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:

Sunday, 28 March 2010

hip clicking again uh oh!

I am concerned that since the jolt or shunt type injury in the shop 9 days ago my hip has been far worse. Pain more constant and pain on weight bearing and as of last night it has started clicking again.. If I flex my hip and abduct (away from body) at the same time sometimes it clicks around the groin region (not painful). It did this prior to my hip arhroscopy for FAI and labral detachment, for years and only stopped post surgery. My left side also began clicking with the same action a year ago when the pain on that side kicked in and it also became symptomatic.
I also have a constant dull ache and increased pain on weight bearing and also since my one to one pilates my pain has increased.
All this pain feels frightening familiar!
But it seems or should I say seemed unlikely that I could have done so much damage just from a jolt 8 months post op surely??!

The disappointment and consequential exhaustion continues then!

12 comments:

  1. Hi Louisa, I have been following your blog with admiration and interest since August 09 when after 14 months I was diagnosed with a borderline normal centre edge angle of 25 and a labral tear to right hip. Although my journey to diagnosis has been no where near as traumatic as yours there has been some frustrating similarities. A GP who just didn't seen to hear what I was saying and took ages to agree to refer me to a specialist, he then referred me to the wrong specialist (someone who's special interest was shoulders aaaagh!), xrays and MRI scans that were inaccurately and inadequately reported on, the "right" surgeon miss reading my MRI report - blah blah blah. Having read your blog I feel you may have visited the same NHS hospital and seen the same consultant that I did. Anyway to cut a long story short, thanks to the physio I saw at work and your blog I finally walked through Prof Schilders doors at the Yorkshire clinic in Nov 09. I had been told by a certain Mr C that in my case the labrum would be macerated and beyond repair. On 15th Jan 10 I had a right hip arthroscopy, labral repair and shaving of the bone at the femoral neck by Prof Schilders. I don't think i've ever had such faith in a man before!!! Anyway what I really wanted to say was that after only a few weeks I started to feel some clicking again similar to pre op and when I asked Prof Schilders about it at my 8 week appointment he said he wasn't concerned about clicking as it was likely to be the hip capsule which was pierced during surgery. He reassured me that the labrum was securely fixed on. I must admit it does really worry me but it seems to happen more if I have over done it. I hope that reassures you as it came from the main man!!
    Thanks for keeping your blog going. Just knowing that there are other people out there slowly working through the FAI nightmare makes it slightly easier to bare. Like you I am trying to psyche myself up for my other hip to be done, it's booked for a few weeks time................
    Really hope you get to recovery,
    ClaireB

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  2. Wow Claire, you're going for it. 2 in a short space of time! I take it your impingement is cam? I also assume your pain has gone post op? Its very easy to overdo it by just doing ordinary things isn't it.
    My one to one pilates tipped me over the edge after jolting my hip, this week.. I think her attaching 10lb weight to my ankles for leg curls on my hamstrings was not wise and suspect she doesn't understand the nature of our injuries enough, though in fairness who does?!!
    Well done you for getting the lot out of the way, wise move!

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  3. Claire do you also see the physio Louise at Physio-cure Esporta?? She is amazing, I think she is single handedly diagnosing Yorkshire's lost and undiagnosed hip patients and sending us off to be formally diagnosed and cured!
    And it just dawned on me re Mr C, yes I was told labral tear but no impingement, but as I had bi-lateral pain I thought how likely is that, that I could've had 2 traumatic accidents and not remembered?!! Then when I saw Schilders he immediately said my impingement was pincer type and that my right hip was in the worse 5% cases he's seen. The discrepancies, even between hip surgeons, are crazy!

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    Replies
    1. Hi Louisa, I am 7 weeks post hip labral repair and FAI surgery and I have quite a bit of referred pain in my knee. Did you experience knee pain?

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  4. I've been having physio at St Lukes Hospital in Bradford pre and post op. I'd gone pre op as I work at the hospital and thankfully my physio persuaded me to get a second opinion from the Prof. The physios there are very up on FAI as thats where Prof Schilders NHS patients went for post op physio. I say "went" as apparently Bradford PCT have withdrawn the funding and so he won't be performing any more hip arthroscopies on the NHS. I live in Knaresborough and North Yorkshire PCT refused to fund my surgery. Although Mr C offered me a hip arthroscopy on the NHS so to be quite honest I don't know whats going on. Either the PCT are blatantly lying or they haven't got a clue what surgery they are being charged for.

    As I understand it my FAI is due to my borderline centre edge angle. I have been into sport all my life and the running and high impact stuff has put extra stain on the labrum causing it to tear, when left the bit of cartilage flapping around irritates the femoral neck stimulating the bony bump to grow. I think it has been classed as CAM but the bump was caused by the tear and not the other way around! I'm so glad you picked up on your daughters leg length discrepancy and everything is now fine. On the bad days I can't help thinking if my centre edge angle had been picked up when I was a baby I wouldn't be going through this now. Although I suppose with it being bilateral there was no difference in leg length I was just generally short!!!

    Before surgery the pain was an unbearable nagging deep ache in the groin and far worse at night. The usual pain killers didn't even touch it and I never managed to find any prescripion pain killers that didn't cause crappy side effects and allowed me to work and drive a car safely. My GP suggested paracetamol was a good all round painkiller. What a laugh!! Fortunately the pain is now much improved but i'm not sure i'm ready to put myself through it all again. Although the scan on the left hip shows the same problems the pain is no where near as bad. More of a sharp pain if I dare to deviate from walking in a straight line. I know it will deteriorate but i'm worried the surgery could make it worse and i'll regret it.

    I was thinking of heading back to pilates but i'm not sure i'm ready for a 10lb weight hanging from my leg yet!! How did your appointment with Prof Schilders go last week?

    ClaireB

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  5. Why are you worried surgery will make your left worse? Or do you mean surgery on your left will put more pressure on your right and therefore hinder that hip?
    Have to say striking similarities in our situations.
    For me only viox touched the pain, I took it for 6 months and then stopped because i fell preg in 2004 and after it was banned for causing strokes!
    Bad about the PCT's esp when in the US they're now starting to cover it. I hope bupa don't retract it... although on bad days (like today) I think I'll hang in there and wait for THR!
    If I could just recover from this first op I'd jump in again and have the next, but anything sets it back.
    Re pilates, the problem is so few or no-one yet is clued up on this condition yet. I think it will be so common in 10 yrs though.
    Thanks, BTW its nice to hear from a Schilders success story, you're not the first, but for some reason, not me!

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  6. Sorry to hear the hips clicking again! I mentioned to my physio about your bum pain & how it went for 24hrs after the "clunk". She said that the sacroiliac joint can become "stuck" & refer pain the the bum, back of the thigh. Then if it shifts or becomes loose again it can relieve the constant pain by relieving the pressure. If it becomes stuck again the pain comes back. We are working on the SI joint at the moment along with my hamstring as I have had constant deep bum pain for as long as I can remember with this hip problem! I recently changed my blog from Nicola's Hip Blog to ICandy NZ & am good friends with Jess. I hope it settles down for you :)

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  7. Hi Louisa, I'm sure the clicking occurs when there is an increase in inflammation in the joint. I reckon that your step down shock has sparked off an inflammatory response so I would do whatever it is that works best for you to reduce that. Hope all is well with the new house etc x

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  8. Hi Louisa,

    nightmare about the clicking again - I did have loads before the arthoscopy and a bit afterwards but it settled down around 3 months post op. I was paranoid though about tearing the labrum again up until the THR..(which I can't recommend enough). When's your appointment with Prof Schilders ?

    Dee x

    ps not been around so much as hips are allowing me to live my life again !!

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  9. Thanks Nicola, I have my si adjusted now and then at a chiro - seems to ease things thou never that pesky bum pain... I think my tight hammys might have clicked over my ischial bone or something, cos I defo also get rear clicking more than groin nowadays... mad all this isn't it! Changing your name is all it takes to confuse me!
    Hi Claire, another Schilders success!!! Pleased for you though, yeah I'm just surprised that a jolt like that can cause such a reaction, I reckon a month to get over it at this rate..a normal person wouldn't have known!! We're exchanging tomorrow and moving May 10th. Seeing Schilders also tomorrow so big day.

    Dee, I knew you were doing well by your absence, fab news, your life back! Why not recommend THR when brought you your life back, after arthroscopic failure? Which was the hardest recovery?

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  10. Hi Louisa,

    Just spent a couple of hours going through all the blogs on here after a fairly panicky couple of weeks and have to say, I now feel worse eeek!

    You’ve been through such a lot of grief regarding your FAI and seem to have become a bit of a guru regarding the whole issue, so I’m hoping you are able to offer a bit of advice to a worried mum.

    My 16 year old son (15 at the time of his first op) had surgery for FAI with professor Schilders in July 2010 for his right hip and again in November the same year for his left hip. He plays football at a high level for a local Academy and had been having intense groin pain during and after matches for at least 12 months prior to being referred to Prof Scheilders by the Academy PT. Schilders is apparently the lead surgeon in the UK when it comes to footballers.

    His recovery seemed to go incredibly well following both operations, only needing medication for the first couple of days and PT starting the day after each operation. (I do believe he has quite a high pain threshold) The therapist at the Academy works with Proff Schilders at the Yorkshire Clinic, so we were lucky to get quite intensive sessions tailored to our son’s needs during the whole of the recovery period from the Academy. He didn’t however actually go back to full time training sessions until 2 weeks ago when pre-season training commenced.

    Now for the not-so-good and the reason for my deviation from what so far sounds like a good news story. After the first couple of sessions he started to complain of the same sort of pain he originally felt in his groin and right hip, although he still maintains a high degree of flexibility and strength. His left hip is fine. The pain is only when he pivots and turns at speed (OK in everyday life, but fairly necessary manoeuvres for a football player) but not when running in a straight line (still very quick at this)

    We funded both operations privately as we did not have private health insurance (still trying to decide which bank robbery to pull off in order to pay off the loans – watch the Yorkshire Post for an update!) Joking apart, we are very mindful of further cost implications, but would have to find the money from somewhere if necessary; can’t wait for the turning of the tables somewhere down the line when the kids look after us for a change.

    We are going back to meet with Proff Scheilders on 24th August (day before his GCSE results, so quite a lot of pressure there!) and would really appreciate any advice regarding questions to ask etc. At the moment we are all very upset and I just know we are likely to clam up if we don’t go well prepared.

    Any help/advise would be hugely appreciated.

    Cheers, Nicky.

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  11. Oh Nicky, thats harsh... by the academy do you mean Leeds? Each team has their preferences based on their experience... There appear to be a handful of these specialist surgeons in the UK Professor Schilders is one, Griffin and Villars are other equally well thought of surgeons in this field.

    I guess the main thing to ask is, is the problem sounding to be FAI related, or muscle imbalance related. My guess is with someone that young and fit and looked after by PT's, that it could be remaining FAI.

    However this could also be a scar tissue problem, I believe there is a high prevalence of this amongst footy players. Scar tissue seems to be able to act a bit like FAI, inducing similar pains.

    I think he may need another MRI-A to see if a labral tear is evident. The grey area is that sometimes its hard to differentiate between tears, surgery sites and scar tissue.

    I'm so sorry that you're not covered for insurance, nightmare... it does irritate me when these things don't work theres no money back option, as Alan Sugar was once quoted as saying, after failed back surgery.

    Is it both hips or one failing?

    Write your list, try keep him on point, don't leave without a clear way ahead. Ask if its a least possible to have the MRI-A on the NHS.

    Schilders has just released a new paper hoping it'll clear the way for people getting NHS funding, if you look at my site for PCT you'll find it, could you apply for NHS? Though I imagine time is of the essence.

    I may not be the best person to ask, as my scope failed too... I wonder... there is a very, very good physio here in Leeds, Louise Grant at Physiocure, Esporta in Cookridge. She specialises in FAI and works directly with Professor Schilders, amongst other hip surgeons and may have better insight and clinical knowledge to direct which questions you could ask and how... If you email me your details I will pass them onto her and I am sure that if she can help you, that she will. My email is louisa.w@virgin.net

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