Future Gimp - Hip Impingement Surgery in my future

[Sinecure]

Its a bit of a long story, but I saw my hip doc on Friday and its looking like I'm going to have arthroscopic surgery on my left hip to fix something called femoro acetabular impingement (FAI). I'm thinking that I'll put it off until the end of the season and schedule the surgery for sometime next May.

WWMD? Anyone had hip arthroscopy for FAI before? What was your recovery time like? I'm talking recovery until you would feel good about skiing hard for 60+ days in a season? I'm pretty sure its too late for me to do this now and be ready in time for this season. Especially since it would be 3-4 weeks before I could schedule the surgery.

My doc mentioned something like 6 weeks on crutches. But I've also read about people being off crutches (not advised by their doc) after as little as a week. I know everyones mileage will vary in this department, but curious about others.

I've had 3 knee arthroscopies, dating back to 1986 so I'm not overly concerned about getting some little cuts in my leg and inserting cameras and tools.

Here's the backstory. Recent x-rays show that I have a cam type deformity of my femoral head. The picture below illustrates this best, but basically the ball that forms the head of my femur doesn't have as defined a shoulder/indent as a normal one. This is true of both my left and right femoral heads, but its only the left one that is causing me problems right now. Why only the left one you ask?

Almost exactly 3 years ago (August 2005) I broke my hip in a motorcycle crash. I fractured my acetabulum (the socket part of the joint) but it was only minimally displaced. In other words, it cracked, but didn't come all apart and so I didn't need surgery. The doc (Dr. Bellino - reputed to be one of the best hip/pelvis docs in the country) warned me that I would probably experience some arthritis development over time. I healed well and I still have a good, consistent gap between the bones of my hip joint. It matches up pretty well with the healthy side (right side). I've been going for annual x-rays and check ups with him since. Last year he pointed out a small bone spur but didn't make too much of a big deal about it. Over the past 9-10 months I've been noticing increasing discomfort in my hip, plus decreasing range of motion (its very difficult for me to tie my shoes normally on the left side). If I want to flex my left leg much, I need to splay my knee out to the side to get this to work. I also notice that my left foot tends to be somewhat turned out to the right, especially doing certain sports. About a month ago I decided to schedule an appointment with Dr. Bellino a few months earlier than my planned October visit.

On Friday he had me get a few additional x-rays taken after manipulating my leg to test range of motion (actually it was a very attractive resident/student who did the ROM test - Dr. Poon - I got so flustered I called her "Poon" and nearly stammered when speaking with her - at least I didn't call her tang). It was with these additional x-rays that he spotted the Cam impingement which is exacerbated by the bone spur on the femoral head. He explained that traditionally the surgery to correct this involved breaking/cutting off the femoral head, grinding it down with a dremel tool (or some equivalent) and then putting it all back together. More recently they've started doing it arthroscopically, apparently with good success.

He advised me to do some online research and think about it. I've pretty much decided to go ahead with it (still need to make sure my insurance company will pay), but would love to hear from maggots who have had it done.

If I were to schedule surgery for mid-late September, it would put a 12 week recovery period right in the middle of December. I just wonder if that's cutting it too close for ski season. The pain isn't too bad right now, although I do notice it every day, whereas at the beginning of summer I probably only noticed pain 1-2 days/week. I think I'll cut cycling out of my exercise regiment and do more swimming. I don't want to damage the joint more than necessary, and leaving things as is will definitely do a little additional damage.

Images:

Normal Joint:



Cam Impingement (for mine, imagine a bone spur somewhere around the 4th or 5th hash mark drawn on here)




Full hip image:

[peterslovo]

Sinecure - there's been good discussions about this surgery, from the surgery itself to recovery, on the "Rider Down" forum over at MTBR.com.

Here's one: http://forums.mtbr.com/showthread.php?t=267967

[Sinecure]

Thanks for the link. MTBR had come up in my google searches, but the link was busted.

That also led me to a yahoo group on the subject: http://groups.yahoo.com/group/Femoro...r_Impingement/

[Jim S]

There are some fantastic docs in the LA and SF (your) area that specialize in this.

I had the pleasure and honor to work with arguably the planet's premier hip surgeon for several years while I was in practicing in Ft Lauderdale, FL; he's now with Stedman Hawkins in Vail.

Pretty good that you had this malady recognized; it's not well known relatively speaking. ++++ vibes. If I had FAI, I'd have it corrected.

[Sinecure]

Current doc for hip is Michael Bellino at Stanford. I should check if there's a doc at Palo Alto Medical Foundation who is great at this b/c it would be cheaper for me to do it there. Bellino is who I saw when I first broke my hip in 2005. He's the main hip/pelvis guy at Stanford. http://med.stanford.edu/profiles/Michael_Bellino/

[Jim S]

Good luck Sinecure.

[splat]

Dude, come on down by the factory.
We can fix that on the vertical belt sander.

I have two friends who are brothers and just got new hips at Stanford.
They are extremely pleased with the work.
But you just want a buff and shine, not a new hip, if you can get by with it.
Once they drive the rods from replacement hips and knees into your bones, skiing becomes less of an option, they told me.
And they both skied, but that's past tense.

I almost had back surgery there, cause, well, it's Stanford.

edit: just saw this bone shave story:

http://www.cnn.com/2008/HEALTH/condi...ery/index.html

[JuliaGifford]

Thanks for the link....

[Sinecure]

The Yahoo Group is pretty useless. I can't be bothered to read the posts 99% of the time. In large part because they have no concept of list etiquette. I find it impossible to read a thread when every single jong replies to a thread by copying the ENTIRE thread in their post. It makes the emails so long and you have to scroll through the same crap over and over. Plus searching becomes a joke.

Oh, and I've put off my surgery until the spring. Doc said I couldn't have skied in time for the season so I put it off until it stops snowing.

[Skis]

How much do feel the reduced ROM will effect your skiing? It seems like if you can't flex your hip and your foot is turned out, it'd be pretty hard to ski.

[Sinecure]

Well, I made it through last season without much problem. But as soon as I got on a bike this spring, the Hip FAI really came to the fore. I haven't ridden a bike since. The pain has been getting progressively worse, and my range of motion increasingly limited. I limp to one degree or another most of the time and I can't do much in the way of exercise. I had rescheduled the surgery for back in June, but then I broke my hand and had to put it off since I couldn't be on crutches with the broken hand. So now my hand is healed and I'm off to surgery this Thursday morning. Hopefully it will go really smoothly and I'll be back on a bike in a month or two and back on the slopes no problem come November or December. I can't wait.

[splat]

Wow, you're going for it now? Swear to God, Sinecure - get a session of orthobionomy while you're on the mend. If you're up here, I'll hook you up. It was the best thing in my protracted mend cycle over the last 15 months. I know it will help if you can spring for it. I gimped into treatments and walked out so utterly pain free and posturally correct so many times it was unbelievable. I saw the swelling in my leg when I was fairly fresh out of surgery go down 30% from a hour and a half treatment. It's prolly going to be mostly about what they cut through to get there that you'll be healing from the most.


Did I mention that your sketch kinda reminded me of how I thought babies were made when I was a little kid?

[wandering, not lost]

Good luck. I'm now almost 8 weeks post-op and would have been cleared to ride a bike on the road except that my doc is afraid I'll mess something up before they fix my hip socket at the end of September. At PT today I actually felt pretty strong, which was nice, and I was able to do some stuff that I couldn't do back in February due to my pelvis being really unstable.

[PuderLuder]

I'm 3 weeks out after my hip arthroscopy for an impingement and general repairing of cartalige that was torn to s**t. Recovery sucks, and I just realized I will have to go buy my season passes while still on crutches! How many idiotic comments am I going to have to endure during the ~30min line at CO Ski and Golf?

[MarkoInTheBoat]

My right hip has been hurting for several years and I have always written the pain off as sore muscles.

Last winter I dislocated my hip, and received several sets of x-rays and CT scans of my pelvis region while I was in the ER for my hip reduction.

X rays revealed that my hips are totally fucked. For starters, I have unusually small hip sockets (possibly a mild case of Dysplasia) and I am wondering if this lead to my hip coming out of the socket so easy.
Plus, to top it all off, I have Cam lesions coming off of both femur heads.

My ortho doc told me that I could live with these Cam lesions as long as they weren't causing me hip pain. But now that I am fully recovered from my dislocated hip, I can tell that I still have pain coming from both hips.

So I went back to my ortho doc yesterday and had a consultation on my hips. I am in a very unique situation because my Cam lesions have been discovered very early on. Unlike most people with FAI, I only experience slight discomfort from my hip and I still have full range of motion in my hips/legs. I feel just enough pain to serve as a constant reminder that something isn't right in there.

Funny though, my left femur has a much larger cam deformity, yet my left hip has never hurt as badly as my right hip, which hurts bad enough to classify as FAI.

The ortho doc has suggested a MRI of my right hip to confirm that the cams are causing an impingement and to check for cartilage damage to my hip socket. I am getting scheduled for the MRI next week. After that I guess I will find out if I need to proceed with arthroscopic surgery to remove my Cams, or if I should put off the procedure until things get worse and I have increased pain and reduced range of motion.

Here are a few shots of the cam lesions forming on my femurs. Maybe somebody with a xray of a normal hip can post a picture for comparison.

Left femur. Larger cam, yet less hip pain.


Right femur. This is the fucker that is causing all my pain.


Thanks to everybody for posting their hip related experiences. I have found the info to be most helpful in making my decision to stop ignoring my hip pain and doing something about it.

[mysteryzombie]

my right hip is cam/pincer combo, films say it's more impinged overall. i could get by with it like it is, i think.
my left hip is cam, but hurts much more.
i am getting surgery but cannot do it till spring. im going to dr kelly at hss in nyc.

[mysteryzombie]

hey sinecure
how did your surgery go??
i hope you are feeling better

[daniellamurphy18]

There must be a cooperation between the patient and the doctor, and some says that there always be legal help from a hip lawyer.


asr hip recall

[Mazderati]

Anyone with a report on long term recovery? Sinecure?

[BraddA]

^^^Bumping this as well. My FAI is due to acetabular retroversion, and thus far PT, ART, etc. have been marginally effective. Curious to hear how others have fared.

[jellero]

the "six week on crutches" caught my eye, that is a long time considering that i was walking without anything, not even a cane after 10 days with a total hip replacement. what would keep the bone spurs from growing back? actually the joint looks good for the most part. i was bone on bone. was there any discussion of replacement? good luck. j

[Mazderati]

Recovery from impingement surgery is longer than total hip arthroplasty (THA), even more so if microfracture is performed. Results suggest the bony impingement does not typically reform after resection.

Osteophytes, the type of bone spur with which you're probably familiar, can occur as a result of the original impingement and may be an indication of bony and/or chondral trauma. These are typically removed if causing a problem and left otherwise. Osteophytes may grow back over time, especially as arthritis progresses.

The FAI patient population is generally young and active. With prosthetic hips lasting somewhere in the ten to fifteen year range, THA is avoided if possible.

[snoqpass]

My wife this done in June, she wasn't so good about using the crutches and set her back a little, mostly pain free now and about 90% improving every day

[jma233]

I wouldn't rush to have surgery based on an xray showing FAI. According to the latest studies nearly everyone of us has Xray evidence of FAI.

Prevalence of radiographic findings thought to be associated with femoroacetabular impingement in a population-based cohort of 2081 healthy young adults.
AuthorsLaborie LB,et al. Show allJournal
Radiology. 2011 Aug;260(2):494-502. doi: 10.1148/radiol.11102354. Epub 2011 May 25.

[Mazderati]

I don't think many physicians would operate based solely on an x-ray.