Femeroacetabular Impingement

Am I the first?

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16/08/2012 at 10:44

Glad your op went well loverunning, but sorry to hear that you can't run again.  I know cycling and swimming will never replace the buzz from running (well, not for me anyway) but at least you can do something - get some cycling mags to read while recovering and give you new ideas for things to do on your bike etc.  Hope your recovery/rehab from the op goes well - the op is actually the easy bit, yes it's painful afterwards for a while but more mentally taxing is the rehab.  I think this has been one of the hardest years ever for me, rehabing with a young child is not ideal and has stretched my patience to the limit at times.

dav0 - I, to, unfortunately am a slow healer.  Why us hey? The pain in my hips is definitely not getting better through doing nothing yet (my consultant said I would notice some improvement after 2 weeks if it had worked, I'm notw 4 weeks on) so I can only hope that it will get better.  I have been told by the consultatant that most people get better with conservative treatment but that usually around 1 in 20 has to have a further op to sort out the illiopsoas, but they don't like to go back into the hip until a year has passed since the op. 

In the meantime my AT has flared back up again.  After having done nothing for a year I have got to the point where I need to know for sure that there is nothing more going on with the achilles other than tendonitis, so have an appt booked with consultant for mid-Sept.  Thought I might as well get it looked at whilst the hip is getting sorted.  If nothing else, a scan will at least show that it is healing (slowly?) or not.  I feel as if I have spent the last year just dropping my trousers to all and sundry to have a prod and poke in various places, it would be so lovely to be pain free and run round with my little boy.  I live in hope ...

I like the sound of the antigravity treadmill Pipes, sounds blissful to run pain free.  Hope your hip feels OK today, if so, go for it and book some more sessions.  It will make you feel so much better to actually say that you have been running.

16/08/2012 at 17:45

best of wishes for the post-op recovery loverunning.Its a major life change to not run but in time it will hopefully be a major life change to be free of pain or pain reduced. Ive been thinking over the last few days that if im unable to get back to running then hopefully i can get cycling at least and perhaps join a local cycling club, used to love going on long cycles as a teenager. I bet cycling clubs will have an uptake in memebership riding the crest of the bradley wiggins wave. You said your cartilage was at 15%, excuse my ignorance but does this mean 15% worn away or you have 15% left?

Pipes, i work very close to the waterworks parkrun but live closer to Victoria Park parkrun which is the one i go to most - though i see they are due to start one up on the East Strand at Portrush soon if its actually along the beach then this'll be one of the most picturesque parkruns around. Parkrun really catching on in NI and i think they are up to 7 of them now. Ive never even heard of anti gravity treadmills but will look into it

19/08/2012 at 19:21

Hi again,

Aww Bumble, nothing like being kicked when your down is there?  Can't believe you're dealing with AT as well as all this... jesus!  The psoas release op seems to be something that is done frequently in the US, but apparently the recovery is about 6 months?  Any chance of a shot into the psoas bursa to see if that calms it?

I know what you mean about being prodded and poked by all and sundry, I've well and truly had enough of it all too.  Also had enough of paying out privately for this, that and the other (no private care) and being mugged off by so called 'experts.'

Still no better here, still taking 1000mg of naproxen per day but it seems to do bugger all for my issues.  Being back at work really isn't helping as I can't get comfortable sitting or standing in front of a computer, but at least it takes my mind of all this.

I'm really rather pissed off with my consultant's lack of answers for this despite further imaging from ultrasound and MR (why do I still have this lump in my upper thigh/groin, for example), and can't help but begin to wonder if something has retorn in there as I just can't seem to shift the pain, which is beyond pre-op levels.  Everytime I speak to him, the goalposts keep moving and he seems to be in denial (his last report read ' has made a good recovery...!'  Crikey, by those standards I'd hate to see what a bad recovery is then!)

I won't mention him on here... yet (although he has been mentioned in a previous post by another) but if this does turn out to be a failure, then I wouldn't want someone else to go through anything like the experience I've had with him.  I would be a little more accepting if it was NHS, but not when I'm self funding privately!

Oh well, there's always hip resurfacing I suppose, but then that's not without grief (dodgy metal on metal implants and cobalt poisoning etc...)

Hope you're not in too much pain loverunning...

dav0

 

 

20/08/2012 at 14:16

Well i'm Day 7 post op and hoping and praying i'm through the worst of it. Have reduced my medication but still on a cocktail of codeine, diclofenac and paractamol to keep the pain at a manageable level. GP prescribed me some tramadol Day 4 to take at bedtime to help me sleep and its worked wonders, had the best few nights sleep i've had in months!! Got a lot of pain, tenderness and tightness in my thigh, all the way from my hip to my knee and still experiencing the clicking in my hip.

Ventured out of the house Day 5 on my crutches to get some shopping but really overdid it and gave me bad IT band pain and swelling so back to bed rest

Using my crutches around the house and managed to do stairs for the 1st time yesterday too - physio starts Thursday.

Parklife - I'm sure he said it was 15% worn, i'm hoping that's what he meant!

Dav0 - your recovery sounds increasingly frustrating, when did you go back to work? How you finding it?

20/08/2012 at 19:50
Glad it seems to be heading in the right direction, loverunning. Tramadol is good stuff in the short term and hopefully you won't be needing it for too much longer. How long are you expected to be on crutches for? I found the two weeks on them bloody awful.

I went back to work last week, four hours a day at first doing desk based duties. It's a bitter pill to swallow when you realise that after all this (nearly 12k poorer), i actually feel worse than before the op. I am working standing up most of the time as its less uncomfortable than sitting and helps my already banjo string tight hip flexors from shortening further! I didn't really feel ready to go back if i'm honest...

Anyway, i noticed that my hip clunked loads in the first month (particularly clams etc) and doesn't now, so I assume its just excess fluid moving around or something?

Hope you have someone running around after you for the first couple of weeks at least - i needed help dressing myself!!

dav0
22/08/2012 at 12:34

Hi everyone

I'm 47 and been running 5 years when I fell victim to the dreaded FAI. I had just had my best year of racing, PBs in all the distances, when I started getting problems at the early stage of marathon training Feb 2011. Being fixed minded I carried on with the training and had my worst marathon ever as I was in some kind of physical hell. I realise how stupid I was to persist with it all now.

I wish I had found this forum a year ago. Like most of you I had more than a year of misdiagnosis and misdirection from private Physio (iliopsoas bursistis, groin strain, weak adductor), Osteopath (sacro-illiac joint/nothing wrong with me), before GP referred me to musculo skeletal centre at Harrogate NHS hospital waiting 2 months for appointment, just to see another physio who couldn't help me and put me on another appointment waiting list for the Consultant, Mr Conroy. By then I was so depressed, tearful all the time and frustrated I opted to go private. I wish I had done so much earlier as the peace of mind that comes with it is worth the cost.

I think the professions have a lot of difficulty diagnosing FAI and labral tears as the symptoms present in different ways from patient to patient so in that light I kinda understand the issue. At no point did I ever experience sharp pain in the hip joint so I couldn't point to a single bit of my anatomy and say 'that bit hurts'. My symptoms were aching groin, adductor, outer hip/piriformis, lower back and a couple of episodes of giving way in the left hip. For a while I could run but afterwards had several days of feeling like my whole hip and groin area was in a vice. This became a permanent feeling and I eventually stopped running completely in July 2011, as well as having to give up the body conditioning sessions I have always done.

I had an xray (clear) and arthrogram MRI with dye (also clear) but the consultant still suspected FAI so after an anaesthetic injection in the joint, I opted for investigative arthroscopy. The consultant found bone impingement on the femoral head, took off 5mm of bone and trimmed and repaired the torn labrum. Thankfully I have avoided osteoarthritis, just in time he said. The liklihood is I will need the same procedure in the right hip.

It is now 13 weeks post op. The first few weeks went well, I was ahead of the curve with regaining joint mobility and strength work went to plan. I was swimming after 3 weeks and cycling on a road bike after 5. Now however I seem to be going backwards. My phys said I could do short jogging intervals after 7 weeks but I get the same old groin/adductor pains as pre-op so I stopped after a few attempts and I'm wondering where to go from here.

I'm watching all your posts eagerly and trying to take some heart from your experiences. I have a follow up with Mr Conroy in 9 days time and I know he will be guided by me if/when I elect to have the other hip done. You have to rememeber, once you have elected, you are on the consultant's conveyor belt, they are doing the surgery but you are responsible for your own decisions. The problem is I don't know if the first one has really got to the root of my problems or if I just haven't allowed enough time or been conservative enough with my rehab (too much cycling is likely). In the meantime I am still supporting my running club where I am race secretary (which is like having salt rubbed in to the wounds as I can't race) and hoping to god I will eventually make it back, even if it is only to train for and race 5Ks.

Ho hum. I am going to be glued to this forum from now on....

 

 

 

22/08/2012 at 16:19

Hi Laura,

Welcome to the thread, and sorry to hear that your still having issues like most of us on here.  I am pretty much at the same stage as you, though the groin pain returned about 5 weeks post op and I still can't sit or walk without it.

I agree that the diverse symptoms of labral tears can muddy the waters when looking for a diagnosis - I wasn't 100% sure what they were gonna find when they scoped my hip.  There also appears to be a bit of a crossover between hip pain and back pain, if you haven't had a lumbar MRI prior to getting the other hip done it might be an idea as it will at least rule out any involvement there.

Great news that you have no osteoarthritis in there, as this seems to result in generally poorer outcomes from hip scopes.  I have to say that jogging at 7 weeks is probably quite 'ambitious' for a rehab schedule - for most surgeons it is forbidden until 12 weeks at least.  Anyway, hope you get some answers from your next consultation; did you know if there was much synovitis in there when it was scoped.  It seems that this can cause persistent inflammation post op and can be responsible for continued pain...

dav0

31/08/2012 at 19:39

How's everyone else getting on with this nightmare?

Still no better here...

01/09/2012 at 22:28

Hi Dav0 ive got a date for arthogtram scan on nhs - 13 sept. Have a little pain on lower back right side only and back of right buttock, as well as inside thigh where attaches to pelvis(latter prob a labral tear). Worried that lower back and right buttock pain might be indicative of FAI.

Sorry to hear of your problems Laura M sounds like a nightmare, when all we want to do is something as basic as run.

05/09/2012 at 14:45

Hi Laura - How did your follow up appointment go with Mr Conroy and hows your recovery? Are you managing to do any exercise at present?

Parklife - the MRI arthrogram is not long off. Just bear in mind though that it doesn't always pick FAI up. When I had mine in Nov 2011 it showed a tear but I was told the etiology of the tear wasn't FAI and i'd be fine to keep running (I so wish I hadn't kept running).

 It wasn't until i saw Mr Conroy in June 2012 at Harrogate and he x-rayed my hip that I got a pincer FAI diagnosis. The arthroscopy I had 3 weeks ago showed that I had BOTH Cam & Pincer FAI & arthritis - not sure which stage. 

Dav0 - how are you? how's being back at work? I'm 3 weeks post op now, hip still feels worse that it did before the arthroscopy but hoping in a few more weeks things will improve. Still using my crutches out the house. Physio won't refer me for hydrotherapy or let me swim yet (apparently due to lack of strength). Back there 18th September. Not driving yet either; the thought of having to slam my right foot on my brake right now is not appealing. Signed off till 28th September so just focusing on trying to get myself 100% before I go back to work and the commute!

 

07/09/2012 at 20:43

Parklife - good luck with the MRA, hope you don't have a comedy wait for the results!!

Loverunning - sorry to hear it's still hurting, but three weeks is so early on in the game.  Hopefully you are noticing some difference though in that the ROM is getting better and the pain is lessening.  Funny that they won't let you in the pool yet - once the incisions have healed, pool walking seems to be THE thing to do to normalise your gait without crutches.

I don't know what you do for a living, but if it is desk based please don't rush back to work if you can help it.  I am still working standing up as sitting seems to aggravate my cranky hip flexors and it really isn't helping, but needs must.

Went back to see the surgeon last week who concluded that my ROM is excellent and that my hip has certainly calmed down, though it is felt that there is still persistent synovitis (inflammation of the joint lining) and local inflammation of soft tissues around it.

I am now seeing a different physio recommended by the consultant as his 'best,' and my first appointment found major shortcomings in my core/lumbo pelvic stability and general control of my femoral head.  Shame its a 120 mile round trip, but I'd do anything to get this sorted.  She appears quite experienced with hip scope rehab and by her own admission, it would seem that everyone is still very much learning as they go along with both the op and the recovery.  Those that have 'sailed through' on this thread without incident are, it would seem, very lucky and perhaps the exception rather than the rule.  Got a similar pain in my 'good' hip so am hoping that the issues are soft tissue related from faulty movement patterns (I can feel that my hip flexors do more than their fair share of work when I walk - lazy glutes); I can still feel that I favour the 'good' side of my body when moving...  I really don't want to put myself through this again with the other side.

This is clearly very much a marathon rather than a sprint.  Bumble - how are you getting on now?

08/09/2012 at 22:17

Thanks re best wishes for arthogram this week. Have completely knocked running on the head. I'm praying its a labral tear and not FAI.

dAV0 -at work would you be better with a high stool and higher desk as your workstation. Im pretty sure under employment law your employer has to provide this and in a large public sector employer like yours it shouldnt be too hard to rustle up.

 

10/09/2012 at 20:49

Davo - well what a difference a week makes! Feel like Ive turned a corner in my recovery - much more mobility and ROM - managed a 2 mile walk with 1 crutch, off all pain meds and managed a straight leg raise (1 week ago I couldn't even lift my leg a cm!!) - that's not to say it's painfree, but tolerable pain.

However, I still have that constant groin and hip pain and clicking and I know when I've pushed myself too much as I get  pain all the way down my thigh. I cannot walk without a limp and my gait is still lopsided so a long way to go yet! Back at the physio on 18th, the reason she would not let me start hydrotherapy was due too lack of strength. Hopefully, by next week she will see the progress i've made and give me the go ahead to get in the pool and maybe even on a stationary bike!!!

I'm signed off work for at least another 3 weeks and have my follow up with Mr Conroy 9th October. I'm predominantly desk based, with a commute - hoping I'll be ok by then - itching to get back to work and normal activity - want my life back, but preferably one without constant hip pain!

I've come across an FAI group on Facebook - there are lots of members in the group across the world who are going through exactly the same thing and there is a thread on there at the moment on bilateral Hip FAI - many saying that symptoms appeared in their good hip post arthroscopy of their bad hip - might be worth taking a look if you are on FB.

The success of hip athroscopy seems very varied; I really hope we are the lucky ones;-)

12/09/2012 at 22:22

Hello been a long time since I wrote on this thread but do feel as if things have moved forward if only a bit.

After the joke wait of 6 months for the results of an MRA it took 18 months to get, I was told at the end of July that I have a too deep socket in both hips (Pincer Impingement) but the FAI only causing me problems in my LH so far.

 MRA showed no cartlidge loss and no labreal tear but sub chondral cysts (apparantly this is enough to cause all the pain I have been feeling) My consultant sent me for a Cortisone steroid injection today (not too bad a process I thought) so we will see what happens. No options of any surgery have been mentioned. Have been told NOT to run at all and no yoga.  Good to hear people still managing to stay positive.

Good luck to everyone and speedy recovery to all.

14/09/2012 at 19:04

Good to hear an update from you, Linz, but not good that everything took so long.  How do you feel about their suggested course of treatment/ no surgery?

Well, my operation was supposed to be today but got cancelled yesterday. Can't describe how gutted I was/ am, as this is the 4th time I've been through this. Ok, the other 3 last-minute cancellations were for the other hip, but you build yourself up for it and make arrangements with childcare/ work, only to find that they aren't needed. 

Hi Laura, and welcome - how are you now and how was your follow-up appointment?

Best wishes to everyone else - hope the aches and pains aren't too bad at the minute.

Edited: 14/09/2012 at 19:05
15/09/2012 at 18:04

I need to get on here more often, so many posts to read through. Welcome to the newbies, hope the information you read on here is useful for your own situations. Always reassuring to know that there are others going through the same thing as you.

Pipes - how annoying to have your op cancelled. There's always so many things to sort, partic if children are involved, so I totally sympathise. Have you been given a new date?

loverunning - sounds like you are definitely moving in the right direction, literally! I walked with a limp for ages (definitely quite a few weeks post-op) so I wouldn't worry too much - think it's quite normal. 

dav0 - good to read that your hip has calmed down a bit. Have you tried sitting on a bar stool at work BTW?  Sitting still gives me lots of pain both sides, but funnily enough the pain has eased somewhat on walking.  Have been doing lots of laying on my front to stretch the illiopsoas so thinking that has helped eliminate some of the rubbing on the bursa.  Bursa is still very inflamed on the RHS (LHS not quite so bad but same feeling both sides so know that it's not the operated part of the right hip causing grief), feels like a sac of fluid which is squished when I bend down or sit at an acute angle. Know what you mean about long journeys as well dav0 in the hope to get stuff sorted - mine's not far off a 140 mile round journey each time to see the consultant.  Next appointment is this week, will be interesting to see what they say this time.  Where is your physio based BTW? I'm sure the consultant will recommend having some more physio.  I'm going to see if they can suggest someone local to where I live. Happy speedy recoveries to everyone else I haven't mentioned.

16/09/2012 at 15:06

Urgh Pipes, sorry to hear about that, mentally it must be so hard when you psyche yourself up for it and they pull the plug.  Hope they give you the premier service and a new date ASAP to make up for dicking you around so much!

Loverunning, good to see that you are finally seeing some form of improvement and I hope it continues for you... onwards and upwards.  Thanks for the FB suggestion - I'm one of the few people left that don't have an account but may set one up... 

Any news on the arthrogram results yet parklife?  Did they bang a local/steroid in there at the same time?

Bumble, glad there is some difference for you.  If you have nailed it down to the psoas bursa as being the cause, is there any chance they can inject it /aspirate it or something?  My physio is based in Croydon (easier to get to than it sounds, but still an epic journey nonetheless) and has good experience of rehabbing hip scopes.  If it's any use, please PM me and I'll send across the details.  I am now seeing her twice a week, and the difference in treatment is like night and day, though I'm yet to really feel any better but its early days yet.  I will be four months post op tomorrow, but have only seen her twice...

Interesting what you say about sitting - I am using a stool at work (thanks for the suggestion parkilfe, spot on) and it does help, but driving is a right pain in the groin and sitting anywhere is unbearable after 20 minutes.  Lying prone over both hips also hurts around the hip flexor areas.  I'm am still utterly miserable about the whole situation and find it hard to accept sometimes that after all this time, money (twelve grand at the last count - bye bye house deposit!!) I'm still battling with it.  I'll be positive about it, then doing some simple, mudane task - bending down to put air in my car tyres today - will be very painful and it brings it all back.   It's hard to reconcile the three tiny holes on the side of my thigh with the disruption and grief this has caused!  Sorry to rant on...

Wishing you all the best and speedy, painless recoveries...

dav0

16/09/2012 at 17:54

Hi dav0.  Ranting on is fine with me, and I'm sure with everyone else who is reading this.  Whilst I would never wish this tedious nightmare on anyone else it is reassuring to know that I am not alone.  I have been trying to be positive (my husband is likely to disagree) but it seems like it's been a lifetime of waking up every day and living/dealing with pain, so of course it's going to make us miserable. 

Who knows what they can do to sort out the bursa if, indeed, that is what it is, but I am taking my husband with me to the appointment this week to try and get some answers - last time they weren't keen to talk about what the options were if the steroid jab failed to work.  There is only so long you can wait to see an improvement ......

Please keep me posted on your progress with new physio.  I'll post again once I've had my appointment this week.

16/09/2012 at 19:08

Sorry to hear of the ongoing daily grind of pain and reduced lifestyles, my issues dont seem near as bad (though theres always an awareness that things could deteriorate).

Had my arthogram 3 days ago, Not entirely pleasnat but fine really and glad to have it done - im not really one for needles! Dav0 yes i believe they injected a local anaesthetic in there before putting the dye in. Just really hoping that its not FAI and if its a labral tear that its straightforward and relatively straightforward to fix. Of course i now have to wait for the consultant to get the results of the scan and for an appointment to be set up. Sweet talking phone calls to the secretaries will be made...

loverunning - all through the past 15 months since i got injured ive been able to use an exercise bike and thought recently to get a road bike and do the real thing. Have really enjoyed it so far and - fingers crossed -doesnt seem to excerbate the hip, though the pain remains 'on a level'. There's a whole world of cycling clubs and events including long distance and believe i am just at the very beginning of discovering a whole new world. Dont want to get too excited in case the cycling causes the hip to slowly degenerate, but if you cant run it seems to be not a bad second.

17/09/2012 at 18:15

Well this steroid injection lark is good stuff. I feel like I have been WD40'd inside my left hip. Have woken up and not winced getting moving. Crouching down with kids at school is possible again. Haven't dared run or get on me bike yet will try at weekend BUT how long will this last if its only treating the inflamation and not addressing what has been causing this it? If I have subchondrial cysts caused by FAI wont the pain just return?  The consultant said there was no cartlidge damage so how come the cysts have formed? If there is no tear do I need surgery? God it all goes round in your head doesn't it? I don't think they talk about the surgical options on purpose. The physio I originally saw 2 years ago said he suspected FAI but that there wasn't an X ray to be had let alone a surgical solution that Derbyshire PCT offered.  I self referred myself back to the physio team 6 months later.

Hope you get another date for your MRA soon Pipes I can't understand why they don't give you a steroid/cortisone shot at the same time as the arthogram why inject twice when its obvious that you need pain relief? Surely that is a waste of time and money.

Anyway will try to pursue just what happens next when see consultant for follow up appointment. In the meantime I have been advised to use a stick when walking the dog! You've got to laugh.

 

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