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:

PCT and HIP ARTHROSCOPY FOR FAI HIP IMPINGEMENT

In the UK many local PCT's either will not fund a life changing hip arthroscopy, or are slowly pulling funding on hip arthroscopy. It is deemed unproven despite fantastic evidence to the contrary, coming out of the USA. Unfortunately US hip arthroscopy success studies do not count as evidence here in the UK.
There are no successful studies yet published in the UK, However, there is the first study about to be published this month, August 2011 in the journal of bone and joint, so people can use this study as evidence for the effectiveness of hip arthroscopys when they apply for funding with their local PCT's

The PCT's have made the study criteria here an impossible one to recruit for. I am informed by a well known leading surgeon that the study would need to be a randomised study, meaning he would need to recruit 'X many hundred' candidates to agree that half of them would undergo a genuine hip arthroscopy to cure them, but the other half would have to undergo anesthetic and an incision site, but yet have no true hip arthroscopy... (compare it to one group of patients getting medication the other group gets a placebo and none of the patients in both groups know what they have received.) the evidence from this to show the surgery genuinely works. This test has made it impossible to do a study here in the UK, therefore impossible to prove it's success and so justifying the PCT's decision not to fund a "clinically unproven" surgery!

It is however important to mention that the requirement for a randomized control study does not apply for other types of surgery such a cancer surgery or cardiac surgery, for these type of surgical procedures they are happy with outcome studies. (these type of studies are available for femoroaceetabular impingement surgery open or arthroscopic) But because FAI is not lifethreatening different rules apply.
But currently no randomized control study has started in the UK.

The NICE guidelines are also very outdated and from 2007.

NHS underfunding is an issue in this country and severe pain is increasingly not a reason to operate, as they down grade and reduce funding even for hip replacements here in the UK, despite its 98% success rate and it been deemed one of the most life changing operations, with regards to quality of life. Hip impingement,treated by hip arthroscopy, is generally a young persons hip condition and without this funding 1000's of people are been sentenced to a life of unnecessary disability and pain, until they reach the age of 55, (if you bear in mind that the average age to get a hip arthroscopy is about 38, then you have another 18 years to go with pain) when they will finally be eligible for a full hip replacement after years of the hips been ravished by FAI.

Hopefully this new paper been released this month, Aug 2011, in Bone and joint will be the argument against PCT's refusals thus far.

Here is the link to the new paper just published, I am informed that you can use this to support your argument that you should be entitled to a hip arthroscopy via the NHS, authorized by your local PCT. Click here http://www.ncbi.nlm.nih.gov/pubmed/21768624


To petition that hip arthroscopys should be available nationwide, please click below

http://www.petitiononline.co.uk/petition/please-sign-to-back-hip-arthroscopy-for-fai-sufferers/3262

2 comments:

  1. First, some relevant back-story: In 2009, after 7 years of hip, groin and back pain, i had an MRA that indicated hip cartilage damage. Did i need a hip replacement? The only way to know was to have an exploratory arthroscopy. This procedure was not commisioned by my consultant's PCT, so we applied to my PCT for funding. They declined, on the basis that it was not clinically effective. My GP wrote back, making the sole point that orthopaedic procedures had advanced rapidly, and as if by magic, Dorset PCT considered me an exceptional case.

    The 'scope revealed a torn labrum as well as excess bone on the femoral head and acetabulum. My consultant considered open surgery to be the only choice.

    In July 2010, i failed a pre-op assessment and everything remained on hold until Feb/ March 2011, when my health had markedly improved. Following another round of scans to check for further deterioration, my consultant was confident i could now be treated via arthroscopy to the same standard as acheived by open surgery. This was the silver lining to my cloudy delay.

    So, we applied for funding....and were declined on the basis that - you guessed it - the procedure was not clinicaly effective. Mysteriously, i was no longer considered an exceptional case. What had changed? The fact i came so close to open surgery was also seemingly held against me ie "If it was good enough then, why isn't it good enough now?".

    Another reason for declining funding was that there was no evidence an arthroscopy was cost-effective. Cost had not been mentioned at all when they turned down the 2009 'scope.

    In summary, Dorset PCT declined funding in Nov 2009, then changed their mind with very little persuasion. A year and a half later - a year and a half of vast orthopaedic advancement - they have reverted to considering hip arthroscopies to be clinically ineffective. The general vibe seemed to be "Why should we treat you differently from anyone else?". That sounds reasonable, until you consider that nobody would ever be given the ok for any new procedure with that attitude...

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  2. Hip Arthroscopy or knee arthroscopy are very effective way of diagnosis and treatment of the health hip & knee related problems.

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