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:

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!






3 comments:

  1. Great advice! But I have to say that I was able to go back to my office job, which requires an hour or two on my feet a day after about 10 days. I was only on pain killers for 3-5 days. I didn't need any special toilet seats or shower stools since I was actually quite mobile after surgery. Recovering from this surgery hasn't been as terrible as I had expected!

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  2. I'd resonate with a lot of your advice, I'm on week 4 of recovery from my secon hip arthroscopy, and still resting at home, although working from home half days this week. Sitting is the hardest, but admittedly I was diagnosed with OA this time, and had bursa remova, adhesion clear up and ITB band extension (full MOT you might say). I was weight bearing on day 3 this time round, and a lot fitter before the surgery than last time. I have noticed a vast difference in my recovery this time from the first time. A lot happier, positive and kicking butt with rehab exercises (whilst not overdoing it of course). It's all a mindset if you can get into a good one and having amazing hubby support is always the best part. Thank you for your words of wisdom on the pregnancy experiences too, I am in that window, and waiting for this to heal so we can start a family, but 36, time is ticking. Great blog, thank you.

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  3. Lots of good ideas, but I don't agree with your assessment of general anesthesia. I've had it with all my surgeries and no problems. After the first, I vomited. For the next surgery, the added something to the anesthesia that prevented that. I have no "hangover," headache, etc. A little groggy for a few hours, but can't do much immediately post op anyway. No pain after surgery either. Again, my surgeon has done a nerve block with some surgeries to help with post op pain. Nerve block lasts about 24 hours so it's really nice for that transition to home. My surgeon always starts the pain meds early. I wake up with a pain med pump that allows me to self administer. Nurses encourage me to use it before the pain sets in, however, I've been really lucky and don't have a lot of pain post op.

    The point is, a good conversation with your surgeon and anestheologist pre op can do wonders for pain management post op. General anesthesia has come a long, long way in recent years. It is much safer than it was way back in the day and there are more options.

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