Femeroacetabular Impingement - Health + Injury

PhilPub

20/01/2011 at 19:21

Eh up sports fans,

I did a search on this and came up with a blank. I've just been diagnosed by an orthopaedic surgeon as suffering from femeroacetabular impingement, which all you physiology experts will work out is trouble caused by irregular bone matter in the ball and socket joint of the thigh and hip.

Choices I've been given are keyhole surgery or give up running. Some choice. So has anyone been diagnosed and/or had surgery / other course of action to get it sorted?

Officially I haven't given the go-ahead for surgery but there doesn't appear to be a whole lot of choice, and I just want to get it sorted and get back running. Just want to make sure I'm doing the right thing.

Ta.

Curly45

20/01/2011 at 20:04

Phil - I have pmed you.

I have actually been on a day course for trainees practising a similar operation on sawbones (anatomical models) and its pretty grusome, but FAI has almost zero chance of self retification so if the pain is serious enough then they almost always recommend surgery (even though there is a risk it can make the condition worse).

I would say you would need the diagnosis confirmed with 3d scans if possible as a first point of call.

Never Give Up Girl

21/01/2011 at 12:54

Phil - I had hip arthroscopy in September for exactly the same thing. I was faced with the same decision give up running or have the op. No brainer for me. The recovery time is long - I was on crutches for four weeks - have only just started running again... Curly is right the surgery is totally grusome but hey you are away with the fairies under the general so in fact I think its the easiest bit the recovery time being the worst thing.. It wont self rectify from what I understand..

PhilPub

22/01/2011 at 11:02

NGUG - thanks for the info. Yes it's a delicate region and I don't want to think too long about what will be going on down there but as long as it gets sorted that's the main thing. Now that you're back running, does it feel as though it's completely back to normal? Is it the sort of thing that might be likely to reoccur?

Curly - thanks again for any referral information. Much appreciated.

Fido2Dogs

22/01/2011 at 11:30

I was diagnosed with a small anterior acetabular labrum tear (i.e. a tear in the edge of the front of my hip socket) in '07 after an MRI with dye contrast (MRA). This may have been partly caused by FAI as later I got a letter asking if I wanted to take part in some FAI research... even though they hadn't really mentioned it at the time.

But my hip problems had already been partly resolved by orthotics (fixed the piriformis hell) and strengthening the glute med. and stretching the hip flexors (which helped stop the labrum tear being rubbed by me running like a gurl).
Initially I was thinking of surgery but having read quite a few stories where it didn't help/recurred/got worse, I thought, "if I can manage this with paracetemol" (which I could) "then no surgery for now ".

Ironically regular training seems to help (as long as I stretch the hip flexors!). Initially swimming and hip distraction (you know, where the fizz puts a belt round your upper thigh and yanks fit to bust - I can do it at home with the bannisters, a yoga belt, and my own weight) helped settle it too. Ultimately it seemed that given mine was just a hurty hip I could manage without surgery there was no rush to risk the bonesaws making it worse.
Now it's just 2 paracetemol before a marathon (if I'm not just training through it).

Good luck with the hip. I'm guessing yours is much worse! You always seem very sensible and good with advice to other runners so you do deserve good luck!

Never Give Up Girl

22/01/2011 at 22:21

Phil - getting back into it - has taken some time - little distances adding each week no not quite back to normal .. so @uggered Paris for this year.. know what you mean re delicate area - physio is one recommended by surgeon so knows what she is doing - does make a difference. Seem to remember you are not down South re referral remind me..

Edited: 22/01/2011 at 22:24

PhilPub

26/01/2011 at 15:38

Fido - many thanks for the info. Yes I suspect mine's not so manageable since the 'impingement' in question is extremely noticeable (even though it doens't show up on an MRI!) so I think there will be some serious chiselling involved, or whatever they do.

NGUG - I'm in London. Any referral info gratefully received.

Fido2Dogs

26/01/2011 at 19:30

Was your mri with dye contrast?
Btw I only got referred for mine (mri/a) after they'd narrowed it down to a joint issue by injecting the joint capsule with anaesthetic (guided by xray) to check the pain all went away when they did. They wanted to stick some cortisone in there at the same time but I passed - thought I'd worry about treatment later when I knew quite what it was...

I think hip arthroscopy is still relatively new, so I hope you can get seen by someone who's done a good few!

PhilPub

27/01/2011 at 13:42

No, just a straightforward MRI, no funny stuff.

Curly's given me some very useful referral info (thanks again!) which i've passed on to my GP. I'm hopeful of being seen next by someone who is a bit of an authority on the procedure, so I would hope that if they're not entirely happy with the current ortho's diagnosis they could refer me for further scans if necessary.

mrmoosehead

08/02/2011 at 08:04

Now then.
I'm in the same situation - cam and pincer fai in both hips at 37. Left much worse - causes major adductor issues and very limited range of movement. So much so that I find it difficult to stretch upper leg and glute area properly.
I was diagnosed in April 2010 after having a great 2009 adventure racing (finally managed to get to OMM Elite). I have had MRIs on both hips and finally got cortisone injections in December, but to no avail.
Have finally got the recommendation for surgery from the Bradford Royal, and the request for funding should be going in now. Not holding my breath though as most of the indications are that the NHS will not fund this application, regardless of how good it seems to be at putting off OA and/or hip replacements. So it looks like my only option is raiding the savings for the 5k per hip required.
I wa sseeing Prof Schilders team - he's reputed to be one of the best around at hip arthroscopies - but he has now left the NHS as they were no longer doing any of the operations, so no point in him being there. Now seeing his protege Mr Bismal. I hope he has learned well.

I considered trying the pain relief option, but I haven't seen it help - the issue is entirely mechanical.
The worst thing is the frustration. I can still go out and run 15 miles o'er t'hills - but I pay for it afterwards. It's really affected my (already limited) ability to let go on steep downhills.

Worried about operation too. Have heard some stories of bad experiences, but then that's all you get on the interwebz- the bad stories. The successful ones are all out running.

Trundle

10/03/2011 at 19:55

I realise i'm a bit late with this, but I thought i'd write it anyway in case anyone else sticks Hip Arthroscopy into the search tool.

In 2007 (aged 28) I was a keen footballer and runner, but noticed what I thought was a slight groin strain before a match. Went through all the usual rest routine but it remained for three months so I went to the GP. Physio didn't fix it, after which I went through 18 months of misdirection and misdiagnosis from a host of physios, specialists, and orthopaedic surgeons.

During this time i kept running (they all said it was fine), despite the increasing pain i'd feel when I was doing it. Luckily a doctor friend of mine did a secondment in orthopaedics and got her boss to see me as a favour. One arthogram/x-ray later and i was diagnosed with FAI due to a bone growth on my femur and damage to the acetabulum.

The decision to have surgery was a no-brainer as I was in a lot of pain, my body was totally lopsided and I just wanted to get back to sport. I had the arthroscopy in Dec 2009 and began the recovery. Sadly my expectations were a little bit high, as the surgeon told me the damage to my cartilage in my hip was so bad that I would definitely get arthritis and need a hip replacement later in life. He advised me to give up football and running completely ( I was quite shocked at 30 years old) - I haven't kicked a ball since and limit my running to the very infrequent 30mins here and there.

To the point - I am still in pain all over my lower body (the body compensating for one injury causes another - knees, hip, groin, ankle, you name it). I can't run. I can't play football. I do maintain the subscription here to inspire me, and in all honesty I don't regret the operation - the damage was already done and i'm not in as much pain as prior to it. It was the two years of misdiagnosis that did for me I think.

I guess if I could give some advice from my disappointing experience it would be to value your rights as a patient above all else and don't be afraid to get second, or third opinions. I don't think FAI will just fix itself so this relatively fledging surgery may be the only solution at the moment.

I don't mean to be one of the "hard luck stories", and i'm sure a lot of people have positive outcomes. Sadly for me running is now a thing of the past and I'm stuck with volunteering at races to be part of the occasion these days

Fido2Dogs

12/03/2011 at 13:00

Funny you should mention football. I suspect it was an incident in five-a-side which might have caused my little labrum tear. Oh I loved the 5-a-side (though I was very, very bad) but have put it to one side now as the chances of injury don't really go well with planning a year of running :/

Pipes

21/03/2011 at 17:37

Glad I've found this thread - I've just got a letter today diagnosing FAI. My first symptoms were 2 days before Abingdon Marathon last year. I ran it anyway and got a PB of 2:58, but it has caused pain on and off since (I'd been lurking on the sub3 thread and already noticed your injury and symptoms, PhilPub). The docs thought it was a stress fracture until I had the MRI done. I don't really know what happens now - I don't have another appointment until May! I will definitely go for surgery, if it's offered.

I will read up on it properly tonight when the kids are asleep but does anyone know if it can affect both hips at once? I've been having pain in the other side since January, although that may just be from limping a bit with the other side.

Also, is it likely that the NHS will provide that operation or would I most likely have to go private? I see Mr Moosehead mentions paying, but wondered whether that's the norm or whether it depends on the severity.

Interesting to read your story F2D - gives me a little hope at least.

mrmoosehead

01/04/2011 at 19:35

Hmm. Well it looks like I'll be going private as the answer came back from the Clinical Priorities Committee (Bradford PCT) this week.
Not a no. Not a yes.
"On hold" pending their analysis of new evidence and potentially new NICE guidelines. Reviewing this and looking to form a policy by the end of the summer.
ARGH.

FAI is one of those things that the longer it is left, the less likely it is that the problem can be sorted.

So I think I have little option but to raid the savings and go private.
Fed up.

Pipes

01/04/2011 at 19:59

Sorry to hear that, Mr Moosehead

It seems illogical when not having the op done would cause a lot more damage (and cost the NHS more) in the long run.
I'd imagine I'll be told the same in May (if not months later).
Please do update on here - I'm very interested to hear your experiences and processes.

I can't imagine running at the minute. The constant discomfort/ pain is frustrating and infuriating as it is.

mrmoosehead

04/04/2011 at 12:49

For anyone reading this, it's worth noting that the new NICE guidelines are in consultation and due to be published in July.

From the look of it, they are angling towards recommending it.
http://guidance.nice.org.uk/IPG213/DraftGuidance

Dennis Doyle

04/04/2011 at 13:43

Going in for a Hip Athroscopy tomorrow to try and cure this! ....was diagnosed by my physio back in July whilst in training for the Windsor Half Marathon ...went to him with what I thought was a groin strain only to be told it was a Femoral Acetabular Hip Impingement.

Like you Phil i can still carry on running but pay for it the next day ie. can't put my shoes/socks on my left leg without great difficulty ...seems to hurt/ache most when sitting at work all day or on long car journey's! ...out running it's fine although I have noticed that I seem to be slightly limping up hills!

Got to say Trundles post wasn't good reading the day before surgery!

Started a thread back in December when my MRI results came in as i too couldn't find much info.

http://www.runnersworld.co.uk/forum/forummessages.asp?dt=&UTN=168807&last=1&V=7&SP=

I've had Athroscopy on both knees in the past with no problems but have been told this is a lot more involved ...a bit worried that when I spoke to the surgeon he told me he could actually make my symptons worse and that there is no guarantee the surgery will be successful ...on the plus side i found out at the pre-op last week that they actually go in from the outside of the thigh not the groin arera where the pain is ...didn't really fancy them fooling around in that area!

mrmoosehead

04/04/2011 at 15:36

Dennis, if you don't mind me asking, are you private or NHS? And which consultant are you seeing?

Dennis Doyle

04/04/2011 at 16:00

mrmoosehead ...luckily my wife has family BUPA as part of her work package so I'm going private at the Berkshire Independent Hospital ...the consultant is Mr Andrade ...Reading is quite a drive from where I live but I was recommended this consultant by the Physio as being the best at this type of op in the area.

Pipes

05/04/2011 at 19:03

Hope the surgery went ok for you today, Dennis. Let us know how everything was and how your recovery goes. Lucky about your wife having family BUPA!

Thanks for the link Mr Moosehead - I'll take a look later.