Femeroacetabular Impingement

Am I the first?

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09/10/2012 at 21:46

Just thought i'd check in 8 weeks post op. Not reallly feeling much different yet compared with pre op. Went back to work week 6; lots of prolonged sitting (in the car and at my desk) and less time & energy to do physio may explain why I feel the way I do. Have been swimming though and been out on my new bike and managed a few miles! Still needing my stick to walk any long period.

My left unoperated hip has been causing me concern and have been experienincing the same pain and stiffness and pain at night. Had my 1st follow up appointment today wiith my consultant, he did x-rays there and then on my unoperated hip and it was a mirrir image of my right - both CAM and PINCER impingment. He's listed me for hip arthroscopy for my left, signed the consent forms today, looking at less than 4 months wait tilll the op;-( 

Was a lot to take in today and the thought of going through all of that again and the recovery is not something I'll be looking forward to, although at least this time, I know exactly what to expect!

How have you found your 2nd op Pipes?

How is everyone else progressing??

10/10/2012 at 09:38

It sounds like lots of you are needing surgery for both hips - is this really common? I am currently waiting for surgery for torn cartilage in my left hip. 'Loverunning' hope you are better soon, I understand the walking thing, that is what I struggle with most.

Since having done the damage I haven't daren't attempt to run for fear of making it worse, assuming that would be the case !?! I have stuck to swimming and x-trainer. Just hope the surgery comes in soon and it doesn't take too long to recover...I hate doing nothing. Good Luck for your second op.

10/10/2012 at 11:08

Hi again Rebecca I think the impingement in both hips is pretty common - my surgeon said the hips are often formed identically.  I don't think cartilage tearing in both hips (without a specific cause like impingement) would be that common. 

loverunning - I go back to work next week (3 wks post op) and am worried about the stiffness from the reduction of rehab exercise that you mentioned.  Did you have any microfractures during your op to still need your stick or is it just ongoing weakness/pain from all the work they did?  

It's good that they're on the ball with your other hip and trying to get that one sorted.  I'm sure that the delays in my first hip, then slow initial appointments for the second, resulted in increased damage and pain in the second hip.  Yes, the first hip struggled a bit with becoming the 'main' hip after the second op, but I'm so relieved to have had them both done in the space of 9 months.  As you say, loverunning, it's good to know what to expect when you have had the op before.

My physio has told me I can come off crutches, as I'm not limping without them.  That's a relief to my other side.  Things are definitely easing up and I'm starting to think that I may be in less pain now than I have been for 2 years.  Neither hip feels anywhere near perfect, but the discomfort is more predictable and less threatening. I'm continuing to ice, take ibuprofen and do my cycling/ exercises.  Might try to get into the pool at the weekend, but without any kicking. If that feels ok, I'll try some light aqua-jogging next week.

10/10/2012 at 18:12

Keep us posted loverunning pipes and everyone.

I now have an even more special reason to follow your progress. Today it was confirmed by the specialist that I have joined the impingement club, the club noone wants to be in. To say I am gutted is an understatement, though i sensed a few weeks ago this was where it was headed. F. F.F.

Cam impingement both hips. Arthrogram only showed smallish degenerative changes to labrum, he sent me for xray there and then, 1 hour later and its FAI.

Specialist, a professor, was somewhat cautious about surgery - says about5% cases are left worse off, about 70 % are left better off but he seems to think mostof these unable to get back to previous high levels of sport - especially for football etc.

However he accepted that hip is may slowly degenerate over time even with modification of activity.

Funny thing is its the right hip that gives me most gip and pain, yet the boney growth was more prominent on the left side, which feels more normal.

We left it that ive to try modified activity for the next 3 months, running on grass and cycling, and see how i feel then make the decision whether i wish to go for surgery.Can i live the rest of my life on modified activity which slowly harms the hip most likely anyway?? Or do i take the risk with the op??It russian roulette - would i just be better going for surgery asap before labrum/cartilage etc degenerate further and leave more permanant damage???

Another thing - the time it takes on the NHS, especially here in Northern Ireland. If I decide in 3 months to go for surgery, they have to then make a funding decision taking up to 6 months. Then procedure isnt done in NI so they fly you to England most likely Dr Mohammed in Wrightington Manchester (after waiting on his waiting list) then 6-9 months recovery. If i go for surgery Ill be sitting here in 2 years probably not yet recovered, and thats only 1 hip!! And thats after already waiting 16 months to get a confirmed diagnosis only today!

Ive had a shitty day so sorry for the rant. I will expore private medicine but i know its probably prohibitively expensive.

Id appreciate any thoughts or questions. Best wishes to all fellow bone hip victims.

10/10/2012 at 18:45

Parklife - hello mate, so sorry to hear the news, really hoped it had been something else for you.

Your surgeon sounds good in that he acknowledges that FAI surgery is not the panacea that some would like it to be, and that 6-9 months is probably far more realistic for a proper recovery than the 'back running in 12-16 weeks' that's bandied about.

The decision is frankly a shite one to make, and I do sympathise.  The jury is still out on whether or not early treatment of FAI will prolong your hip's longevity, though my surgeon and the rheumatologist that treated me argued that in their experience, to continue activity on a damaged, FAI afflicted hip will only accelerate deterioration.  Even now, some five months out, I still can't say if I've made the right decision with mine, and only time will tell with that one as I really feel in more pain now than pre-op, though the horrendous lower back pain I had on sitting has thankfully gone (touchwood it never comes back etc).

I didn't want to moderate my activity - I can't, my job depends on it - and I figured that to leave it would only cause irrepairable damage in the future, hence the decision...

On the flipside, at least you now know what you are dealing with for sure, though I know it will take time to get your head round it.  I'd write more but I'm off out, so will come back later. 

Hope everyone else is ok...

dav0

10/10/2012 at 21:46

Really, really sorry to hear that, parklife. Lots of decisions for you now...been there, done that etc. Twice.  So I know it's a horrible position to be in.  But obviously, as I chose surgery both times, you know what way my decision went.  Has your pain got worse while you've been waiting?  If so, can you imagine it continuing to develop at that rate as time passes?  For me, the difference in the right hip in the space of about 6 (relatively inactive) months was enough to convince me that surgery was my best option - better to take the risk of not fully recovering than knowing that it would definitely always be there/ getting worse.  

It's useful that Dav0 is more hesitant about the op as his experience of post-op recovery hasn't been quite as smooth.  I'm still not right at 9+ months post op on the left side, but I can definitely say that I'd rather have the discomfort I have now than the pre-op pain.

It's a long process getting the op and recovering from it, and sounds even longer for you, if that's what you decide to do. I can't say anything to make that any easier At least you wouldn't t have the 16 months initial consultation wait. And they may simplify the process in N.I. as time passes. It seems to be getting easier to get the op on the NHS now that the NICE guidelines are more in favour of the op (I think - as mrmoosehead had that problem over a year ago).

Btw I had more pain in the right hip, but the surgeon says that it had less damage when he operated. I think that might have been something to do with where the tear/ impingement were positioned. But I may be wrong.

How are you doing, Dav0 (when you're not out and about)? Glad the back pain has eased - at least that's something...

 

11/10/2012 at 23:27

I had a strange dream last night, a gorgeous girl, reminiscent of maid marrion, was walking towards me holding out a femur bone in her hands???

Thanks for the responses, its a bit late and ive to go to a wedding this weekend so ill post on sunday or monday, have a disturbed dream free weekend, if thats possible.

12/10/2012 at 10:13

I have just found out where I am being referred to for surgery - Mr Conroy at Harrogate...waiting list is at least 4 months....if not longer..fed up!!!

Is this about standard for the NHS, wandering if I should see if I can get referred to someone quicker, not sure how though.

12/10/2012 at 10:51
I was referred to mr Conroy in April 2012 for my right hip, had my 1st consultation with him mid June 12 & was told 4 months wait for surgery but they rang me early August and offered me a date of 13th August which I took.

6 week follow up with mr Conroy on 9th October, diagnosed with FAI in my left hip. Have been listed and advised 4 months wait again.

4 months wait for surgery in the NHS is good in comparison to other Trusts + Mr Conroy is very experienced and an excellent consultant so in my opinion well worth the wait!
12/10/2012 at 12:30

okthanks for the advice, Ive not got consultation app yet - what do they do during this? How did your surgery go in August?

12/10/2012 at 13:00

At the consultation in June he sent me for x-rays there and then (at this point the only diagnostic test i'd had done at my local hospital was an MRI Authogram and this had only confirmed a tear, no FAI at this stage).

Mr Conroy reported on the x-rays whilst I was there which confirmed Pincer FAI and Tear. He did a physical examination and I filled out some questionnaires on my level of pain and activity. I signed the consent forms and had MRSA swab/blood pressure and he put me on his list then for surgery.

Surgery in August on my right hip found CAM & PINCER impingement, labral tear and degenerative changes/damage in my joint i.e. Oesteo arthiritis. Had my labrum anchored and the impingement removed. He said I had a section (about 15%) which was completely worn. I was in overnight and discharged the following afternoon. Mr Conroy saw me the morning after surgery and went through everything with me and said NO MORE RUNNING!!

I was on crutches for about 4-5 weeks and couldn't drive until week 4/5 - still using a walking stick. Had 6.5 weeks off work. Started with pain in my left hip week 1 of recovery and has progressively got worse. Started swimming (only crawl) and bike at week 5/6

Whilst my operated hip does feel different, it's still very sore even at week 8. Sitting for prolonged periods, driving and laying down still hurts and causes my hip to become very stiff. I'm still walking with a limp. Sleep is still affected by pain. If I twist it in certain positions it still hurts. My hip also locks and grates/cracks. Walking up stairs is still difficult without holding onto something. My hip feels like it lacks any 'power'. The scars have healed nicely but my skin still hurts to touch at the top of my thigh.Mr Conroy said this is all normal and could be 1 year before i start to feel any reduction in symptoms.

What the surgery has done is stopped the impingement and slowed down the damage the FAI was clearly doing to my joint. Whilst it can't take away the OA and may not have relieved my symptoms just yet but i'm hoping it's delayed the need for THR.

12/10/2012 at 14:46

Oh goodness, poor you....sounds dreadful. I have already had an x-ray and an MRI, diagnosis only shows small tear to cartilage around ball and socket so hopefully that is all it really is. Just getting bit fed up. It doesn't sound as bad as you have by near. Just want surgery out of the way so I can start the proper recovery.

You really think no more running? Its running and combat classes that I miss, xtrainer is fine at the mo, but I am fed up with this intermitent inability to walk far and run around as I am used to.

I really wish you a speedy recovery, ill let you know how I get on with Mr Conroy. Doc sending in my referal to him today - finger crossed and good good luck.

I was only on crutches when I did the initial damage for a couple of weeks, its been better since (having gone through the inability to do anything much)

Not been told yet that I have FAI - so hoping its just the tear (assuming they are two different things)

12/10/2012 at 21:07
Normally a tear is the result of some abnormality, FAI being the most common. Although tears can happen as a result of trauma e.g a fall. The arthroscopy will be your best chance of diagnosing what's caused the tear. I really hope that you don't have the dreaded FAI and that your tear is able to be fixed allowing you to resume running again

Absolutely no running for me unless I want to do
More damage to my hips being diagnosed with arthritis at 33 is bad but the thought of not running with my club again and doing a lake district trail race is just rubbish
12/10/2012 at 21:39

loverunning - I agree with you about the club thing.  I haven't really run with my club for almost 2 years now and I really miss it.  I still go to races and have sort of made a position for myself as club photographer (even though I know nothing about photography!), just so that I can stay in contact with them.  There are now lots of people who I don't know as the club has moved on so much since I was fully involved.  Who knows if I'll ever run with my club again, but I really do feel for you if you have been told you cannot run again Hope your pain eases soon.

Walked a couple of miles today to and from work. It was nice to be out and about, but my hips and legs are very tired now. Need to take it easy tomorrow.  Things feel pretty good in the newly-operated hip at the minute...less positive on the other side, despite the determined stretching, icing and strengthening.

13/10/2012 at 14:05

Ugh, sorry to hear about your other hip, loverunning.  It's sometimes hard to look at the situation you're in and find any rational benefit as to why we've undertaken this surgery, but I hope in the fullness of time that we will all be vindicated by the final outcomes.  I'm nearly 5 months out now, and was doing pretty well with the new physio until last week, where its taken a bit of a nose dive.

I had got to the stage where I could squat, cross train and had even been put on a jog/walk programme (jog for 5 mins - 1 min intervals - during a 30 minute walk), but have developed what I hope is glute pain on the operated side (started off being painful going up stairs and now I'm walking with a limp...arrrghhhh!!)  I think - hope! - it is a glute medius issue, as it hurts to sit/lie on my left bum cheek.  One thing I had found is that not driving has helped immensely with my angry rec fem; I have been freezing my nuts off on a motorbike instead (a 1200 Bandit with nice low footpegs for anyone that's interested) - and much of the anterior thigh/groin pain is beginning to slide.  Still on anti- inflammatories and have been for nearly 5 months... I hope this isn't doing any long term damage to my internal organs!

Interestingly, my physio wasn't big on cycling due to the fact that the high angle of flexion irritates the rec fem, and I think binning this has helped also.

Pipes - I'm sure you'll get there, if the joint was essentially sound when scoped then it has to be recoverable.  Good to hear that the most recent hip seems to be doing nicely, hope it stays that way.

loverunning -  A year seems to be a fair assessment of recovery rather than the 12 -16 weeks quoted (still think surgeons are over egging the efficacy and recovery times of this procedure).  I still don't feel like my surgery is a success at this stage and I guess I won't be able to judge it fully until a year has passed...

Rebecca - are you trying physio as an addendum to medical investigation?  I only say this because if you do not have severe FAI, you may be pleasantly surprised with the results.  Either way, it'll help you to be as strong as you can be before you go into the surgery - especially focussing on core strength (yes, I know its a ball ache but it really does make a difference!)

parklife - hmm, gorgeous women and bones...erm, dunno mate, but you sound like a psychologist's wet dream!  Enjoy the wedding and try not to smash the buffet/free bar/ bridesmaids too much...

dav0

Edited: 13/10/2012 at 14:08
15/10/2012 at 09:27

davO.

I am not currently having physio, as its a tear I have to the cartilage I guess its not just going to fix itself with or without physio. I am using the cross trainer to keep up muscle strength. Went walking about for an hour yesterday....paying for it now, getting the pincing in groin.

Passed my running pals out for a run in the sunshine...was a littel jealous, would have been lovely out there yesterday.

Hope you are going ok

15/10/2012 at 21:38

Absolutely Rebecca, pipes and lrunning, used to love going running in the autumn most of all especially on bright clear blue sky autumn days with the sun low in the sky. Now 16 months since i was running purposively - training for races, enjoying the camaraderie of parkrun, know what you mean pipes about clubs moving on and being left standing still, but....

after the shock of my fai in both hips 5 days ago other events overtook me such as family illness, work, and a wedding to attend. But am now a lot calmer and doing some research and need to research more.

any pain/discomfort/lifechanges i suffer seems to be currently the least restrictive out of anybody on this forum at this moment in time

I can walk for miles no real issues, and seem to be able to use an exercise bike maybe twice a week only slight discomfort after.

But, i know that when i have tried running pain returns straight away and can linger for up to a week. Before any hip problems were considered and it was thought by professionals to be groin only, i was doing phased return to running, initially this was ok but when upped the tempo for the first time, other areas became sore for the first time - lower back, outside edge of hip(trochanter??), left hip pain increased for first time. These areas have remained sore and problematic albeit such pain reduces with rest but i know it gets worse when activity restarts.

I think i am moving toward a decision

to have the fai bone shaving surgery.

the main reasons

1.I think if i don't then my hip will gradually deterioate and in so doing wreck labrum and cartilage permanently, speeding up the need for THR. Whats the popint in doing modified activity if its still damaging your hip, albeit at a slower pace?

2.Am i right in saying - if i go for surgery now while the damage to hip is at its least, i have a better chance of overall success. I think of Tyson Gay US sprinter - he had FAI and had surgery 1 year before London olympics but was recovered to the extent he came 4th in olympic final and took medal in relay. Now i know he has a brilliant surgical and physio team but surely the fact he got surgery early before further degeneration counted in his favour?? What do you think??Why would i continue to cycle etc knowing this is irritating and frictioning away at my hip??Anybody got Tyson Gay's number so i can ring him up and ask him?Pipes,Lrunning and DAV0 - do you think if you had got surgery earlier would your post op results been better?(hope the asking of that question by myself is suitably respectful)

3.I think i have now accepted a full return to running unlikely even post op. I ran marathons and was training for my first ultra when got injured - i now accept its unlikely ill be able to do this again - but not being properly physical active seems too much to give up on and i hope more modest goals post surgey have a good chance of realisation - parkrun x1 weekly, long 40-50mile cycle, x1 weekly etc. I know theres a risk i could be worse off from surgery, and thats a sobering thought but i hope to minimize the risk by getting the surgery sooner before more damage done.

Any thoughts on this evryone??

All good in theory, but there's the practical side of negotiating funding and waiting lists on NHS.Plus i know theres a chance of second hip going in due course as has happened to some on here. I'm going to research private hip scopes this week any ballpark figures for FAI surgery if done privately and do they allow you to put down a deposit and pay in instalments (surgery on the never never!!)

anyone recommend a private surgeon?

thanks again

 

15/10/2012 at 21:39

ps apols for long post! being succinct not a strong point!

15/10/2012 at 23:05
Thanks Rebecca, fingers crossed for you that you might just have the tear only and no FAI? I only say this cos there is apparently evidence from cadaver studies that many people have labral tears that can become asymptomatic and not hurt. Not sure how long you've been suffering for though.

Know what you mean about watching others out there doing their thing running etc... so hard not to get down about it!

Parklife, gotta say that as my tear was a result of trauma from a roll around at work, i didn't really continue to do my usual level of exercise on it afterwards, so i don't think leaving it for nearly 9 months to be operated on was the issue, as such. What I do know is that from infantry soldiers with this injury, i am told that 'those that put up with the pain' and wait until it becomes unbearable tend to have less favourable outcomes.

I wasn't promised anything prior to the surgery, as the governing factor for success is apparently how much articular cartilage is left and how good a state its in. 'Once its gone, it's gone,' pretty much sums it up. I think my issues with the op stems from poor quality rehab, hypermobility (yep, this doesnt help things either) and a badly inflammed joint to start with... If i had another go, i would have touted for physios like i did surgeons and picked the best one!!

In terms of cost, mine was 6795 as a package (anaesthetist and overnight stay, and follow up). This didnt include the hip block injection I had done before, which was another 2195. I think mine was more expensive than the going rate foe the surgery - Schilders quoted me 4500 all in for the surgery at St John's Wood hospital...
16/10/2012 at 00:19

Parklife really feel for you having been diagnosed with FAI. It took me well over 16 months from the symptoms first appearing in my right hip to getting the surgery, biggest battle being getting my PCT to fund the surgery. During that time my hip deteriorated rapidly, at that stage I had no idea I had FAI, so in the early stages I kept running, zumba, spinning, trail runs in the Lakes up some very big hills, even trained for a marathon (which I never got to run in the end).

By the time I got my surgery my GP had prescribed me tramdol for the pain I got at night, even sleeping had become painful. Even just day to day activities like driving, walking up stairs, getting out the car, sitting at a desk all became an effort (post op they are still an effort!)

I do wonder if i'd have got the surgery when the symptoms first started whether I'd have the degenerative damage in my hip. That's something no one seems to be able to answer.

I went into my surgery rather naively, thinking a 2013 return to running at my club would be easy peasy, how very wrong i was. Having a hip arthroscopy is a game of russian roulette and a 'good outcome' is to experience lesser symptoms post op, not neccessarily be symptom free.

FAI  hips are like worn tyres on a car and a hip arthroscopy is about patching them up, getting some more mileage out of them but replacing them is inevitable; its just a question of when and for how long they will last in their worn state. 

Going private, if paying out of your own pocket is very expensive and as Dav0 has shown, even after all that money you can't always guarantee a good outcome. On the other hand, waiting on the NHS might result in further damage and degenerative change! No easy answer for you i'm afraid.

And yep, modifying/adapting your activitiesand being patient seems to be the post op motto. My other half has just got in the London Marathon and has started his training and i'm soooooo envious!!! I want to be out there training with him, instead, I'm in the pool, focusing on becoming a 'swimmer' instead of a 'runner' - managed 40 lengths yesterday of crawl, and my technique is improving no end. Discovered I'm actually quite good at it! My upper body and shoulders has never looked so toned!!

Bought a decent bike too and did a few miles and some hills over the weekend ; freewheeled down a 1 mile hill with the wind in my face...now that fet good!

 I'm not pain free or symptom free and most days I question why me and get down about not being able to run....but i'm trying to look at FAI as my detour in life...leading me to discovering new things and new places I never knew I loved ....I'm ebracing detours!!

 

 

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