Arthroscopic FAI surgery and hip resurfacing

[spiller]

Hi,

I'm a very active 40 year old male who about 6 months ago started to feel groin pain. After working my way through the system here in Toronto i eventually got an MRI and have been diagnosed with FAI (in the left hip for sure, but I suspect both) with a large osteophyte collar and torn labrum.

I am currently on a very lengthy waiting list (6 months) just for a consult with an OS to discuss whether I am a candidate for athroscopic surgery to repair the labrum and remove the osteophytes. Unfortunately the MRI showed some evidence of joint cartilage loss already, I'm not sure to what degree though.

3 questions:
1) Can anyone tell me if having arthroscopic or open surgery for FAI will in any way effect me being a good candidate for hip resurfacing later?
2) Does anyone have any experience with the rate of cartilage loss in FAI?
3) There is only one Dr. listed in the Toronto area for FAI, does anyone have any information they can pass along re. other OS in the GTA?

Many thanks one and all.

[Barbara]

Sorry to appear ignorant but I have no idea what FAI is or OS in the GTA?????

Barbara

[spiller]

FAI is Femoral Acetabular Impingement.
Orthopedic Surgeon in the Greater Toronto Area.

[Todd]

Spiller,

If I'm not mistaken, Marion Gabrik is of the MN Wild is being treated for the same/similar issues.  I don't have an answer, but would suggest getting into the next Dr. Chat on this website.  You'll get some information and direction from a highly regarded source.  Good Luck!

[spiller]

Thanks Todd i will join in.

As for Gaborik, I don't have hands around the net like he does, but I do like to strap on the blades. I hope this hip does not put an end to that.

[dw]

I believe there have been baseball players Jason Isringhausen  on the st. Loius Cardinals for sure who had this surgery, and he was back playing pro ball afterwards. More recently Mike Lowell (Go SOX!) and Chase Utley have had hip surgeries. they are both expected to be ready for the season come opening day (Lowell was a labrum tear, not sure what the deal with Utley is).

[brownie]

Spiller,

I also live in the GTA area, am a male 49 years of age, very active golfer up until about 4 years ago. As a kid(12 years old) I had pains in my right knee and the family doctor would xray and say there was nothing wrong. Finally sent to Sick Kids and they xrayed my hip and determined the problem was slipped epiphysis. They operated and I still have the two pins in my hipabout a month after the surgery I fell and fractured the femur. I was in traction for six weeks and a body cast for six weeks. Everthing had been fine up until around 2002 when I noticed while walking the golf course, that my leg would stiffen up and I would get extremely tired. I went to see an OS in 2004 at the age of 44, he said I had developed  Osteoarthritis in my right hip, and that I was ready for hip replacement but at my age wait as long as possible. It got to the point where to play golf, I could no longer walk, I had to take a cart. In the spring of 2008 I heard about hip resurfacing and did a lot of investigation on the internet and decide to look for a Doctor in Toronto who did the surgery. I was able to get an appointment at St Joe's hospital in June 2008, the doctor reviewed the xrays and asked that I come back a month later as he wanted to review my case with other doctors. I went back at the end of July and was told that there was nothing they could do for me. I then asked that Doctor to refer me to Dr. Frank Smith out of Hamilton Chedoke Hospital, an appoitment was set up for November 08, at that appointment he looked at the xrays and said he could not promise he could do a resurfacing but if he couldn't do that he would be able to do THR. The surgery is scheduled for March 5/09 at Hamilton Henderson Hospital. The concerns her has on the resurfacing are the neck of the femur may not be large enough, plus the pins will have to be taken out which means he will have to graft bone into the holes left by the pins. Means no weight bearing for six weeks. Also my right leg is 1 inch shorter so THR he would be able to straighten me out.
I would suggest you try and get a referral to Dr. Frank Smith at Hamilton Heath Sciences

[spiller]

Thanks Brownie.

I'll look up Dr. Smith. Good luck in March.

[Bionic]

3 questions:
1) Can anyone tell me if having arthroscopic or open surgery for FAI will in any way effect me being a good candidate for hip resurfacing later?
2) Does anyone have any experience with the rate of cartilage loss in FAI?
3) There is only one Dr. listed in the Toronto area for FAI, does anyone have any information they can pass along re. other OS in the GTA?

FAI surgery probably will not affect your candidacy for hip resurfacing, since it addresses soft tissues and osteophytes only, but you want to check with a doctor to be sure.  Cam FAI was my underlying deformity as well.  I had many osteophytes and probably a torn labrum.  I first noticed it at about the same age as you did.  I never had surgery to treat the FAI directly. 

The most important criteria to qualify for hip resurfacing are strong bone and a good femoral neck.  As long as the FAI surgery doesn't compromise the bone or the neck, you'll probably be okay.  The bigger question is whether it will really do you much good.  I think that depends on your level of activity and the degree to which your cartilage has already been lost.  If your cartilage is already mostly gone, you might consider skipping directly to plan B--Hip resurfacing.

My first hip appointment was in 2001, and I had significant but not complete cartilage loss.  By 2005 it was mostly gone.  By my surgery (5 days ago), it was completely gone.

[John from Thornhill]

Hi Bionic,

I too am from the GTA, but went down to Columbia and had Dr. Gross do a hip resurfacing on me Dec. 4/08.
He told me I had FAI, no one here in Canada had told me that, and he was able to handle that issue quite
easily during the surgery.  I have heard that OHIP has paid for FAI treatment in Colorado, so if you are having
trouble you may consider that route. I do not think you need to treat the FAI separately as with the right
surgeon it can be handled during the resufacing surgery. I am feeling great and would stronly recommend Dr. Gross.

I note he is in the chat room Feb. 17th, so why don't you ask him directly.

John

[Bionic]

Hey John,

Did you mean to address that to me or to Spiller?  I'm already a Gross Hippy, and a happy one, too.

[Pat Walter]

Dr. Gross does a lot of FAI patients.  Here is a page I put together to explain more about it.

http://www.surfacehippy.info/fai.php

Treatments for FAI don't always work and I have read about a number of folks that ended up with hip resurfacing when the treatments did not work.

Pat

[spiller]

Thanks John and Bionic.

John, was there a reason why you opted to not get resurfacing done here? Also, did OHIP pay the cost of your surgery with Dr. Gross. I'm not surprised that you did not get an FAI diagnosis, I was told by my GP that it was early arthritis and that there was nothing to do but wait until the joint deteriorated and get a THR.

I first heard of FAI on this site (thanks Pat) and after further research pushed to get in to see a specialist who after an MRI confirmed it was FAI and possibly treatable. My only problem is the extended wait time to get in to see one of the very few OS in Ontario who performs this arthroscopic FAI surgery.

I too have heard of the Colorado/OHIP situation, I'm researching that now.

Thanks all.

[saadjallad]

Hi there, Im 28 and extremely athletic.  I had a microfracture arthroscopy done to my right hip in 2007 @ a clinic in vail.  They also repaired may laberum,  It did nothing except make the problem worse.  The Drs said it failed because the arthritis was too advanced.  My advice is not to do the arthroscopy if you have severe arthritis or severe cartilage loss.  Wait it out and do your Hip resurfacing with one of the surgeons on this web site.  Hope that helps 

[John from Thornhill]

Thanks John and Bionic.

John, was there a reason why you opted to not get resurfacing done here? Also, did OHIP pay the cost of your surgery with Dr. Gross. I'm not surprised that you did not get an FAI diagnosis, I was told by my GP that it was early arthritis and that there was nothing to do but wait until the joint deteriorated and get a THR.

I first heard of FAI on this site (thanks Pat) and after further research pushed to get in to see a specialist who after an MRI confirmed it was FAI and possibly treatable. My only problem is the extended wait time to get in to see one of the very few OS in Ontario who performs this arthroscopic FAI surgery.

I too have heard of the Colorado/OHIP situation, I'm researching that now.

Thanks all.

[John from Thornhill]

Hey Spiller,

I went to Dr. Gross on my own volition and have not approached OHIP for payment. As the out of country process required pre-approval, I do not think I would be successful after the fact if I went to OHIP for payment. I just wanted to get this done, was not impressed with the options locally, did not want a THR, and hence via this site, decided Dr. Gross was my best bet both from the perspective of excellent care/surgeon and cost. I had looked at Dr de Smet, and was booked there, but the distance and other issues made me want to have the surgery closer to home.

At the end of the day, I wanted the most experienced surgeon I could get, and as quickly as possible. I did not mind paying for it on my own.

Good luck with your decision making.

John