# Hip Impingement



## JD Risk (Nov 7, 2005)

I've been diagnosed w/ femoral acetabular impingement in both hips. In the left hip, which is worse, my problem comes form a mishaped femoral head. On the right, the acetabulum has some abnormalities, but may not be as much of a problem. I'll wait and see what happens w/ the left hip before I proceed w/ the right. 

I'm contmeplating surgery and my doctor wants to proceed arthroscopically and if it looks bad enough he may want to open up my hip. I'm really trying to avoid a large incision and having my hip dislocated. I've heard of an arthroscopic equivalent to full hip dislocation for correction of this problem. I'm thinking my doctor may not be familiar w/ these techniques and am currently seeking other opinions. 

Presently the only things that give me pain are prolonged standing, strenuous activity w/ lots of sudden movements such as basketball and karate, and some weight lifting exercises such as squats. Biking never bothers me except for really long rides when I occasionally feel a popping sensaition coupled w/ sharp pain. For the most part, biking makes my hips feel better.

I'm 27 now and I believe my cartilage is in relatively good shape so having surgery will hopefully bring me back to near 100% and greatly reduce my chances of develping bad arthritis and needing hip replacement at a young age. 

Hopefully someone here has some insight they can share.

Thanks.


----------



## WheelsForHeels (Jan 5, 2007)

*Hip surgery suggestions*

I also have misshapen femurs on both sides with symptoms similar to yours. The cause is probably different, but the results are similar. I'm a little older and have progressed to athritis. Good thing is, I'm still able to ride without problems.

I've consulted with virtually every well-known hip surgeon in the US. For a future arthroscopy, I've consulted with Dr. Byrd in Nashville. He's one of the fathers of this procedure in the US, and from what I've read, his skill is far greater than that of most other surgeons. Maybe that's why some of the instruments are named after him and why he's the leader of numerous symposia on the subject. Fortunately, he accepts insurance. You might want to see him too.

When/if that fails, they've now got resurfacing options (what Floyd Landis just had done), which apparently have great results, though there no long-term studies yet showing how long the resurfacing lasts. Five years from now, there will be better information available.


----------



## pro-gravity (Oct 27, 2004)

Hey,

I was diagnosed with Cam impingement (both hips) about a year ago, but started feeling pain in my hips about 2-3 years ago. My symptoms are quite similar to yours, but I have stopped all impact sports, in order to preserve the remaining "good" cartilage. This past august I had surgery (full dislocation) to correct the impingement with Dr. Millis in Boston. At about 5 months post-op I couldn't be happier. Recovery is no walk in the park, but if you are currently in good shape and are committed to rehabilitation it is bearable. In may I get my other hip operated on. The reason I opted for the open surgery was to make sure everything gets corrected properly by the surgeon, who has full view of the socket. For me the arthroscopic approach would be ideal, but it is still relatively new. If you want more information about the subject check out http://health.groups.yahoo.com/group/Femoroacetabular_Impingement/

good luck

-Patrick


----------



## JD Risk (Nov 7, 2005)

Thanks for the information. I talked w/ my doctor again and I've decided to have surgery. For me, it seems to be the best thing to do if I want to continue to be active. I'm hoping it can be taken care of arthroscopically but I've consented to full dislocation if conditions warrant. For those who have had full dislocation surgery, what is the time frame like for getting off of crutches and making a full recovery?


----------



## pro-gravity (Oct 27, 2004)

Recovery from full dislocation is more tedious than most hip surgeries because part of your greater trochanter is removed during surgery then screwed back on. This step allows access to the hip socket while reducing the chance of avascular necrosis. I was non-weight bearing for 4-weeks (toe touch), then 50% weight bearing for 2-weeks and finally full weight bearing at the 6-week mark. I used a single crutch for a week until I was comfortable walking on my own. Supposedly full recovery takes 1 year, but at 5 months I feel about 80% (walk without a limp, weight-train, but no impact activities for now). I could definitely push myself harder, but focus all my energy to strengthening my leg muscles. I highly recommend looking into full dislocation or atleast get an opinion from a surgeon who specializes in that surgery. This surgery (full dislocation or arthoscopic) is still in its infancy, so please consult a surgeon who is as experienced as possible. Check out this site for an experienced surgeon in your area. The Childrens Hospital in Boston was top notch. http://hipuniverse.homestead.com/files/PAOSurg.htm


----------



## PhotoMom (Jun 23, 2005)

Here's the link to the place where Floyd Landis got his hip done http://www.birminghamhipresurfacing.com/

I don't know anything about surgical dislocation of the hip, but when I was 15, I fell off my horse and dislocated my left hip. The doctor was able to put it back in place and I didn't require surgery. But my hip sure can tell me when it's going to rain!

:~)

PhotoMom


----------



## JD Risk (Nov 7, 2005)

Thanks for the help. I'll check out that site. I'm waiting to see what my insurance provider says. I'm sure I'll have to argue w/ them for a while before I can get anything done.


----------



## PhotoMom (Jun 23, 2005)

Story of my life - fighting with insurance companies... hope it all works out for you!


----------



## pro-gravity (Oct 27, 2004)

The full dislocation should be covered by all insurance companies because it isn't considered "experimental". I have heard stories of the arthroscopic surgery (can be considered experimental) not being covered mainly because of the insurance companies the surgeon accepts. Also make sure the hospital is covered by the insurance company.


----------



## isiah (Nov 26, 2007)

*Cam Impingement*

Hi

I am a 40-year-old male and was recently diagnosed with cam and pincer impingement. My acetabulum was also a little shallow. After years of basketball, tennis and most recently intense cycling for the past three years the pain presented and I was diagnosed.

I had surgery on my right hip. The doctors arthroscopically cleaned up a torn labrum and removed a bit of cartilage. They also removed a bone chip the size of a golf tee. A second physician shaved the impingement with an open incision. I am three months out and my right side feels good except for the hyper-stimulated nerve running down the right side that should improve. The cartilage damage was at grade 2.

Occasionally, while walking, I have dull soreness in my left groin. Unlike my right side, I "feel" each step on my left side. And, because of the surgery I have a greater range of motion on my right side. But the labrum is not torn on the left side.

The doctor advised me to give up running and distance cycling. I have taken up and enjoy swimming. But I am considering surgery on my left hip because I can notice a slight difference while walking and, because of the impingement, the left side will likely get worse.

Will surgery prevent further damage? Will it prevent the need for a hip replacement on my left side? Would you opt for surgery just so that you could walk without slight discomfort? Would you wait till the pain was more prominent? Or would you go have a second surgery? What would your doctor recommend?

I understand the two schools of thought: 1) Avoid surgery and opt for it if you have more "bad" days than "good" (as far as pain) and 2) Have surgery soon enough to prevent long term damage. My "pain level is a dull pain in my left groin and I feel each step on my right side.

I am consulting with my physicians but am seeking further opinions.

Thanks,

Isiah


----------



## jezhkrider (Mar 22, 2006)

JD,

I had an op to correct FAI on my right hip in April this year. I had it done in London UK, by one of the UK pioneers and leaders, this is a key thought in who you choose. I would choose a guy who does hips, hips or hips, not hips, ankles, knees etc. you want the guy who does 5 hip scopes a day, not that many a month. do your research well. Your paying find and demand the best.

the result of this was that it was bloddy painful to start with, but after a few weeks of partial weight bearing ( which started with a walk to the john 30mins after coming round ! ) i was off and away with a mild limp. 3 months post op i was back riding, with some stiffness. In Sept this year I went to Italy and rode 1800mtrs ascent and 75 k in a day, no problem, this says the issues is fixed. I had the cartilidge fixed and the bone shaved. If needed i would not hesitate to have the left done by the same guy and in the same way. avoid an open incision if you can avoid, the use of the Arthroscope is not a new technology....in the right and and experienced hands.

good luck and take it easy while you line up your op,

I am now waiting to get my sholuder fixed, but thats another story............


----------



## JD Risk (Nov 7, 2005)

It's been almost a year since I started this thread. I guess it's time for an update. I had my left hip scoped at the end of January to correct cam impingement. They shaved the head of the femur, removed the labrum (beyond repair), picked holes in the acetabulum to stimulate cartilage growth, and removed a floating bone fragment. Recovery was easy - 2 weeks on crutches and about three months of taking it easy. The worst part was when one of my incisions got infected and had to be reopened so I could jam gauze into it daily to wick out all of the cruddy fluid in there. 

Before surgery I had chronic aches in that hip and groin pain that would get severe at times. Those symptoms are now gone, although my range of motion has barely improved. I am still met with sharp pain when I try to push beyond my limited range. I can live with that. I guess it's related to the fact that my labrum has been removed. My pain-free range of motion is enough for me to play basketball, lift weights, ride, and run as much as I want with little to no pain afterwards. I'm pretty happy with the results. 

I have pincer impingement in my right hip that I haven't done anything about yet. I don't know if I will, since it hasn't been getting noticeably worse. My doctor seems to think it would be very difficult with the scope, although he mentioned some other procedure that isn't quite a full dislocation that may be appropriate. I'm going to look into other doctors and hope medical advancements are made in the mean time that will make my condition more easily treatable by arthroscopic surgery. Anyone know any good surgeons in the northeastern U.S.?

I've also taken glucosamine chondroitin for a while and it really seemed to help. I haven't taken it for a while but I'll probably start again soon. Does anyone have any insight about this supplement? Who would benefit most from taking it? 

The only advice I can give others with similar ailments is to carefully evaluate your situation. Figure out what activities cause you the most pain and why, determine if avoiding these activities will significantly prolong the life of your hip, and decide if you can give them up. If you can't, then you'll want to consider surgery. Don't take any shortcuts with rehab and whether or not the surgery is successful, at least you'll know you've done all you could have. It's in your hands as much as it is the surgeons.


----------



## Hud (Jun 22, 2004)

Re. glucosamine and chondroiten, my dad has been on it for a while. He said it takes 4-6 months to start making a noticable difference. There has to be existing cartilage for it to build on, if there is not cartilage left it won't do anything.
Hope this helps.


----------



## sorehip (Jul 16, 2008)

has anyone responded to this? Iam about to have surgery and need to know if life will get better for activity after fai surgery.


----------



## jezhkrider (Mar 22, 2006)

Sorehip, I think reading the posts many questions have been answered, quite what you are asking has been answered i am unsure.

As per my posts i can say, yes life is better and more bearable post surgery. I still have to watch my posture etc, and sometimes get an impingement type feeling, but i would say i am lots better than pre op, where i began to limp and where cycling became a real issue. I had the op in April and in sept the same year rode 1 week in Italy and rode 1800m of ascent in a 80-km long day, the hip dealt well with that. no issues.

I hope this recap and the reminder to look thru all the posts helps confirm you are taking to right steps.

I can only refer to Arthroscopy, not open surgery.

Good luck


----------



## pro-gravity (Oct 27, 2004)

*FAI Update*

I just want to give an update. I recently reached my 2 year anniversary from open FAI surgery conducted by Dr. Millis in Boston. My other hip is about 1.3 years post-op (same surgery). Everything is great. I ride just as much as I did pre-op, but without any discomfort. I have also returned to playing ultimate frisbee. If you have any reason to believe you have a hip impingement get it checked out by a specialist in the field. The sooner the problem is fixed, the potential damage is vastly reduced.

take care,
-Patrick


----------



## anagallis_aevensis (Sep 1, 2008)

Well I need my left hip done, the sugeon has suggested doing it arthroscopicly, I'm based in the UK and will be using the NHS, how do I check out how good the guy is? Jezhkrider, who did yours?


----------



## FURIOUSSTYLES (Sep 8, 2008)

*Left hip as well*

I am getting my left hip dislocated on the 26th of Sept. My other side is starting to act up and am anxious to get it over with since i have not ridden anything in a while. The Doctor I am seeing and having do the surgery actually goes to the UK quiet often for additional training so i will ask his staff of any recommendations. I am seeing a doctor at the University of Colorado-


----------

