Hip Femoroacetabular Impingement and either Arthroscopy or Resurfacing?

[JohnnyD]

Hello,
I am new here...
I have been diagnosed with bilateral hip FAI.  The pain and symptoms have been around for over 4 years now.  Actually, I suffered an injury in a whitewater kayaking accident in Feb 05, where I tore my abdominal muscles in what is called a sports hernia.
The sports hernia is linked to hip fai in many cases.  Only the FAI wasn't diagnosed until last  June (2008)...
Anyhow- Dr Bryan Kelly, who works with Dr Su at HSS/NYC, is an arthroscopy specialist in the hip for FAI. 
My left hip is the more painful than the right.  The left side has a cam type impingement with pieces of the acetabulum rim busted off and floating around loosely.  The femoral head has a big old bump on it and the neck is squared off anteriorly and superiorly.  There is definitely a posterior labral tear and maybe an anteroir tear as well.  The angle of the neck is way off.   there is no lessening of joint space.
The right side, worse by film, is both cam and pincer impinged.  There is probably a labral tear.  There is a big bump on the femoral head, and the neck is squared off again, causing the angle to also be off.  There is no real loss in joint space but there is evidence of degenerative change (OA).

Those films were taken last September.

The thing is, I can do things like walk a lot without real pain.  I cannot crouch and I cannot sit "Indian style" with my left leg whatsoever.  I cannot run.  The last time I tried to ride a bike, I did so on flat ground for about a 1/2 mile and ended up with serious groin and hip pain for days.  I can swim without real pain afterwards.  I can probably hike some but I stay away from the  woods with all of the ticks we have in upstate NY (Lyme disease is very bad here).  Adduction is not happening with my hips.
A couple of years ago, pre-diagnosis, I tried doing things like pilates and yoga, and stretching which always seemed to bother the glutes, adductor attachments, and groin.  I have not done them since and those muscles are not as painful.
I have lost most muscle in my legs and hips.  Yes they are weak.
Trying to do hamstring curls, even with 7 pounds on each leg yields pain in the SIJ and low back.
Sitting is difficult on the left cheek.  I lean to the right.
When walking, the left side seems dysfunctional in the fact that the gait is off during the pushoff phase...it catches and feels off.

SO...I am only 38 years old, and was a competing athlete before all of this happened.  I want to get back into sports again, particularly whitewater kayaking, surfing, and riding my beach cruiser bike around.  I also want to garden and bend over to pull weeks without straining the muscles and tissues of the sacrum.  Bending seems to be the worst thing for me.
I am concerned that the arthritis in the hip that they CAN see is a bad sign.  Usually, the damage is worse than what they see just in films, then they go in and things are beat up quite a bit worse than expected.  The posterior labral tear showed up in film as 12 to 3 o'clock (I was told that is big), and that labral tear was found in 2006 in a hip MRI.
The recovery rate for FAI arthroscopy with a good surgeon is about 80%.  It is a long recovery, I hear 1 year.  It would hopefully buy me 5-10 years before needing a THR or resurfacing, providing all goes well.  But I hear the scary stories, and I wonder if it is smarter to just get resurfaced???

I have an appt with Dr SU in a month.  Yes, I am nervous about it all.  I only have insurance until the end of this year.  I am tired of not being active.

Did any of you get offered arthroscopy  and end up needing resurfacing??
Have any of you been told you have FAI and got the resurfacing due to arthritis?

I am not sure where to turn!

Sorry for the long post.  Thanks for any advice, and for listening.

Cheers
john

[Pat Walter]

Hi

You are young to have hip problems, but so are some of the other men on this group.  The best input you could get would be from Dr. Su and maybe a free consultation from doctors like Dr. Gross of SC and Dr. Mont of MD.  Both have done over 1500 resurfacings and will give free email consultations if you attach your x-rays to your email in a digital format as a jpg.

I am not a doctor or medically trained, but did not think the sucess rate of arthroscopy was that high.  I have heard of a number of people that had it and it did not last that long. Sometimes they post on this group or the Yahoo Surface Hippy Group.  That is why I say I didn't think the sucess rate is that high - no stats to back it up.

I think it best to ask the really expeirneced hip resurfacing surgeons what they think is best.  We are only patients and don't have the great deal of experience they have.

A large number of Dr. Gross's male patients have FAI.  He is very use to dealing with resurfacing for FAI.

After you get input from the experienced hip resurfacing surgeons, you will have better info to make a decision.  The nice part of resurfacing is that you can be active fairly quickly for most normal activities. 

I am sure others will give you some thoughts about arthroscopy.

Good Luck.

Pat

[DirkV]

Hi John,
Sounds like we might have similar background. After gradually losing function in my hips and living with minor symptoms, I was surprised when I finally went to a doc and got xrays and arthritis diagnosis. I guess I just thought that it was normal aging to limp and be sore after activity - sounds stupid now.
It turns out I had FAI and over many years of active lifestyle, did the damage to the soft tissue which eventually led to arthritis.
I went to a sports doc who specialized in FAI arthroscopy for my initial diagnosis, but he said I wasn't a good candidate for arthroscopic surgery because my arthritis had progressed too far.
There was a lot of research and weighing decisions after that, but about 1 yr after that, I had bilat hip resurfacing. I'm now 1 yr post op, and am absolutely delighted with the results. I had a similar goal of regaining a broader active life - before surgery I could still keep active at a few things, but I could only do those few, low-hip-impact things.
Good luck,
-Dirk

[JohnnyD]

thank you for the repies/info.
ugh...still concerned and confused.  i always hear of people who were in too much pain to walk as the ones needing resurfacing.
anyone else?

[socalhippy]

Hi

Your case sounds a lot like mine.  I had 2 arthoscopic surgeries last year.   The first one in Feb to fix a labral tear.   However I saw a news story about the impingement and my symptoms matched so I went back in.   June was a more extensive surgery and in addition to another tear there was a large bone ridge.  Two weeks ago I went back in to my sugeon because I couldn't stand the pain, grinding, any longer, and my husband thinks my condition is getting worse not better.   My Dr. said I need a resurface.   I am 37 (soon to be 38) and I have an appt next week to talk go see Dr. Schmalzried about resurfacing.    I want someone to do it that has extensive experience.   Last year I wasn't too keen on having it done but now I can't wait.   I will let you know how it goes.   I can't schedule it until July but I am counting the days.  Good luck.  I hope this helps a little bit.
Kelly (surfacehippy)

[kwarendorf]

Here's my 2 cents. In February of this year I had a left hip resurfacing. I was not in too much pain to walk, but walking had definately become a pain (in the a**). I had impingment and a labral tear. My Dr. mentioned arthroscopy as a possibility, but only if an MRI showed that there was still more than 50% thickness in my cartilage. There wasn't. Now my right hip has begun display the same symptoms. I met with my doc yesterday and we discussed arthroscopy. He said that they were being less aggressive with it rather than more as a treatment option. I asked if it was at best a stop gap, rather than a permanent solution. he said that was more than likely the case and they could not foretell how long the stop gap would last. Apparently once the intact cartilage is "breached" the integrity/makeup of the remaining cartilage is changed. Arthroscopic repairs leave the 'questionable' cartilage in place and there is not enough data to predict how long it will last.

I asked if it was unreasonable or unwise to skip over the arthroscopy and go right to resurfacing if repairs are needed. He said it was neither. That's the way I'm looking at it.

If the MTA tells you they need to raise the subway fare from $2.00 to $2.50 to get the trains running right, raising the fare to $2.25 doesn;t do much good 

[JohnnyD]

thanks again!
kwarendorf- what is a stop gap?
i am still confused-
i didn't have an mri.  my xray showed the totally obvious impingements and boney growths along with the pieces of the acetabular rims busted off in each hip.
i did have an mri done in march 06 that showed a big posterior labral tear on the worse/more painful and dysfunctional side.
i brought that mri to my doc in june 08, my first visit with him, when he took the xray that i just described.  so at that point he ordered a 3d reconstruction ct scan to see the exact shape of the bumps on the bone. 
when we went over the ct scan, he said the joints are really beat up.  both sides have labral tears, as he has never seen an fai syndrome without labral tears.  i asked "do i have arthritis?" and he said "yes."  yay.
anyhow, i imagine he thinks there is no reason for an mri since he sees the hips are already trashed enough?
i meet with dr edwin su in a month.  he works with dr kelly, who is the doctor that does the arthroscopy.
my thoughts are- if the chances of returning to sports are greater with resurfacing, then i would want to go for that.  especially since the arthroscopies are often just as diagnostic as they are for the actual operation.  i wonder what the percentage of arthroscopies is, that showed more damage once inside than shown on films?
i read about people who had arth surgeries and didn't recover, or, a year later, had some weird movement happen where their hip got injured again.
i don't want that to happen to me.
i want to do my sports again, for certain not to the fullest extent of my past but at least to do them again!
just this morning i had to crouch/bend down and my hip has been sore all day.

[kwarendorf]

A stop gap is a temporary solution. From what I've read the scope is a possibility for less damagaed rather than more damaged hips. You don;t paint a pretty pictue os your's  I have a personal fondess for the Doctors at Hospital for Special SUrgery and I'm sure Doctor Su will guide you in the right direction.