Femeroacetabular Impingement

Am I the first?

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23/03/2014 at 20:55

Thanks Rebecca. I'm due back at sports med next week so I will ask for an MRI referral. Sorry to hear that's it's come to the stage of a re-op for you. I'm in 2 minds about surgery. Sometimes it seems like it's my only hope but so many people still seem to be struggling after. It's really an impossible choice and only a crystal ball could help me make the decision. The worst part is I've emigrated out of the uk, and would probably need to travel back to get surgery, abandoning what has so far been a pretty successful emigration effort.

08/04/2014 at 14:54

Hi all

I am 1.5 weeks post my re-operation on left hip. They told me they had to remove the cartilage as it was too weak to repair, and they removed some more boney bits that could have caused the re-tear. I think I am doing ok. I can get around the house ok, frist week was not so good. Not sure what the removal of the cartilage means, they did say, its just can't re tear. Doing exercises,  basic streghthening, from physio, a little unsure whether I am trying to get around the house on own a little too early...Hope you are all doing well!

06/05/2014 at 11:16

Hi all, I am now 5 weeks post op and get clicking in the groi and aching in leg down to the foot. I still need two crutches when out and about....I still have 2 weeks off work...to be expected?

 

I am sure if wasnt like this the first time around....

21/08/2014 at 14:12

Six months post second op, should I still be experiencing the stabbing pain in groin? Still kills if I do the FAI test. Hope all are doing well

09/09/2014 at 21:50

Time to check back in folks as I am having a shocker, a nightmarish scenario.

Now about 20 months post-op. Things had been going OK, went to see a new physio March, I had no pain, slight limp, and doing moderate exercise no running. He started strengthening further the muscle around my hip with squats. It worked, I had no pain, great ROM and was flabbergasted to gradually start gentle running again.

About 2 months ago whilst doing a strengthening squat I felt a tear. Not for 1 minute did  consider it to be a labral retear, and thought it was a smallish groin strain. After rest was able to get back to gentle painfree running. Only to slightly reinjure it in very innocuous fashion about 4 times since,walking up stairs etc.

This week the pain has shot up and is very similar to the type and location of pain prior to FAI surgery. I now understand this to be a retear of the cartilage. Am gutted.

I went private for my op. I can't afford to do that again. Am frankly devastated. Spent over 6k only to be 20 months later be back where I started. Now have pain, back to no activity/diminished quality of life, waiting lists, funding issues with NHS to deal with. I can't believe this.

Any thoughts all welcome.

Rebecca, you have been through the mill many times over. What does your surgeon say?

 

01/12/2014 at 17:22

hi all, how is everyone doing? I am 8 plus months post second op and still have severe stabbing pain, clicking and general pain down into foot, is this to be expected...? back to hospital tomorrow, but not sure they will do anything as I have had the op done twice now

01/12/2014 at 17:27

Oh Parklife, I FEEL your pain. Yes I had it done again and they removed the cartilage, but im still in pain daily, very much so at night too. Talk to your surgeon and take their advise. Ive been told they won't do anything a third time, but too young for hip replacement. I do want them to take a look though, but im sure they will refuse, ill let you know after tomorrow. Keep smiling...

 

08/01/2015 at 15:57

Hi how is everyone doing in the new year?

09/01/2015 at 20:53

Hi Rebecca I think its just you and me keeping this thread going at the mo!

Happy New Year!

My Right Hip, the one that has been operated on, is modestly uncomfortable but doesn't get worse with cycling I guess the boney bit doing the damage has now been shaved away. I can almost feel the ripped cartilage right round the socket- it goes into my glute.

I took the bull by the horns and went and seen my surgeon again. He was very sympathetic. On reflection, my physio had me doing far too many lunges and squats putting far too much unnecessary force on the stiched up cartilage. I regret this a lot. I have not had a good overall experience with physiotherapy as a profession.

Surgeon wants to operate but then that is £££ which kills me financially but I have no other option as I can't really go through the NHS to have a look at another surgeons work. Needless to say I have made savings in other areas of my life.

This is the incredible bit - the month I had my op the surgeon tells me a new technique came out involving stem cell which might make the cartilage 'heal' better in lieu of it not being a vascular area. Costs an extre few hundred quid. I had a wry smile at this - the month I had my op this new technique comes out!  You have to laugh but I walked away headshaking.

Now, I had been doing a bit of cycling which has been a bit of a godsend but the left hip is now accelerating in terms of pain/not coping with exercise. 2 problem hips. Previous Xrays had shown the jagged bone sticking out rubbing into the cartilage in classic FAI pose. So that will need an op at some point and I have already been referred for NHS consultation.

Life's never a gentle rowing boat on the village lake, eh?

That sounds hard going having had your cartilage removed? Does anything help the pain like even painkillers even a little bit? Do they even know what is causing the pain?

 

10/01/2015 at 12:02

Grim stuff all around I'm afraid.

FAI doesn't "just" happen in the vast majority of suffers. It happens because of something. If you do not change or identify the something, the pain will return.

OS are great at dealing with structural issues - bits of bone growth or torn labral tissue, they are pretty poor at dealing or identifying functional issues - the whys and not the whats.

There is now compelling research stating that tears and extra bone growth can be totally pain free and is pretty normal in an aged population.

Unless you know why (as in bio mechanically) you ended up with FAI, dealing with the structure won't always change the cause and certainly will not alleviate your symptoms...

11/01/2015 at 15:59

Thanks for ur post six physio,

though I would say that the surgeon operating and shaving the bone and repairing the cartilage tear over the hip socket did eventually sort me out, I was pain free and felt as good as new....until doing lunge and squats (overdoing it in hindsight) caused a retear...too much pressure on a stitched weak spot?

Possibly there is a difference between small normal degenerative cartilage tears with age, and great big rips in the cartilage?

I would love to know why the extra bony growths occur in some people and not others; has their been any more research on this and I would be grateful if you could point me to relevant articles.

Regards

11/01/2015 at 16:46

Hi parklife - Here's the tricky bit - feeling better is not the same as getting better. It's pretty easy to make someone feel better, but harder to keep them better.

If lunging and squatting caused a re-tear (after a decent time period) then unfortunately it was most likely going to happen anyway - the lunge and squat are just coincidental to the cause. Any OS worth his salt will try to deflect away from his work....

Bone growth has a genetic element - can't change that, and if this is you it will grow back and you will have to have it done again, as your genetic make up remains the same.

Bone growth also has a more biomechanical vibe to it too - and this is more common. Think OA hips and knees - the older you get (more joint play/movement) the more bone growth there is (can be pain free).

The extra bone is laid down in a response to the excessive stress that's being put around the joint margins, due to the extra joint play and motion. I think FAIs could possibly fit into this category.

Let's say your hip has excessive joint play (not necessarily range) and bone is laid down. The bone is shaved etc but the joint still has excessive play - nothing has really changed...your hip may well feel stiff, but that's most likely muscle stiffness which is trying to protect you from the excessive joint play...

11/01/2015 at 19:07

Thanks sixphsio appreciate your response

so is there anything that can be done about the biomechanics side of things?

I had done a lot of pilates to strengthen core and a weak core had been identified as a previous problem.

It will be interesting to see if any new surgery reveals any new growth of bony bumps, which was pressing into the cartilage from underneath.

The thing is I had not been that active since the op at Xmas 2012. Just pilates, virtually no running and a fair bit of cycling, some swimming.

 

15/01/2015 at 16:57

Yes - absolutely, this is key. You need to get greater movement through your thoracic spine to take the excess load away from your lumbar spine and hip - it's why you've had an issue with your "core".

You can get your core as strong as you like but unless you have control of that strength, it's pretty pointless and you've lost control of it due having a stiff thoracic spine. All your rehab must be how you do it rather than just doing it. Getting stronger is easy, getting control is trickier as you need the ability to move better - this is the thing you don't and why after a good 12 months+ you re injured yourself.

Don't worry about the bony lumps - your cartilage has no nerve supply so you won't feel it...

15/01/2015 at 20:19
Just read the first few pages of this and the last. I'm 6 weeks post op - arthroscopy to fix a labral tear. I'm really pleased how it's gone and I seem to have lots if strength back. Can't run for another few weeks but back to swimming and cycling.

I have a question though. I didn't have any boney bits that needed shaved so the op was quite straight forward but pre op the worst of my pain was in the buttock. It sometimes felt like deep muscle and sometimes more like bone. The surgeon said the repair would not necessarily help this pain as it was probably unconnected but when the were in there they'd have a look and see if there was anything obvious causing it. While on strong pain killers following surgery this pain disappeared (first time in a year) however, as soon as I stopped the pain killers and started moving around this came back. Now the GP says this is probably sciatica because my spinal MRI showed a bulging disc in the sciatic area. The MRI was in July and this us the first time anyone has mentioned this.

My question is have any of you had a similar pain in the buttock and side of hip area, that has improved since your surgery?
15/01/2015 at 20:28

Hi Mini - your OS has fixed your structural issue (the labral tear) but hasn't a clue about the functional cause, hence the butt pain.

Your symptoms are brother and sister and totally connected....

Your butt will get better if you find and treat the cause...you'll also find it'll help your hip too

15/01/2015 at 22:52
That's what I think too although the tear could've been the result of a bike accident. I've always been a neutral forefoot runner but you you think it's worth getting checked out for orthotics?

I have been seen by various private and NHS physios over the last 14 months but everyone draws a blank.
17/01/2015 at 16:42

Tear could be due to a bike accident, might also be totally coincidental - some tears are totally "normal" and symptom free.

Not sure you need to worry about orthotics - neutral's good

....you just haven't met the right physio yet! Gotta (sometimes) kiss a lot of frogs

23/01/2015 at 13:11

Minni

I have had survery twice, the first time the labrum re tore, the second time they remove the cartilage. I STILL get pain in but and hip, front and side of thigh and deep groin pain - same as pre both surgeries

Six Physio, any recommendations

25/01/2015 at 18:10

Hi Rebecca - yes, find out why. Labral tissue is designed to take even load, until it finally gives up the ghost due to excessive movement/age. Unless you've had a traumatic incident you still haven't got to the why.

The most common pre disposing factor for FAI/labral issues is excessive joint play (how much glide and slide between femoral head and acetabulum) - this is not the same as range of movement.

Excessive joint play is the natural compensation for lack of motion elsewhere (and vice versa) - the general pattern is a stiff, pain free thoracic spine (postural driven - computers, sitting, slouching etc) and a lumbar spine - hip complex that moves too much as a compensation. The body detects this excessive joint play and so protectively stiffens up the muscles around the hip and pelvis - so the muscles feel stiff, but not the joints....it's super hard to distinguish the difference.

The excessive joint play and compensatory muscle stiffness cause huge amounts of shear and grind through the hip joint (and labrum). This is where you feel your symptoms, but it's not the cause.

Get your hip as strong and as mobile as you like, but unless you've got the ability to move better through your thoracic spine and less through your lumbar spine - hip complex you're, unfortunately, going nowhere fast..... 


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