FAI (Impingement) with Arthritis - is Hip Resurfacing an option?

[sunshine]

Hi Everyone


I'd really appreciate some advice.


I've been suffering with hip/groin pain for over a year and a half and a recent MRI arthrogram revealed I have both cam and pincer impingements, a very thin and torn labrum and some arthritis (mild) in the head of the femur.  The arthritis was shown as a cyst about the size of a pea.  I've been told I will need a hip replacement at some point but unfortunately I am not a candidate for a arthroscopy as there is some arthritis present and the operation probably wouldn't make much difference.  The suggestion is that I wait until the joint deteriorates until a hip replacement is necessary and I have cortisone injections.  I am not thrilled about this at all, I am concerned about the long term use of cortisone and I don't like the thought of continuing the reduce the quality of my life during this time.  I have some level of pain everyday, some days worse than others.  I'm currently managing on paracetamol, ibuprofen and tramadol.   So far I have only seen NHS doctors, but I do have a private appointment with Mr Douglas Dunlop in August to discuss my options.  I know Mr Dunlop does hip resurfacing and I'm wondering whether I may be a candidate for this.


I am a keen skier and fairly active, the thought of having a hip replacement and not being able to ski worries me!  I know people do ski with THR but the risk of dislocation does concern me.


So, I am wondering if anyone can help me understand whether my condition may be treated with a hip resurface.  Thanks in advance.

[sunshine]

Oh and I should say I'm a 40 year old woman.

[Ljpviper]

Hello,

 Welcome to the board. Yeah if you have arthritis even mild I would not risk a scope, we have a couple of failures on the board, including mine. I would reach out to Dr.Gross, he did my right in April 2016, I am doing great.

My advice, why wait and be in pain every day, its silly, your loosing time you wont get back. Dr. Gross has done all types of HRs from mild arthritis to bone on bone, and Male and Female.

Good luck,

Larry

[John C]

Welcome to the forum. It looks like you have been doing some good research. Here are some of my thoughts on the points you made.


I had a scope done when I was in your situation. I had about a 40% improvement that lasted about 3 years before I moved on to a resurfacing.

As a full time professional ski instructor, I can say that hip resurfacing can work very well for skiers. I had my hip resurfaced 8 years ago, and ski hard on it in all conditions. I also have a few friends and students who ski hard on resurfaced hips, and all seem to be doing well. I know many people who ski with THRs, but I have also seen a few dislocations and fractures with those. It seems like most surgeons will give more cautious guidelines for skiing with a THR as compared to a resurfacing.


I have heard from more than one expert that cortisone injections will accelerate the deterioration of a hip joint, so  I think your concern there is well founded.


If you look at the results of any large studies involving multiple surgeons, you will see that success rates for 40 year old females are often not as good, but a lot depends on bone size and other issues. I think that the key for you is to find a surgeon who can show high personal success rates for your precise category. Dr Gross was mentioned as a good example of that, but I gather from your NHS comment that you are in England. We have heard a lot of good reports about Mr's McMinn and Treacy in England, so they might be worth contacting as well as the surgeon you mentioned. My advice would be to focus on their results with females in your size and age group, as opposed to just looking at their overall results.

[catfriend]

Obviously only a hip resurfacing surgeon can answer your question. Since you are in the UK I also recommend making an appointment with Dr. McMinn. The reason I recommend this is because you are female. The BHR device may not be available in your size. However, Dr. McMinn has developed an alternate "polymotion hip resurfacing device" for women. There were two entries on it on this forum earlier this year. Check out these links: http://surfacehippy.info/polymotion-hip-resurfacing-device-by-mr-mcminn-2015/  and http://surfacehippy.info/elaine-williams-first-polymotion-hip-resurfacing-patient-with-mr-mcminn-2015/    Even if you are technically a candidate and the doctor you see doesn't have access to a suitable device then you won't be left with much of a choice, so I say see the doctor with the correct device for an answer.

[karlos.bell]

  Sunshine. Hi. Yep been there and done all that. Had failures with scoping and my hips never recovered the issue of groin pain never went away. As the hip wears with pincer and or cam dominant the muscles and tendons give up on those areas due they cannot function as they would like to. I have had groin pain for the last nine years. I could not find a surgeon to help me in NZ as my hips had worn due to activity and pincer dominant wear. The pain is unbearable at times and the life sentence I went through was crap. Finally 8 years on and 7 of those on crutches Dr De Smet sorted the issue.
The operation was made even more difficult by the FAI surgeon due to taking away much needed bone he could have used be WELL AWARE OF THIS.
My groin pain is abating (tendon, quads, iliopsoas, adductors) are getting back to normal. I had poor bone blood circulation so I could not get an un-cemented femur component due to all the arthroscopy work and delays that never worked.
Dr De Smet Belgium does women small sizes and increments of 2 mm so you get almost the exact fit.
I can say I am not yet fully rehab ed due to the extent long time of weakness but it is coming back.
I  say skiing is not an issue as I am doing glut max squats at present to build up lost muscle this is helping the groin pain. I myself would love to ski again as I lost years years back due to floppy hips.
In hind site I lost years of my life mucking around when De Smet indicates of all things these may last the rest of your life. The success rate is excellent if installed correctly.
I wish I had the opportunity when this happened your doing the right thing ask around.
Your on heaps of drugs this itself indicates the problem.

Not that I can feel your pain you have my empathy on the situation. Your hips as well may never wear further than they are now at present so you could be like this for the rest of your life. That is what happened at my point of FAI it never got any worse. On Paper it looked good but it was the issue.
Ok that's my experience of the whole FAI - Hip thing in a nut shell.
A congenital issue you seeming cannot fix especially if your pincer dominant.

Cheers Karl

[RebeccaT]

This was pretty much my story, starting at 38 or so. I did the cortisone injections a few times. They helped progressively less each time, but they were helpful in the beginning. My doc would only do every 3 months and I stretched it out to 5 or 6 most times. At 41 I finally decided I had to do something else and had resurfacing with Dr Gross. I am about 7 months out and it is fabulous ... pretty much no pain (unless i pull my knee all the way up to my chin...) and totally normal range of motion as far as I can tell. I would do it again in a heartbeat.

[sunshine]

Hi everyone

Thanks for all of your comments, it was really helpful.

I have now seen the hip specialist. Unfortunately my hip is in a mess but I'm not a candidate for hip resurfacing as my bone size is too small.

I'm having an arthroscopy in September for the consultant to take a better look and possibly tidy up the damaged labrum. There is also a hole inside the socket which he wants to look at. After the scope I am probably being referred to a consultant in London for a possible periacetabular osteotomy (where they cut your socket out of your pelvis and reposition it at a better angle to stop the rubbing. This will give me some more time before I will need a full hip replacement.

Does anyone have any experience of a periacetabular osteotomy? Any stories welcomed!  Thank you.

[catfriend]

I repeat my suggestion that you get a second opinion from Dr. McMinn as he is resurfacing women with his new device. Good luck.

[karlos.bell]

  Sounds all rather experimental??? Sunshine. I wonder how successful this type of thing is if it fails you have no socket worse off.....  Some stuff to think about. You need to send your Xrays to some one like Dr De Smet  (you indicated "the hip specialist") and get there full opinion on it for free. May be you have done this may be not. Small sizes lots of surgeons do these world wide so may be you need to be more patient on your decision. A scope Labrum refix yep that may help but from my experience the damage now has been done it does not matter how much the Labrum refix will do once wear is set in that's it... The Labrum stabilizes and deepens the socket so you may get more popping.  Good luck . Cheers K

[badbone]

I repeat my suggestion that you get a second opinion from Dr. McMinn as he is resurfacing women with his new device. Good luck.

Please see Dr. McMinn.
You will have fewer limitations with a resurfaced hip as well as longevity.
Exhaust your options in order to make a well informed decision.

[Pat Walter]

Welcome to Hip Talk

Sunshine - love your username!

My suggestion would be to definitely email several of the top surgeons to find out more about what your options are.  Dr. De Smet is a free consultation. He is in Belgium.  Mr. McMinn is another option.  Mr. Treacy in the UK is another option.  Please make sure you have several opinions from the top resurfacing surgeons before making decisions on what you want. 

You also don't want to wait too long before you get your hip resurfacing, if possible.  You hip can deteriorate beyond the point of allowing a hip resurfacing. You can't tell that from your pain level.  A surgeon needs to look at your x-rays.  Dr. De Smet often uses the Wright C+ for women.  He also has access to other devices.  So please take time to email the surgeons from additional information about your options.

http://surfacehippy.info/hip-resurfacing-surgeons/

Good Luck.

Pat

[Slinkycarrot]

Hi there,


I am in a similar boat to you - I'm a female aged 37 and I have mildly dysplastic hips and have had 5 failed scopes to fix labrum, cam and pincer work etc with no success.  Still in pain after 3 years of failed operations I found myself in the same position as you - with mild arthritis, not a classic case for the resurfacing.


Anyway I have decided to go ahead with the resurfacing, along the lines as wanting to get on with my life and not have to deal with other issues arising from defunct hips.

From personal experience with scopes, I wouldnt go again - I think the more you have and mess around in the capsule the less likely of success.  I also looked into PAO surgery but decided against it and was advised against it by a PAO specialist - it is brutal and if you have any degeneration already present then you are only buying yourself a limited amount of time (rather than 15 or so years when you are younger). 


I would definitely speak to the McCinn centre - I actually just phoned them when I saw on this message board they had done a plastic (polymotion) resurfacing.  They told me that they now have the Icon metal-metal device available in small sizes for women so it is possible.  Their preference is to use this device rather than the plastic one - apparently that is only for special circumstances such as metal allergies.


I would also speak to Dr De Smet - I am booked in for bilateral resurfacing with him using the conserve device and he has had good success with women.


Anyway, agreeing with the above posters - speak to the recommended resurfacing specialists for their advice as the advice you received does not sound correct.  Good luck!