Femeroacetabular Impingement

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  • 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)

  • 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 againimage



    Absolutely no running for me unless I want to do

    More damage to my hipsimage 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 rubbishimage
  • 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 image 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.

  • 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... image

    dav0

  • 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 image

  • 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

     

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

  • 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...
  • 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!!

     

     

  • apologies for the spelling, its been a long day!

     

  • 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

     

  • 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.

  • 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?
  • 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.

  • 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...
  • 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.

  • 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

  • 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?

  • 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.

  • 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!

     

  • 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.

     

     

     

  • 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.

  • 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.

  • 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

     

  • 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

  • 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...
  • 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 shouldersimage got a referral to a shoulder specialist for MRI and X-ray..... That's kinda put an end to my swimming for nowimage maybe I've just overdone it!
  • thats terribly bad luck loverunning, hope its a much more simple shoulder problem.

  • Hopefully it'll just be a muscular problem from the swimmingimage think my GP is only fast tracking me due to having impingement in my hips. I'm sure rest will sort it
  • Loverunning, you poor thing. Sorry to hear that... Are you hypermobile by any chance?



    I have had shoulder impingement problems before due to hypermobility and biased training in the gym (too much bench pressing and pushin exercises, not enough pulling, results in a tight and overactive chest, front delts, upper traps; lazy external rotators in the shoulder and back rhomboids etc which hold the shoulder girdle in place). Swimming front crawl added to the problem. The good news is that it can be sorted with physio to restore the balance (resistance bands, then cable machines working external rotators and upper back), but like everything takes time. There are some quite specific tests that can be done to check for impingement and/or rotator cuff damage - a good physio should be able to diagnose it pretty quickly.



    How's the hip rehab doing?
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