Femeroacetabular Impingement

Am I the first?

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16/10/2012 at 00:21

apologies for the spelling, its been a long day!

 

17/10/2012 at 20:30

Thanks for responses davo and LR - good answers and good reading.

Dav0 - the professor told me i had good gaps between my femoral head and socket in the xray i think he was referring to my cartilage looking fairly ok from the xray does this sound right? The more cartilage the better the chance for better recovery as you say.

Point taken about good quality rehab and if i go for surgery i shall put effort into finding a physio experienced in this field.

LR - That is the trade-off/ juggling act which is wrecking my head -ie  does getting surgery earlier give better chance of results? Surely it must. Pain thresholds have caused me to modify my activity since i first got symptoms 16 months ago - ive been using an exercise bike instead and hopefully not 'firing on' on FAI hips will stand me in good stead. However, i notice slightly increasing pain even though not very active - noticeably my lower back - and wonder if its beginning to start snowballing which makes me feel like i've got to act decisively rather than 'soldier on' like those infantry soldiers of Davo.

Good attitude about 'lifes detours' LR. I had been thinking the same when i switched from exercise bike to real bike - i was loving cycling again and was trying to be positive - at least i can cycle long distance if not run - then the bloody pain flares up again after hill climbs and a 50 miler round the Ards Peninsula - remember that place Pipes ha?? 

So i rang over to Prof Damian Griffins office in Coventry and to Prof Villers in Cambridge just to get ball park figures. Roughly the same,  £6000 for surgery, £250 for consultation, though Griffin would want a £370 CT scan to be done. What would be the benefit of CT scan?

I think one of them does instalment plan which might dictate who to choose?

What i might do is go for the private consultation first and use it as a 2nd opinion really, write down loads of questions and get loads of info, then leave it aweek or 2 to decide.

One question - when the bone is shaved, is there a chance that it might grow back and re-impinge in future at the same spot?

Spoke to a friend of a friend who is a physio, she urged caution re surgery, rekons surgery 'is the consultant's moneymaking business (even if NHS)' and thinks sometimes surgeons plough on with surgery when other options should be pursued first of all. She used the word 'cowboys'. Mmmmm

 

17/10/2012 at 20:54
loverunning wrote (see)

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.  

Loverunning - your words (or similar) goes through my head on a regular basis, but I refuse to believe them at the minute. I still imagine I will get back into regular running at a reasonable pace at some point in the future, even if that means being patient for a year or two more.  As parklife says, there are runners who have had FAI and/ or repair to a labral tear (Tyson Gay, Lisa Dobriskey, Nick Willis) who made it to Olympic finals this year.  Obviously, none of us are that good or are likely to have that much rehab support, but they should still give some of us hope, unless of course the surgeon has said running is a no-no.

Parklife - my surgeon told me that the boney bits could grow back.  Interesting to hear your/ Dav0's info re. private costs of surgery - something I may (reluctantly) bear in mind for the future if the left hip doesn't settle.  I actually found out a few weeks ago that my new colleague is related to Damian Griffin. Unfortunately, she doesn't think he does 'mate's rates'. No idea about the CT scan, sorry.  Sounds like a reasonable plan to go for initial consultation as a second opinion...

Trying to get the exercises in but it's tough to do enough now that I'm back at work. I'm shattered! But the recently operated hip is feeling ok, so I can't complain.

17/10/2012 at 21:10
Parklife, as far as i know the benedit of the CT scan is that is gives a 3D image of the femoral head, thereby allowing the surgeon to see how much bone needs to be cleared. However, mine wasn't keen on them as it is 400 times the radiation of an xray and he said that he would 'dynamically' test the joint for impingement when he was in there (as in remove bone, joint out of traction, move through rom to check for impingement - repeat if necessary)... This also saved me 400 sovs...!

If you have good spacing on xray, then this generally a good indicator of little articular cartilage wear. Again, i think CT is superior to xray for looking at this.

Good to hear the hip is doing ok Pipes, just be weary of those hip flexors when being sat for too long!!

The back pain for me was worse than the groin pain, and this sealed the deal for surgery as far as i was concerned. I have had relief from this post surgery (touchwood it doesn't ever return!!) Interesting point about the willingness of private surgeons to cut you open at a whim, as i very much believe this is the case with most of them. If the only tool you have is a hammer, then every problem looks like a nail, right?
17/10/2012 at 22:14

No way, radiation! Another thing to research and worry about! A 3-d scan of the hip does sound good though.

I note though that Villers didnt seem to ask for a ct scan, seems to be surgeons choice as you say.

i wonder, does strong core reduce probability of bone regrowth? maybe not.

17/10/2012 at 23:03
As far as radiation goes, i don't think its anything to worry about for blokes at least and they are pretty routine as far as i know. I had a CT scan on my back when all this kicked off (talk about barking up the wrong tree) and it took about 1.5mins... much, much quicker than MRI.

As i understand it mate, there is apparently studies that suggest there is a link between FAI and lots of activity in your teens. It also seems to be more prevalent in those that spend a lot of time in hip flexion (i.e. hockey players, footballers etc, anyone that's bent over). I used to run a fair old bit as a teenager and played football etc, but no more than a lot of others...
17/10/2012 at 23:27

that would be me then davo, used to play football at school then come straight home and do a paper round, as well play on a saturday...where did all the energy go??

i kind of like the idea of a ct scan though.

Am a bit concerned about the impingement growing back over time, y'know, after its been shaved away during surgery. My specialist said that he oftens sees those who go for the surgery back again in 3 or 4 years with the same problem i wonder if this is what he meant? I guess there isn't much data on this as its still early days for this technology.

Pipes -  it does sound like you are making progress, hopefully you will run again, maybe forget longdistance running for now and aim for regular parkruns - that wouldn't be bad and where i am now id take it to be honest so long as i could cycle 40 miles as well.

25/10/2012 at 22:47

How is everyone getting on??

I'm still researching and considering my options - can anyone help with or point me to any info about -- the possibility of the shaved bone growing back over time after the operation?

cheers

31/10/2012 at 22:01

Really shouldn't come on here to vent and feel sorry for myself but it has hit me tonight when I was swimming up and down on my own in an empty pool at my gym just how much I miss running...... running in the rain; running with my club; running when ive had a bad day, running in the countryside on a sunday morning; running with my ipod blasting out my favourite songs; running in a race and having something to train for.

Yes I'm thankful I can swim and bike but its just not the same and it's complete torture living with someone who is marathon training!!!

Anyone else feeling like this?

01/11/2012 at 16:56

loverunning - you can always come on here and vent/ feel sorry for yourself.  I think we all feel like this from time to time - I certainly did last week as I was having a bad week at work and no way of getting it out of my system.  I'm still a misery-guts this week, but thankfully have a week off work to get some sort of strength to fight the battle again.  I also live with someone who is running well at the minute and have to bite my tongue when he goes out/ talks about his times. Hope you feel a bit better about things soon. Keep venting if you need to, though.

parklife - I'm getting on ok - some days I don't have much pain, other days I'm limping on the recently operated side. I've not been doing my exercises as much as I should because of work/ the cold, which may be causing extra aches.  I hope I'll be better at exercising from tomorrow when I plan to start driving again as I'll be able to get myself to the gym/pool.  I'm afraid I have nothing concrete about the bone growing back - just a comment from my surgeon a few times about this being a possibility.

6 weeks post-op tomorrow. 6 more weeks til I try a little jog. But the hips will need to feel a lot better than they do today if that is really going to happen.

02/11/2012 at 22:01

Yeah such a real downer and twist of the knife all of this, loverunning and pipes, and i still haven't even had the surgery!! Know what you mean, for the first time in my life, at age 34 , i feel middle aged. Rather than full of beans, active, have a go at anything. Now my default position is 'wonder if it will hurt my hips'. Its shite. Can feel a wee bit of weight going on too.

The gloom of missing out on running and now cycling, the 'why me' misfortune syndrome, and the worry about all the inns and outs about surgery are never far away. In fact I had a real shite week too. Was trying to come to decision about whether to go for surgery or try and get by on activity modification, so last saturday went on a 60 mile cycle to 'test' my hips. The cycle was a joy, the feeling of exhaustion and later endorphins was just like the old days, but next day achey hips. Not in a massive masssive way, just a feeling of being a bit more reactive and achey. And it was Thursday morn before it started to subside. Started drinking in the house mon, tues and wed evening like a twat!!

My sanity couldn't cope, ive 5 grand in the bank, hard saved but Villars office are to  get back to me next week about a consultation. Ill go for this and be better informed. Spoke to a girl here in NI who was seen by Villars 4 years ago and her hip was a mess but she has no regrets about surgery, isn't back to her elite hockey playing but can run 10k on a treadmill.

I went to the leisure centre tonight and did half hour on exercise bike and hips are burney/bit sore just 2-3 hours later.

AND, the so called goodleft hip feels like its playing up just as bad as bad right one. I remember LR saying it was shocking how quickly hips deteriorated with activity..though id still put mine in the mild to moderate bracket...for now.

Nothing wrong with ranting i feel better for it though apols again for goin on!

 

07/11/2012 at 21:22

Back again.

 

Still struggling with hip pain, been to see Physio again and he still thinks its FAI. (I agree with him, my symptoms get better as soon as I stand and periods of sitting are painful)

Trying some Physio exercises (hip distraction) and have been to see GP to get another referral.

I just cant believe how much pain and misery this causes me and nobody can agree on a daignosis.

 

 

 

07/11/2012 at 23:25

Mickster, i don't know your history but its really only going to be a specialist who is going to be able to diagnose FAI - and they will do this with aid of MRI, arthrogram and X-Ray.Did you ask GP to refer to sports medicine? thats who diagnosed me though mri and arthrogram pretty much inconclusive - i waited months for these, and yet a simple XRay which took less than an hour while i waited showed up FAI straight away - perhaps discuss having xray as first port of call?

If its FAI physio exercises aren't going to help much apart from building up core strength/pilates, i believe.

At ;least your physio is aware of the condition and sounds clued in. The first physio i went to see was ineffectual over several months, and thats being kind. A bloody clown more like, and a clowns can be dangerous. My second physio was really good though.

07/11/2012 at 23:28

http://www.express.co.uk/posts/view/338490/Kyle-defies-medics

Mickster and evrybody. Here is a reassuring and heartwarming story of a Scottish footballer Kevin Kyle who had near enough given up his career after misdiagnosis and being sent for hernia and groin ops when all along it was tear and impingement!! Went to see Professor Griffin and he has been able to make a comeback!!

Its actually worth googling 'Kevin Kyle' as there are several newspaper articles about his injury woes and unexpected return to playing.

08/11/2012 at 20:57

Loverunning: I feel your misery, I miss my old life.

 

Parklife: Had X-ray, it said "CAM impingement with bony protruberence at femoral neck" so I went for an MRI which said "There is no evidence of any CAM impingement" and " no labral tear" so surgeon said he didint think FAI was causing my hip pain.

Went back to my Physio again and he does some tests (hip flexion) and comfirms FAI, he gave me "Mulligan (lateral hip distraction) techniques" (http://www.thesportsphysiotherapist.com/femoroacetabular-impingement-current-research-and-best-practice/). 

Just got an appt with Trauma and Orthopaedic Surgery next week.

Cheers,

 

Mick

 

08/11/2012 at 22:26

mick, keep us posted with your appointment next week.

I don't understand how the xray shows a bony protusion where bone shouldn't be and but on a basis of the mri fai is deemed less likely.

Mine was opposite way round, mri showed nothing, arthrogram showed smallish degen changes of labrum, which prompted specialist to do an xray, on basis of xray he confirmed fai.

 

Good luck with appt

08/11/2012 at 23:40
Mick, just briefly mate my MRI supposedly showed no evidence of a Cam impingement either, but it was plainly visible on xray and was removed in surgery! So big the surgeon had to put my hip in traction twice to clear the joint, in fact.

Also, don't forget that the MRI is 'read' on the subjective interpretation of the radiographer... CT is the gold standard for visualising bony protrusions. Hope you are all well, i'll post with a better update on my recovery at a more sociable hour...

Good luck with the appointment...
08/11/2012 at 23:51
Mickster my MRI reported no FAI just a tear, wasn't until I got referred to a hip specialist in Harrogate and he did x-rays did I get a pincer diagnosis and wasn't until I had the arthroscopy that they found out I had cam, pincer, tear and stage 3 arthritis.

Been having probs with my shoulders since my arthroscopy, saw my GP today, thinks I have impingement in my shoulders got a referral to a shoulder specialist for MRI and X-ray..... That's kinda put an end to my swimming for now maybe I've just overdone it!
10/11/2012 at 11:22

thats terribly bad luck loverunning, hope its a much more simple shoulder problem.

10/11/2012 at 11:38
Hopefully it'll just be a muscular problem from the swimming think my GP is only fast tracking me due to having impingement in my hips. I'm sure rest will sort it
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