Experience with surgery to correct FAI?

[Miguelito]

Hello!

I had HR on my right hip last year, and now left hip is problematic. Arthritis/joint space narrowing is only moderate, not severe, but my PT thinks the Cam lesion is very large, and there is clearly some labral fraying (as any 43 year old with FAI would have, I guess) but not some major tear. Pain isn't a big problem yet, more a nagging ache (though I have greatly restricted my activities already, quit golfing, biking).

While I am still figuring out exactly what is going on with the hip, and how best to address, I think I'm in kind of a gray area with this hip. The hip isn't really ready to be replaced yet. I think what would be ideal is if I could get five years or so out of arthroscopy (I think) to debride the FAI and clean up the labrum. But I think at my age (over 40) many surgeons don't want to fix the FAI/clean up the labrum because there is already too much damage done. One surgeon (who nicely looked at an Arthrogram I sent him) said (through an assistant) that he didn't think I was a candidate because there was already arthritis in the joint, less good outcome.

I'm sure my age counted against me with that surgeon, who hadn't met me. I have a followup visit with one other (local) surgeon, who saw me once and sent me for a steroid shot and PT. He might (my PT who read his notes tells me) think I am a better candidate for the lesser surgery than the other surgeon (who nicely rejected me).

My question then is: Have any of you had surgery to correct FAI/labrum? If yes, can you share some of your experience/advice, especially as you have probably also had an HR subsequently (which I assuredly will [again] as well)?

Thank you!

Mike

P.S. I am jumping the gun a little with this post, as I don't really know what my options are yet. I'm frustrated that this is happening so soon after my other hip went. I literally had just weeks between when the resurfaced hip started truly feeling strong and when this one started to cause me problems.

[David]

Mike,
I had the FAI scope, 3 labral tear repairs and microfracture procedures done (at 47yo) 11/08 on my right hip that I eventually had BHR'd in 08/11.  Suppose I saw some relief for about a 1 year period until the OA crept on fast.  Looking back I guess I would have done the same again.  I was not mentally prepared for the hip replacement in 2008 as my pain was somewhat bearable.  I was ready when I was ready.
Hope you figure it out for the best outcome.
D.

[Miguelito]

David,

Thank you for the (quick) reply!

Follow-up question (hypothetical, I hope). Say your other hip goes, and you are faced with the same choices. Would you again bother with the scope/fai/labral/microfracture surgery (my that's a lot  ) or would you eschew that and just go with the hip replacement (maybe after waiting a little bit longer)? Knowing what you know now, of course.

Thanks again,

Mike

[Dannywayoflife]

I had a scope for cam and pincer fai it gave me very mild repeat for maybe 6 months. If I had the choice again I'd of just had it resurfaced

[Miguelito]

Dannywayoflife (Danny?),

Thanks for reply! How bad was the arthritis in the joint when they did the scope (mild, moderate, severe)? Should have asked David that as well. How long after the scope before you had the resurf?

Thanks again,

Mike

P.S. Just noticed that you had your 2,000 post on the same thread that I had my 100th. Apropos of nothing.

[John C]

When I was around 50 I had my hip scoped. This was before they talked much about FAI, so I had debridement of a torn labrum that was beyond repair, a partial synovectomy, and a smoothing out of some areas of damaged cartilage. It was very sore after any serious activity for about three months, and then I would say I maybe had about a 20% improvement for a couple of years. I knew going in that I had mild to moderate arthritis in the hip, and so I was not an ideal candidate for the arthroscopic procedure, but figured that it was worth a try with minimal risks. Since I have not pursued this option with my other hip which is slowly going bad, I guess that this answers the question of whether I would do it again. I had the first hip resurfaced about 7 years after the scope.
Among friends who have had arthroscopic surgery on their hips, I would say that about 1/3 were happy with the result.

[Dannywayoflife]

Hi mate my X-rays were misleading. They showed only mild arthritis but on seeing inside the joint the surgeon said it was in a terrible state. Bone on bone. I had to wait just over a year to get resurfaced but that was thanks to the NHS rather than having to wait for it to get worse.

Danny

[hernanu]

P.S. Just noticed that you had your 2,000 post on the same thread that I had my 100th. Apropos of nothing.

I think Nostradamus wrote about this... Numerology RULES !!!

[David]

Mike,
I think I would defer a big percentage of that decision to my surgeon, but if I were in the position where I wanted to get back into performing my athletic endeavours to the best of my ability asap, my quick answer would be I'd go straight for the BHR if I were eligible.  In some ways the FAI surgery rehab was not easier than the BHR, the relief was not as quick and the improvement curve much slower and plateaued sooner.
D.

[HippyDogwood]

Mike

I am 46 and have fai both hips. The lesion is larger on the right side but the pain is far worse on the left.

I am a golfer and my take is that the fai is like slamming a door into a door stop. In the golf swing the front hip (left for me) takes huge impact and the back hip far less. Despite the smaller lesion I have managed to fracture the left hip socket and various other tears and cysts through golf but am holding out for hopefully another 12 months before BHR

I enquired about debridement on the right as whilst there is grade 2 to 3 OA it gives me virtually no problems. I saw a surgeon who specialises in keeping hips going and was rejected as his view was it would only give me a little extra time and it was causing very little impact on my day to day life. The left was way beyond repair.

In contrast Brandt Snedeker had an FAI debridement shortly before playing his best ever golf, so age does seem to be a big factor as well as OA grade - catch it early and it could be a good option

All the best
David

[Tin Soldier]

We've seen this topic a few times here and this particular thread will help out my brother who is in a similar situation with moderate OA in the hips and obvious FAI.  He's considering the scoping, but questions the longevity of the "cleaned up" hip.  I suspect he will be in the same place as me within a few years and maybe the scoping will buy him some time.   Based on these posts and from what I've seen before, it is very questionable about what you gain from scoping vs jumping straight into HR.   

Miguelto - having already been through one HR, I think if I were in your shoes, I might just jump right into the next one.  That's exactly what I did, but I knew before even thinking about surgery that both hips were pretty much the same deteriorated condition.  Maybe you could have Phillipon or other really experienced arthroscopy surgeon give you some advice.  This certainly seems like a good case for a few opinions, if you can get them.  Good luck.

[karlos.bell]

Hi Miguelto. Having had FAI pincer dominant op in 2013 after 6 years (injury and related stuff in 2007) personally it is now worse. Looking at getting Bilateral done with Dr De Smet as there is only 1 really experienced surgeon in NZ who will do HR. He won't do it for me as I am not the normal case. So its dam hard if the body will not give up on you and they are crook through FAI. Good luck if you can convince the surgeon. Had FAI massive when I was 41. FAI is also very hard to pick up on. Good luck I would like to know how your getting on. Cheers.

[dfox]

Hi Mike. My situation was different but I still had to decide how long to wait to have a BHR. My hip was not a candidate for anything other than replacement.

With a total hip replacement the recommendation was wait as long as possible since the joint lasts about 15 years and may wear out within my life time.

From what I've read the Birmingham Hip life expectancy is not yet known. It's a metal on metal joint so it shouldn't wear out.  Based on this I decided to have the BHR as soon as possible so I could maintain my good health with an active life style.  I'm not quite 3 months post op but so far I'm very pleased and would do again.

Dave

 

[HippyDogwood]

I am glad this topic has been bumped as 12 months on stem cell treatment is getting very positive commentary here in the UK

Plenty of posts in this thread highlighting limited success of arthroscopy for FAI where oa is present but stem cell treatment offers the prospect of a repair which may last for far longer than merely tidying up a damaged area. Well worth some research before deciding on a course of action

[Miguelito]

Karlos,

Wow, a lot has happened since I last posted on this thread. Last December I had another appointment with the local surgeon (who I really like) and he took the FAI surgery option off the table. He said it was too far gone. He was clearly correct. SEAThis was the first time he saw the Arthrogram I had done in the spring of 2013.

As I had already had to quit golfing among other things because of the left hip, I pulled the trigger (perhaps a little quickly) and had the left hip done by Dr. Gross (he had done the right in 2012, which I was very happy with) in March.

Everything has gone great, knock on wood. I would say there are already days I ALMOST forget about the surgery (though I am still limited in the typical ways; stairs, running, etc.). I have gotten very lazy with my rehab and do nothing rehab specific, the opposite of what I had planned to do.

Thanks for asking after me. I wish you the best of luck with your decision! It was really almost a relief to me when the FAI doc took surgery off the table. They really don't want to do it on people north of forty. He would have taken a chance on me (until he saw the arthrogram, I think) because he thought my physical condition (aside from the FAI/labrum) was very good, but even when we were discussing the FAI surgery he was very clear that at best it would be a holding action for x number of years (determined by heredity, activity, etc.)

The day after my appointment I scheduled surgery with Dr. Gross. I picked early spring, so that the snow would be mostly gone and so I could golf in the summer, which I have, mostly pathetically, but I blame the operator for that and not the hip.

Mike

[karlos.bell]

Thanks Mike.
"I get it" your back to normal having a few beers with the blokes instead of trying to get the hip better, or just smelling the roses and enjoying life. Not sure if that is right but maybe?
Ok yep have done the stem cell thing and "nope did not work". Got a NZ bloke to do the fat stem cell thing was worth the try. Not so regulated here in NZ.
I thought it did work but the real trying thing is to be normal and do normal things and the hips still played up big time. Same old Same old.
Recently not sure if my previous posts but I took anti-anflams for 3 or 4 days felt so good I went for a normal walk at some great hills near my place. (8 KM)
Thing was I spent the next 4 days in bed in massive pain recovering and took about 1 month to get back to my straps and walk properly (my properly is crap) so no this is the test when you do normal things like that and suffer so much it is "abnormal".
Like biking still gives me heaps of issues and if their is anything more low impact than that would maybe be the couch!!
All in all be great to know that FAI would work but only in the early stages it would I  guess, but through my experience of being so long with it, I would have to have a negative view on it now.
I have sent some questions to my FAI surgeon but I have had a "nil reply" as I think he has not got the answers or the case examples of success.
Nor have I been able to find these on any other web site or world wide.
They have found the reason for FAI and the damage it does but only a real experienced surgeon can diagnose this.

Cheers Karl