Femoro-acetabular Impingement and Labral tear recovery thread

[gibbssco]

I was born with some pretty shitty hips, so on March 14th i decided to try and fix one of them. Surgery for FAI and labral tear. Lots of bone shaving and labrum stitching, a little bit of microfracturing to produce some psuedo-cartilage as mine is pretty thin. First few days i couldn't really do anything by myself, but now a week and a half out i'm hobbling around on these crutches pretty well! First post op is this monday with Dr. Shane Nho down in chicago. I will update as milestones and such present themselves. There's like, two or three other threads on here about it so I kind of just want to spread the word. Quite a few people have this and don't know about it.

[gibbssco]

faK. That should read 'Femoro-acetabular Impingement' in the title...

[gibbssco]

Just had my two week post op. doc said everything looked good, then he showed me how much bone he had to shave off to make my hip 'round.' Holy shit. It was quite noticeable! He even had two of his cronies come in and pointed out that he took the most bone off of any of his patients....I hope that doesn't turn out to be a bad thing. Turned in my CPM machine and vascu therm chiller, so it's all manual movement and ice packs from here on out. Still have the brace/ crutches on, over the next two weeks I will be increasing weight bearing from 20% to full (theoretically). Physical therapy here we come!!

[TBS]

So if i understand this, you had bone spurs growing on the femoral head which shredded the labrum? I'm no doc, but this sounds gnarly. How much bone did the doc remove? What's the expected rehab period?

Good luck with this

[gibbssco]

Thanks telebobski! Yup, they called it a "cam" type impingement. The top of the 'ball' didn't neck down really, and i had two gnarly ridgelines coming down the front of the ball, like dunes in the sand. Doc said all things considered, it should have looked WAY worse on the inside of my hip. It's still pretty bad, but that gave me some consolation expected recovery is 3 to 6 months....I am praying it's more toward three...biking season is just around the corner!! I will post pics when i receive them.

[DocChronic]

Keep the updates going. Going in for my first meeting with a surgeon for the same issues......

[gibbssco]

Good luck doc, what specifically made you seek a surgical consultation?? Just got done with my 6 week post op. other than being super tight (which I have always been) the doc likes progress...finally back to full weight bearing, although I was cheating quite a bit near the end there! He says I can start pushing with the stretching and flexion now a little more, and recommended swimming and stationary biking now outside of PT. the trainer is coming out of the closet TODAY!!! I still get pinching in the front of the socket, near my groin but he thinks that's a product of tight muscles. One thing....focus on your core!!! It's where most problems stem from, the psoas specifically. Well, time to board my plane...one of the only shitty things about living in a cave, where things like hip specialists are non existent ;D

[DocChronic]

Gibbs-
Had a trauma to the hip surfing about 5 years ago. Got compressed over my front foot. It just seems to be getting worse over time. Didn't bother me but once in a while skiing, but the surfing seems to aggravate it to the point where I can only surf one or two days in a row. Going on a surf trip for 2 weeks in august and now i'm freaked out it will be a waste of money if i'm in pain and can't surf. Same as being in the mtns when it's dumping and you are on the couch. Torture.

So I consulted with a local doc that is supposed to be one of the best. David Gazzaniga in Newport Beach, CA. He's got a good background. Also i just came off of 8 weeks of physical therapy focused solely on the hip and core region. 2 good days of surfing at week 8 and it was killing again and bothering me for 2 weeks straight after that. That was it.

Doc looked at some x rays and at least said the head of my femur looked ok. Don't think i had any ridges like you. They took a bunch of x rays before the MRI. I had contrast injected too. They also hit me with a steroid - Kenalog that he said will help. Not sure what the diff is between that and cortisone.

So i see him in a week to go over the MRI. I'll do what i can to avoid surgery though. Seriously considering HGH or some other kind of therapy if possible. BTW I'm 39 and been skiing and surfing hard for over 30+ years in both sports.

Thanks for the updates.

[gibbssco]

At PT yesterday I achieved better ROM in the surgically repaired hip vs my old shitty hip. Makes a dude wanna fist pump in a room full of midgets!! Haven't been able to get in the pool yet, but the trainer is going well, only a little sore after a 45 min session. My PT is concerned about my ROM though. Apparently because I've been this way for so long, my pelvis and saccharum don't really move well...it's like they Are welded together. So were gonna focus on that for a while. Makes sense cause I've always had lower back issues, just a bummer that it might affect my hip recovery :/ Doc, how'd that appt go??? MRI is the way to go man, sounds like you at least have a labral tear...

[gibbssco]

Compared to ACL recon, I was back to walking around normally WAY earlier...not too terrible if you do have to go the surgery route....

[gibbssco]

Rode my Mojo HD for the first time on pavement two days ago!!!! FKNA!!! Only did 4 miles, but it felt great! Today was bike to work day, so me and a co worker rode from his house (5 miles). It was at a little more ginger pace than I did tuesday, and now i can feel a little discomfort in the socket. But my PT did some stretches yesterday where he pulled my hip to get movement in the socket, so maybe it's that?? Either way, I am fucking pumped to be off the trainer! Haven't started swimming regularly yet, just a few times, but Monday I'm making it a point to go 3 times a week. will update with further milestones as reached.

[gibbssco]

Well, it's been a few months since i've been on here but lemme recap. Started mountain biking pretty frequently after this post, and Scuba diving quite a bit. I would do too much, have a relapse, get better, do too much, etc... but overall I don't have pain sitting at work any more, and I have more flexibility in the joint. I can't pull my leg over my head, but it is noticeable and my back pain has considerable subsided as a side effect of having correct hip mechanics. Probably will do the other one, but i have my last appointment October 14th with the ortho. We will make the decision on the other hip at that point, but i will probably get it done.

[gibbssco]

Terrible at updating this shit..

I guess since October I weaned off the biking and started hunting alot. Sitting in a duck boat(with improper posture, like me) is not good for your hips....was sore and angry until hunting season ended. Have been pretty slack on my exercises but chanced it last weekend and went to bohemia opener hoping I wouldn't be carried off the hill in a stretcher. Overall, things went well. Hip was sore, but not as much as i thought it would be. We will see how ski season goes, back pain is a little bit better, but by no means gone.

[Mazderati]

Would you have surgery again if given the choice? Did Nho put you in one of his braces?

[gibbssco]

Maz,
I guess I would, because I am having the other hip done on March 20th. Recovery was better than a torn ACL, but still took a long time to start to feel normal. I did therapy until November and wish I would have had a month or two more. I still struggle to put my socks on, but my back pain has been significantly less and I've been hitting bohemia pretty hard (bumps, moguls, drops, etc.). Guess overall i can't complain, i still have some sharp socket pains from time to time but I would say an improvement in lifestyle definitely. Hitting the chiropractor hard before I get cut to address major rotation in my pelvis/ L2-4/ and counter rotation in my neck....I am a bio-mechanical cluster fuck!!!! Nho did put me in a brace (4-6wks), but it mainly just impeded me from bending over at the hip....not a big deal.

[Mazderati]

Were both of your hips pretty bad? Journals suggest complete recovery can take over a year. I'm more concerned with microfracture than anything else; really hoping it can be avoided.

[gibbssco]

To give you some insight into my plight,

When I decided to get the ball rolling, and went and saw our local hip doctor here, when she walked in the room (after never having seen me before, and reviewing my xrays) she literally turned around, saw me, and exclaimed "holy crap!" That was the first thing she said...I replied with a befuzzled, "what???" To which she replied "OH, I just thought you were going to be way older..."

Awesome to hear, right? She thought I was 60, and was gonna recommend a double replacement. Cool story Hansel, I know. When I was in high school I would have to hold my breath to tie my shoes, because I would get shooting groin pains if i tried to bend at the hip at all. I had a little bit of microfracture on my surgically repaired hip socket...Nho was surprised that it didn't look way worse than it actually was. He was expecting the lining to look like swiss cheese. Weight bearing restrictions are longer if you get microfracture I think...I'm interested to know why you are uber opposed to it (other than the fact that it is intrusive as fuck!!! )

[Mazderati]

Microfracture adverse because 1) the cartilage that forms is fibrous and not as durable as the original hyaline and 2) it's a path that, once traveled, likely eliminates any other cartilage repair options that are currently available.

I'd rather get the bone resected, labrum repaired, and then try a combination of growth hormone, stem cells, blood platelets, and distraction. But finding a surgeon who is both experienced and willing to diverge from their existing protocol is not easy. Assuming I don't pass out, I'll be awake for surgery to take a look at what's left of the original cartilage and make a decision on whether to proceed with microfracture. I'm gonna try to GoPro that shit but don't know if they'll let me.

[BraddA]

^^^my doc is pushing for microfracture as well. He also wants to replace my labrum with a cadaver's IT band. Shit. Shaving of both cam and pincer as well.

Really struggling to make a decision, frankly. My ROM is great, until it isn't. Aside from the standard groin pain, which is minimal, I've had a series of incidents in which I am unable to straighten my leg. Attempts to straighten my leg or thrust my pelvis forward produce the single greatest pain I've ever experienced. Then...it goes away - ROM returns, pain disappears. Bizarre. Anyone had experience w/ labral detachment as well as tearing? I've been told this is the cause of the sporadic ROM loss, and I agree, but it's tough to sign on for such an aggressive procedure when the extreme inconvenience only manifests a few times a year. On the other hand, when I lose ROM, I'm fucked. Totally worthless.

[Mazderati]

Good or bad, mircofracture is the current standard and what surgeons are comfortable with so that's what is used.

MRI shows my labrum looks like a stretched ear lobe. Zero degrees interior ROM. Hoping it just needs anchoring but won't know until the doc gets in there. I've opted into surgery as a preventative as much as corrective measure. THA is not something I want to experience any time soon, or at all for that matter.

[gibbssco]

Well shit boys, its beginning to be about that time when I go under the knife again....

Maz did you get cut yet? Who is doing yours?? Is he doing stem cell shit? Reading splats thread on it, sounds awesome but I wonder how the application would translate from knee to hip. Yeah, they are both articulation interfaces, but serve different biomechanical purposes. So when you say "interior ROM" do you mean like, pulling your knee up to your chest/ rotating to sit with that leg crossed on top of the other is super painful? I've never been able to sit indian style for the record. cant drop my knees down far enough, and just end up slouching my back and leaning back instead of putting weight forward.

Bradda that sounds terrible. I've never had a situation where it completely locks up...Nho put a few sutures in to anchor my left one. Unfortunately I'm not sure how much good it did, because after skinning these last few weeks, walking correctly feels like someone is sticking a dagger in my groin. I'm hoping I just went too hard....maybe cortizone shots are in my future. Who the fuck knows. At least my posture and lower back pain have significantly improved eh?!

[Mazderati]

Next month with Philippon. No stem cells but some PRP. I'm going to try and get some PRP periodically after surgery. Tried to get on a regimen of growth hormone and/or test pre surgery but no one wants to touch it.

No interior ROM means I can't swing my leg out like this:



So trying to pivot at the waist and lean your hips back up the hill is next to impossible. So are full squats and deads. I'm a super sloucher in Indian style too.

You going back with Nho? I've heard and read good things about a guy in Minneapolis; Chris Larson I think. One of the team physicians for the Vikings. Almost went with him myself.

[gibbssco]

Yup, the wait list for Dr. Larson was mega long when I started down this path so I opted out of his care.

March 20th I went under the knife again for the right hip. No microfracture, no sutures, he just cleaned up the labrum and SHAVED A METRIC SHIT TON OF BONE off of my femoral head. Like, 20-25%. Before and after xrays had me shitting my pants! Anywho, this time around was a little easier, maybe because they didn't have to do any stitches and anchoring so phys therapy is progressing nicely. Turns out I DIDN'T have microfracture on my left hip after talking to Nho april 7th at my check up. seriously considering this stem cell prp thang for in the future, when health care will cover it?????

http://www.regenexx.com/

Nho says he can do PRP but with no stem cells....Not sure if trying that first, and then advancing to the stem cell/PRP combination would help/hinder results? Hoping for some 5-10 year case studies to come out on this shit. $5600 dollars is a lot of dollars, also. My next apt is in 5 weeks. I will update then.

[chewymix]

so apparently i have this - CAM in both hips with 2 tears in left and 1 tear in right. Some delamination is also apparently present on the left. X-Ray is below and i'd be interested to know if others think the CAM looks bad or not as i have nothing to compare it to.

[Mazderati]

gibbs - The combination of both PRP and stem cell seems like the best way to go, but as you mentioned, insurance coverage may not be there. PRP should help even on its own.

chewy - Looks like some decently sized lumps. What's your range of motion like?