Anyone had/got a hip Femoroacetabular Impingement? (FAI)

fudgey

Evening all, had the results of my hip MRI today, and well, not good news really.

I had a left hip arthrogram MRI a couple of weeks ago, where they inject a dye into the joint then scan.
This all stems from a left knee issue that i have been having over the last 5 or 6 years, where my knee dislocates and locks up. Each time it happened the pain was worse and it locked up longer, with the last time being fathers day this year at mountain mayhem, a 24h endurance event... I was getting out of a tent for my last stint when crunch, my knee went again and locked up for an hour and half until the medical team finally managed to free it.

My god that hurt.

Anyway, after the second knee MRI the consultant finally listened to me and arranged a hip MRI after i said i think the knee is the symptom and the hip is the cause as i have had a lack of movement/pain for a good ten years now.
So the lack of movement in my hip is straining my knee, as it only dislocates when i get up off the floor, except one occasion last year when it went as i knelt down.

Anyway, it seems i have a CAM on the ball joint, a bone growth that limits the movement of my leg and causes pain, the ball is also elongated, not round and to top it off i have a labral tear.

He said that surgery involves cutting open the hip, dislocating the hip, sawing off the abnormal part then nailing back together. And yu end up with a big scar, up to 12" long.

But he said this has a limited success rate, and there are not that many surgeons that will undertake it.

He also said that i can expect arthritis in the next 10-15 years, i am 34 at the mo, that was great news...

Basically he doesnt want to operate, said in a few weeks time i can have a steroid injection to help with the pain and has referred me for physio. Said to avoid running (i do) but cycling and swimming are ok, except i pointed out i cant do breast stoke as i cant move my leg to kick...

Went out on the bike sunday and done just over 31 miles, after an hour my hip and knee were aching and i have hardly been out on the bike since my knee went in june, as a result i have put on over half a stone and feeling pretty fed up. Sleep is also another issue, i cant get comfy and can only sleep lying on my right side, which probably doesnt help my hip... I get between 4-7 hours sleep a night.

Sorry for the essay, but i would be interested to hear anyone stories of similar problems, what the operation was like and the recovery.

Its a long process to recover, there are two options they do for the operation, one is cut you open with circa 12 month recovery, and the other is using an arthroscope and key hole surgery, but that still has a 6-8 month recovery from what i can gather.

I dont know wether to push for an op, or if i am best off just putting up with it until i can no longer walk or the pain is far greater?

I was doing reasonably well on the bike last year, but this year has been quite a letdown.

kingrollo

[url=http://www.bikeradar.com/forums/viewtopic.php?p=19740881#p19740881]Fudgey[/url] wrote:

Evening all, had the results of my hip MRI today, and well, not good news really.

I had a left hip arthrogram MRI a couple of weeks ago, where they inject a dye into the joint then scan.
This all stems from a left knee issue that i have been having over the last 5 or 6 years, where my knee dislocates and locks up. Each time it happened the pain was worse and it locked up longer, with the last time being fathers day this year at mountain mayhem, a 24h endurance event... I was getting out of a tent for my last stint when crunch, my knee went again and locked up for an hour and half until the medical team finally managed to free it.

My god that hurt.

Anyway, after the second knee MRI the consultant finally listened to me and arranged a hip MRI after i said i think the knee is the symptom and the hip is the cause as i have had a lack of movement/pain for a good ten years now.
So the lack of movement in my hip is straining my knee, as it only dislocates when i get up off the floor, except one occasion last year when it went as i knelt down.

Anyway, it seems i have a CAM on the ball joint, a bone growth that limits the movement of my leg and causes pain, the ball is also elongated, not round and to top it off i have a labral tear.

He said that surgery involves cutting open the hip, dislocating the hip, sawing off the abnormal part then nailing back together. And yu end up with a big scar, up to 12" long.

But he said this has a limited success rate, and there are not that many surgeons that will undertake it.

He also said that i can expect arthritis in the next 10-15 years, i am 34 at the mo, that was great news...

Basically he doesnt want to operate, said in a few weeks time i can have a steroid injection to help with the pain and has referred me for physio. Said to avoid running (i do) but cycling and swimming are ok, except i pointed out i cant do breast stoke as i cant move my leg to kick...

Went out on the bike sunday and done just over 31 miles, after an hour my hip and knee were aching and i have hardly been out on the bike since my knee went in june, as a result i have put on over half a stone and feeling pretty fed up. Sleep is also another issue, i cant get comfy and can only sleep lying on my right side, which probably doesnt help my hip... I get between 4-7 hours sleep a night.

Sorry for the essay, but i would be interested to hear anyone stories of similar problems, what the operation was like and the recovery.

Its a long process to recover, there are two options they do for the operation, one is cut you open with circa 12 month recovery, and the other is using an arthroscope and key hole surgery, but that still has a 6-8 month recovery from what i can gather.

I dont know wether to push for an op, or if i am best off just putting up with it until i can no longer walk or the pain is far greater?

I was doing reasonably well on the bike last year, but this year has been quite a letdown.

I would avoid postpone the op if you can.

Can they not recommend a course of PT to help you manage the problem ? - if not try enrolling on a yoga class

I thought I had this - and I know a surgeon he said to avoid - with a hip there is no room to get in - so its more invasive - the rehab is massive. You could also introduce a fully working hip into a leg that has been adjusting to this for most of your adult life - you could then find you need secondary ops on your knee.

Is this degenerative ? - or the result of an injury ? - if its degenerative its harder to treat - if you fell and broke it its more easily fixed.

I d Google like hell and work on managing the condition - through exercise PT, knee supports etc

Good luck....

fudgey

Thanks fir the reply. I have booked a session with a injury and rehab specialist tomorrow, thinking any physio would be ages away on the nhs but had a call today, with an appointment for thursday.

Anyway i will still go tomorrow, even tho ill be paying.

I think its heredetary as my mother also has an elongated ball, but not sure about any bone abnormalities. The specialist also said i would have had it from childhood, but only really started to notice it around 10 years ago.

My knees these last few days have been playing up too.

Hopefully ill have a bit more to go on after tomorrow, so fingers crossed.

fudgey

Seen the injury specialist last night and he has given me some strengthening exercises to do for the hip abductors and some for my knee, and quads.
also got physio tomorrow.
so ill see how i get on. its not going to be a quick fix but i have a followup appointment in may, so at least i can go in and say i tried.

kingrollo

[url=http://www.bikeradar.com/forums/viewtopic.php?p=19744919#p19744919]Fudgey[/url] wrote:

Seen the injury specialist last night and he has given me some strengthening exercises to do for the hip abductors and some for my knee, and quads.
also got physio tomorrow.
so ill see how i get on. its not going to be a quick fix but i have a followup appointment in may, so at least i can go in and say i tried.

That won't be time wasted.

I tend to combine the set excercise with some gym work to relieve the boredom

welsh_14

Hi Fudgey, I have had the same issue as you in my right hip, I had bone growing on the joint which I have had removed. My left hip now has the same!

Interesting the surgery he is suggesting as there is a newer technique which was used on me. It involved 3 1" cuts in my hip and some sort of tools were inserted (i'm not medically trained so that's the best i can do describing them!!). The hip had to be pulled out but not dislocated. So I have 3 tiny scars and each one only needed 1 stitch. Where are you in the country? I was in and out of hospital in the day as well.

I spent 7 weeks off work with physio every week and roughly a year of physio/exercises etc before I was riding the sorts of distances I did before. Its really not easy! I was back on the bike in roughly 6 months on easier trails (MTB) and shorter road rides.

I still have problems and it will never be fully healed, but no where near as many problems as before. It supposedly slows down the degeneration rather than stop it completely. At 26 when I had the op that sounded good to me. My problems are caused by the damage the bone did to my ligament and cartilage. It takes a lot of work to keep my hip muscles strong and they seem to get weaker quicker if I stop the exercises, but I saw it as a small price to pay!

I can now sit for long car journey's without painkillers and playing 5 aside once a week. I tried twice a week but it caused pain. In my opinion once is better than the none before the op.

I saw my surgeon a few weeks ago after a flare up of pain and the CT Scan showed there had been no further issues with the area where the bone was taken from and that the pain was down to the cartilage damage.

If you want to know anything more let me know!

fudgey

Thanks for the reply. I am near swindon, wiltshire.

I started doing the exercises on weds that the injury specialist gave me and my god, i could hardly walk after and thursday i was in pain!
Went to the hospital yesterday to see the physio there, and it was a student, i must say he was very thorough and liaised with his supervisor and they both ended up in with me and said i was an interesting case! Ha

Anyway, they gave me a couple of additional exercises to do.
I was still aching like buggery today but just got on with it and done another session, and my leg surprisingly feel so much better! No aches at the mo, so will carry on tomorrow.

Re the surgery, im not sure if the consultant was trying to put me off giving me the worst case scenario, but after reading up about it there are two ways they do it, the second is like you say, using an arthroscope and keyhole.

itboffin

I've had the shoulder version of the same problem and went to new hall in Salisbury the consultant there had me in straight away taking off the bone spur, cleaned up the joint and did something (a stitch i think) on the labral tear, i do still sometimes get the odd slight dislocation if i'm sitting for a long time in the car or an airplane but other than that i'm pain free and fully mobile.

11-12 hours on the bike no problem at all.

My advice nay top tip would be if you need any surgery get it done whilst you're young because once you hit middle age recovery takes FOREVER no joke!

the last operation i had at Swindon general i'm pretty sure they struggled to bring me round, waking up to half a dozen very panicked looking hopital workers is far from ideal :?

fudgey

[url=http://www.bikeradar.com/forums/viewtopic.php?p=19748971#p19748971]itboffin[/url] wrote:

I've had the shoulder version of the same problem and went to new hall in Salisbury the consultant there had me in straight away taking off the bone spur, cleaned up the joint and did something (a stitch i think) on the labral tear, i do still sometimes get the odd slight dislocation if i'm sitting for a long time in the car or an airplane but other than that i'm pain free and fully mobile.

11-12 hours on the bike no problem at all.

My advice nay top tip would be if you need any surgery get it done whilst you're young because once you hit middle age recovery takes FOREVER no joke!

the last operation i had at Swindon general i'm pretty sure they struggled to bring me round, waking up to half a dozen very panicked looking hopital workers is far from ideal :?

I agree with it taking ages to get over anything, im suffering that at the moment.

I actually went to cheltenham for the mri's this time around. As when making the appointment they asked if i wanted closest or soonest, i of course said asap and that was tebur/cheltenham and cirencester. I work in south cerney so its not that much more effort really.

I wasnt even given a date for swindon, and last time i was there it just didnt feel like they were interested.

I have been doing the physio every other day, and hope to start doing it daily but i have been feeling like death these few days and was off work sick today (first time in 5 years!) supposed to have physio again tomorrow morning, hopefully i will make it but will probably go home again after.

I think the phsyio is making a difference to waking up stiff and in pain, but not sure what is related to how i am feeling at the mo or if its due to the exercises. Lower back pain etc but. My legs were agony after the first couple of times doing the exercises but that seems to eased now.

DavidfromWarboys

[url=http://www.bikeradar.com/forums/viewtopic.php?p=19746420#p19746420]welsh_14[/url] wrote:

Hi Fudgey, I have had the same issue as you in my right hip, I had bone growing on the joint which I have had removed. My left hip now has the same!

Interesting the surgery he is suggesting as there is a newer technique which was used on me. It involved 3 1" cuts in my hip and some sort of tools were inserted (i'm not medically trained so that's the best i can do describing them!!). The hip had to be pulled out but not dislocated. So I have 3 tiny scars and each one only needed 1 stitch. Where are you in the country? I was in and out of hospital in the day as well.

I spent 7 weeks off work with physio every week and roughly a year of physio/exercises etc before I was riding the sorts of distances I did before. Its really not easy! I was back on the bike in roughly 6 months on easier trails (MTB) and shorter road rides.

I still have problems and it will never be fully healed, but no where near as many problems as before. It supposedly slows down the degeneration rather than stop it completely. At 26 when I had the op that sounded good to me. My problems are caused by the damage the bone did to my ligament and cartilage. It takes a lot of work to keep my hip muscles strong and they seem to get weaker quicker if I stop the exercises, but I saw it as a small price to pay!

I can now sit for long car journey's without painkillers and playing 5 aside once a week. I tried twice a week but it caused pain. In my opinion once is better than the none before the op.

I saw my surgeon a few weeks ago after a flare up of pain and the CT Scan showed there had been no further issues with the area where the bone was taken from and that the pain was down to the cartilage damage.

If you want to know anything more let me know!

This, well mostly.

A couple years ago I went through about 6 to 9 months of aching right leg, lots of physio and then got lucky enough to be referred to an excellent consultant in Cambridge. I had the bone growth which had been causing damage to a ligament. He put me to sleep, used the keyhole method to grind down the bone and then removed some stem cells from my hip bone to mix with gelatin or something to spread on the injured ligament to aid repair.

I was off work for two weeks, about a week on two crutches and another week on one crutch. Was back on the bike in about 6-8 weeks.

I'd say by that time I was about 90% better, took another 6 months or so to get to 97 and now I can barely remember what the fuss was all about. I made a conscious decision to stop running at that time but this year I'm racing towards 6000 pain free miles.

Of course, I doubt any two cases are the same.

The guy now operates out of London as well, if you want details pm me.

Good luck, whatever you decide.

fudgey

Wow, thats the quickest recovery i have read about! That would be ideal, but
Iike you say everyone is different, and the only luck i usually get is bad luck! Ha.

Went back for physio again today, he basically checked over the exercises i am doing to see that i was doing them correctly and told me to carry on, gave me some variation to try and said he will keep an open appointment for a month in case i need to go back.

Other than that just carry on with what i am doing.

fudgey

Went back to the hospital today as i had another knee locking incident at the end of Jan.
basically the consultant went through the mobility exercises again and gave me his thoughts as to what was causing my knee to lock, said that it could be the ITB going into spasm and doing it, but he couldn't be sure.

Anyway, he spoke to the consultant that i seen the first time last august and said that he doesn't believe in the operation to shave the bone etc as it only has a 50% success rate, but i cant see any other option as the physio i was doing has made it worse. partly because one of the exercises means i have to bend my ankles a lot, but where i broke my right one 4 years ago it doesn't move much any more, and around Xmas time i could barely walk so stopped doing that particular exercise. I don't think the others are helping either, i just have a constant ache in my hip, and under my knee cap.
He said my hip is quite bad and that at some point i will need a hip replacement but they wont do that for a good number of years due to my age (35) as i will need more than one. The other thing he suggested was an injection into the joint but that will just mask any pain and not actually rectify any issues. The other option was basically to take pain killers, which again i don't want to be constantly taking.
So, what they have done is put me forward for a clinical trial in oxford, where i will either receive more physio or have an operation. So i am now waiting for the dates etc for that come through.

Fingers crossed something will be done, i really dont think physio is going to do much more.

fudgey

Got the appointment through today for the 4th of May at the Nuffield Orthopaedic Centre in Oxford. The Mr Glyn-Jones Hip Clinic.
A quick google shows that he should be pretty good!

Alex99

Fudgey wrote:

Went back to the hospital today as i had another knee locking incident at the end of Jan.
basically the consultant went through the mobility exercises again and gave me his thoughts as to what was causing my knee to lock, said that it could be the ITB going into spasm and doing it, but he couldn't be sure.

Anyway, he spoke to the consultant that i seen the first time last august and said that he doesn't believe in the operation to shave the bone etc as it only has a 50% success rate, but i cant see any other option as the physio i was doing has made it worse. partly because one of the exercises means i have to bend my ankles a lot, but where i broke my right one 4 years ago it doesn't move much any more, and around Xmas time i could barely walk so stopped doing that particular exercise. I don't think the others are helping either, i just have a constant ache in my hip, and under my knee cap.
He said my hip is quite bad and that at some point i will need a hip replacement but they wont do that for a good number of years due to my age (35) as i will need more than one. The other thing he suggested was an injection into the joint but that will just mask any pain and not actually rectify any issues. The other option was basically to take pain killers, which again i don't want to be constantly taking.
So, what they have done is put me forward for a clinical trial in oxford, where i will either receive more physio or have an operation. So i am now waiting for the dates etc for that come through.

Fingers crossed something will be done, i really dont think physio is going to do much more.

Just a thought... have you considered trying a recumbent bike? I think they often use a different range of motion at the hip and might at least give you some enjoyment and a way to maintain some fitness while you are working out the best course of therapy. I hope things work out for you

fudgey

I think the wife really would divorce me if i bought another bike hahaha.
I must admit, i am not a fan of the recumbent.
Nice idea however, hopefully ill have more of an idea of what can be done after this next appointment.

Alex99

Fudgey wrote:

I think the wife really would divorce me if i bought another bike hahaha.
I must admit, i am not a fan of the recumbent.
Nice idea however, hopefully ill have more of an idea of what can be done after this next appointment.

Wouldn't be my first choice either! But, it is pedalling, and outdoor.

kingrollo

Recumbent bikes are great for some injuries \ conditions. Unfortunately hips they are actually worse for. They are serious fun though.

Out of desperation I tried a brooks saddle - which has been fantastic - although in some ways they are hard, there is more give and it moulds to your shape over time. The B17 imperial I have is £66 amazon - as your in such dire straits Fudgey it might be worth a punt ......you can always sell it on....

fudgey

I currently have a Spesh Romin Evo 143mm wide, which is better than the Selle Italia SLR flow i was using but still after 30-40 miles i get uncomfortable.

Since January tho i have massively upped my cycling time, and other than one time of my knee locking up outside Sainsburys in Cheltenham due to me stretching my thighs, my hip and knee have been generally ok.

This weekend just gone we dusted off the MTB's and went to the Forest of Dean, of course on an MTB you move around much more than on the road bike so both hips and knees were a little achey after that, and yesterday i managed 40 miles on my carbon bike that still has the SLR flow on it, i was quite uncomfortable after 20 miles but i think that is mostly due to developing a sore right on the front part of my left sit bone, probably from the upped seat time.

I will look at the brooks as i have heard them mentioned a lot on here, but at the moment my knee and hip havnt been causing me 'too much' grief.

Yes they still hurt and ache a bit, but i have managed a few 50-70 mile rides so far this year and have another sportive on the 28th, but will only do the 100km route.

Cheers

kingrollo

Fudgey wrote:

I currently have a Spesh Romin Evo 143mm wide, which is better than the Selle Italia SLR flow i was using but still after 30-40 miles i get uncomfortable.

Since January tho i have massively upped my cycling time, and other than one time of my knee locking up outside Sainsburys in Cheltenham due to me stretching my thighs, my hip and knee have been generally ok.

This weekend just gone we dusted off the MTB's and went to the Forest of Dean, of course on an MTB you move around much more than on the road bike so both hips and knees were a little achey after that, and yesterday i managed 40 miles on my carbon bike that still has the SLR flow on it, i was quite uncomfortable after 20 miles but i think that is mostly due to developing a sore right on the front part of my left sit bone, probably from the upped seat time.

I will look at the brooks as i have heard them mentioned a lot on here, but at the moment my knee and hip havnt been causing me 'too much' grief.

Yes they still hurt and ache a bit, but i have managed a few 50-70 mile rides so far this year and have another sportive on the 28th, but will only do the 100km route.

Cheers

I had the Romin - I could never get comfy on it - probably because of my injuries. But clearly a quality piece of kit. The indentations made by my backside on the romin pointed me towards the brooks as a possible solution. I was quite clearly digging in on one side -even through padded shorts. The brooks sort of 'gives' - well its worked for me. doesn't look great on a kuota but at least Im out there !

fudgey

Small update, went to the Nuffield orthopaedic centre in Oxford today and i have been invited to join their FAI trial. Basically out of 214 50% will have the hip arthroscopy and the other 50% will receive physio. Who gets what is chosen at random so i dont know what ill be having yet.
If its physio, its a new type apparently, used on the southampton football team and has cut injuries by 40%. This will be 8 sessions over 5 months and if at the end of it its no better you can have the op.

Hopefully ill know more in a week or two.

bigglosfan

Was just browsing the forum and because of your proximity to me and my own leg/hip issues I thought I'd have to respond (newbie to the forum)! Not exactly the same problem but...

I had a motorcycle accident almost 4 years ago where I completely shattered my acetabulum by putting my femur through it! Then for good measure snapped the ball of my femur off. Had two operations (at the JR in Oxford) to insert 6 pins in the leg and three plates to rejoin my pelvis together. I had three months on crutches during which time I did all the physio I could and some hydrotherapy (at the Nuffield). This all helped massively.

I took up cycling about 18 months ago to get fit as jogging was out of the question! And this has been the biggest help to getting rid of the residual lower leg pain (I had some nerve damage too). I wasn't a cyclist before so couldn't say if the accident has had an affect on my abilities but I've gone from struggling on the 11km commute to averaging about 250km a week with no pain after rides. If anything, working hard up hills has built the muscle up to protect the joint and delaying an inevitable hip replacement.

Be interested to hear your progress!

fudgey

Ouch, that sounds nasty!
Bit late on the reply tho!

Well, today i went back to the Nuffield hospital, had a follow up MRI in January and the surgeon compared both today.
My hip looks to be pretty much exactly the same as the first MRI so the physio i undertook has not made things any worse, so,that is good. But as it did not help the next step is keyhole surgery.

Turns out i have the onset of arthritis in the hip so he will see how severe it is, clean up the rough bone on the balljoint and if possible repair the labral tear. Also where the tear is, a piece of bone has grown so that will be removed at the same time.

This is supposed to suppress any further onset of arthritis and prolong the time before i will inevitably need a hip replacement...

2 weeks ago i had a knee arthroscopy on the same side and was diagnosed with a significant tear to the lateral meniscus, so will be speaking to a consultant at some point to see if that is repairable.

I will be getting my monies worth out of the NHS this year thats for sure...