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FAI Information (Hip injury) - Updated info and surgery results - Page 2

post #31 of 100
Thread Starter 
Quote:
Originally Posted by evaino View Post
 

Sorry to hear it - hip pain sucks. I had surgery for a torn (shredded really) labrum and FAI 5  years ago after over a decade of recurring pain and trying everything to fix it. For me the result was great - I went from daily celebrex to not even knowing if there's advil in the house. I still do all the sports I love, including skiing, playing ultimate and playing tennis. I also train or have trained a lot of people with hip problems. Some were post-surgery, some pre-surgery, some trying to avoid surgery.Here's my opinions:

 

1. The poor outcomes are hugely exaggerated above. If you read forums, of course you'll see lots of negative outcomes - the people who have positive outcomes tend to not be writing about it on online forums. Now if you have arthritis in the joint already, then the likelihood of a poor outcome is high. But not certain. I had arthritis going in and so the surgeon also did some microfracture. I used that as motivation to be 100% committed to rehabbing properly. That meant doing all the exercises but also not returning to anything too soon. I think a lot of people jeopardize their outcomes by returning to activities too soon and without adequate strength.  

2. Did they talk about Femoro acetabular impingement (FAI)? There's a high correlation between the two. If you have a labral tear of unkown origin, odds are you have FAI. Fixing the tear without addressing the FAI is not a great idea. If the surgeon you're seeing isn't considering this, then you should find a different surgeon.

3. Just because you have a labral tear, doesn't mean that's the cause of the pain. This is the challenge of imaging.They've done cadaver studies where something like 97% of hips have torn labrums. The torn labrum may just be a part of aging. The medical community doesn't yet know why some are painful and some are not. Similarly, if you have FAI, it's not a certainty that that is a problem. I read one study where they were trying to see if squatting could be a test for FAI. They had to throw out several of their healthy participants because imaging showed they had FAI.

4. Non-surgical treatment does work for some people, but not for all. I don't think it's possible to predict who can avoid surgery and get pain-free, but I think it's always worth trying first. I've had a couple of clients who were able to be pain-free and avoid surgery through a combination of proper training, good manual therapy, and avoiding certain activities. I've had other clients try the same thing and not be able to avoid surgery. If you try to avoid it - I'd suggest setting a time frame during which you'll work hard to avoid surgery.

5. When I mention activities to avoid, I think it's important to consider that effect on your quality of life. So for me, skiing wasn't an activity I was willing to give up. This will be a very individual decision. The first one I get my hip clients to avoid is squats. The deep hip flexion is not a great position for these people. Similarly, cycling can be problematic because of this angle.  

 

Good luck with whatever route you take. 

 

Elsbeth

 

THANK YOU!

 

so some quick info:

 

1- agree 100%

 

2- FAI, did not meet for followup with OS.  He actually specializes in arthroscopic FAI procedures  I believe he was th 1st in CO to do this procedure.  

 

3- part of the MRI and arthrogram (I assume you know what that is) they inject the socket with lidocaine and Cortisone (I love cortisone).  In addition to seeing the flap tear and vertical tear, on the MRI, another test is  if the cortisone and lidocaine causes the pain and other symptoms like restricted range of movement to be greatly reduced, they know where its coming from. If the pain doesn't go away, they know the pain is still being caused by something else. In my case I had rather severe groin and Psoas pain as well as quad and Trocanter pain. Almost all of it is gone  Some of the pain is still in my PSoas and groin but I think those muscles were so inflamed it may take a few more days (its just been since thursday afternoon).

 

4-I have been dealing with this for almost 1.5 years with Message therapy, ART therapy chiropractic and traditional PT. Every time I get it under control it just comes back once I start to use it heavily. 

 

5- Cycling and skiing are paramount. I need to do these things. Not willing to give either up.  But I haven't been able to run either and even walking up steep trails is difficult.  Forget sitting for longer than 1/2 hour too!  

post #32 of 100
Quote:
Originally Posted by Finndog View Post
 

 

THANK YOU!

 

so some quick info:

 

1- agree 100%

2- FAI, did not meet for followup with OS.  He actually specializes in arthroscopic FAI procedures  I believe he was th 1st in CO to do this procedure.

3- part of the MRI and arthrogram (I assume you know what that is) they inject the socket with lidocaine and Cortisone (I love cortisone).  In addition to seeing the flap tear and vertical tear, on the MRI, another test is  if the cortisone and lidocaine causes the pain and other symptoms like restricted range of movement to be greatly reduced, they know where its coming from. If the pain doesn't go away, they know the pain is still being caused by something else. In my case I had rather severe groin and Psoas pain as well as quad and Trocanter pain. Almost all of it is gone  Some of the pain is still in my PSoas and groin but I think those muscles were so inflamed it may take a few more days (its just been since thursday afternoon).

4-I have been dealing with this for almost 1.5 years with Message therapy, ART therapy chiropractic and traditional PT. Every time I get it under control it just comes back once I start to use it heavily. 

5- Cycling and skiing are paramount. I need to do these things. Not willing to give either up.  But I haven't been able to run either and even walking up steep trails is difficult.  Forget sitting for longer than 1/2 hour too!  

 

Ya, as I was writing that, I was thinking that based on what you've said, surgery is probably what you'll want. I know I'm super happy that I went that route, as are a couple of my clients who had it. And you're absolutely right - if the MRA cuts the pain, that's a pretty sure sign that the problem is in fact within the joint. Sounds like you've done your homework and that you're in good hands. 

 

Elsbeth

post #33 of 100
Thread Starter 

@evaino 

 

your info and reinforcement is most helpful as you certainly know what you are talking about. I have been gathering as much factual info as possible. I asked a lot of questions at my initial dr appt ( he did my ACL and Shoulder too) as well as when i had the MRA to understand where I need to be.   Any other advice is appreciated

 

So my next move is to meet on Wednesday with the OS, at that time I will review the MRI and findings, discuss whats going on (FAI?, Pincer Cam issues) and options. My biggest concern is trying to refixate the flap tear and if the tear inside the socket can be repaired or minimally debrided.  It is not clear if the tear is in the area with blood flow or not.   thoughts?  

post #34 of 100
Quote:
Originally Posted by dakine View Post
 

~~HGH

...I don't think so but longevity supplements are an interesting subject.

I have been taking 7 keto DHEA for about 30 years and other things too.

Age 69 in two weeks.

 

 

Quote:
Originally Posted by Finndog View Post
 

send me your recipe!!!!!  Thumbs Up

 

Dakine, send me the recipe too or share it here. :) I am interested in knowing what actually works for people.  Obviously, you can stay fit, win the genetic lottery, and manage stress, but I am interested in specific things that others do, that, perhaps the masses do not do.  That would include longevity supplementation. 

post #35 of 100
Quote:
Originally Posted by dakine View Post


Quite simple.
I'll be 69 in a couple of weeks.
Over half of my contemporaries are no longer with us.
Time is the most precious thing you have, don't waste it by whining.
A freaking men.......old age ain't for the weak
post #36 of 100

Let me give this a bit of thought.

Following my advice is probably about as smart as taking fitness advice from Hunter S. Thompson.

I do have some personal opinions that might be worth sharing.

Winning the genetic lottery probably trumps everything else.

My Aunt at 95.


Note what she is eating.

More later.

post #37 of 100
Quote:
Originally Posted by Finndog View Post
 

@evaino 

 

your info and reinforcement is most helpful as you certainly know what you are talking about. I have been gathering as much factual info as possible. I asked a lot of questions at my initial dr appt ( he did my ACL and Shoulder too) as well as when i had the MRA to understand where I need to be.   Any other advice is appreciated

 

So my next move is to meet on Wednesday with the OS, at that time I will review the MRI and findings, discuss whats going on (FAI?, Pincer Cam issues) and options. My biggest concern is trying to refixate the flap tear and if the tear inside the socket can be repaired or minimally debrided.  It is not clear if the tear is in the area with blood flow or not.   thoughts?  

 

My recollection is that debridement vs repair/reattachment is not conclusive one way or the other. I know I"ve seen some outcome studies, and I thought they actually favoured debridement but I could be remembering that wrong. My take is that it's one of those things where you'll get 3 different answers if you ask 3 different hip-specialist surgeons. But I haven't read up on the surgical techniques in a few years and the body of knowledge on this is evolving quickly.

post #38 of 100

Hey Finndog - sorry to hear about that labrum. My (not so) short story - I've probably had a torn hip labrum for close to four or five years or so. First noticed problems back when I used to run, but mostly the only time it was an issue would be when I would go to stand up after sitting awhile and I would get a sharp groin pain, or occasionally the same sharp pain while walking. But I didn't have it diagnosed until about a year ago as it became progressively worse and more frequent, and the pain started to extend more into the hip, particularly when sitting still for extended periods, and sometimes with walking (I no longer run due to other orthopedic issues). There is only OS who currently does arthoscopic hip labrum repairs at the Cleveland Clinic, so I saw him. He very carefully looked at all of my films/MRI, and said that due to some hip degeneration (I'm 56) along with the labral tear, he could not guarantee that I would have better than a 50% chance of getting good results from the arthroscopic labral repair (which involves six weeks of non-weightbearing). He recommended that I get an opinion on a hip resurfacing, from which many "younger" (40's on up) and athletic types have had good results. So I saw the PA at the office of the only Cleveland Clinic OS who does the Birminham Hip Resurfacing, and it turns out that I would probably be a good candidate for that procedure, unless they were to get into the OR and find that my small-sized hip would not accept the smallest size component which is made - in which case I would need a total hip replacement. I was scheduled for the BHR procedure on February 26th - next week - but I cancelled it a couple of weeks ago.

 

I took Voltaran (NSAID) for years (for all of my joint issues), have tried every OTC/glucosamine/herbal/etc you can think of. Have done PT, modified activity, cortisone injections into both the hip and psoas, hyaluronic acid (Euflexxa) injections. At times I have been so miserable that I would have jumped into an OR had I been driving by one. But I recently (November) had my great toe fused (good old arthritis), and have been very stressed about adjusting to that "new toe" and regaining my gait.

 

So my sports doc who has saved me from many surgeries sat down with me and looked at all of my films and we decided that I should wait on the hip surgery. I have just started on a low dose of Celebrex, and have been surprisingly doing okay - meaning that I can sit longer and stand longer than I have been able to for some time. And even though I have thoughts that I would rather go ahead and get a repair than stay on medicine with the risk of side-effects from that, right now the thought of having a permanent change to my body (potential hip replacement, since I am not a candidate for a simple repair) is too much for me to deal with right now. I am still able to do the things I want to do, though I occasionally modify (I don't lean over too much into the bike with a deep hip flexion because I know it will hurt the next day), and just for the heck of it I just started taking Pilates to see if it will either hurt or help. Now that I have a plan, should things get a lot worse, at least I can relax and go ahead with it. Everyone says that when their lives got too miserable, every day, and they knew they could no longer take it, then it was the right time for a resurfacing/replacement. Mine isn't too miserable every day, so I'll wait.  

 

I think I'm gonna head out for skiing tomorrow and see how the "new" toe is working. . . .

 

Lots of good stuff, Evaino - thanks for sharing!!

 

Good luck, Finndog!

Kitty

post #39 of 100

Dakine, wow does your aunt look good!! And young!! I might be similarly blessed, because my Dad is 87 and bowls weekly, and just joined the YMCA. I think I might have some of his joints, but he just keeps moving anyway. . . . walks 78 laps inside the circular floor pattern of his house daily (one mile).

 

Meanwhile, maybe I'll get me some of that cottage cheese. . . . 

 

Kitty

post #40 of 100

I've had a torn labrum for 4 years now, and just now is it getting bad and big enough for the mri to see. It held up for a while, but Im kinda glad it gave out because now I can get it fixed. I knew it right when it happened, and Ive seen multiple surgeons and had multiple cortisone shots and had multiple MRIs done with no acute injuries present...Funny how now that Its gotten really bad over the last 6 months, its actually present on an MRI now as well. When the surgeon does physical tests, I clearly have a torn labrum, but also sometimes I get bicep tendon subluxation. The top of my bicep tendon, in the bicipital groove, is probably calcified and definitely perma-inflammed. It sucks, and Ive known for the last 6 months, but I have been holding out on surgery till the end of ski season. My surgeon is ready to go ahead and fix it in april, cant wait. Its gonna be 6 months of dedication before Im back in the gym hardcore, but It'll be worth it. 

 

The past two cortisone shots I had just made it worse, I had one in august and one in january. I can still do pull ups and major back exercises, but havent been able to do anything for my chest/shoulder/bicep region. I can only do light stuff, and I can still tell that it gets aggrevated. Just pressing the bar, chest press or overhead, makes it feel terrible for a week. I do a ton of rotator cuff work to get it nice and strong before surgery, I just hope It all comes together well afterward. 

 

Edited: I feel stupid, thought you meant shoulder labrum, not hip. Im sorry Finndog, get well soon. 

post #41 of 100
Thread Starter 

@SkiSafe No worries! I had that fixed last summer :D

 

@kittygal - Yikes! sounds like you have a plan but sorry there's no good answer for you. I think your case is a lot like what @evaino was describing as far as arthritis hindering a successful surgery.  The OS here actaully does the joint smoothing arthroscopically as well as the FAI arthro  and a partial replacement procedure. IF worse comes to worse, maybe looking to a surgeon out here or in Utah as an alternative?   

 

I see the OS Wednesday and will report back with options

 

@evaino   Thanks again.  this is most helpful  

post #42 of 100

Now that I am forced to consider myself "old" I'm paying attention to "really old" people.

Kittygal's dad says what I  keep hearing...just keep moving.

One other really good thing to do is lose any excess body fat to minimize the load your joints carry.

I worked down to 165 from 175 and I feel both quicker and stronger.

You don't want to lose all your body fat because you will need some in emergencies.

Range of motion exercises like yoga or swimming are important to geezers.

Surgery is sometimes the only answer but it is never certain and should always be very carefully considered.

Trying to find a workable balance between activity and recovery isn't easy.

Recovery is critically important to the long term.

A really big day is going to take two or three days for stuff to heal.

Still beats the alternative.

post #43 of 100
Thread Starter 

UPDATE: I saw the OS yesterday, the cause of my tears is due to FAI syndrome which explains a lot of my issues with pedaling my bike and some issues when skiing. It probably contributed to my ACL tear.  I am going to have FAI arthroscopic surgery to reshape the femeral head towards the end of March.  

 

http://outpatient.stanfordhospital.org/clinics/orthopaedics/sportsmedicine/procedures/hip/fai.html

 

 

 

an article on my dr and the procedure

 

http://www.steamboattoday.com/news/2013/sep/22/monday-medical-new-surgical-technique-resolves-hip/


Edited by Finndog - 2/20/14 at 5:28am
post #44 of 100
Quote:
Originally Posted by Finndog View Post
 

UPDATE: I saw the OS yesterday, the cause of my tears is due to FAI syndrome which explains a lot of my issues with pedaling my bike and some issues when skiing. It probably contributed to my ACL tear.  I am going to have FAI arthroscopic surgery to reshape the femeral head towards the end of March.  

 

http://outpatient.stanfordhospital.org/clinics/orthopaedics/sportsmedicine/procedures/hip/fai.html

 

 

 

an article on my dr and the procedure

 

http://www.steamboattoday.com/news/2013/sep/22/monday-medical-new-surgical-technique-resolves-hip/

 

That sucks although at least they know the issue and can fix it.  All the best!  Looks like your guy is a expert as well and that will help I'm sure.

post #45 of 100
Thread Starter 
Quote:
Originally Posted by Scott43 View Post
 

 

That sucks although at least they know the issue and can fix it.  All the best!  Looks like your guy is a expert as well and that will help I'm sure.

 

yeah, the MRI clearly showed the deformity once he pointed it out.  What is interesting is that the area of impingement is where you raise your femur when pedaling or flexing in skiing, it also prohibits rotation of the femur inward causing the leg to track to the outside.  Started rehab yesterday as well to get some muscles to fire that have decided to shut down. Need to get the muslces going and in as good of shape as possible over the next couple of weeks. Actually pretty psyched to get this done. 

post #46 of 100

Thank you for sharing what is going on. Always interesting and you never know when you'll be learning something from someone who's "been there, done that!" Good luck!!

post #47 of 100
Thread Starter 

well, I hope to be able to post up a video perhaps!  Surgery set for later on in March.  

post #48 of 100
Good to hear they figured it out.

So now y'all have me worried. I've had hip pain for awhile. Kind of comes and goes but seems to be around more now. Driving seems to make it worse. Not sure if skiing is any worse than driving. I have taken a day off of intended skiing this year due to the hip. That same side knee is stiff often due to artroscopic meniscus "cleanup" aka removal. Also had acl done on both knees but left has no probs.

I've had a long history of tight right IT band and some hip pain in the past. Prob 10 years ago went to an Osteopath who helped it a lot.

Question is when should one be concerned and what are the initial things to do to avoid the surgery route?
post #49 of 100
Thread Starter 
Quote:
Originally Posted by Tog View Post

Good to hear they figured it out.

So now y'all have me worried. I've had hip pain for awhile. Kind of comes and goes but seems to be around more now. Driving seems to make it worse. Not sure if skiing is any worse than driving. I have taken a day off of intended skiing this year due to the hip. That same side knee is stiff often due to arthroscopic meniscus "cleanup" aka removal. Also had acl done on both knees but left has no probs.

I've had a long history of tight right IT band and some hip pain in the past. Prob 10 years ago went to an Osteopath who helped it a lot.

Question is when should one be concerned and what are the initial things to do to avoid the surgery route?

Tog, that's a tricky question since hip problems pretty much mimic lower back (especially SI joint pain), groin pain that also involves the Psoas into the lower abs, Sartorius pain running all the way down to the inside of the knee  (this tends to feel more sharp pain). It can also show up as IT band syndrome and sharp pain in the Trocanter.  I would tell you that in my case, with FAI (a femur with a mishaped head) there is nothing you can really do and this is why it usually shows up in athletic people involved in running, skiing, soccer, hockey and bicycle sports.  It eventually ends up tearing up the labrum.   

 

Not to freak or attempt to diagnose but sitting is one of the most painful things for me. It causes cramping of the Psoas and pain in the glutes and groin. Not fun. You can do some simple tests for your hip to see if you can produce clicking/popping or pain in your hip.  

 

https://www.google.com/search?q=hip+pain+tests+on+youtube&rlz=1C1WPDB_enUS502US502&oq=hip+pain+tests+on+youtube&aqs=chrome..69i57.10796j0j7&sourceid=chrome&espv=210&es_sm=93&ie=UTF-8#q=hip+labrum+tear+tests+on+youtube 

 

If you have any doubts find an OS who is up on his/her stuff and has experience with sports related hip injuries; especially FAI. I let this go too long. Although my PT told me last summer that he thought I had a hip issue, I didn't listen to him since I didn't feel like I had a hip problem. I would have bet anything that it was my L5S1 or my that I had retorn my mesh. I went to chiro's and massage therapists who kept me going but eventually, the muscles gave out as the femur became less stable and the pain increased markedly.  My OS took about 5 minutes to determine it was the hip.   The only trustworthy test is a MRA (MRI with an arthrogram) so don't let anyone MRI you without the arthrogram. 

post #50 of 100
Thread Starter 

SURGERY UPDATE

 

I had surgery last thursday the 20th.  All went extremely well. I have some pics and a video coming. I will post up for those interested in all that was repaired.  

 

The OS ended up modifying the Femur and the Pelvis which is called a cam,pincer Combined impingement by using a dremmel -like tool grinding away a portion of the bone.  In addition, the flap tear was repaired (not cut). He performed a form of micro fracturing (not sure of the term) but he roughs up the underlying bone and then anchors the labrum to the socket.  He then had to debride some remaining tearing. For those who are interested in this type of surgery, here's a really cool video of how my surgery was done. What is really interesting is the specific leg-boom and use of fluoroscope to ensure proper range of movement of the leg.  This is an actual surgery so just be warned, although its not gory or bloody.  Its not my surgery but it is the same technique used.  

 

click on the top (first) video labeled "Hip Arthroscopy, The Procedure"

http://www.hiparthroscopy.net/hip_arthroscopy_in_depth.php

 

 

I have only 2 incisions.  I have remarkably little pain. Its very sore and swollen but I was off pain meds in 24 hours (I had considerable pain prior to the surgery with limited range of motion). I take 4 Aleve per day to retard bone regrowth.  I am on crutches but allowed to weight as pain allows. I don't use them when around the house.  I cannot start rehab till this coming friday. I do isometric leg contractions, heel slides and such. No moving leg laterally.  I have about as much range of motion now but nearly no groin/abdominal pain.

 

Its good enough to bend and so I am able to do other exercises and some core workouts. 

 

Too early to truly tell but it does appear that the femur tracks more straight, I don't feel as twisted in my hips,and certainly does have a greater range of movement when flexed like sitting.  

 


Edited by Finndog - 3/25/14 at 9:56am
post #51 of 100

Wow, that's amazing stuff! What's your recovery time?

post #52 of 100
Thread Starter 

hard to say. the "book" says full unrestricted use in 4-6 months. I think a lot depends on how much work is done on a person and the technique used. I know that my OS uses dr. Samson's technique (lateral) as opposed to others who have longer recovery periods but again, in my case both the cam and pincer was involved and there was labrum repair.  Typically, people with repairs are restricted to non-weight bearing but my OS does not follow this but rather "bearing as tolerated" protocol.  So to answer the question, I don't know!  I hope to have a better idea after PT on Friday but my hopes are that I am cleared for stationary bike use by this weekend.  

post #53 of 100

That's great! My husband still feels pain in his shoulder almost 7 months post-op on occasion. He also had microfracturing and was told that it will slow down the healing. It seems that everyone is different and every surgery has a different healing time. That'd be pretty awesome if you could be on your stationary bike by this weekend. Thumbs Up

post #54 of 100
Thread Starter 
Quote:
Originally Posted by contesstant View Post
 

That's great! My husband still feels pain in his shoulder almost 7 months post-op on occasion. He also had microfracturing and was told that it will slow down the healing. It seems that everyone is different and every surgery has a different healing time. That'd be pretty awesome if you could be on your stationary bike by this weekend. Thumbs Up

 

we'll see, this is my hope...  that doesn't mean the PT will agree ;)

post #55 of 100

Well that sounds like good news all around Finn.  Glad to hear the surgery went well.  Hopefully you'll be in 100% fighting shape for next season.

post #56 of 100
Wonderful report, Finndog!!! So glad that you made it through with flying colors AND that things seem to be moving along so well for you! I would love to be able to have a "quick" surgery and recovery and get back to feeling good (if I could only keep all of my body parts on the same schedule for awhile). So it's nice to hear that it sounds as if you are heading in such a good direction!

Thank you so much for the information and great details!

Best of luck with your progress!! Keep us in the loop!

Kitty
post #57 of 100
Heal up. Make that PT your bitch.
post #58 of 100

Missed this before. Heal up ASAP!

post #59 of 100
Thread Starter 

WARNING SURGERY PICTURES----

 

 

 

 

A couple of pics. I have more but its hard to see what's going on,  On a side note, this looks a lot like a corned beef sandwich :D

 

the 1st 2 show the labrum separated from the acetabulum (hip bone).  the second is the labrum being reattached.  the 3rd is a view of torn labrum before debridement (cleanup)

 

 

 

post #60 of 100

Great news, bud.

If your doc is giving you "as tolerated" advice, he is telling you to listen to your hip, not to that vestigial part of the brain that is, and will forever remain, 18 years old.

You know, I have heard of people spending hundreds or more on footbeds, binding adjustments and boots tweaks just to get into proper mechanical balance.

But even you would agree that having a hip revision procedure to get into proper alignment is just a wee bit over the top.;)

D1

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