FAI Femoro Acetabular Impingement

[jezhkrider]

Hi,
I have just been diagnosed with FAI, which causes pain in the hip joint. It came on about 16 months ago, I thought it was tight muscles and ignored it. Having spent 3 months off the bike with a neck injury and the problem still be present and getting worse i guessed it was not muscle realted, its not. Basically the ball and socket are mis matched and cause rubbing of the cartilage, and ultimately arthiritis, none of this nice. Surgical intevention would appear to be the only sollution.

The Surgeon said that this is a common issue with cyclists, any of you guys had, or heard of this and any related treatments?

Thanks,
Jez

[robdamanii]

Consulted a sports doc yet? It only came on a year and a half ago, but the degenerative process is likely pretty advanced to begin to cause symptoms.

I'll probably be crucified for this, but consider a good chiropractor with experience in extremities and sports treatment. Perhaps a few adjustments of that hip will at least alleviate your pain and allow you to function without surgery. Nutritional supplementation might be worth considering as well. Worth a try anyway...at that point, I'd do pretty much anything to avoid going under the knife for a hip surgery.

[robdamanii]

Yet another double post. What's up with the server today?

[jezhkrider]

Hi Rob,

Yes i have seen two sports Orthopedic Surgeons, both of whom confirm the diagnosis. I have had great sucess in the pasy with Chiro and Physio but fail to understand how either will change the shape and form of the bones that are causing the Impingment.

i agree that surgery should be avoided at all costs, however it looks like the options are from what i can see are:
- become a slob and do no activity to cause the impingment.
- carry on with the help of drugs, phsio and pretent its not an issue because i can't feel it and deal with the arthiritis when it eventulally come
- have an op hope all goes well and be back on the bike in 4-12 weeks.

There only seems like one option available to me?

Jez

[pro-gravity]

Hey Jez,

I am quite familiar with Femoro Acetabular Impingement (FAI). About 2 years ago I was diagnosed and this past august I had open dislocation to correct the impingement. So far my recovery is going well. I could probably even return to riding, but want to take it easy before I get my other hip operated on (in May). Unforturnately, this bone deformity will not get better on its own. In order to delay (or hopefully prevent) hip resurfacing in the future, intervention must be taken as soon as possible. I highly recommend consulting a surgeon, who specializes in FAI. FAI can also be treated arthroscopically (less invasive and lower complication rate). A great messageboard for this topic is http://health.groups.yahoo.com/group...r_Impingement/

also a list of qualified surgeons
http://hipuniverse.homestead.com/files/PAOSurg.htm

best of luck,
-Patrick

[jezhkrider]

Patrick,

Many thanks for your post. You have confirmed my understanding, even though my Physio wants me to see what they can do, i just can't understand how moving muscles will re shape the bones?

I am seeing a hip specialist here at home but intend to use what he has to tell me to line an appointment up with "The man" in the UK who is a real specialist in this field. I have been advised by another surgeon to seek treatment outside of HK for this problem.

Can Cam, and Pincer forms be treated by Arthroscopy do you know? Obviously its a case by case scenario.

Thanks again, good luck with your recovery and future op.

Jeremy

[pro-gravity]

Jez,

I know CAM can be treated arthroscopically, not sure about Pincer.

-Patrick

[slowtrain]

Same thing has happened to me, plus what looks like a success story (so far). a year ago, out of no where, serious IT-band, hip flexor and quad pain during/after cycling, with increasingly sharper pinching in my groin. PT didn't help and the MRIs confirmed FAI (cam-type) and labral tears on both hips.

8 days ago I had the arthroscopic version of the femoral neck debridement (grinding down the bone) and the labral tear repaired at the UMichigan hospital. I can tell immediately that the impingement is relieved and i'm very optimistic., especially in that they found no damage to the cartilage of the hip proper... i'm having hip 2 done in 4 weeks, and the expectation is that i'll be back on the singletrack by July.

i'll feedback more as i recover.

good links i found:
http://www.hipfai.com/
http://uuhsc.utah.edu/ortho/patiente...tmt_faisdd.htm

[jezhkrider]

Hows the leg feeling Slowtrain?

I saw the specialist here in Hong Kong who has confirmed i have mixed form FAI, with both Cam and Pincer forms. I have been told they can trat the CAM and Pincer using Arthroscopy. They can pull the labrum back and debride the Acetabular and do the same on the Femoral head.

Strangely, and against Dr instructions i went in for a race at the weekend, and beat my target time . After no pain either. I have been doing some Pilates too this week which has really helped a lot. awaiting reply from the Surgeon i have selected in the UK to give me a date for the procedure.

Thanks,
Jez

[slowtrain]

I am 2+ weeks post-op, and am so glad i did the surgery. I am on crutches (4 weeks of 50% weight bearing so the bone they whittled heals), and my leg aches, but i can tell it's corrected. I saw the scope pics of the ravaged labrum and the repair, plus saw the money shot where with my leg pushed up to my chest: no femur hitting the labrum!

I have already scheduled hip #2 for late March. My advice is that if they can do it scoped, go for it. every day and pedal stroke you wait is more tearing of the labrum and eventually, destruction of the cartilage in the ball and socket.

[jezhkrider]

Slowtrain,

Hope the recovery contiues to go well.

I know have a date and conformation that all can be done by Arthroscopy.
I am having to wait a bit ( quite typical in the UK ) till the end of May. i could have been on the table 2 weeks ago here, but would prefer "the Man" in the UK to conduct the procedure. I guess if he is busy doing hips he's going to be good, and as the old saying goes, "the best things in life come to those who wait"

Hope all goes well for the next op in a few weeks, hope to hear that this one has produced the same positive results.

Cheers,
Jez

[snook36]

Slow train, can you please tell me the name of your surgeon? I've just been diagnosed with FAI and no one does the surgery here in florida. I will fly anywhere to get it done if the surgeon is good. I am hoping to have the arthroscopy. Did your doc say you can go back to unrestricted activity after the rehab? I like to bike but running is my passion and I hope that I will be able to continue after all this.

[jezhkrider]

Hi this is the link : http://health.groups.yahoo.com/group...ar_Impingement

there is a Dr in Colorado called Dr. Phillipon his name comes up again and again in this forum. Good luck

[slowtrain]

i am fortunate enough to be treated at the Uof Michigan, surgeon Karl Schultz. fantastic. i just had hip number 2 done last Friday and I am already at work (though the leg/hip is sore!).

50% weight-bearing day 1 (it's out-patient via the scope) for 4 weeks, 2 weeks on a cane and after the 6 weeks i can start crashing in the woods again. should be better than new! hip #1 was 6 weeks ago and i can tell it's aok!

good luck

[jezhkrider]

Good to hear of the success of your treatment. I have my treatment next week now its come forward. will report back.

wish you a speedy recovery and fun crashing in them woods when the time comes!

[snook36]

Slowtrain, thanks for the reply. That is most encouraging and I wish you the best of luck with the recovery. I am compiling a list of surgeons through out the country that have experience. Hopefully I can find one that takes my insurance (Blue cross PPO by the way). I live in florida, so this is going to be a pain in the ass, but I'm going to do what I have to do. Slowtrain, did you have a CAM impingement or was it combined with Pincher?

[jezhkrider]

Slowtrain Snook, how are you fairing? Just back from the UK where i had my op. Great surgeon, he did a Labral repair and removed a cam impingment from my right leg. I was up walking 45 mins after coming round, flew 12 hrs to HK 8 days after and feel so much better already. Due to the method of repair i am partial weight bearing for 4 weeks on crutches but have been told i can hit the static bike after 4 weeks, great news! what these people can do through the 'scope is amazing.

pls post how you are post op and in search of your surgeon.

Jez

[jezhkrider]

Snook, have you located your surgeon?

Slowtrain how are you?

I am now 8 weeks post op, walking with no problem but find bending over the bars on the static bike a problem, sticking with cross training.

[slowtrain]

life is good for me. I'm 10 weeks post-op on hip 2, 16 weeks on hip 1. feeling great and starting to ride harder. i know what you mean about getting down low on the road bike; still a bit uncomfortable, but i'm letting pain be my guide.

I am out of shape, and my pelvis/lower back/ legs all hurt, but i believe the skeletal issue is fixed and now it's just being old and fat and slow i'm battling! good lulck.

[fauxpas]

Very interesting thread on the FAI! I too have been diagnosed with FAI in my right hip. I'm 49 y/o and I've had the pain off and on for about 2 1/2 years.The pain is certainly exacerbated by long periods of mountain biking. Being an operating room nurse (yes, a male nurse!) specializing in orthopaedic procedures, I've replaced literally hundreds of knees, hips and shoulders, and needless to say, total joint replacements are SERIOUS surgeries. I've chosen to have an arthroscopic debridement and repair soon because, as mentioned earlier, delaying the repair can lead to advanced arthritis and ultimately, the need for a total hip replacement! The results of total hip replacements on patients under 55 years old has been less than encouraging. In fact, the need to have a REVISION of that hip within 10 years is around 30%, that's too high for me!
So, it sucks that we were born with funky hip joints, but I think if we recognize the problem (there are still a lot of orthopaedic docs out there that aren't aware of FAI!), alleviate the impingement, then we should be able to continue biking for many years to come, with our original "funky" hips!

[pro-gravity]

Great Post. I am glad you are getting the necessary surgery to hopefully prevent the need for a hip replacement (or resurfacing) in the future. I feel as though FAI is more common than most people realize. Unfortunately people don't receive a proper diagnosis until there is too much damage in the hip to salvage.

Currently I am about 1 year (left hip) and 1.5 years (right hip) post-op from open (full dislocation) FAI surgery. This past month I have finally got back into mountain biking after a 2 year hiatus. Everything is back to normal. Best of luck with your surgery.

-Patrick

[fauxpas]

Thanks, Pro-Gravity, for the vote of encouragement on my upcoming surgery. I believe I'll do well and hope to be riding as strong as ever before too long! Like you, I also have FAI in both hips, but for now, only the right side is symptomatic; time will tell.
It's encouraging to hear you are doing so well after your open debridements bilaterally, and it's good to hear your activity level is back to normal!
You're so right about people with FAI being diagnosed too late. My guess would be that a large portion of the hips being replaced today, could have been delayed, or possibly, prevented all together!
So, my advice to fellow athletes, who do activities requiring repetitive motion, and suffer from medial hip pain: if your doctor tells you your x-rays are normal, be sure he or she is educated on FAI and knows how to rule it out! If they're not "hip" to FAI (sorry, I couldn't pass on the pun!), get another opinion!

[pro-gravity]

I was only symptomatic in my left hip upon surgery. However, x-rays and a cat-scan indicated both of my hips were affected. Oddly enough my "good hip" had an even larger bump (impingement) than my "bad hip". I figured since I was eventually going to resume athletic activities it was best to resolve FAI in both hips before symptoms/damage arose in my "good hip". A MRI with contrast should give you a good indication if there is any labral damage in your non-symptomatic hip that should be addressed. Take care.

-Patrick

[fauxpas]

The MRI does show a tear in the symptomatic hip, haven't done the "good" hip yet. I'm going to have the symptomatic hip injected with a little steroid/marcaine mixture next week. I'm hoping that will provide me with some restful nights, at least for a little while! Ride it like you stole it!

[bidda]

New to this forum, but have read many posts on this subject. Have 52 yr old hips, 1 with FAI and want to know if there are riders out there >50 who've had surgery to reshape the femur to get rid of the impingement. I've read that most candidates are younger but I want to postpone replacement until that is the last option. I'm concerned about the limitations w/replacement vs reshaping surgery. Any info will help my decision making process.
Thanks, bidda.