Femeroacetabular Impingement

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  • Heh I bet they loved you at Stratford - esp if you were in a dull bit! Congrats on the parkrun win btw image
  • Thanks image Body definitely felt parkrun (due to not training) but head doesn't yet realise I'm injured and tried to push as usual!

    I was on the Greenway - so yes, a dull bit! Had bells on my arms and in my hands as well. Made a bit of noise...
  • Pipes, do you mind me asking which PCT have agreed to fund your operation? Bradford PCT won't. Kirkless and East Riding have recently I believe. Postcode Lottery scenario.

    I have had to take the plunge and book in privately. time is running out.

    Have just written out a timeline for my diagnosis - it's frightening how slowly stuff happens on the NHS - e.g. taking almost 6 weeks to type up a letter that was dictated by the consultant.

    To summarise to process. It has taken a year for the NHS to do: an x-ray, 2 MRI scans, an injection, 2 consultations and decide not to fund my operation. It will have taken 4 weeks from consultation to surgery with Schilders privately.
  • mrmoosehead - I'm in Oxfordshire. Postcode lottery, indeed. I also wonder whether the situation surrounding the injury plays a part in their decision. They said they had enough evidence that this was primarily acute damage and therefore more likely to have a positive outcome (ie the impingement hasn't yet caused much general wear-and-tear and that my pain is caused by a specific tear/incident). I worry a little that they may take a different attitude when it comes to my other hip, which is shaped the same way as the other one but hasn't developed pain in the same way.

    My timeline so far has also been much quicker - first doctor consultation in January, anticipated surgery in August.

    It's a shame you are having to pay to get treatment - I really hope you get a positive result. I have heard positive reports about Dr Schindler. Do you have a surgery date yet?
  • Yes, in a week friday (10th June). It's amazing how quickly things happen when you're paying out of your own pocket.

    Absolutely cacking myself about the outcome. Had a lovely run on Ilkley Moor this evening, beautiful sunset, calm, lovely.

    }:8(
  • All,
    Had my surgery on my right hip last saturday.

    Synopsis:
    damaged cartilage (probably due to impingement) that had to be removed, and thin in places - again due to impingement - microfractures to encourage regrowth. Cam impingement shaved down, but labrum too thin and tatty to detach to take down pincer impingement - compensated by more work on cam.
    Prof seems to think positive outcome though.

    I'm pretty mobile. No pain, just aching. Even took a trip into Leeds on the train yesterday. Doing all my exercises like a good boy. including 2x30mins on exercise bike. Painkillers not really required.
    Obviously the proof is in the pudding, and that will be a long way off.
    If you are intersested, I will be tracking progress on my training log at
    http://www.attackpoint.org/viewlog.jsp/user_1874/period-7/enddate-2011-06-17
    http://www.attackpoint.org/log.jsp/user_1874
  • That sounds really positive and reassuring, mrmoosehead. Thank you for writing so much detail about the procedure and how you have felt since then. I'm so glad that you don't have significant pain - I will certainly be tracking your progress on here (please do keep us posted) and on your training log. Do you have lots of follow-up appointments?

    I phoned the hospital to see if they had any idea when I would find out about my surgery date. They had thought early August but the receptionist today just said it should be done by mid-September, due to holidays etc. I'm happy enough with that - it will affect work, but not my trips to America and Ireland.

    Do you know when you'll be able to return to normal activities (eg. work), mrmoosehead? And how long will you be on crutches for, assuming that you are on them now?
  • Just been out for a few beers at Ilkley Brewery and walked the mile home on the crutches (via another pub). Great to get out. Main mobility problem is sore hand from crutches.

    Work I've already been doing some from home (I'm self employed IT contractor) Going to be doing more from next week, then commuting to York/Leeds for a contract from 4th July. Hope i'm not pushing it too far.

    Usually I think they reckon 4 weeks on crutches, at least 8 before running. Office work from week 3 onwards, heavy work from 6-8.

    If microfractures are put in to help cartilege regrowth, then crutches for 6 weeks, no runnign for 13 weeks.

    I have a couple of follow up appointments in the next few weeks, a big booklet of the exercise plans for the first 4 weeks and then it will be dependent on progress.
    Outpatient appointments will continue for years as they need the data to prove the efficacy of the procedure.

    Will keep updating attackpoint.
  • The microfractures bit I've not heard about before, is that a new wrinkle?
    What are you allowed to do eg cycling/rowing/swimming/yoga/nookie?
  • Hahah. Exercise bike straight off - best results from surgery come to those who do the planned exercises apparently.

    Won't know about anything else until first follow up @ 2 weeks. I guess they look at my specific rehabilitation then.

    http://en.wikipedia.org/wiki/Microfracture_surgery

    I'm guessing that the exercise bike is to ensure the cartilage and bone regrow in the correct way.

    Hydrotherapy is recommended - might go and stand in a pool and look stupid whilst the kids play.

    Trouble with all this rehabilitation is that it takes time. almost 2 hours of exercises a day - which is ok whilst I'm working from home, but once I have to start commuting again it's going to be difficult. And being self-employed, I don't get a company to pay me whilst I'm 'off sick' - and I've got to repay the costs of the surgery, so I can't delay working.

    As for nookie? Heaven forbid, I've been married for 13 years, you'd have to ask my wife };8)
    (don't tell mrsmoosehead I said that)
  • Thanks again for all the info - I now have some idea about what to expect and what to tell work. I will keep an eye on further progress but you seem very upbeat and energetic, which is great!
  • Good luck mrmoosehead! ...I had this operation 2 months ago now and my experience is not to disimilar to yours except that i have been told not to run ever again!

    I too had micro fracturing and was given crutches and told not to put any weight on my left leg for 4 weeks after the operation ...then starting with Hydrotherapy I had to learn how to start walking again ...things have progressed quite quickly since the Hydrotherapy ...I am now cycling in the gym 3 or 4 times a week.

    Very disappointed not to be able to run again ...I have basically been told that i will deffo need a hip replacement at some point ...and if I run that could be in the next 3-4 years whereas if i don't I could get 10-12 years ...so have been advised no high impact sports.

    What i have found though is that it such a new procedure people even the consultant and x2 physios i've seen seem unsure of things ...ie. you could run but you might need a hip replacement in 2 years time but on the other hand you might not we don't know! ...as one physio said we're all guinea pigs at the moment!

    I would be tempted to keep running because if it's going to happen it's going to happen but my wife was in on the consultation and has told me in no uncertain terms I will not be running again as i need to put the family first!

  • Hmm. Interesting.
    Both consultants I have seen have made noises along the lines of 80% chance of returning to previous level of competition.

    If you're following my training log, you'll know that I have OA in teh hip that will come back to bite me at some point. But at the moment, I'm just desperate to get back out on the hills again.

    And there are many options before THR, such as a resurfacing etc. And people do run with a THR. I'm hoping that by the time I get to that point, the research will have come on so far as to allow me to continue some running regardless.

    It's possible that your cartilage is more far gone than mine. I am 50% weightbearing on the affected leg and have a good exercise program that involves 2 lots of 30 mins on an exercise bike from day 1, increasing to 45 mins.

    What you have to remember is that this operation has three things to try fix:
    1) the impingements that may have caused the problem (simple mechanical issue)
    2) labral tears (the labrum is the 'collar' around the socket (usually caused by (2) or other injury
    3) cartilage damage - removal and microfracture. (usually caused by overuse or other condition)

    Number (3) is the problem one in that proper cartilage can't be regrown once it has gone. The microfractures promote growth of a stand-in scar tissue type cartilage (as I understand it) that isn't as good as the original, but will help.

  • Yes i think my cartilage damage was quite bad ...needed to be internally stitched and held together with 2 metal anchors ...the physio said I had it really bad and had only ever seen one case as bad in the past ...as I said I was non weight bearing for 4 weeks.

    Good luck with the rehab ...I have been told its a long old stretch and could take 6-12 months to fully recover.

    Going to have to take up cycling ...but it's not quite the same as a good run is it!
  • Ouch. sounds like your cartilage was oop the creek. Sorry to hear that.

    Nothing is a simple and 'spiritual' as throwing on some fell shoes and heading out onto the moors.

    Yes, long recovery, especially as I'll have to have the left hip done as soon as possible.
  • How's everyone doing? Any updates?

    Got the date for my op through - 28th October. Double the expected waiting time but I'm not complaining - I get to go on my holidays just beforehand! Got a pre-op appointment mid-September. My right hip is giving more trouble than the left but, because the left was the first to appear and be investigated, they will continue to deal with the left one first.
  • 10 weeks post op.
    First proper MTB ride last night. All appears to work well, apart from poor skills on MTB and general loss of fitness.

    6 weeks on crutches was hard work, still not allowed to run til sept 10th.
    Saw consultant (schilders) yesterday morning. Got a good review. Overall, on target for a complete recovery and have better ROM (range of movement) than prior.


    He was on Calendar news last night talking about FAI and arthroscopies and the stupid funding situation.

    Still no new NICE guidelines, even though they were supposed to be published last month.

    North Yorks and Bradford/Airedale PCTs still not funding the op, despite Schilders providing them with all the evidence that they have requested to back up the efficacy of the op.

    I am planning the left hip now. Going to ask for funding, but fully expecting to be another 5 grand poorer before xmas.

    Good luck for October.
    Were you funded by your PCT? If so, which one, and did you have to argue the toss?
  • Things seem to be going well for you, mr moosehead - that's great news. I'm sure it's been tough on crutches - that's the bit I'm dreading the most! Fitness will come back easily enough, I'm sure, although there's no rush.

    Shame that you will probably have to pay for the other hip as well as the first. I'm getting my op on the NHS through Oxfordshire PCT. I didn't have to argue the toss at all - the surgeon seemed to be keen to persuade me that the op was the best way forward, although I had already decided that was what I wanted. I just hope it's the same when I come to have my right hip done as well.

  • All the consultants were very keen for me to have this op, my doctor fully supported it.
    Bradford and Airedale PCT will not fund it for a variety of excuses. Mainly around the status of research and the NICE guidelines.

    The research has been done, and the guidelines should have been published by now. It'll all be too late for me though, unless I sort it soon. The earlier this is dealt with, the better the chance of recovery.
  • Thanks for the link, mr moosehead - very interesting to watch. I'm impressed with your fight and only wish it would pay off for you. Do you know of any PCTs that are close to home that you could request to be treated by instead?

    Been running a bit this week - did 13 miles in total without too much discomfort or stiffness afterwards. This time last year I was averaging 10 miles a day, in preparation for Abingdon Marathon. But I am grateful for every stress-relieving mile I can run at the minute.
  • Oh, that's not me in the interview - some other poor chap in North Yorks who is in a worse way than me.

    As far as I know, your PCT is the araea in which you live. You can request treatment anywhere, but it is funded by your PCT.

    To get funding from a different PCT, I think you have to move house.
    Which would cost me more than the operation I think. image

    Only 2 and a half weeks til I can run.
    Walked 5 miles on the moor yesterday. So good to be up there.
  • Derbyshire PCT won't fund hip arthroscopy either at present won't even do an x-ray or scan to diagnose what physio suspects as this is a pre-op diagnosis tool and there is no op.Just got to go back to physio on Nov if nothing changed. Feel bloody minded enough to keep running to make it hurt so have more obvious limp!!!

    You got to laugh! Maybe I'll ask Santa for funding.

    Still, had lovely walk with dog in Peaks last Sat, glorious. Thinking of digging out Touring Bike that I had custom made when I was 20  and seeing if more comfy than cheap mountain bike.

    Good to read some success stories. Thanks

  • I'm booked in for Left Hip now. GP is asking for funding again, but I don't expect any to be forthcoming from Bradford and Airedale PCT

    With respect to funding by PCTs, don't expect the position to change anytime soon...

    New NICE guidelines that were due out in July are not coming out until at least October as they haven't got round to it.
    Needless to say, they received a rather terse reply to that email.
    You can follow what NICE say (and contact them to ask them why they haven't done it yet) here: http://guidance.nice.org.uk/IPG213
  • Hooray! Have run!
    With the ilkley harriers family group.
    Started very carefully after good stretching.

    Was running ok, but a bit blowy up the hills.
    Scared of any leaping and dancing over rocks and things, but settled into it after 15 mins.
    Kept smiling to myself - I was out running!

    Coming down the 'ski run' was a bit of a trial. - right hip is only the tightness in the front, but left hip(non-operated one) was really complaining and transmitting down the adductor.

    Stiff afterwards in the left hip, right seemed fine. Did lots of stretching whilst watching England fail to look convincing at all against Argentina in the Rugby World Cup.

    So, all is well so far. 6 weeks to build up some fitness again, and then...
    Left Hand Side! image
    Self funded image
  • Hi Linz - sorry to hear about your injury and difficulties with your PCT as well. All these stories make me realise how lucky I am to have one that is funding the op so happily. The strange thing is, though, that I've been running a bit more in the past 2 weeks and haven't had the bad pains - just stiffness. I even did a parkrun today in 21 minutes, without any significant problem. Makes me wonder whether I am doing the right thing having the surgery...although I know I am in the long-run (no pun intended).

    mrmoosehead - I'm really pleased for you, being out running and not having much problem with the operated hip. That's reassuring. When is your next op?
  • 21st October.
    The good thing about self pay is choosing when and where and who.

    If all goes according to plan, then I should be back to 'normal' around march/april time. Might aim for a jaunt round the Saunders next year.
  • Dear all, to keep you updated, the new guidance has been published.

    http://www.nice.org.uk/nicemedia/live/11328/56416/56416.pdf

    Current evidence on the efficacy of arthroscopic
    femoro–acetabular surgery for hip impingement
    syndrome is adequate in terms of symptom relief in
    the short and medium term. With regard to safety,
    there are well recognised complications. Therefore
    this procedure may be used provided that normal
    arrangements are in place for clinical governance,
    consent and audit with local review of outcomes

    So let's see what the PCT say, eh?
    Probably - "we're going to start a process to renew the new guidelines and we'll decide by next year"
  • Interesting and reassuring - thanks, mrmoosehead. So are you going back to the PCT to see what they say re. your op, or are you just accepting that it has to be private again?

    Got a letter yesterday to say my op has been postponed until 7th November (from 28th October). Not too bad, I guess - just have to rearrange a lot of things (like work and childcare).
  • Well, I'm in on the 21st, I don't think that the PCT will approve it that quickly. I'll be onto the docs on monday.
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