by Nathan | July 31st, 2007
It’s a long story, but for the benifits of the internets I should probably summarize from the begining.
Vanessa and I started training for triathlons ~ May 2004, both having been quite active prior to that. I was cycling and Vanessa was primarily running. I was never good at running, tried a few times but stuff always came up, shin splints, knee aches, etc. Triathlon training started reasonably well, even the running was going pretty good. The intensity of the workouts ramped up fairly quickly, and progress was being made with the running and it was feeling pretty good. By December I had my first sprint distance AG win (5th overall?), with ~ 25min 5K I think.
Around February 2005 after a particularly intense swim workout (lots of hard pushes of the wall) I woke up w/ an extremely stiff right knee. Basically worked through it for quite a while, after warming up a bit it was ok. I went to my PCP who prescribed PT. Started the PT and did another sprint tri (my last), (AG win, 4th overall, ~19min 5k). I’d pulled back the running intensity a ton, and at the suggestion of my PT I tried running faster to try to make it less jaring on the knee. At this point the diagnosis was a persistant patellar tendonitis. Well, I tried that once I think, and wound up w/ a bad groin strain. The kind where you can’t put all your weight on that leg, or even walk normally. I stopped running entirely, focusing on traing for my first Leadville 100 mtn bike race which I completed.
I tried running a little after ompleting Leadville, figuring I’d given the knee/groin plenty of time. The groing was immediately a problem, subsequently I was referred to an orthopaedic at Lovelace. X-ray, MRI of the knee showed no issues and the groin was still considered a soft tissue injury. Had a couple 30 day courses of prescription anti-inflamatories, had a pelvic x-ray to rule out a possible stress fracture. Unfortunately, I think this ortho was primarily used to dealing w/ older patients in need of knee replacements. With the idea that things would get better I signed up for Ironman CDA, and all the diagnosis said nothing was wrong.
I recovered strength in the groin, and the knee was feeling ok. However, groin issues continued throughout IM run training. I did minimal running, with lots of discomfort. Certain stretching types of movements would result in a click/pop from the right hip. I had 2-3 Prolotherapy treatments for both the knee and groin w/ my PCP. I limped through IM (5hr marathon) and stopped running entirely and spun up for my second Leadville 100 mtn bike. In September Vanessa and I both signed up for Ironman Wisonsin (figuring I just needed to take a few months off running) I didn’t run (at all) starting in July, until around November when I started a very slow, deliberate build to running again. Things felt ok for a while, but by December while on vacation it was apparent that the hip/groin/knee was just as bad as ever. It was obvious to me that this probably wasn’t a muscle strain issue, and strength didn’t seem to be a problem. I basically made my PCP prescribe a knee and pelvis MRI, and give me a referral to the best knee doctor in town (still fixating on the knee, since that was where everything started), Dr Wascher.
I had the MRI, they did the knee w/o issues, and were doing the pelvis. They stopped the scan and informed me that they’d “forgot” that they needed an intravenous contrast dye and to sign here. They hooked up an IV and loaded me up w/ a gadollinium dye. I thought this was odd, and figured they’d hadn’t “forgot” but maybe found something interesting. I got the report for the MRI from my PCP’s aid on a voicemail type system, extremely lame and without detail, but the words “bone lesion” were involved and that I needed to make an appointment. From that it is recommended I get a radiograph (x-ray) of the lesion. I get the x-ray done and picked up, and have all my films/reports when I go see Dr Wascher. The report on the x-ray says that the bone lesion looks benign and isn’t uncommon and generally goes undetected unless you’re looking for something else in the area. But, the report points out that of interest is a bony portrusion on the right femoral diaphysis that could be causing femoral acetabular impingement. Dr looked at all my films, reports, checked over my knee and we agreed the most interesting thing was the hip issue. He referred me to Dr Franco at NM Orthopaedics for the hip and Dr Wilson at UNM Cancer Center for the lesion.
I went to see Dr Franco, I think in April, for the first time. He looked at the x-ray and MRI and felt the impingement was significant, and had both hips x-rayed in a different position which really showed the bump on both femurs. “X-rays could be in a textbook” I think he said. I investigated having surgery done in Vail w/ Dr Philippon, sent my films there for consultation and their diagnosis was the same as Dr Franco, no surprise. Dr Franco’s recommendation was to have arthroscopic surgery to correct the impingement, and look for any tearing of the labrum. I ultimately decided to have surgery with Dr Franco, partially b/c a week long trip to Vail for surgery and PT would be very costly, but largelly b/c Dr Franco was extremely personable and responsive, I had another couple appointments over a few months with him where I was able to ask lots of questions. I originally scheduled surgery for September 21, but also said if there was a cancellation in July I would be interested. (The idea being that I should be mobile to help Vanessa who is still training for IM WI)
The opportunity came together in less than a week to have surgery last Wednesday (7.25), and with some things going on at work it was a good time to get off the books for a while (know anybody needs an engineer?).
Surgery was 7.25 (day 0), arrived at 06:30 and paid my facility co-pay ($1600, gasp) (all this is “out of network” with my crappy insurance). After that was the standard pre-op dog/pony. I woke up in recovery around noon I think, in a bit of pain and more than a little nauseous. Nurses there are great, btw. Hooked up w/ some more IV drugs, which have the effect of knocking you out for another 45min.. After that I started to come around fairly quickly, and we were out of there by around 2pm I think. Felt good enough tanked up drugs for the rest of the day, americano and a Golden Pride #2 b-fast burrito hit the spot after not eating in previous 17hrs or so. Presciptions were 2 weeks of Relafin anti-inflammatory, and asperin for DVT. Percoset as needed. Anti-nausea meds as needed (which are great for nausea, but also make you go to sleep for about an hr). Crutches and 20-40lbs of weight bearing on the affected leg.
Day 1 (Thursday) was ok, stayed on the percoset and laid around. Noah came and hung out for the afternoon, and also picked up my DVT machine and plugged me into it. Pain wasn’t bad, moving around was a challange. Watched Greg the Bunny DVDs. =) Up and down to the bathroom, things are tender and stiff, can’t move the right foot forward of the left foot.
Day 2 (Friday) sucked, not so much the pain but the gastro-intestinal implications associated with the general anesthetic and percoset were pretty severe. Milk of Magnesium resolved one issue in favor of another, and I tried to quit the percoset. Removed the surgical dressing that morning (very disgusting) and showered. Three small incisions each w/ one stitch. Getting the dressing off and showering was quite a bit rougher than I’d anticipated. Vanessa helped out tremendously. Ultimately went back to the percoset mid-day, but was generally off my feed. Noah hung out again that afternoon, watched some motorcycle DVDs and an 80s classic “Dragon Slayer”. Good stuff.
Day 3 (Saturday), much improvement. I took my last percoset at ~ 7am, and switched to tylenol. Still nauseous and not enjoying food, digestive system having not yet reached equilibrium. Still taking my asperin and NSAIDs as directed. Lots of TV. Lots of getting up to the bathroom (pretty much starting day 0 I was up to pee about every 2 hrs, trying to stay hydrated w/ all the drugs).
Day 4 (Sunday), improvement continues. Didn’t even require tylenol, since then I’ve just taken some tylenol PM in the evening to help me sleep. Stomach is pretty much settled, and I got out a crutched my way up and down the street for about 20min. Layed on the floor and did some crunches and stuff, did a few lifts of the leg. Range of motion is much improved, not nearly as stiff and can move my right foot well forward of my left. Went to Matthew and Elisa’s for dinner and to watch Nacho Libre in hi-def, and the premier of Shark Week.
Day 5 (Monday), improvement platues. Pretty much what I expected, things feel ok. No pain of note, things are getting stiff from lack of activity. Doing much more for myself, doing some small things around the house. More core, more crutching up/down the street.
Day 6 (Tuesday), today. Pretty much same as yesterday so far…. One week follow-up is Thursday morning.
Incisions as of today, the bruising is coming in nicely. =)
Vanessa has been extremely helpful and sweet, and lots of people have been kind with the well-wishes. Noah has been very helpful, and having somebody to hang out w/ has been great.
Oh yeah, as far as the bone lesion I saw Dr Wilson and he didn’t think it was of concern, and we would follow it for a while. I’m scheduled for another x-ray in November to see what it is doing, if anythng.
The Hipscope website is a good resource.
I’ve had mobilizations and never felt like that. I’ve had this since the first couple days after surgery, it’s just taken center stage with time.
Adhesions? Do you mean like scar tissue? I definitely have some major scar tissue in the front of the hip joint limiting my knee to chest ROM.
As for the facebook page, you should still join. So many more ppl use facebook than yahoo. There’s a bigger chance for more people to get informed and a larger discussion.
I found another facebook group
“understanding hip impingement, fai”
good one to join too
adhesions - yes, scar tissue….
they totally nuke your muscle balance and the way that the muscles work together….
Kt, another theory about why arthritis can accelerate after hip arthroscopy is that chondrolysis takes place–breakdown of the cartilage cells–due to the trauma of the procedure itself. From what I’ve read, surgeons are starting to recommend against it even if arthritis is only mild on imaging (as mine was did).
I’d also like to say what a waste of time I believe MRA and x-ray to be for detecting hip pathology. 9 months before my scope, my MRA showed “mild degenerative changes,” no evidence of imingement, and a small labral tear. 3 months before my scope, x-ray showed mild degen changes and obvious cam impingement. When they went in, I had impingement, a big labral tear, and severe (delamination) arthritis. WTF?
Thanks for the info, Mel - I’m gonna go look that up.
Makes more sense than not having a seal on the joint - considering that the radiologist just took a whole PILE of fluid out of the joint before he could get the cortisone and HA IN the joint.
But it feels better now w/ the pressure off.
My Dr. said that he had one lady from Phillipon for followup, and she went from good to bone-on-bone in 3 months.
Now hoping my lube job helps for a few months and looking for a joint person.
PS - looking it at like ‘at least I get it done BEORE I retire’…..
Yep - and I had the thermal thing done to try to rebuild the labrum - and possibly as part of the chondroplasty as well. Looks like it can show up in ANY joint that gets scoped, tho.
Chondrolysis of the hip is a rare disorder, characterized by progressive and rapid destruction of articular cartilage from both joint surfaces resulting in secondary joint space narrowing and stiffness. The authors report an unusual case of chondrolysis of the hip following mini open excision of a symptomatic acetabular labral tear. After a symptom-free period of 1 month following the excision of the torn labrum the patient started complaining of progressive hip pain and loss of movements. The rapid deterioration of the clinical functions and concentric reduction of joint space to less than 3 mm, consistent with chondrolysis, in the absence of evidence of any other hip pathology, led to the diagnosis. Intraoperatively extensive degeneration of joint cartilage was observed. Cementless total hip arthroplasty relieved the pain and allowed return to activities. The authors suspect that the use of thermal electrocautery during labral excision may have been responsible for the subsequent chondrolysis. The case is being reported not only for its rarity but also to alert treating surgeons of keeping the possibility if this condition in mind as it can pose a diagnostic dilemma.
So since this blog is supposed to be about FAI - I think I’m off…
I need to go find one re: supine anterior hip replacement.
good luck kt, the yahoo group page is pretty active. it’s nice that you can see stuff just when you check your email. ( I have a yahoo account)
thanks for helping me out
Did I miss something, kt? Are you having your hip replaced? Did you have a new x-ray? Just wondering what you meant by the supine anterior etc.
Mel…my pain was soooo similar to yours and symptoms were sort of mirroring them (and those of several other people that hit complete bone-on-bone at around 7 months), that I decided to go ahead and get a new set of x-rays shot.
Yeah - joint deterioration on the weight bearing areas since surgery. Getting close to bone-on-bone. The cortisone plus HA that I had is helping - but it’s just a ‘delaying action’ - esp. if there are loose bodies in there that were causing the fluid buildup. Plus even tho it’s helping I’m still walking w/ at least one crutch - and need 2 to get around the block (altho I can at least do one crutch then the other now). Keeping about 10 lbs off the hip.
AND at this point I don’t have the ROM to get back on a horse w/o hurting.
So I can’t do anything till the end of the year for personal reasons anyway - and if I get enuf strength in the muscles to offset the joint condition, fine. If not, I figure that shots will get me 6 - 9 months max (probably still not on a horse, tho).
So I’m starting to talk to total joint guys re: replacement. There are some in the area (got names from my scope doc) that use a special table that allows them to do the replacement from the front - and to not cut any muscle. People seem to heal MUCH faster.
There’s a video on this page by one of the docs here - he has small embedded vids of some people 2 days after the surgery.
http://www.hipsforyou.com/doctorinterviews/kreuzerinterview.php
If you go to his website there are also notes from a PILE of people who have had it done and had really, really fast recovery.
Best of luck to you, kt. Was that Synvisc, the HA you’re referring to? My new surgeon said I wasn’t a candidate bec I’m bone on bone. I’m glad it’s working for you. (Plus he said since it’s not approved for hips, I’d have to pay out of pocket for it…did you?)
My replacement is end of October. Posterior entry. I’m going to ask the surgeon about getting resurfacing, where the head of the femur isn’t replaced but capped with a metal surface.
Information is exponentially greater versus hip scope. We have lots to learn.
It was orthovisc, but yep - I had to pay out of my own pocket.
Didnt’ have to pay for the injection itself since they were injecting cortisone at the same time.
I’m actually wondering if the PT session w/ the relief guy that started the major psoas and locking issues started the whole downhill slide….but no way to know at this oint.
I don’t think I’m a candidate for resurfacing - small bones and a family history of osteoporosis.
Actually mine is a “PATH” procedure, for percutaneously assisted total hip replacement. Small incision + puncture for a rod-like device like the ones we had for hip scope. A “minimally invasive” procedure. But I still want to ask about resurfacing. I have very dense bones. Probably from the very activities that led me to arthritis: hi-impact aerobics (back in the 80s) and tons of walking, always.
I have the same symptoms but all xray, mri, and artherogram are normal. Im afraid to go to anyone else as they may think Im nuts!
Is it possible to have all results normal with this?
I was looking for a site that was more specific and I found that here. Thank you for documenting the first days after your surgery. I am scheduled for Jan. 4th with Dr. Franco. I have had this hip pain for over ten years and it has gotten unbearable. The pain wakes me from a deep sleep and if I get up too fast, I would fall. I’am worried about the cost. Is the cost managable?
Hi Elizabeth, my suggestion is send all your info for a 2nd opinion. Philippon’s group in Vail reviews this stuff at no charge.
Chris,
Good luck! If you’re concerned about the cost, talk to Pres ahead of time. They should be able to give you a very good idea of what your out of pocket is going to be, and I would think if you are upfront with them they will have recommendations or be able to work with you.
Everybody! I’m constantly surprised how active this has been, considering it was just a simple few blog posts I did to document my situation more than 2 yrs ago. Well, now you can look forward to the sequel, sort of. Had my right hip done July 25th 2007. I will be having the left done November 25th 2009 for the same issue. Symptoms not nearly as bad as the right, but becoming noticeable so it is time. Check in with you all ~ November 26th…
Nathan
Elizabeth,
In response to your question about imaging findings:
Impingement is still a relatively new finding and it’s possible that the doctors evaluating your images are not really looking for it. But it should be apparent on xray to a trained eye (such as Dr. Philippon, as Nathan suggested).
That being said, I know–because it happened to me–that significant arthritis can be missed on both xray and arthrogram. My pre-arthroscopy images showed no significant arthritis, but when I had my arthroscopy the surgeon found grade IV arthritic lesions. Perhaps you’re hurting from undiagnosed arthritis.
Nathan–all the best on your second scope!!! Please keep us posted. And thank you for maintaining the blog. I’m having my scoped hip totally replaced tomorrow. The arthritis ruined my chances for recovery. My unscoped hip, well, I don’t know its future. It’s got a tear, but it probably also has arthritis despite a nice looking joint space. Cortisone is helping it for now.
Mel,
Sorry to hear you are having to go the replacement route. Best of luck, hopefully this resolves your trouble. Do let us know how it goes.
Nathan
elizabeth….
DONT believe the radiologists reports! They need to be read by somebody experienced in FAI.
Mine said “small tear - no evidence of detachment”. Reality was ‘completely shredded and mostly off the bone’. Both surgeons I talked to said that they see ‘normal’ on the rad report when there are obvious tears sometimes.
Anybody heard from Rebecca lately? I was mostly checking in to see how she was doing!
Good luck on your next surgery Nathan!
mel…
unfortunately the orthovisc only helped for about a month.
now the femur is locking in the socket and I have to get the PT to get it out….
probably not going to wait till after the first of the year for my replacement now. did you get yours done? how are you doing?
Just want to re-emphasize some already important information expressed on this blog:
1) More than any other factor, the presence of arthritis makes or breaks the success of hip scope for FAI. I’ve learned that if even moderate arthritis is present, the trauma of the scope procedure is likely to send the arthritis into overdrive, despite the surgeon’s attempts to clean it up along with the FAI.
2) Imaging studies, or at least their interpretation, can be way off base in terms of documenting either impingement or arthritis. Be sure that the ortho interprets them. But even if you get a clean bill of health on arthritis–say, a good joint space on x-ray–the actual degree of arthritis might not be clear until the hip is scoped.
kt, I had my hip replaced Friday 10/30, came home yesterday, am doing very very well. Almost walking without crutches–seriously. If you can free yourself from pain now, I highly recommend it.
With my unoperated but FAI-bearing hip in mind, I asked my surgeon if it’s possible to go in for a scope procedure but switch to total replacement if a lot of arthritis is found. Wouldn’t that be nice? But of course he said no, that’s not possible at present.
WOW!
Totally jealous. Going to the anterior hip guy tomorrow.
Having some sinus surgery on the 16th to clear up a chronic
infection and then doing the hip ASAP after that. Percocet
isn’t even doing much at this point.
Glad to hear you’re doing so well!
Ps. At least if they find a bunch of cartilage damage maybe they will pull out and have you come back in a couple weeks for a total.
so i have had my mri’s done on both hips…as of now they are “moderately trashed,” with some arthritis in each, loose bodies, one is cam and pincer, the other just pincer. big femoral bumps/cysts. the cartilage has thinned a bit here and there.
i had an xray with a hip resurfacing specialist in nyc about 2 months ago and he said there wasn’t arthritis that would warrant resurfacing.
my mri also said “loss of signal at L5/L4″ which i hope only means weakness.
i am trying to get a bit stronger before surgery, which i am scheduling next week for probably february, but i cannot do much other than walk!
any suggestions?
btw, i am seeing dr kelly at hss/nyc, but am also considering dr buly at hss as well. any tips?
thank you!
All you guys bashing Philippon are CRAZY!!! Had my hip done and am rocking. No problems at all. I don’t know where you are getting your info from but the web is full of BS, don’t forget.
Trey, who’s bashing Philippon? In fact, there are several recommendations to take advantage of his consultations. I’m glad you had a positive outcome, not everyone will regardless of who performs their surgery. People are welcome to describe their experiences, and not be told they’re crazy. This is, in fact, my personal blog and I wrote this particular post over 2 years ago describing my FAI experience and right hip scope. I returned to Ironman triathlon after that surgery, and am 1 week out from hip scope to correct FAI on my left hip. I intend to be back racing next season. You are welcome to describe your positive experience with Philippon, which will better serve your cause battling BS than contributing to it by making assertions and telling people they are “crazy”.
Nathan
I hope you are recovering well from your recent surgery.
This site really has taken off hasn’t it? I first found it about 18 months ago. That would be a few hundred posts behind this one! It sometimes seemed that us fellow hip patients had kidnapped your site for our own uses; I hope some of the information posted since your last surgery is useful to you.
For anyone who’s interested in longer-term recovery from a labral tear:
Well I had a hip arthroscopy just over a year ago for a labral tear with no FAI or arthritis (age 30s). My surgeon is one of the very few who do this procedure in the UK and he was clear that he couldn’t predict long-term outcomes ‘cos the procedure is new and constantly being refined. To recap my earlier posts, I’d been in lots of pain, unable to sit comfortably, had a significant limp etc. I felt much better immediately after the surgery, during which about half of my labrum was removed. Between that and the traction my balance was the thing I had to work on most. I have had good progress but have to work at getting back toward 100% and suspect I may have to continue a hip exercise program forever to maintain my result. Long story but I didn’t get any physio follow-up until almost a year after the surgery, I’d just been shown initial exercises to do at home, stretches and strengthening type. My own rehab programme was based around walking (aiming for further or faster or losing that limp!) with a bit of balance work. I attend physiotherapy now and just recently was cleared for low-impact gym work (which is supervised by a physio at the local hospital’s gym.)
For info, my physio said that almost all hip patients find their leg rotates inward following surgery, i.e. when lying flat on your back with your legs straight and heels touching the bed, if you point your toes straight upward toward the ceiling, the affected side may in fact be pointed inward but feel like it’s pointed straight up. I’d been walking around like this for amost a year post-surgery until it was picked up. If you are affected then it’s important to work on fixing the rotation before doing any impact work. I’d gone through a hip strengthening programme before the surgery too but it still happened, so be warned. For any pre-op patients, if your physio recommends hip exercises before surgery, I’d second that idea!
Also, a balance board (aka wobble board) may be a good investment, a side-to-side one is great for getting both legs working together again. (The side-to-side board can also be used front-to-back to work the knees and ankles, and the circular type of board are more advanced. You can also make the side-to-side board more difficult by doing exercises on it, like bending or catching a ball etc.)
Hi Katie,
I’ve been continually surprised how much traffic one little blog post has generated. I’ve found all the discussion to be quite informative, and I hope it has helped other people out.
My recovery is coming along, had my first PT appointment today. I feel pretty good actually, the biggest challenge is being patient. =)
Nathan
Heya,
Just wondering I have not really been told a diagnositic name for my hip condition and i think it is the same as your but ia not sure.
my Hips sockets overalp the ball of my hip ball too much is that genrally the problem you had?
I am planning to have surgery to remove the labrum cut back the hip socket right the way round and have the labrum, reattatched.
Is this anything like what you had?
How painful is it? I have exams 3 1/2 weeks after my surgery do you think i will be ok to revise and sit the exams..
Sorry for all the questions, just a little apprehensive :-/
thankyou
Sharrow
Hi Katie. I am curious to hear how you are doing. You commented in your last post that the operated hip tends to turn in. May I ask you if that is still a problem or have you done some exercises or theraphy to fix it. I too have the same issues and I am post five years of a labral tear surgery and still dealing with a few issues, still significantly weaker in the operated side with foot and knee problems and compensation issues on the right top off with a herniated disc from my imbalances in the hip. I have basically been in and out of rehab and still trying to figure this out. I have seen a myofascia release therapist that has helped a lot with soft tissue issues and have started pilates about a couple of weeks ago. The pilates is doing wonders for my foot and my knee issues as well. And my core is getting so much stronger as a result. I was amazed to find out how weak my core was though with all the rehab I have done. Please continue to post your rehab and I do have a blog called got hip that I recently began to track my progress. I also have info on there about other rehab practices. Still working on it though. Good Luck
my blog is http://shotbod66.blogspot.com Hope I spell it right still new at this. Funny how a hip injury has forced me to learn more about blogs.
I’ve been diagnosed with labral hip tear and hip impingment and considering surgery at HSS in NYC with Dr. Buly. Is anyone on the other side of this surgery with DB and can recommend him?
Hi Shotbod
Sorry I’ve not been on this site for a few weeks. I am told that my leg rotated inward due to the glutes on that side being weak. I have had improvement since doing exercises to build up the hip, though like you, I still have some issues. I suspect that I will always have to deal with an imperfect hip by continuing an exercise program.
My physio described the situation as: the muscles around the hip hold the leg in place by all the muscles working together, if some hip muscles are weak the leg can be pushed out of normal alignment by a set of stronger muscles. I will go into detail in case this helps someone.
There are 3 sets of glutes and various exercises to work each. Luckily it is easy to feel “the burn” in your butt and know if you are working the glutes (rather than e.g. just the leg muscles). If you search for hip abduction / hip stability you should find visual guides (e.g. http://www.fitlink.com/exercise?type=bodyweight&exercise=clam)
I have managed to get rid of the inward rotation through building up my glutes (I think it was particularly the medial glutes) and the exercises I use are the clam (lying on my side) and the standing and side-lying hip abduction. I also do hip flexion and extension for general hip stability but I do the hip flexion lying down as it doesn’t feel right yet standing up. As a general note, many hip exercises can be done either standing or lying down and sometimes the lying down option is good for avoiding gravity and letting you get your technique right.
Another sign of hip muscle weakness (apart from the inward rotation) is the Trendelenberg Sign - although there are other reasons for showing the T-sign (http://en.wikipedia.org/wiki/Trendelenburg%27s_sign). The photo isn’t ideal as I think seeing the full body helps illustrate the point. The best I can describe this is: stand on a step / stair and imagine you are about to step downstairs. Think of the body standing straight with both hips and knees being level with each other at this point. Now lift your good leg so your weight is supported by your affected hip. Bend a little as though you are stepping down to put your good side foot on the floor / lower stair. Ideally your affected side will still stay straight(ish) through the hip and knee and you will generally look straight and supported through the upper and lower body. If your pelvis tilts significantly to the side rather than staying level (You can put your fingers on the jutting-out part of your pelvis to test this) you’re likely showing the T sign. The affected hip and the knee will look awkward rather than looking in line and stable. You can exaggerate the movement to get the idea - life one foot off the ground a little and deliberately drop your hip to get the idea. This is difficult to describe! But it’s another indication that you may benefit from building up the hip muscles.
Best wishes to everyone
I have hip impingement and loss of motion in left hip. I am 29 very active how long was the recovery and was it worth it? Do you feel 100%?
Hello all -
I am scheduled for arthorscopic labraum tear repair (plus osteoplasty, rim trimming, possibly debridement and who knows what else!) next week. Has anyone had any experinece with United Health Care covering or not covering these types of procedures?
Would love any input!
Becky
Hi Ken,
In short: 12 weeks to get back to running, 4-6 months to get back to “real” training. 1 year to get back to where you were post injury. I’m increasingly convinced that the longer you dealt with it prior to correction, the longer the recovery and vice-versa.
Becky,
I’m presently on United and my Nov 2009 surgery was covered. Your hospital should be on this and getting pre-approval. If you are concerned, call them, they work for you. =)
Also, don’t be surprised later to get a bill from the anesthesiologist, they don’t work for the hospital and generate a separate bill usually.
Cheers,
Nathan
Hi Nathan -
Thanks for this info…I hate to ask…but…!…can you tell me exactly what procedures your Nov surgery inlcuded..? For example, my upcoming surgery will include some or all of the following…labral tear repair/debridement, osteoplasty, synovectomy, rim trimming….whoa! I’m under the impression that UHC covers some, but not all of these…and I’d certainly sleep more deeply (under anesthesia!!) believing that I was really covered…!
thanks again -
Becky
Dr David J. King in St Louis is a phenomenal orthopedic surgeon. I had both hips done with him. Left on 11/10/09 and right on 01/26/10. He trained with Marc Philippon in Vail, at Steadman Hawkins. Just google his full name and his website will show up. I can’t say enough great things about him. He uses a procedure where they can graft your labrum using part of your iliotibial band if the labrum is destroyed. I needed that on my left side. All done outpatient and arthroscopically. He is truely on the cutting edge! If I can help anyone please email me at jim_koopman@hotmail.com!!
Hi Guys
Have been diagnosed with a cam impingment in my right hip. No laberal tear but have been experiencing a dull ache in the last year. I have surgery on 1st June with Marcus Bankes in London and he recommends i go ahead as i still play alot of sport and I have a family history of hip replacement.
Have been reading past posts about the latest theory that FAI surgery can actually acclerate the degeneration of the cartilage. Is this really true??
I’ve consulted 3 hip ortho surgeons within the past 2 months (in Michigan, USA) regarding my FAI. The feedback I’ve received is very consistent. None of them claim to have enough data to support long term outcomes. Philippon published a 2 year study at: http://www.ncbi.nlm.nih.gov/pubmed/19091999
This study makes FAI sound promising for the short term anyhow. It’s good to keep in mind that the arthroscopic surgery itself is diagnostic in nature. Mike, I hope you don’t have a tear, but my P.T has seen patients who go into surgery thinking there is 1 tear, but the scope reveals more. With that said, it can go the other way as well.
It’s my understanding that osteoplasty (shaving/reshaping the femor) should reduce trauma to the cartilage/labrum. The hope is that post-op degeneration of the cartilage will slow down. Maybe you will be one of the family members who doesn’t have a hip replacement if the FAI technique proves out to be successful as a “prevention” of sorts.
I wish you a quick and long term recovery.
Hi Leona - Thanks very much for your informative response. Have you had surgery?
My surgeon also states that the long term outcome is unknown as the FAI procedure is relatively new. I guess I am subconsciously hoping that the procedure will act as a preventative measure for avoiding a hip replacement and tbh is the main reason I am going for surgery. My big fear though is that the procedure may acclerate arthritis as has been suggested in some of the earlier posts - either way its a gamble though with a cam lesion, my family history and a hip that now aches at 38yrs I am thinking that it can only get worse over time.
I’m not experiencing the degree of pain as some of the people on here and still do sport without significant pain so have doubted whether surgery is the correct option. The images don’t show anything abnormal other than the cam lesion. My surgeon however is saying that now is the perfect ‘window’ to carry out the precedure but is not guaranteeing that it will prevent a total hip replacment. I guess the tagline is that ‘Your damned if you do and damned if you don’t'!!
Hi Mike,
I hear ya! Surgery does seem like quite a gamble and since we can’t just “grow a new hip if something were to go wrong” I’m very hesitant. I have not had surgery…am still gathering information.
Hi Leona
Just out of interest how recently were you diagnosed and what with? Have you been in great pain?
I have been in A LOT of pain for several years. During my 4th round of P.T., in June/July 2009, finally a therapist recommended imaging of my hip and suggested that I may have FAI. I had never heard of FAI, but the fact was therapy continued to aggrevate my hip. The MRI revealed a labral tear. X-rays show bone growth/spur that will require osteoplasty to slow down future tearing/cartilage damage. Additionally, my IT band may be lengthened and the trocanter bursa removed. Add to that a “capsular plication” (cutting and folding together soft tissue in my hip socket to minimize laxity that I have in the injured hip.
It’s been a long winding journey of treatment, rest, pain tolerance, lifestyle change, followed by more treatment (including injections) and lots of imaging to discover the FAI diagnosis. Surgery sounds like a whole new chapter of pain and even more lifestyle change without much guarantee for long term relief. Hence my extensive information hunt and skepticism.
I wish I felt more positive about this, but the reality is that surgery is not reversible. Shaving bones, debrieding or anchoring soft tissue, cutting capsular tissues and removing bursa’s are serious stuff. Simply put, I could go through all of this and still wind up going back in for a bionic hip. One that I am likely to outlive!
Today’s tag line is a quote from Yoda: “Do, or do not. There is no try.”
Thanks Leanne - I will let you know how I get on. I’m putting faith in my surgeon who is top rated in London and has operated on rugby players here for the same condition.
I’ve joined the facebook group for Hip Impingment which is useful.
Keep in touch and good luck!
Best Wishes
Mike
Hi Mike,
Can you give me “directions” to the Facebook page you mentioned?
Hi Leanne
If you type in : - ‘Understanding Hip Impingement, FAI’ into Facebook you will find the group.
Mike p:
I had failed FAI because of arthritis, which was considered minor on imaging studies but was found to include a delamination lesion on scope.
My current surgeon (who replaced the hip 5 months ago) says accelerated arthritis can be evident in as little as a month post-scope, even if arthritis was only mild pre-scope (I agree with whoever said that arthroscopy is a diagnostic procedure). General trauma and heat from the procedure may be the reason it happens. He is very reluctant to do arthroscopy on anyone with arthritis now. I could use it on my left hip but we’ve both agreed I’m not a candidate because I have some evidence of arthritis on xray (plus I’m 60).
I’d raise the subject with your surgeon. I’m sure s/he will have an opinion.
Melissa
i had fai surgery performed last monday with dr kelly at hss in nyc…cam and pincer, femoral cyst, labral anchoring, loose bodies removed, and capsule repair.
sore as heck now but starting to get around. he is very skilled and i hope for the best.
i went 5 years with the pains and none of my sports due to lack of knowledge where i live.
i already feel my op’d leg working differently, am doing pt twice daily and feel my glutes awakening.
the other leg is due for it too but i am waiting several months.