femoral acetabular impingement - hip stuff replacement

[karlos.bell]

I was wanting to know and I am not a real message person but has anyone you know of in the surface web site has "femoral acetabular impingement" then had to have resurfacing as the femoral acetabular impingement surgery did not work.
 
I keep getting the door shut on me with regards to Ortho surgeons due to having too much or full thickness cartilage on the weight bearing part in my hip sockets.
Both hips have different issues but I had rather deep hips sockets being an active person the hip impinged caused femoral acetabular impingement.
This has damaged the socket and femur on the rim areas and some on the femur., some grades left and right.
I have to strap and wear a brace for my right and have to with the left after a while.
I limp on my right nearly all of the time lots of other stuff too many too mention. Knees give out on me due to the hips.

Really I have now had a guts full of my hips after 7 years of this but I have since found out that persons that undergo surgery for replacement with full thickness cartilage can have a complete failure.
Does anyone know about or heard of this or what they may have found to combat the issue?
 
 
In NZ and I suppose around the world they will not do a replacement if found medically to have a good reason not to.
I have the reason in the end but medically it looks ok so go away they say.
I like the BHR and is an excellent idea if installed correctly.
I have to see my ortho surgeon on my femoral acetabular impingement (FAI) in June but I would really like to see DR Blackley in the end but I do not want the door shut on me again.
 
I notified a DR Bose same thing too much cartilage, also lots of other surgeons
I have not had much success in getting help and it looks as if my operation money I paid out for recently was 5 years or so behind its time. My hips are not getting any better and I believe they never will no matter how much money I through at them now it is too late.

Any help would be an advantage as I am at a complete disadvantage when asking for help when medically it looks ok.
Thanks Karl.os

[ahausheer]

For what it's worth-

In my early 30's I presented with knee pain (for past 15 years).  Finally saw a doc and he said it was my hips, the pain was referred and was actually from my hips. X-rays showed well preserved cartilage spacing (in hips) but I had bilateral FAI. 

MRI also showed bilateral FAI and labral tears. 

Had open surgery to correct FAI and labral tears on both hips. Surgeon was no good, surgeries did not help, pain returned and I still had an FAI and labral issues in both hips. 

Had arthroscopic surgery on both hips - pain still persisted, and it had me nearly housebound. 

Something was not showing up on x ray or MRI and I would not take no for an answer.

Got turned down by a surgeon for resurfacing due to ''too much cartilage remaining'' thus not a good candidate.  Was told there are ''good reasons for this''. 

For many months, could not walk more than a minute or two due to pain that would last all day and it was coming from inside the hip socket/groin and medial thigh to the knee.  Needed low grade opiate pain meds most days.  I was ready to cut my stupid leg off.

Finally found a doc willing to do a BHR despite my ''well preserved cartilage spacing''.  Thank god he believed me and not my ''imaging''!!!!

Now, 3 months out from surgery and my hip doesn't hurt!  Still recovering, the muscles and tendons are at maybe 50-60 percent, and it was not easy for me personally, but absolutely 100% glad I kept being proactive and found a surgeon willing to trust the patient!

You should definitely try open and/or arthroscopic surgery for FAI/labral issues first. But if that fails then keep pursuing a resurfacing.   Try other options first though as there is no going back after a resurfacing.  It works wonders but it is essentially a procedure of last resort.

[John C]

Glad to hear that you are doing so well. It creates such an amazing change in our lives when we find the right surgeon, the right surgery, and an end to a life in pain.
I wanted to offer my non-medically-trained thoughts on the other surgeon's comment about "too much cartilage remaining" being a reason to delay surgery. For others who might hear this, I thought it might be useful to know at least one of the "good reasons for this". One of the reasons has to do with the nature of the blood flow to the femoral head. As arthritis and joint degeneration progresses, the routes of the blood flow to the femoral head usually changes. This change in blood flow route as joint degeneration progresses can positively affect the health of the femoral head after resurfacing surgery, and therefore the bone ingrowth into the prosthesis. In some cases, having good cartilage can be an indicator that the blood flow route has not yet changed.
I am sure that your eventual surgeon took this into account in deciding that you were a good candidate, so this information would not be relevant in your case. However, knowing this may be good for others to understand in terms of how it might affect their specific case. In some cases, having good cartilage coverage may be a valid reason to delay surgery.

[ahausheer]

Glad to hear that you are doing so well. It creates such an amazing change in our lives when we find the right surgeon, the right surgery, and an end to a life in pain.
I wanted to offer my non-medically-trained thoughts on the other surgeon's comment about "too much cartilage remaining" being a reason to delay surgery. For others who might hear this, I thought it might be useful to know at least one of the "good reasons for this". One of the reasons has to do with the nature of the blood flow to the femoral head. As arthritis and joint degeneration progresses, the routes of the blood flow to the femoral head usually changes. This change in blood flow route as joint degeneration progresses can positively affect the health of the femoral head after resurfacing surgery, and therefore the bone ingrowth into the prosthesis. In some cases, having good cartilage can be an indicator that the blood flow route has not yet changed.
I am sure that your eventual surgeon took this into account in deciding that you were a good candidate, so this information would not be relevant in your case. However, knowing this may be good for others to understand in terms of how it might affect their specific case. In some cases, having good cartilage coverage may be a valid reason to delay surgery.

John C-

Good info! Thank you.  Do you think this applies to cemented femoral components (BHR)?

I would love to learn more, do you have any sources or any recommendation where I could get some info regarding cartilage spacing and surgical outcomes? 

Also perhaps I should clarify.  At 36, just doing the most basic of house chores put me in pain that lasted all day.  Grocery shopping was guaranteed to lay me up the rest of the day due to pain. I would literally brush my teeth on my knees and always sat down in the shower due to pain.  My surgeon may have allowed some additional risk to surgical outcome as I was losing my ability to walk.

[John C]

Hi ahausheer. There is info out there regarding the change in blood flow to the femoral head as arthritis progresses, but I am not sure if how this affects the health of the femoral head after resurfacing is theoretical, or whether there are published studies to back this up. I know that Dr Gross has quoted this as a concern on a few occasions, but again I do not know if his concerns were theoretical, or based on published results. Before I had my surgeries, I read pretty much every paper published on resurfacing, but now that both hips have been done, I no longer have this stuff at my finger tips. I continue to have a Google alert in place, so any new papers published still come across my computer.. Sorry that I no longer keep this stuff handy, but I am sure that if you do some thorough searching, you will come across some info on the subject.
It sounds like you got your surgery just in time. Congrats on making the decision and moving forward.

[Pat Walter]

I know I had more information from Dr. Gross about Femoral Acetabular Impingement, but just can't find it. I did his interviews a number of years ago.  Some of it might have been in his video interviews.  I think I remember that many of his young male patients had FAI. He does a lot of hip resurfacings for FAI, maybe more than other surgeons. So if anyone is having problems of too much cartilage, they might want to send their x-rays to Dr. Gross and get another opinion.
In this article on his website

http://www.grossortho.com/types-of-arthritis

He said:  "Most patients who have severe hip arthritis at an early age have some underlying deformity of the hip; the most common in young men is cam FAI (cam type femoral acetabular impingement), while dysplasia is the most common deformity in young women. However, genetic factors that determine the quality of cartilage and level of activity may also play a role. In my experience 80% of men under 55 have cam FAI and 30% of women under 55 have dysplasia."

He has a list of all his publications here:  http://www.grossortho.com/patient-education/scientific-publications
Pat

[karlos.bell]

  Hi all that post was a fair while ago, I forget what I had posted.
But after hip resurfacing cured the issue due to the type of hips I had. I am doing amazingly well now and very normal.
I cannot turn the clock back but only look forward. Onwards and upwards!
My muscles and degeneration from years of FAI are still improving and the left knee pain took 4 years to go!
I had full cartilage in both of my hips and no offer to help me walk.
The only degeneration was due to FAI not my overall health. Slight wear!
There is a massive amount of steps I have not included to get to where I am but if anyone wishes to PM me no problem.
Concluding after my resurfacing De Smet informs me the wear rate is perfect at this point. I will be tested next year will be my 5 year anniversary. If it comes out perfect hopefully I will never need an upgrade. Time will tell.
I have done some amazing things I thought I would never do in life so it was life changing for me.
I hope others have the success I have had through surgery and good consultation of the issue.
I am less on this site now due to time constraints and getting back to normal. Hobbies, work, etc.
I see this post has a veiw hits over the years.
Amazingly now he has (De Smet) a ceramic on ceramic resufacing device that too is amazing!
Pat you do a great job, and all others (John)
Cheers K

[karlos.bell]

  Hi all that post was a fair while ago, I forget what I had posted.
But after hip resurfacing cured the issue due to the type of hips I had. I am doing amazingly well now and very normal.
I cannot turn the clock back but only look forward. Onwards and upwards!
My muscles and degeneration from years of FAI are still improving and the left knee pain took 4 years to go!
I had full cartilage in both of my hips and no offer to help me walk.
The only degeneration was due to FAI not my overall health. Slight wear! Gaps!
There is a massive amount of steps I have not included to get to where I am but if anyone wishes to PM me no problem.
Concluding after my resurfacing De Smet informs me the wear rate is perfect at this point. I will be tested next year will be my 5 year anniversary. If it comes out perfect hopefully I will never need an upgrade. Time will tell.
I have done some amazing things I thought I would never do in life so it was life changing for me.
I hope others have the success I have had through surgery and good consultation of the issue.
I am less on this site now due to time constraints and getting back to normal. Hobbies, work, etc.
I see this post has a veiw hits over the years.
Amazingly now he has (De Smet) a ceramic on ceramic resufacing device that too is amazing!
Pat you do a great job, and all others (John)
Cheers K