Notching Impingement - what to do about it?

[joshb7_]

I am 3 years post op and still struggling with impingement, especially on flexion beyond 90 degrees. Bringing knee to chest, running, kicking, cutting toe nails etc still causes problems. I have issues with tight/weak quads/hamstrings and lower SIJ back pain as a result.

I am desperate to return to running and a sporty life, but with my hip and a degenerating left hip with constant low back pain, this is unachievable. Something needs to happen as no amount of rehab or stretching makes a significant difference to this. I have been struggling with pelvic compensation patterns for over 12 years now (still only 32 years old!).

My hip surgeon and another prominent hip surgeon both have reviewed my MRI, xray and CT scans and have suggested that they wouldnt do a BHR revision as they believe the components are positioned correctly and that the impingement is just an unfortunate side effect of the surgery that I will have to live with. This seems hard to accept, given this has left me in a relatively worse off situation than pre surgery.

A CT Spect scan has said that notching of my femoral neck is causing my problems. When I read about notching it states that this is usually do cup malposition. Has anyone had any experience of 'notching' or any BHR revised to another BHR to alleviate impingement? My surgeon is very reluctant to open me up again, but I wonder if he does then he may find something that he can fix. If there is nothing that he can do then at least I know we have tried.

Also, Ive read that notching can lead to femoral fracture if left untreated so surely it is in my best interests to potentially try another surgery to fix this? Can psoas impingement cause notching or anything else other than cup placement????

[jimbone]

Josh-

Sorry to hear you're having difficulties.  You mention your 2nd hip is also degenerating and having SIJ pain.  I wonder if the unoperated hip is contributing to your back pain.  I had a 30 year history of back problems- mostly a result of an accident that led to decaying discs and by the time of my surgeries [bilateral] the SIJ was problematic as well.  Since the two HR procedures the back issues are no more and my surgeon Dr. Pritchett told me in an early consultation, the back surgeon I was considering consulting to resolve those problems-especially the SIJ- would insist I get the hips fixed first.  As it turned out for me he was right and as mentioned, fixing the hips relieved the back issues.  No way to know if this would be true for you but it might be worth discussing with your surgeon and/or any other consulting surgeons you have spoken with.  I might also ask them if a 2nd HR would having any positive effect "balancing out" your hips to reduce the  notching/impingement.  Hope you find some relief from the current situation.  Best of luck.

[imgetinold]

Josh.....who was your original surgeon.  How many resurfacings had they done? 


If it wasn't Dr. Gross, Dr. Su, Dr. Pritchett, or Dr. Brooks in the US, you might consider getting a second opinion from one of them.  They're the best (I'm partial to Dr. Gross), and if it is, in fact, a poorly positioned cup, they'll see it.  I imagine they could re-position it and save your implant.

[Saddlepal3]

I agree with the last post - that you should seek opinions from some/all of the highly experienced resurfacing surgeons.

[joshb7_]

imgetinold - I'm in the UK and had it done by a very experienced surgeon with over 4000 BHR's. My surgeon does not wish to revise me and says there is nothing from any scans that he could potentially fix to improve my situation. This is what confuses me. Surely if my hip is notching on the femoral shaft then I would assume that the cup doesn't sit perfectly and hence a revision of the placement should fix this??? But my surgeon is very against this and warns me of further risk of impingement etc and 100% against a total HR. Keep getting told its a by product of BHR and that sometimes they cause impingement. Advised against surgery on my left, even though I would rather get it done before it starts to get really bad and then affect the rest of my body.

saddlepal - I have consulted many of the top surgeons who have viewed my xrays. Some say live with it, one says he could revise me with another resurfacing, others suggest psoas tenotomy. Again I'm baffled by the differing opinions and how one surgeon out of ten is adamant that the cup placement is too high and hence the problems I'm having. The two that have seen my in person both suggest just living with it. At 32 I would rather not have to just live with it and never have the opportunity to live impingement free and play sports/run etc.. if there is a potential solution to fixing both hips and my back.

Do you guys get range of motion in your resurfaced hips with flexion, abduction??