FAI Hip Impingement (Femoro-acetabular Impingement)

FAI Hip Impingement Awareness facts - It is estimated that approximately 15% of the young, adult population have hip impingement, so who do you know that might have it?
Hip impingement causes painful labral tears within the hip socket.
Hip FAI symptoms are misleading to the average medical professional, as FAI hip impingement pain frequently presents as low back pain and interesting only 10% of back pain is ever clinically diagnosed and cured... Which begs the question what percentage is actually caused by hip FAI or hip impingement, as its otherwise known.
The more active you are, the more likely you are to trigger hip impingement symptoms, so busy mums and gym bunnies beware... but at least you're in good company as many premiere league football players have also suffered FAI hip pain.
Hip impingement is diagnosed through x-ray and labral tears are diagnosed through MRI arthograms - but both need to be read by hip consultants specifically trained in FAI hip impingement.
There are 60,000 hip replacements every year in the UK and it now appears that FAI hip impingement, over the years, could be the leading cause of hip osteoarthritis. A silent epidemic.
Hip arthroscopy can reduce the hip impingement and reattach the torn labrum to the hip socket. This surgery can eliminate the pain and disability caused by FAI hip impingement and divert the need for hip replacement in later life.


Also please feel welcome to join in our help and advice forum for support. We have 3 advising FAI expert hip surgeons, 3 PT/physios and a sports medicine doctor as well as the largest international FAI hip impingement forum on the net:

Wednesday, 11 June 2014

Hip Arthroscopy rehab - A psychological perspective, by guest writer Mandy Graham.

Hip Arthroscopy Rehab – The Psychological Perspective
Mandy Graham
BSc (Hons) OT; Msc OS
Hip Arthroscopy Patient 2014

My Story by Mandy Graham:
I’ve had ongoing back problems since age 18, but it didn’t cause any major problems – I still managed to run a half marathon aged 20! Occasional flare ups would generally get better with physio. 

The problems with my hip started in my late twenties – I would notice after certain activities e.g. gardening or decorating / DIY, that I would experience pain in my left buttock – but on waking the next morning it had gone. 

In 2010 aged 31, I had my first child. The pregnancy and 4st weight gain definitely exacerbated my hip problem but once she was born, it eased and although unfit, I was able to walk with the pram most days for 45mins to an hour and lost most of my baby weight. 
In 2012 I had my second daughter and gained 5st in weight! This time I was less active after the birth and I have still not lost all the baby weight! However my hip pain at this point was still only intermittent following activities that involved lots of bending.

I’m an Occupational Therapist and have specialised in mental health for the past 14 years. My jobs have gradually become more sedentary, as I moved into management roles. 

The real flare up for my hip came when I changed jobs in Sept 2013 and had a 50 mile round trip to work every day and then a 10 min walk from the car park. Looking after my 1yr old and a 3yr old also meant lots of bending and sudden movements. 

So, I went to see my GP, armed with a letter from my Physio and suspecting hip impingement.  The pain was getting difficult to cope with at this point and I was referred to Mr Conroy. 
After an x-ray and MRI arthrogram, I was diagnosed with FAI with labral tear in Dec 2013 – at this point I was on Ibruprofen every four hours during the day and 30mg codeine on a night for pain – plus tablets to prevent irritation of my stomach. 

The impact on my daily functioning and quality of life was quite severe at this point and definitely impacted on my mood. 
The most upsetting part was struggling to look after my young children and not being able to take them to the park, or to soft play centres by myself. Getting through the day at work after not sleeping well was also a major struggle.

I had surgery on 26th Feb 2014. Immediately after surgery came the massive relief that my hip pain had gone – I came off all pain meds 4 days post op and just used ice! 
The first 4-5wks I felt great – no or very little pain, doing all my exercises (very motivated!), resting, eating well (probably too well!), took it easy and didn’t feel guilty for being off work! What did surprise me was how tired I felt and I had to have lots of afternoon naps. However I felt content just being at home (we moved house the day after my operation!), enjoyed day time TV and the peace and quiet as my daughters were in nursery all day. 

6-10wks post-op was emotionally hard. I felt I should be better by now. I felt frustrated, less motivated to do my exercises and my mood dipped. I also still felt really tired and had put on nearly a stone in weight – which made me feel rubbish! 

At 10-12wks I started to look back at how far I had come and the realisation that this was no quick fix! So at 12wks post op, guided by my knowledge of being an OT, I wrote some hints and tips to maintain positive mental wellbeing during the rehab process. I hope you find them useful.


Hints and Tips for Patients
Disclaimer – the following hints and tips are intended solely as a generic guide from a patient perspective. You must follow the specific advice and rehab information given to you by your designated health care professionals.

Pre-surgery
Think about how you are going to spend your time post surgery. It Sounds simple but it’s really important. Our roles, routines and daily responsibilities all shape our personal identity, and these things change post surgery – not just for a few weeks but it may be months before you can return to activities and hobbies that make you who you are. Patients need to think about how this will make them feel. 

For me even though I was in pain for months before my operation I was still managing (all be it a daily struggle!) to work full time in a demanding job, be a mum, have a social life, and have a very busy routine. Suddenly all that changed. 
As OT’s we call this occupational disruption. At first it can be a novelty – time to watch movies, read books – great I hear you say! But after about 6wks it becomes more of a frustration and there’s an urge to do more but the body is not responding as it needs time to heal – and this can lead some people to feel low in mood. 
This is even more of a challenge to sports men and women who are used to being physically active.
Be open with your employer about how long you may be off work. Of course this depends on your job role, your entitlement to sick pay and exactly what surgery you’ve had done. 

Working in the NHS my colleagues all thought they knew about hips and thought I’d be back in 6wks max. 
When I hit the 6wk mark and still felt so drained and tired I was so relieved for my doctor to explain that often people need 12wks or more off work. 
It didn’t stop the feelings of guilt about being off though so it’s important to view this as your time for your rehab. 

My surgeon says a successful outcome is 50% surgery and 50% physio and rehab afterwards – so you must commit to this and make others aware of the importance of this time on your recovery.

Ensure you have adequate child care sorted out – You will need help to look after young children due to all the bending involved. 
Older children may be able to help you with tasks around the home but you will need quiet time too to rest and sleep. 

There may also be financial implications if you are paying extra nursery / child care fees. 

From an emotional perspective it can be very hard when you can’t pick your child up when they have fallen, or carry them when you are on crutches, or go to them when they wake in the night. 
Although it is hard try not to feel guilty about this – think about the longer term and hopefully that if you focus on rehab now you’ll be able to run around after them in the future!

Practice relaxation methods in the weeks BEFORE surgery – I’ll suggest some simple self help techniques in a moment, but it’s important that you are comfortable and familiar with these, so you can implement them easily post op. Relaxation also helps with pain management pre-op. 

Realistic goal setting - Think about what’s really important to you – what are your post op goals going to be? Discuss these with your surgeon and physio – they will help you understand if they are realistic or not! 

For me all I wanted was to be pain free – I could not mentally see past that point, which is why I think when I was pain free so soon after surgery (lucky me!) – and then off my crutches – it was like ok, so now what? What is realistic? – I simply didn’t know.


Post-Op
Focus on the here and now – I would often feel frustrated about how little I had accomplished during the day. My husband and daughters would leave the house at 6:30am and return at 6pm. My husband would ask (in a caring way) – “so what have you done today?” – Erm... I did one load of washing, put the dishwasher on, made a few phone calls / sent emails and had a nap! 11 hours would go by in a flash. 

I didn’t feel lonely being on my own, as it never felt that long, but having previously had a very busy work and home routine it did real strange just “being” rather than doing. 
However “being” and focusing on the here and now is very important especially as it can be difficult to plan for the future – such as days out, holidays – how far will I be able to walk in three months time? 
There are a lot of unknowns. 

For an athlete this can be even harder, thinking about when they will be able to return to training or competing. 
It may be useful to read up on “Mindfulness” which involves paying attention to the present moment, and can help people change the way they think, feel and act.

Adapting daily activities – Being independent in personal self care can be quite easily achieved post op with assistive equipment such as raised toilet seats, shower stools, bath boards and seats, grab rails, sock aids, long handled shoe horns and long handled grabbers – anything to make life a bit easier is good! 

Adapting leisure and work activities however is more complex as they are so individualised. An important coping strategy for me was re-establishing my priorities, expectations and aspects of my identity. 
For example, in my role as a mother I couldn’t get down on the floor and change my toddler’s nappy, but I could still breastfeed her which meant the world to me. 

We had just moved house and although I couldn’t help move any boxes, I did all the phoning round, changing our address, organising workmen etc. It was about re-adjusting the daily activities (or occupations as OT’s call them) to create purpose and meaning to my day.

Maintaining positive mental wellbeing – There are various self help strategies that patients can use to maintain positive thinking, improve mood and combat stress during difficult points in their rehabilitation. 

Guided imagery or visualisation CD’s; 
Laura Mitchell method & 
progressive muscular method (adapted around hip area); 
Autogenic relaxation; 
colour relaxation; 
diaphragmatic breathing; 
meditation; 
positive affirmations and self talk; 
comedy and laughter; 
reducing caffeine intake; 
eating a well balanced diet; 
following sleep hygiene principles; 
complementary therapies such as acupuncture, 
reiki, 
reflexology, 
hypnosis – can all be very helpful. 

Patients should however seek prompt help from their GP if they are worried they are becoming clinically depressed.

Social support – is crucial for practical and emotional support. Consider your social environment – do you live alone? Are family aware of the rehab period post op and potential support needed? 

Many patients use online forums and blogs for support. Personally I found these on the whole very helpful as I was able to ask questions and seek reassurance in between medical and physio appointments. 
However there is a down side – hearing about cases that haven’t been so successful, or over comparing yourself to others. 
For example I saw a post from a man who had completed a triathlon at 12wks post op! Of course he didn’t say exactly what surgery he had done and I suspect he was athletic and fit before his surgery, but it didn’t stop me comparing that I could only just manage to walk around the supermarket! 
Just remember that recovery time is very individual and no two surgeries, or pre-op circumstances are exactly the same. 

Measuring progress – Range of movement, muscle strength tests, and various standardised questionnaires about pain, daily functioning and quality of life are commonly used as clinical outcome measures. 
However for me it was more meaningful to think back about how I was a few weeks previously and what I had achieved in my daily life – which was of course unique to me. 
However remember to do this with the motto that this rehab is commonly “two steps forward and one step back” and that it may take a whole year to fully recover!

Conclusion

There needs to be a holistic approach to hip arthroscopy rehabilitation. Rest and physiotherapy exercises are important, but patients also need to look after their mental health if they are to achieve the best outcome. 

We know there is a strong link between physical and mental wellbeing. As recommended in the white paper Closing the Gap: Priorities for Change in Mental Health (2014), best practice approaches for physical conditions should include potential psychological care needs. However there needs to be more research done in this area.

By Mandy Graham, BSc (Hons) OT; Msc OSHip Arthroscopy Patient 2014

Sunday, 16 February 2014

FAI Hip Awareness forum, help and advice site - new surgeon and PT/physio joining.

Just to update... Our help and support FAI Hip impingement forum on facebook has a new surgeon, Bart Eastwood from the USA. He joins a small team of FAI hip surgeons, Giles Stafford and Simon Garrett, both UK FAI Hip surgeons, who generously share their time and knowledge to help FAI patients online.

Also a new PT, Stephanie Di Stasi from the US and Physio Amir Taklar from Australia, joining Louise Davies - Grant from the UK, to help FAI hip impingement patients, on the same FAI Awareness site. Louise, Stephanie and Amir are all recognised by ISHA (International Society for Hip Arthroscopy).

If you need advice, help, support or just a hippy natter, then please come join us on facebook.  The group is securely closed, so only fellow FAI Hip Awareness members can see your posts onsite.

Hip Impingement (FAI) Awareness: https://www.facebook.com/groups/FAIhip/

Tuesday, 22 October 2013

FAI hip support forum with onsite surgeons.

This Hip Impingement Awareness site has a related forum for you to seek reassurance and advice.  We are in the unique and privileged position to have 3 FAI Hip Surgeons actually on the site, who generously share their expertise. We also have the best FAI expert Physiotherapist on site, along with an FAI specialist Pilates expert.  This facility is all in one place, to help members who need guidance and reassurance, when dealing with all aspects of FAI hip impingement... and just to keep you company, there will be coming up for a 1000 members on the forum shortly.

If you have FAI hip impingement, please feel welcome to come to the fastest growing FAI forum on the net. Whether you need support, whilst undergoing hip arthroscopy surgery, or need reassurance during the rehabilitation phase after hip arthroscopy, then come to us.  Perhaps you are just suspecting your pain symptoms maybe FAI and you need to compare symptoms, or you have experienced an FAI surgery failure... whatever stage you are at, this FAI Awareness advice centre forum will no doubt be able to help you.

Join us here: https://www.facebook.com/groups/FAIhip/

Thursday, 15 August 2013

Best FAI hip surgeons - US, UK, Worldwide Map

Map of the best fai hip surgeons worldwide.

The best hip consultants map locates and gives details of the very best hip impingement surgeons around the world. These FAI surgeons are listed because they are world renown, established and proven top FAI hip impingement surgeons... or because their names have repeatedly come up in a very positive light, with frequent good outcomes, on the FAI hip pain Awareness forum  https://www.facebook.com/groups/FAIhip/  
Best hip impingement surgeons listed with a blue pointer.

Also listed are a number of FAI physiotherapists, who are also specialists in FAI rehabilitation. Currently there are not many PTs trained to even recognise FAI, but the ones we have so far are listed, with pink pointers, have vast experience with FAI hip impingement muscular issues and rehabilitation.

Also included are a number of hospitals/clinics, who support 3T dGEMRIC scanners. These scanners are the most advanced that the medical profession have to offer.  They can be a key tool in hip arthroscopy patients, as one of the major factors to cause a hip arthroscopy to fail is inadequate cartilage. 
X-rays and standard MRIs are proficient in showing up cartilage QUANTITY. 
However the 3T dGEMRIC MRI, is the first scanner able to map cartilage QUALITY. Anyone questioning the integrity of their cartilage, may want to ask for one of these scans, before undergoing FAI surgery. Example of dGEMRIC image of a joint with good space, however where the image is yellow & red is where the cartilage, whilst good on x-ray, is of poor quality and can be a poor contraindication for a successful hip arthroscopy.

Click on this worldwide map of the best FAI hip surgeons, please click the icons to travel around the map to find the area, or surgeons you are interested in... if you also want an actual live review of a specific surgeon, then come the the Best FAI Hip Surgeons forum, link above. 

Thursday, 16 May 2013

How to prepare for Hip Arthroscopy for FAI

Top 10 tips for preparing for FAI hip surgery.

1.Your surgeon:

Are you sure you have the best possible 'FAI expert'?  You do not want a general 'hip expert' to 'have a go at a hip arthroscopy', you need an FAI expert.  Ideally your surgeon should be doing upwards of 200 scopes per year and have been doing them for several years.  

Its never too late to delay, until either you are sure he is the right FAI surgeon for the job, or you reassess and find the right FAI surgeon for the job. Please see the post for best/top FAI surgeons in your area and also hip arthroscopy success rates.  At the very least, please ask the "how many scopes do you do per yr/ have you done ever?" question.  FAI hip impingement surgery is very, very new and very technically demanding.  

Also diagnosis is best done by an FAI expert and ideally one with a strong background in hips, so they are able to know when your case is suited for a hip arthroscopy or not.  
This is your hip and your pain and your choice of consultant may well dictate whether your surgery succeeds or not.  Picking an FAI hip impingement surgeon is much like a marriage, "pick your FAI surgeon in haste, repent at your leisure!"

2. Your surgery:

Are you having the correct surgery?  This sounds a silly question, BUT in the hands of a lesser well practised hip impingement surgeon, they can miss issues such as hip dysplasia, or version issues such as acetabular retroversion and femoral retroversion.  
These issues can co-exist with FAI, but just having a hip arthroscopy/scope, for FAI will NOT reduce your symptoms and will you will inevitably lead on to needing further surgeries such as a PAO (peri acetabular osteotomy) or reverse PAO or SDD (open surgical dislocation and debridement).

Please ask if you could have any of the above issues, it is amazing how many people discover the hip surgeon was aware they had dysplasia prior to scope, but never thought to mention it, especially in light of the poor outcomes associated with this diagnosis.  SO ASK.  

Again, PLEASE make sure you're FAI surgeon is one of the very best and that you know that from recommendations, moreso than his opinion of himself, or his secretary's opinion. 
To find reviews on FAI surgeons please visit here:  


3. Medication before/during and after hip arthroscopy:

medications for after surgery:
If you're NHS you will be given crutches and painkillers etc, when you leave hospital. If you're a private patient you will be charged heavily for these.  This can total £150 and your private medical care, most likely, won't pay for this aspect (check first with yours, as they do vary).  

I would recommend buying the crutches prior and even practising with them, because that will give you some sense of how to manage in those coming weeks. See link on how to use crutches, esp on the stairs (most hip patients nemesis!)  

Also prior to hip arthroscopy, ask your OS/Consultant what meds he will be prescribing you, as you will be able to obtain these from your GP, for much less money.  

You will be prescribed anti inflammatories.  However if you are known to have a stomach problem with taking any of these, please mention this, as many people suffer stomach issues taking such anti inflammatories, esp when taking them medium to long term. Please ask for another type, some are kinder on the stomach. Naproxin and celebrex seem to be coming out with less stomach issues. Also ask for a stomach protecting medicine to take, as you will be taking these for a good many weeks and possibly months.
  
They will also likely prescribe either, or both co-codamol or/and tramadol; beware these can cause constipation and it is worth asking now, for something to take to help with that issue, like lactilose. 
It is better to do these irritating things prior to surgery, as everything takes a lot of effort in the first weeks post op and can do without these inevitable distractions.

It is also becoming increasingly routine to have to have daily stomach injections of heparin post op.  It will save you around £80, to get these from your GP, rather than when leaving hospital, if you're a private patient. 

You will also need large waterproof plasters, so you can shower daily. Some surgeons advise not to shower until healed, I am afraid I can not DO not showering and certainly not for a week, so that is the alternative option.

Drugs during surgery:
Another factor to consider is what drugs would you prefer to be getting during your surgery? Often people assume the only a general anaesthetic is available to them.  However a spinal anaesthetic is also a very good option. Most people who have a spinal with sedation, say they wouldn't go back to a general anaesthetic, having experienced the spinal.  It doesn't sound like a nice option, but it's positives outweigh any negatives.

General anaesthetic V Spinal anaesthetic with sedation:

With a general anaesthetic you're out cold, 
BUT you have a strong hangover and frequently sickness, which all can last several days 
Also with a general anaesthetic there is then the issue of how to manage immediate post op pain, you're more likely to wake in pain. 

With a spinal anaesthetic, you're still knocked out for the duration (sedated/unaware) unless you WANT to be awake.  
However when you wake, post op, your pain is at zero, due to spinal anaesthetic and also there is no sickness hangover, or moods etc. 

Medications prior to surgery:
Remember also, in the weeks prior to surgery, to ask about taking potential blood thinners or other high risk medications, in the run up to surgery. Some consultants want you to stop taking things like the oral contraceptive pill, or supplements that thin the blood like garlic, vitamin E etc.  Let them know what you're taking, so they can recommend what you need to stop taking, in the month prior to surgery.

4. Physiotherapy and exercise.  

Please do the leg work (literally!) and find yourself a really good FAI experienced physiotherapist prior to surgery.  This is another job that people leave until post surgery to do, but then feel too drained to deal with finding one and lose out by on the help and advice offered by a physio, in those important early weeks. 

You really want to be starting out on light physio from day one. I would recommend Louise Grant at Hip Physiocure in Leeds, possibly the most expert in post op care for FAI and PAO patients in the UK.  They also holds twice weekly hydro water rehab sessions, which are fantastic for rehab and also meeting other young people going through hip arthroscopy. See this link: http://www.physiocure.org.uk/hip_physiotherapy.php
If you're not able to visit this hip rehab centre, please find the nearest available to you, your surgeon should be abe to direct you to the best FAI physiotherapist in your area.

You will also need a stationary bike, set on no resistance to rehab on. Set the seat so that your hip is least impinged when cycling.   If it causes you to suffer hip pain, do less or try cycling backwards.  
Whilst I am a great believer in rehab, if it causes your hip to flare up, simply do less repetitions, or time. Rest seems to be underestimated in this recovery and having had 3 scopes now, I think that it is essential.  

I note that men rest easily, then do an hours rehab and feel ok, BUT often women still continue to do some form of housework and childcare and then struggle with that hours rehab!  Ladies especially, don't overdo it!

Also consider starting your exercises prior to surgery, PREHAB, it readys your body for the increase in exercise and helps strengthen the associated musculature.

If you can't get to an experienced FAI physiotherapist, then there are 3 sites I recommend.  I would only caution that to be aware that we don't always do exercises correctly when unsupervised.
Rehab: 



5.Commitments immediately after hip arthroscopy:


When can I look after young children after hip arthroscopy for FAI?

If you have young children, you're not going to be able to take care of them for as long as you're on crutches. If they're babies and toddlers you can't lift. If they're older you still will be unable to do things like serve dinner.  You WILL NEED help. Try not to feel guilty about not being able to take care of them, remember in the long run, you will be able to do much more with them, once you have recovered.

When can I return to work after a hip arthroscopy for FAI? 

If you have very light work, the minimum before returning to work will be 2 weeks. During those 2 weeks you will be taking strong drugs, feel  washed out from surgery and anaesthetic and you will be getting to grips with a demanding rehab programme. I would say take as long as they will allow you, at least a month.  If you're job is physically demanding, standing, lifting, walking, then it could be 3 months or so and you may need to go back limited hours in the beginning.  Expect to feel under pressure to return, but never the less, please try take as much as you need and are allowed.



6. Activities after hip arthroscopy for FAI:


When Can I drive after hip arthroscopy for FAI?

As soon as you are not taking drugs such as Tramadol (which effect your perception) and when you're hip is strong enough to enable you to do an emergency stop. I have driven as soon as 4 days post op when I had my left hip arthroscopy, I have an automatic car and I also wasn't taking Tramadol that surgery. I have also waited 5 wks to drive with my first hip surgery, on my right hip. It was a more involved and painful surgery and I struggled to regain strength. So it truly does vary.

When can I sit after hip arthroscopy for FAI?

You can begin to sit immediately after surgery, but it may help to sit on raised chairs, sofa's and beds for your own comfort. You can do this by simply placing a cushion beneath where you would ordinarily sit. Try keep your hip from being impinged, so when sitting keep your hips higher than your knees. Gradually the sitting pain should go.


When can I have sex after hip arthroscopy?

I would say though its awkward to ask your surgeon, its worth the momentary blush, as it could be dependant on what work you had done when he was doing the surgery. Some say wait until after the 6 wk check up, some may say with caution, when you feel you're able, but keeping in mind you've had hip surgery!  It may also depend on whether you're male or female.  


7. What aids can I get to make my life easier immediately after a hip scope?

*Crutches, without them you're going nowhere!

*A raised loo seat is a god send, they're fairly inexpensive. 

*A shower stool, makes showering much more do-able.

*A pick up stick, to make picking things off the floor a easier.

*Sucker handles, to put by the loo or shower for support.

*Non slip shower mat.

*Two icepacks, one in the freezer, one on you.

*CMP (constant passive motion machine) for US patients.

*Game ready Ice machine for US patients.  

(For UK patients apparently cycling and ice packs will do, rather than CPM and game ready!)


8. What equipment should I get for hip arthroscopy recovery?

*Exercise bike, upright.

*Foam roller.

*Therabands.

*Miracle balls, or tennis balls for stubborn, tight muscles.

*Hot water bottle for those same muscles!

*Swiss ball, wobble board, or for the uber fit a bosu ball! Only really recommend these, if you use them routinely prior to your op, otherwise swiss ball only.

*Rucksack or cross body bag as if you intend to go out using crutches, you will need a way of carrying things.  This can also be handy for carrying things from room to room also.


9. What to do before surgery:

*Run all errands that need and will need doing in the month after surgery.

*Stock up and start online grocery shopping, it will make your life A LOT easier. 

*Clean your house and arrange for someone else to do that for you for the first month after surgery. Same for laundry as much as you can.

*Also for the sake of your sanity, get yourself that book that you've been meaning to read, or that DVD series you were going to catch up on, etc.  The recovery for hip arthroscopy is without question a long game and keeping your sanity throughout this much depends on mindset.  If you can say to yourself 'these next two months are "MY TIME" to recover, regain strength and I may as well make the most of it!' That really will help you get through those weeks.

*Also join a support group, it really does help to find friends going through the same op, at the same time https://www.facebook.com/groups/FAIhip/ 
   


10. What do I need for the day of surgery?

*If your very nervous, let the staff know immediately, sometimes they can shuffle priority, so you're seen sooner in the day.

*Jog pants or loose relaxed clothing for leaving. Don't do what I did and take your skinny jeans, just to find you leg is so swollen you can't actually get them on!

*Mobile/cell and charger.

*ipad & magazines - more for distracting you whilst you wait for surgery,  as after you're on drugs and it goes by in a haze.

* Wet wipes, great for sticky hands, a quick wash down, makeup removal, you name it, invaluable!

* Pen and pad, your memory is shot and you might want to write down Q's for the consultant, or make lists for your partner/mum/friend to do for you. 


So good luck if you're facing hip arthroscopy right now, there really is life after FAI! ... Keep Calm and hop on!