months post operation. They basically shaved the bone in 2 places, removed 20% of my cartelidge, and stitched/repaired cartelidge in 2 places. I would like to return to BJJ, but I do not want to get an early hip replacement (I am 35). I would like to know if you got the surgery, and if you have or are planning to return to bjj. You can send me an email at bok673@yahoo.com
      Sincerely,
      Tony

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  10. Dear George G,
    Its not easy to go from a fit active person to one with such limitations, but such is the irony of a condition like this. You need to find a very good hip arthroscopy FAI surgeon and get yourself fixed. There are many FAI sites on facebook and one I set up recently called "best hip surgeons - reviews' whereby you can ask a community of FAI sufferers to recommend you a good FAI specialist as there are many learner ones out there who will not tell you of there lack of experience. If you have any hope of returning to a sport or such extreme range of motion (and people do) , you have to have surgery and the sooner the better.
    I totally understand your sadness and loss but for yourself and your family and your love for sport you will benefit for finding it within yourself to tackle this... treat the FAI as the opponent/enemy and the rest of your body as you, you will beat this! Keep me posted and let me know if I can help in any way.

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    1. Hi Louisa

      Like George here i also practice BJJ. Funny thing though I hurt my knee during training 8 weeks ago, when i heard a popping sound followed by a sudden sharp pain. Needless to say is was out for about 5 weeks before i could resume training. Everything was fine, could run, skip rope, do squats you name it with no pain in the knee.
      However whenever I rolled and depending on how my knee was angled I would get these sharp burst of pain in the knee followed by a short period of numbness. I just did not make sense. I went an orthopedic surgeon last week and he told me after examining my knee that there is nothing wrong with knee and that the problem is with my hip.
      He even had x-ray done to show me the FAI! Has anybody here experienced problems with their FAI, but felt nothing in the hip but only pain in the knee?

      He advised to take it easy and continue to work on extending my ROM for the hip slowly until the pain completely disappears.

      What I don't get is that I have never had problems with my hip and how can hurting my ACL affect my hip and how it can cause me to feel pain in my knee when extending my ROM of the hip?

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  11. Dear Louisa.
    Thank you for the kind positive words. With time I am realising that I have been suffering from hip,groin pain and clunking noises from my hip as long as I can remember, only that it has gotten worse in the past year due to my high level of activity. The situation is making more sense with time and I am walking today which is great.
    With research I have found a doctor named John O'Donnell here in Australia. I am waiting for him to review my scans to see if he can help me. He is very busy as he sits on many boards and the earliest he can see me is on the 15th of August. This is ok as I can do the surgey the next day, pending on his review of my scans in the next couple of weeks.
    I will look into facebook as you have mentioned as I also would not mind a second opion. Dr O'Donnell is well known for hip scopes all over the world but I am still wanting to know more as I am still learning about the procedure.
    I will keep you posted, thanking you again for your help.

    George G

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  12. O'Donnell is one of the absolute best I have heard of and has a fantastic rep! Never heard a bad word against him. Good news, hope all goes brilliantly!

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  13. Hi. Nice to see that I'm not alone when it comes to the hip impingement. I am a 41 year old mom of two. I had an injury at work 5 years ago, a slip and fall. That was the start of the whole hip journey. Took a year to convince Drs. that I wasn't crazy as nothing showed up. Finally a year later they thought I had a labral tear. Had a arthroscopic surgery to fix that. Still was having problems. Seen a hip specialist who diagnosed me with a cam and pincher impingement. The wait list was 2 years and then did a new MRI which showed no arthritis. So the plan was to go ahead and do the surgery arthroscopic. The date was set for this May 15. I got a call last week to go back in the surgeon wanted to rediscussed things with me. He said that he felt that I had arthritis even though it was not showing up and that I should not be in that much pain from a impingement. Even though I have a 9 and 11yr. old and am kept very busy I believe that because I am still busy that is causing the lingering pain, anyways he felt that I should just do a hip replacement and be done with it because he feels the arthroscopic procedure will not be successful, he said I could opt. to do the repair open hip which is a nasty procedure or his recommendations was the hip replacement and be done with it and be good for 20 years. He says it is less invasive to do a hip replacement. My surgery date is in 12 days and I feel I should either cancel and have more time to think this over as he just told me a week before surgery about the replacement or go with the arthroscopic procedure first. Any feelings from other readers on this? Thanks.

    Well having a hard time saying cut off my good joint when there is no signs of arthritis. It sounds like I will have more limitations with a hip replacement then I do now. I told him if that is what he reccomends then let's go for it. Now I am thinking am I crazy, cut off a good joint because the surgeon says eventually I will need a replacement??

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    1. My God cancel now and get a second opinion! There is no rational behind this decision!?? There is no mad rush, FAI does cause that pain, esp if you continue to be v active and with children you are, he has no evidential signs yet of arthritis, he offers you an open rather than scope when the success for that procedure is actually no higher.
      Where are you? There will be a better FAI surgeon in the area.
      I have no problem with THR, but in the correct circumstance and at 41 theres no downside to giving a scope a chance as without arthritis or with limited arthritis your chances are good... BUT do not have a hip arthroscopy with this surgeon even if he comes back around to your way of thinking as alarm bells are ringing suggesting that he is very much out of his depth.

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    2. Thanks, I spent the whole day crying yesterday!! Now I have the flu on top of that. Was suppose to go and do prescreening yesterday but the drive was a 4 hour round trip so I cancelled was so sick. I phoned the surgeons office and said that I need to talk to him again so I am going next Tuesday. Cutting things very close to surgery and it's too bad that he decided to throw a hip replacement on me 2 weeks before my surgery date. I want him to do the arthroscopic procedure and take my chances with that until there is evidence of deterioration and that hip replacement is my only option. I have never been so depressed! I really hope I can get this awful feeling gone before the 15 because I really don't think it is good to go into surgery feeling so messed up.

      I live in Canada. My surgeon is refereed to as one of the best. He also has 4.4 star rating from his patients. I thought that was pretty good. I guess in his opion he was just saying that the scope procedure to fix the FAI is just a temporary fix why not get a replacement now and save a future operation. But untill your hip my hip actually has signs of arthritis I'm having a hard time with that. If this operation only buys me 5-10 years then be it. He has done about a dozen arthoscopically now. As his speciallty was the open hip for the FAI. Which I know he will want to do now that I have changed my mind. But you are saying that there is not much difference in the out come of the open or scope? My Dr. says that he can get more precise measurements with the open hip. Which is why at my age he said just go with the replacement less invasive. It would be awful to find another Dr. at this point as it has been 5 years since my accident. The wait time in Canada is years. So I think I should just take my chances with him and ask to scope. So frustrating.

      So Louisa, sounds like we about the same age. Did you have the continuous ache in your hip with the FAI? I imagine you were active also. I find that if I kept my activities to a minimum it is pretty good. But I like to keep fit so I walk 3 times a week, do some crunches to keep stomach toned and cater to my needing children. I also live on a side of a big hill so walking up to the barn to feed my horse is always uphill. So I think that doing all these daily activities is what is causing the chronic pain, the irritation of the impingement always impinging. One would think that if you needed a hip replacement there would be little bit of arthritis showing on the x-rays or MRI?

      Sorry for rambling on. Feels good to talk. So how are you doing now with your hip. How far are you post op? Oh forgot to ask, did you have knee pain with your FAI? I do, lots, I imagine it is the referred pain from the hip.

      Thanks for sharing. Tammy

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    3. Oh Tammy this is awful, I am 40 now, occasional knee pain but thats the IT band pulling from the hip. Are you on facebook? There is a group 'understanding hip impingement' that you need to join and I think you should post this on the helpsite and gain reaction to what you're telling me, as you feel to be sleep walking into this procedure. 12 hip arthroscopies makes him a new kid on the block, you should be with someone who does 100's per year, year on year. He maybe 4 star but not in FAI clearly.

      I feel for you, yes I know that pain, had one failed scope, had another with a fab new surgeon and I'm improved, but as was 8 yrs till I was in the right hands, its a long road back muscular- wise... having my left scoped next Frid, but with same good surgeon that I totally trust, who knows what he's doing and does 100's per yr.

      There is also a section within this FAI hip awareness site on Canadian FAI experts too, type Canada into this blog search.

      I can't tell you what to do, but I seriously encourage you to join the FAI group on facebook Tammy and ask other's opinions and also get yourself some needed support through it too, its a lonely business this FAI stuff currently as still quite new. If you join the group I will find you there, or find me.
      Best Wishes Louisa Weeks-Browning.
      ps yes your lifestyle will effect you, do less it hurts less, but slowly your world shrinks.

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  14. Thanks Louisa, you have been very helpful. I will go to the fb group and check out the other site. Were you ever once asked by one of your Dr.s if you were done experimenting and just do a hip replacement and be done with it? Or did you ever ask yourself that? With no arthritis showing a replacement is very hard to except.

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    1. Tammy,
      I was reading your story. It sounds very much like my own. I slipped and fell. I knew I tore something in my groin/hip. All of my scans,MRIs came back normal. Finally, I couldn't walk,sit,stand,or even lift my right leg up. It took about 5 ortho docs,2 general surgeons,1 needless exploratory lap, multiple meds/injections,excruciating PT and finally a hip
      arthroscopy with FAI and labral tear repair in Oct 2012. It's now 6 months later and the pain is back... so disgusted because I was doing great. My ortho doc said " you're not crazy,we know it's your hip." He suggested a cortisone injection and if pain continues... a hip replacement! Uugh! Will this pain ever end? Not sure what will happen from here. I'm just so depressed. I am 39 with 2 small children as well. I guess it all remains to be seen. You're definately not alone.

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  15. Generally they won't replace your hip unless you have v little, to no joint space, so the only option I was given early on for THR was to wait in pain for 5-10 yrs, then we'll replace. Not an option!
    Hips aren't ordinarily replaced whilst you have a few mill joint space on x-ray. Have you got or seen your xray? Do you have joint space?

    If offered a THR I would consider a it for my right hip, because it has grade 3 arthritis now (grading is 1-4, 4 being the worst), but only if it wouldn't correct with a hip arthroscopy... I'd rather that, than go on to try open surgery, which seems to be a hellish recovery (but this is all personal opinion, rather than advice.)

    I think its probably unethical to be offering you a hip replacement with no arthritis present and don't forget hip replacements have their issues too, the Du Puy scandal and another recently
    (http://www.arthritistoday.org/news/asr-depuy-hip-replacement-recall078.php),
    but theres no going back from THR and I'd see it as a last resort... a good one, but a last resort nevertheless.

    I would seriously think about delaying if I were you, using your flu as an excuse and then do some serious research and get yourself a second opinion... I understand everything takes time in Canada, but you are talking about a major joint and the rest of your life and I wouldn't trust this surgeon's opinions as they are without foundation. The thing about FAI is you need an 'FAI specialist', not a 'hip specialist', without that you're lost.

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    1. Hi Louisa, Sunday morning, feeling a bit better flu wise, trying like heck to get more food in freezer and things off my check list. I have gone over this with my Physio therapist and feel a bit better mentally. She was shocked to hear that the Dr. would just suggest to do a thr especially with no arthritis, healthy cartilage and good range of motion. Yes I still have good space in my hip. She had suggested to do the original plan which was the scope and if he preferred to do it open hip then do the open hip way as that is what he specializes in. He is very familiar with FAI as he has done it open hip for years. The PT told me that all she can say about DR.Ackerman's work is that he is a perfectionist and when she sees his patient's the work is good. So I am booked to go back and see him Tuesday and I am just going to say that I think that this pain is from going from the time I get up till pretty much bed time. My husband works out of town so I have to pick up on his chores and if you are continuously bothering the impingement why wouldn't you have continuous pain? What I don't get is that he had the surgery done about 7 years ago, I didn't hear him tell me that he wished he opted for a hip replacement. Anyways I am just nervous that he might frown on me second guessing him and not believing him. I will let you know how it goes on Tuesday.

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    2. Hi Louisa, thought I would check back in and let you know how things went. Well I did go back to talk with the surgeon which he was very glad I did. He explained things to me once more and as to why joint perserving did not work in favor for me. So I felt comfortable with everything and his explaining and agreed to the THR which I had on May 15. I can tell you that MRI's sure don't tell you the whole picture. All my imaging, all 3 MRI's said everything looked good which made me very skeptical, once the surgeon got in the hip, a very different story. My laburm was pretty much beyond repair, condral lesions, yellowing of the cartilage which is the onset of arthritis, and the oddest thing was that my muscles were actually fussed onto my hip joint which took the surgeon an extra hour to carefully cut away and push down so he could cut off the joint. So had I pushed the scope the muscle part would of been missed and I still would of had discomfort of sorts. I am just about 2 weeks post op and crutching around pretty good considering I had so much muscle cut which is not a normal procedure for a THR. I have talked with a few people around my area with THR and they really have no limitations except the running. One lady is on her 24 year of her replacement and just starting to feel loosing. So I have a little ways to go yet but feel really glad things went well and looking forward to physical future. I just wanted to thank you for your support during my very emotional time. It was very appreciated and I wish you the best.

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    3. Glad to hear you are doing well... wish you all the success with your THR. You are quite right MRI's do not tell the whole story by any stretch. In my case 3 times they have been incorrect, but luckily I have had a salvageable hip non the less. I am sure you will do well, THR's are generally very successful procedures.

      Delete
  16. Hi Louisa,

    I also live in Leeds and have been following your blog for a while. I would be grateful for any advice you can give me. In brief my story is as follows...

    After four years of misdiagnosis (trochanteric bursitus etc etc) I was diagnosed in January with pincer FAI. I'm female and 27.

    I was on the NHS and after not being satisfied with my consultant and researching my symptoms myself I was sure I had FAI so I paid to see Schilders who confirmed my suspicions. I then sought funding from the PCT which has been approved and I was referred to Jon Conroy in Harrogate who I saw a few weeks ago.

    At the same time I have started a new job and it appears I am eligible for BUPA cover for my operation (even though it's an existing condition). My question is really what experiences, you have had with either Schilders or Conroy as now it looks like I can go private it seems I can chose between the two.

    Any opinions of what you've heard or experienced would be greatly appreciated. I'm really nervous about having this procedure done so want the best person possible to do it.

    Thanks in advance.

    Charlie

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    Replies
    1. Hi Charlie,
      Can I ask which policy you have with Bupa that covers an existing condition please? I need to have an arthroscopy, have just been told by my OS that he no longer performs arthroscopies on the NHS so want to see if I can take out a health insurance policy or be added to my partners.
      Many thanks!
      Sam

      Delete
  17. If I were you I would see both and then choose, personally I opted away from the area, as I was stung by that choice previously and finally this last year went for a surgery in London with an excellant surgeon called Paul Jairaj, putting geography aside I was VERY happy with that choice and Bupa paid. The reason I was so happy and prepared to travel was because his surgery is minimal, he does a hip arthroscopy like everyone else, BUT he doesn't do a wide capsulotomy he makes 3 v small incisions into the actual hip capsule and this meant to me 2, not 6 weeks, on crutches and 2 weeks, not 5 'months', before I could climb consecutive stairs.The difference phenominal having experienced it both ways. Paul Jairaj is at the London Sports Orthopedic 0844 561 7157 and I can not speak highly enough of his skills. I would never choose geography over skill again.
    That said I hear Jon Conroy has an excellant reputation, but have not had surgery with Conroy, so could not comment and I think you will know my history with Schilders, my hip arthroscopy with him did not go very well and 2 yrs later, I was found to have a remaining cam, left by Schilders and scar tissue complications also, that said I am aware he has done successful surgeries on others. If you want my personal opinion and it is no more than that, I'd say Paul Jairaj, based on my 2 recent succeessful surgeries with him. Have Bupa, will travel!! We're the lucky ones!

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    Replies
    1. Hi Louisa,

      Thanks for your reply. I have taken your advice and have an appointment with Paul Jairaj in 2 weeks. I emailed him after your blog response and he has been so helpful. I'm starting to feel like I can finally get this sorted.

      BUPA have said that they will cover the consultation fees but if I go ahead with the surgery there might be a short fall as he is 'BUPA recognised' but not 'Fee Assured'. Was this the same when you saw him? If so, was there a difference that you had to pay? How much was this? I don't mind paying the difference if I'm finally going to get some relief but if this goes into the £000's I'm going to struggle.

      Anyway, I'll keep you updated with how it goes. In the mean time, how is your recovery going? Are you finally pain free and back to normal?

      Thanks

      Charlie

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    2. Hi CHarlie, I am please that you have hope now. I had surgery on my right Nov 11 and left May 12, my right I am struggling with a little, but I had pain at a disabling level for 9 yrs (6 were misdiagnosed) and a botched op with another surgeon in 2009, missing a cam and forming profuse scar tissue, which Paul Jairaj had to address. This hip manybe toast I am not sure, there is quite a bit of grade 3 cartilage damage which wasn't a good find. Never the less PJ hasn't given up on this hip and it might just be a steroid needed to calm it down... jury is out. But I would say PJ warned me this was a second bite at the cherry having had a less that great surgery with someone else previously.
      However I am delighted to say that my left hip, untouched by any other surgeons hands previously and only symptomatic for 3 years is doing really well and the recovery from both surgeries was pretty awesome compared to passed experience.

      It is however a slog, you're deffo compromised in activity levels for first 3 months, though I was walking and driving at 2 wks post op. My left is doing so well at such early days I am confident of a full recovery within 6 months of surgery. I can't say the same of my right hip but it was truly messed up by years and years of misdiagnosis and a previous failed op so I can't hold that against Paul Jairaj and yes he is efficient, I hurt myself a few weeks back and was concerned so emailed and amazingly (for a surgeon) had a reply from his holiday, which was incredibly considerate.
      I wish you all the best, keep in mind progress isn't a straight line, there will be ups and downs for sure and don't expect too much for 3 months. Please keep me posted. Best wishes, Louisa

      Delete
    3. ps shortfall was £450 from memory. but that was it. I think Bupa paid 1050, as they haven't up'd their rates in 10 yrs. Its a pain there is a top up to pay, but as I was happy overall it helped numb the financial sting! :)

      Delete
  18. Hey just curious....I am on my 2nd scope (life side) in 3 years. I have another schedule at the end of the summer (right side). I originally had a labral repair, but tore it again, so now I have a labral reconstruction with an allograft. LONG story and I won't get into it more. Completely random question here-Just curious if any of you have any thoughts on those Vibram Fivefinger shoes. I'm thinking it probably wouldn't be a great idea bc my lower half is so jacked, but thought I'd ask y'all if anyone wears them. Thanks-

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  19. I wouldn't recommend any fad driven shoes until they have been available to the public for a good time, as most often they return injuries in ordinary people. In your situation I see no benefit to be gained by wearing these Vibram Fivefinger shoes, just risk. Recover fully from your surgeries first.

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  20. Hi Louisa, I just wondered how you are doing since your recent surgery & has it worked? What did your new surgeon do differently? Did you have another tear repaired? Are you now pain free? I had hip arthroscopy last year to correct hip impingement and repair a labral tear but suffered constant pain & inflammation in the joint afterwards. MRI arthrogram showed scar tissue which I've recently had a revision to remove. I'm still in a lot of pain despite being more than 3 months post op. The joint seems to flare up after minimal exertion, despite anti-inflammatories and other meds. My life is a misery as I can barely walk without it flaring up and the pain is horrendous at night, preventing me from sleeping. My main concern is that the scar tissue has reformed as I feel its unlikely that I've had another tear as I haven't exerted myself or put any stress on the joint since the last op. Wondered what my options are if this revision hasn't worked as I don't want to risk more scar tissue with further arthroscopy? I'm interested to know how you are doing and if you had a revision to remove the scar tissue you suffered. How many weeks post-op are you now?
    thanks

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  21. Hi Lousia. How is your hip now? what did the new consultant do and has it worked? Are you now pain free? Did he find more scar tissue?I had hip impingement surgery & repair of a labral tear last year. I was in contiunous pain afterwards, with the hip inflamming really easily on minimal exertion. I was rescanned and found to have scar tissue. This was removed > 3months ago and I'm still in tremendous pain and on lots of pain meds. I'm worried that the scar tissue has returned or the cartilage torn again (although I haven't done anything which may have caused this). I'm wondering what options I have for the future as any intervention risks more scar tissue. Just wondered if you got rid of your scar tissue in the end? and are you now pain free?
    thanks

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  22. The more I read this article the more inclined I am to have mechanical solution like they had in the movie "Hugo".

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  23. Louisa:

    I wanted to thank you for your blog. There seems to be a lot of pages on FAI but not much patient testimony. I started to develop problems with my hips when I was 27 and was diagnosed with FAI and labral tears when I was 30. After an MRI they determined I wouldn't need major surgery like hip replacement for it, but I might benefit from heaving the tears fixed and some reshaping done, or whatever they do.

    I've been worried that the surgery will be ineffective or leave me with more problems than I have no, so I've been trying to control it with lifestyle. This basically entails the right combination of sitting, and standing and choosing my surfaces to sit on wisely. I've gotten better at managing it but I can tell it's still getting worse because it's a lot quicker to flare up now than it used to be, and once it starts aching it takes 3 days to 2 weeks for the discomfort to go away. It's not unbearable pain but it's a deep, unrelenting ache that really, really, REALLY ruins my day and makes it difficult to function because I can't get comfortable. It makes me feel like I'm in my 70's.

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  24. Sounds like you're approaching the time to reconsider your decision on surgery. There are stats out there, saying hip arthroscopy is effective, but much depends on your choice of surgeon and your exact condition, (see surgery success rates). By not having surgery you're also taking a risk, the risk is that you damage your cartilage beyond needing a minor surgery. Hip arthroscopy success rates depend on a number of things, but one factor relavant to you is cartilage damage, the more you have the lower your chances of success with a hip arthroscopy. I tried modifying my life inadvertently when misdiagnosed with my right hip and on purpose with my left and the price I paid with my right is arthritis of that hip also. Do your research on the op, your surgeon etc and have a re-think as what your feeling will not go away. You could try delay further by using steroids but you will still be delaying the inevitable ans risking the above.

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  25. I am 38 years old. I used to be fit and healthy... I injured myself at work four and a half years ago, performing some not so heavy lifting. My injuries were covered under Workcover... When i originally presented to my doctor, I informed him I had pain radiating from one hip, across my lower back, to my other hip. I was diagnosed with a muscle strain, and prescribed anti inflammatories and bed rest. When this treatment proved unsuccessful, and my doctor would not revise his diagnosis, I changed doctors. This doctor believed my back was the problem, ordered a CT scan which showed one disc bulge, and insisted my hip pain was referred from my spine. My hips were not investigated.i was prescribed analgesics, which did not work, and the pain persisted. I had an MRI which showed another disc bulge. Still my hips are not investigated. I am prescribed every narcotic available, which do not work. I am referred for spinal injections, medial branch blocks and sacroillyiac blocks, both times these do not work. I am referred to a neurosurgeon, who also isists my hip pain is referred from my spine, and rushes me in for a double laminectomy, artificial disc replacement (L4/L5) and spinal fusion (L5/S1). I attend my post op review some months later and inform my surgeon that the pain is still there. He refers me to an orthopaedic surgeon, and for bi-lateral hip MRI. They find labral tears, sub-cortical cysts, significant cartilage loss, cam lesions (FAI). My ortho referrs me for hip injections, which provided me with moderate relief for about six hours. Workcover sent me for an independant medical review with their ortho. He stated he was horrified that i had had spinal surgery in the first place, was deeply disturbed at the way the psurgery was performed (abdominally) and indicated, my neuro was a 'cowboy' who 'jumped the gun'. He firmly stated he is of the opiniion that I never had a spinal condition to begin with, it was my hips all along. He susequently recommended that i have bi-lateral hip arthroscopies, followed by double total hip replacement. I have since undergone hip arthroscopies, 3 months ago (left hip), 2 days ago (right hip). My ortho indicated post my left hip, that he did not repair the cam lesions, as they were not as bad as he expected...three months later, my left hip has flared up again, rehab has been cancelled until further treatment. As for the right hip, too early to tell. Feel like, after four and a half years, i am back at square one, having had major surgery for no reason at all, surgery which cant be umdone. And so it continues...

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    1. I am so sorry to hear your experience, it does actually echo my own for the most part. I am totally confused as to why you needed scopes prior to THR's? And if there is evidence of labral tears etc why your surgeon did not remove the cam. Where are you?

      Delete
    2. Louisa,

      I am located in Australia. As I stated previously, my case falls under the Workcover system. There has been confusion from day one. Every doctor / surgeon you speak to provides a different opinion. I think my current surgeon is taking a conservative approach, considering the spinal surgery's lack of success (it wasn't needed in the first place). As for the non-removal of the cam lesios, i don't know. That is a question that I will be raising at my post op review. There is not much point undergoing diagnostic tests, identifying multiple problems, fixing only half of them, and expecting the condition to miraculously disappear.I even had my doctor say 'sory, i made a mistake', not that that helps. I feel like I have been put in the too hard basket.

      Delete
    3. Louisa,

      I would like to say how sorry I am to read about each and every person, on not just this site, but so many others aswell, and what they have gone through, are going through. For myself, I have found this experience to be one of the most dehumanising experiences I could ever imagine. The workcover system is a system in dire need of reform. We, the powers that be, need to focus more on primary patient care, and less on minimising financial liabliity. Doctors, insurers and lawyers need a refresher course in empathy. Anyway, I'll get off my soapbox for now.
      Thank you for setting up such a site, which allows so many of us to come together for support, advice, or just to vent.

      Delete
  26. Very interesting blog.

    Im 26 years old. in the military. And have just gone thru a surgery to correct a labral tear in my right hip. Doctors were saying it was FAI and then found an actual bone spur in my hip. Its damaged the hip flexor tendon and to make matters worse the surgery was unsuccessful as far as getting the bone spur out.

    They spent 1.5 hours fixing the labrum, hip flexor tendon and pulling out damaged tissue before they could get to the bone spur... I'm worried because.. they don't sound like they are considering going back in. and i'm having worse pain than before surgery. its been about 1.5 months since surgery and i'm still on crutches. I've gone in to see my doctor and they still want me to continue with physical therapy. I'm worried because i had a dream to continue Mixed Martial Arts. But now i'm shopping for walking Canes at 26 years old :(

    I will gladly take any advice on this subject. I'm afraid i will continue to get worse and never be able to run or train ever again.
    And i know time in the military is ending very very soon as they are not keeping broken people.

    ReplyDelete
    Replies
    1. I'm sorry to hear what you are going through. I too am ex-military. I was fit and healthy, played sport, jumped out of planes etc...never had a problem. Then my body decides to pack it in at 34. I had a lot of differnt opinions, from a lot of so called specialists, almost all contradictory. Ended up being misdiagnosed, followed by needless spinal surgery...guaranteed problems for the rest of my life. As for the FAI, this condition seems to be somewhat of a mystery, limited knowledge is a big problem. May I suggest...do your research (on both the condition AND your doctors)...and YOU dictate what happens to YOUR body...keep pushing, don't take no for an answer. I injured myself four and a half years ago, feel like i have pretty much marked time. At 38, this has impacted on every aspect of my life. It can be very disheartening...but try to hang in there. If you find yourself at your lowest point, try to think...it can only get better from here.

      Delete
    2. Dear Valour, Find out who is the good FAI & hip arthroscopy expert in your area, go back to your doctor and insist on a referral. Doctors are driven by £$£, not compassion and they don't like to order tests (least in the UK) as it costs them money so resistance is typical and therefore your polite insistance essential. You need a referral to the best FAI guy, a physio referral might be enough though. You should not be on crutches 1.5 yrs post op. Its hard but you have to find your inner strength and be politely pushy... be your own advocate, it is the only way. You have to literally make this happen and walk away from anyone who is unable, or unwilling to help.
      Come onto the support groups on facebook, its good to have company and there are almost 1000 people with FAI now, from all around the world all swapping experiences, theories and supporting each other. Look me up and I am happy to link you up to all the groups, same for you Todd... and BTW I completely agree with what Todd is saying also.
      Do not sink, you're not alone and there is always a way out of a situation, with persistance, Best Wishes, Louisa Weeks - Browning.

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    3. its only been a month and a half since surgery. but still its disheartening.

      My foot went completely numb today while i was in church...

      The symptoms of the hip problems, coupled with the sideeffects from surgery. just really freaks me out.

      Im wondering if i should try and pursue some other form of physical rehab? should i try yoga? i guess im just afraid of furthering the damage. but i need to build strength somehow or its never going to get better.

      Delete
    4. Not yoga no, don't you have a PT protocol to follow? If not used these, they are specifically aimed at FAI patients post surgery:
      http://myfaihippain.blogspot.co.uk/2011/09/hip-arthroscopy-recovery-exercises.html

      PS, 6 weeks post hip arthroscopy is very, very early days as far as this recovery is concerned, its much more protracted that a total hip replacement.

      Delete
    5. I have aquatic physical therapy. but pain levels are increasing instead. hip is popping multiple times a day. shooting pains, numbness. cramping in my leg. something doesn't seem right.

      Delete
    6. Then you need to go back to your surgeon, you should be due a post op assessment around 6 wks, explain your concerns and hear what he has to say. Its not a black and white op like where you have your appendix removed and all is ok within a week. Its a slow progression over 3 to 6 months of bone and soft tissue healing and realigning and with that comes set back flare ups and pain that hopefully slowly leaves you.

      Delete
  27. Hi Louisa,

    Just found your blog and am so grateful, as I've had trouble finding informative sites online. I'm in the process of choosing an FAI surgeon and have found 2 that are highly recommended but differ widely in their post-op procedures and estimated recovery. One has a longer estimated recovery, with CPM, pillow role, 2-3 weeks crutches, etc; the second projects his recovery will take half the time, using only medication and limited time on crutches. Have you heard of such varied post-op procedures? Could there possibly be a new type of FAI surgery that is easier to recover from?

    I would be wary of the shorter recovery time except that both surgeons recommend each other!

    Yedida

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  28. The only varient I am aware of is whether the surgeon makes a T or L cut into the actual hip capsule V's 3 small holes into the hip capsule instead. The T or L cut is called a wide capsulotomy. I had recently had the minimal approach and it meant 2 weeks on crutches, v's and earlier op using the T/L cut (wide capsulotomy) which gave me 6 wks on crutches.
    BUT ASK because sometimes its just bull or protocol stuff and not based on YOUR ACTUAL recovery. It also depends just what you needs doing once they're in there, ie microfractures, because that will increase the length of time on crutches, no matter what entry is made into the hip capsule.

    Dont let them confused by saying all is arthroscopy and so requires 2 or 3 incisions into the skin, I'm taking not talking about how they cut you open, its about how they get into the actual hip capsule (the hip capsule is a massive network of muscles covering your hip joint, with increasing evidence pointing to less trauma there, the easier the recovery!)
    I recommend asking and if they're 'both' using the same wide capsulotomy because if so your recovery will 'feel the same to you' no matter what they say. Larson in Minnesota US is a fan of this approach, as is Paul Jaraij in London, UK, there may be more... Marc Philipon in Vale released a paper recently agreeing with this theory too. Good luck

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  29. Thought I'd Chime in on some success. I had my left hip Labral tear and reshaping done April 18th and then the right on June 27 (no tear yet, but visable fraying from impingment). I'm back to a very physical dock job and played pretty intense soccer last night! The arthritis is here to stay so sitting for long periods kinda sucks..... but most everything else has been recovered. For comparison to others, I was pretty much pain free 24-48 hours after surgery and had none of the complications I read on the forums. In the end I'm very satisfied I went through with it after putting it off for a number of years. Dr. Cara Beth Lee was very honest and patient with all my questions.....and the outcome speaks for itself. Best of luck to everyone heading down this road....not all bad news :)

    ReplyDelete
  30. Hi Jezzeppi excellent news, nice to hear good news like that.
    I had Cam removal from right hip femor neck on 25th Aug, but seem to be struggling, cannot really walk any distance without pain, seems to be mainly groin pain,, kind of constant at the crease, shooting pain in groin when walking up stairs, and abductor twinges on the wall of the thigh next to the groin, is this something you ever experienced Louisa ?
    I have tried to keep on top of the ROM, but after I do it, it all seems to just tighten right back up, I've just started to do ROM in the pool under guidance, hoping that will help, but it doesnt feel great.

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  31. Dear Anon, Please join us here, I am struggling to answer individual Q's here as I'm recovering from pneumonia after drinking some dodgy water in Spain! Please link to our forum here: https://www.facebook.com/groups/FAIhip/

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  32. Hello. I had a hip arthroscopy done 8 months ago for ongoing hip pain. A labral tear was repaired but my pain continued. Approx one week after surgery my hip began clicking/ catching again. I have had a repeat arthroscopy performed where a cam lesion was removed. Unfortunately My hip began catching approx 10 days post op. I'm very concerned that it has failed again. I'm worried that a THR looking like the only option now for pain relief. I'm on morphine patches which aren't helping. I'm only 31. Any advise? Thanks

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  33. Hi Ed please come to this site as I am struggling to reply to everyone and this is easier for me and better for you https://www.facebook.com/groups/FAIhip/

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  34. Louisa,
    I was recently diagnosed with FAI after experiencing primarily back pain for two and a half years. Looking at doing an arthroscopy in the near future.
    I'm trying to decide between two surgeons--one came recommended by a respected surgeon my dad works with out of state. I was referred to the second through my primary doctor. He also seems very qualified and has many years of experience with this procedure. He can also get me in a couple months sooner.
    I noticed that you stress the importance of choosing the right surgeon. Is it worth waiting? I am getting so impatient, and the pain is increasing. I haven't been able to find an unbiased opinion of the second surgeon. Do you have recommendations for tracking that down?

    ReplyDelete
    Replies
    1. Yes try this site, its very active with recommendations and questions re current FAI surgeons.

      Delete
    2. Ooooops I mean this site:
      https://www.facebook.com/groups/BestHipSurgeonsReviews/

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  35. I'm not even 2 weeks post op... For cam pincer, debridement , and remodelling of the ligament Teres.. The moment I woke I felt relief ... The pain before the operation was so bad I'd sit and cry but thanks to Dr Parminder Singh ( Melbourne) that is all behind me .. The pain is minimal as I recover , I resting taking arnica and Chinese herbal medicines as well as my western meds to aid recovery and doing 'everything' as I'm told ... I'll introduce exercise as advised and seeing I love the gym and yoga I'm finding it a challenge to rest so much but I will , as the first 6 weeks post op have a large impact on the outcome ... I just wish I had the artheroscopy sooner ...

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  36. Acupuncture as well as your normal physio , works wonders in regards to pain and stiffness and also inflammation .. A clicking or poping sound in the hip is normal after the operation as the hips " seal " has been opened for the operation , this usually settles after 3 months ...

    ReplyDelete
    Replies
    1. Thanks for your input and best wishes for your continued good FAI surgery recovery.

      Delete
  37. Wow. Amazing to find a blog like this. 3 1/2 years ago, as I was trying to recover from a scope procedure on my right hip, I visited another blog religiously. Everybody was doing poorly of course.

    I ended up with a hip replacement 9 mos after my scope, with a new surgeon. I had developed bone on bone arthritis, tho I had entered into arthroscopy with a pretty good looking joint. I had a labral tear and impingement, but lots of joint space and only mild arthritis acc to MRI. Arthroscopy accelerated the arthritis--the theory is that the heat and trauma of the procedure are too much for any existing arthritis to deal with, and it goes into overdrive. Maybe your labrum is all fixed up, but the tradeoff is breakneck arthritis.

    So guess what kind of device I got when I had the hip replaced? Metal on metal. I was fine for about 3 yrs. I am now in pain, trying to get my cobalt and chromium levels tested to see if I have toxicity from metal ions...or maybe one of the pseudotumors that have been cropping up with the m-on-m prostheses. Lovely! My surgeon is with me, he wants to set things right (and I guess avoid having me joint one of the tons of lawsuits taking place over the devices). Revision would involve replacing the cup only. This poor hip has been through a lot but I would do it to get rid of the toxicity risk.

    Meanwhile, my left hip hurts from...a labral tear and mild arthritis! And there's not a damn thing I can do about it surgically. I might ask for a cortisone shot, but I just had some for bone spurs in my toes!! Anyway, I will, like many other people, look for my own remedies, and I suppose wait for further degeneration, then have it replaced. I eat well, my weight is good. But I'm a 63 yo woman. I should never have been encouraged to have arthroscopy in the first place. The chances of having arthritis are just too high when you're in or through your 50s, and it's a sure way to blow your chances of success.

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    1. I agree Melly and there just wasn't (still isn't) enough info out there regarding the condition and options. Anyone with extensive arthritis should steer clear and also given your age and how recovery for THR is easier I can not understand why you were put through that. So irritated you were given the metal on metal, compounding the situation.
      Take a look at this document from around Nov 2011, it details the difference in success rates with metal on metal verses other implants and is infuriating because they obviously must've been turning a blind eye for some years. This article is very informative and may help you decide what material to use next time. You may have to cut and paste this link. Best wishes ps note page 127.
      http://www.njrcentre.org.uk/NjrCentre/Portals/0/Documents/England/Reports/9th_annual_report/NJR%209th%20Annual%20Report%202012.pdf

      Delete
  38. Thank you for the reference Luisa. Amazing that metal on metal got to take off the way it did with so little scrutiny. My surgeon was even one of Wright's prized educators, traveling around the country (I'm in US, but I'm sure he went abroad) to teach other orthos how to put in Wright's m-o-m prostheses. He also went on and on about the advantages of a larger femoral head, saying that I could do absolutely anything I wanted and not fear dislocation. Well I've been very active with my larger head, from yoga and pilates to Zumba and weight work. Now it turns out that female gender, large fem head, and high activity levels are major risk factors for m-o-m failure.

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  39. Hi Louisa, thanks a lot for all these info about FAI. I'm going to have a hip arthroscopy in one week time. I was wondering if you knew a good physio in London, someone who is used to the kind of rehab program required after such a surgery? I'm going to ask my surgeon too but if you know someone it will be very helpful. Thanks a lot.

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  40. I'm 37 and have always run, basketball, boxed, karate, kitesurf, etc. My chiro diognosed FAI in both hips plus osteo arthritis in both but more so in 1 side.

    I had pain at time but learnt I could manage the pain by limiting to one run a week but no karate or basketball, but still knew it was not quite right.

    I was hoping surgery would improve and I could get back into my normal routines.

    Had osteotomy end Nov 12. FAI plus labral tear, around 1mm cartilege left at time. Surgeon shaved down bone and scraped out cartilege, now classed grade 4.

    Post surgery, surgeon pointed out cartilege shot and no hope of resuming running, or basketball, perhaps some light boxing, kitesurfing if limit impact on hip, replacement will be needed but can't give time frame.

    It's been 5 months now and it is still painful most of the time and I still walk with a limp. I've tried doing some light exercise about a month ago a couple of times but think I overdid it and pulled up sore, so I've stopped.

    I've been regular physio and doing my rehab farily regularly. At present I'm feeling as though it is worse since surgery and if it doesn't improve I shouldn't have gotten it.

    Has anyone else had similar experience and do I just need to give it more time? Or have I just sped up replacement time?

    I understand unfortunately I'll never run or do karate again, but was hoping to be pain free to light box and perhaps kitesurf, but worried about that now.

    Has anyone else heard about a hip reconstruction rather than replacement? How does it work? Does it work? Should I just go for replacement?

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    1. Did this get any better for you? I am 5 months out and can barely walk in starting to think something went wrong and I made an awful decision having surgery

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  41. I was 59 years old when I decided to give arthroscopic hip surgery a try to correct an impingement problem and resulting labral tear. Bone was removed from the femoral head in addition to the lip of the acetabelum. My surgeon, Carlos Guanche in Van Nuys, CA was also able to repair the labrum back into place with two small anchors. Damaged articular cartilage was removed in addition to the loss of some cartilage on the femoral head.

    It's been just over 14 months since surgery and I am hiking 20 milers again without pain. And my hip is still improving. Key for me was in allowing myself 18 months to recover and continuing with PT exercises. I didn't force the recovery! Hip strength and flexibility continue to improve.

    My recommendation is to do your homework, first by choosing a surgeon wisely. I had four on my list, and as it turned out, they are the four top guys in the U.S. (Brian Kelly, Thomas Byrd, Mark Phillipon, and Carlos Guanche). Secondly, pay attention to the x-rays and MRI. Since my joint spacing was consistent and I wasn't in a great deal of pain and still functional, I chose to take the risk. There is no guarantee this surgery will work for everyone. But for me, it's been a major success.
    Cheers,
    David

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    ReplyDelete
  43. Hi, I agree. One need to find a good surgeon with good experience in recognising FAI conditions and "repairing" it. I am after one arthroscopic surgery (after nearly 15 years of looking for the right diagnosis!). Next day I was at home, vaccuming etc. Pains dissapeared! Of course "repaired" hip is not 100% as good as the old one was, I could have several minor complaints but still great that this condition can be arthroscopically fixed. Now (two years after the surgery) waiting for the second surgery for my other hip. Unfortunatelly it does not always help - my friend had a surgery with no results.

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  44. Thank you for this well articulated well thought out information.There are so many horror stories out there and when your considering this surgery everyone gives you theirs. Or you run into people like that guy from Upright Fitness who want to tell you what you have doesn't exist. I am 5 weeks post op and, thank god, ran into blogs like yours. Chose my surgeon very very careful (Chris Larson who you quote) and I could not feel better. I haven't felt this great in years. My case was straight forward. No arthritis and my labrum was still intact. Torn but intact. Everyones hip is different but for me this surgery has been a god send. Thanks again for spreading the good news!

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  45. Really happy to hear of your success. Glad you chose wisely, it really can make all the difference.

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  46. I had my FAI surgery in April of 2014. I initially went into the doctor with groin pain due to a half marathon. I had never previously had groin pain. My hips have never been flexible, but never did I think I had an issue requiring surgery. Two orthopedic surgeons suggested FAI surgery. Now a year after the surgery and 2 months of physical therapy my hip hurts constantly, whereas before I only had a brief 5 month span of groin pain, and ZERO hip pain. I'm 32 and have always been pretty active with running, soccer, basketball, etc., My surgeon told me I shouldn't be running again. Why did I do this surgery?!
    Is my life really done in regards to running? Any ideas for good physical therapy would be appreciated.

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    Replies
    1. 5 months out and I'm in more pain than before surgery / really regretting this

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