Is FAI an indication for hip resurfacing?

[GIBLET88]

Hi
Since this is a relatively new condition for me, I plan to go through some PT and physiatry treatment for several months.
I am trying manual therapy which seems to help a fair amount but to be honest, have not been active much lately
I will see how things progress (or not).  I plan to keep the appt with Dr Su for September unless I decide that I can live with the symptoms for awhile.
I have decided to attempt the elliptical with minimal effort and see if there is pain
An x ray in 6 months may demonstrate more changes than the one taken last month. I will not wait more than 6-9 months to have a repeat x ray.
That may be the motivation to plan for the surgery for late 2012.

Oh well.
Enjoy your weekend!

[Dannywayoflife]

I'll third the xray thing! When I looked at mine with my arthroscopy surgeon he said it's not that bad and he was very confident that he would be able to fix me but said after the op that my joint was very warn. So they only tell part of the story!

[Tin Soldier]

With my X-rays, the spacing was so far gone that it was obvious to arthroscopic surgeons and HR surgeons that HR was probably the best treatment.  I guess I was lucky that the x-rays, pretty much, told the whole story.  I had severe pain in the left hip  (operated in Feb) yet the spacing was more and degeneration was more apparent on the x-ray of the right hip.  Each of the docs that looked at me were rather astonished that the pain was worse in the apparently less degenerated hip.  I think they were missing the fact that I likley had a torn labrum in the left hip.  Never had an MRI so we really never confirmed what that pain was from, but from what I've read, it was likely torn labrum.  My HR surgeon didn't say antyhing about it.

BTW - I never really finished my search for a surgeon that would do arthroscopic cleanup.  MY PT, who actually worked with Marc Phillipon in CO, said that, like most surgeons, they'll be choosy about who they work on.  He thought maybe someone would be willing to do arthroscopic surgery on me, but based on the fact that the surgeon in Portland (Wagner) gave me a pretty convincing argument that the hip would not be stable after arthro work, I figured I'd better stick with HR.

[ScubaDuck]

There didn't seem to be any question from my x-rays that the gap was pretty narrow.  There was amazement that I could function as well as I could and wasn't in more pain.

@Tin -  did I know that you saw Wagner in Portland also?  That is the ortho that told me to wait and come see him for a THR.

[Tin Soldier]

That's funny about Wagner.  I really liked the guy and I thought for sure he was the one that recommded HR.  Maybe it was my PT that recommended it, geez, maybe I just stumbled on this website without anyone telling me about HR.   How the hell did I get here?  I guess it's been a pretty long run for me on OA and I lose track of some of this stuff.

[GIBLET88]

I had two additional surgeons respond after reviewing my case, mri report and x rays via e mail. These two surgeons (McGinn and Marwin) suggested that I explore arthroscopy and consult with a highly experienced hip surgeon. I spoke to Dr Bryan Kelly's office and they suggested that he review my case to see if I should consult with him. Within 1 day I received a call stating that I am not a candidate for arthroscopy and referred me to a hip surgeon at HSS, Dr. Padgett. I understand that Dr Padgett is not an advocate of resurfacing. I am going to PT and being treated by an HSS physiatrist and all the resurfacing surgeons feel that I should try and hold off a bit before surgery.
Is there any purpose in seeing Dr Padgett? He will probably tell me that the next step is a short stem THR.
Thanks!

[David]

Are you seeing Dr. Moley?  He is good and is in the same office as Dr. Su.
David

[GIBLET88]

No I am not.
My physiatrist is going to give me some PT and an injection under flouroscopy since my lower back also hurts. I do not have the classic anterior groin pain since my pain appears deep within the hip, the piriformis and sacroiliac region. This injection is to rule out lower back involvement.
Might as well get a definitive diagnosis and do some PT until I see Dr Su in 2 months.

[gary2010]

Most of us have received similar terrible advice. These are the issues as I see them:

The reason for asking you to wait for resurfacing is that the blood supply in the severely arthritic joint becomes intra-osseous. This consideration does not apply to THR, but why would you want one of those?


"I am sceptical to do resurfacing in a joint which does not show these changes because the blood supply is outside bone which could be damaged during the resurfacing and the increased blood supply situation has not yet occurred. There could also be a phase in early arthritis where the blood supply could be less to trigger these changes which eventually becomes favourable for resurfacing.
The other reason is that of course when the joint space is still maintained one has to think whether other the pain is originating from somewhere else and not the hip per se." - Vijay Bose.

They ask you to wait before having a THR because they don't last very long.

If you have lost mobility and your quality of life is diminished you have a problem that demands a solution. Cortisone injections may provide relief but will accelerate degeneration to some extent, they are not without side effects, similarly NSAIDS (strong ones that work) reduce bone density and attack the digestive system. These options will compromise your health long-term, as will inactivity.

If you are really at an early stage of OA, arthroscopy to relieve the cam impingement and repair the labrum may give you a few more useful years; you could then get resurfaced. It didn’t work for me because I had no cartilage left; I was resurfaced the following year.

In short, you need more information; I would suggest sending your x rays in jpeg format to Bose or De Smet.

[GIBLET88]

Gary,
Thanks for the solid advice.
My x rays have been evaluated by Dr Su, Rogerson, McGinn and Marwin.
All thought that I would eventually be a BHR candidate. The latter two advised me to  explore the possibility of arthroscopy. Dr Bryan Kelly told me that I am not an arthroscopy candidate..
It appears that the options are running out and I will do my therapy and see Dr Su or Marwin in the fall. If the symptoms worsen, then I assume the x rays will show more advanced OA

[gary2010]

I should mention that not all practitioners believe in arthroscopy, in fact not all believe in F.A.I. It's a new treatment for a new diagnosis. The fact is, once your O.A. is categorised as 'moderate', you wear the joint out pretty quickly if you are active, and that takes the guesswork out of it. The main thing is to find a resurfacing surgeon with plenty of experience and one who is an enthusiastic advocate for the procedure. They really do want you to succeed!

Good luck G.

[Tin Soldier]

Gary - great stuff, I think I took the guesswork out by playing soccer and having no clue that I had FAI or early signs of it.  You'd think the fact that I had trouble clipping my toenails at least 5 years ago would sort of suggest something to me.  I think the increased pain and stiffnees I would get from playing soccer twice a week could possibly be drectly proportional to the amount of damage I was doing to my hips.  Pain for 1 week = 1 more mm of spacing.  I'm being extreme here, but I think there is some truth to it.

For me, FAI was an interesting topic that provided me a little hope that maybe I wouldn't need a full-on prosthesis.  It was fun while it lasted and then I came here.  The ironic thing is that the cranky old surgeon that told me I have bi-lateral OA at the very beginning, was right.  He justed neglected to give me more info on FAI, OA progression, HR, or even THR. 

[GIBLET88]

Yes, great info.
Does anyone know how to contact Dr. Smet? Perhaps he can review at my x rays and MRI report and give me an opinion.
He sounds like one of the most experienced surgeons in the world and has more flexibility of devices than most of the US surgeons due to FDA approval process. Thanks!

[Dannywayoflife]

If you google dr de Smet it will bring up his clinic, also why don't you google dr Bose in India I contacted them both and they were very helpful especially dr Bose.

[Lopsided]

http://www.hip-clinic.com/en/contact/info-request

[GIBLET88]

Thanks for the info. All the surgeons advised me to wait for HR due to early arthritis. I guess Gary's info regarding the vascular supply helps explain why it's premature to have an HR until there are greater arthritic changes.
Several of the top surgeons on this site advised exploring arthroscopy for the CAM FAI but Dr Bryan Kelley at HSS says I am not a candidate. Other than PT and physiatry visits, do I have any options or do I need to live with the discomfort and adjust my lifestyle until the arthritis progresses to the point where I am an HR candidate? The various NSAID pain meds don't help at all. Thanks again!