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FAI/Hip Labral Tear

marty funkhouser · · Unknown Hometown · Joined Dec 2007 · Points: 20

What is a "loose" hip joint? A hip that dislocates? That is incredibly rare and potentially very dangerous. It is also almost always associated with incredible forces such as during an auto accident. Just because a surgeon claims that a torn labrum causes instability and future arthritis doesn't mean it's true. That claim needs to be supported by evidence. Surgeons used to claim that patello-femoral pain was caused by tight lateral structures in the thigh. Tens, maybe hundreds of thousands of operations were performed until evidence showed that tight lateral structures were usually not a factor in the condition. Doctors have claimed for decades that it should not be possible to throw a baseball overhand with a full-thickness rotator cuff tear, however a recent study showed that ~10% of major leage pitchers show a full thickness tear on mri.

My point is that the medical community can be pretty bad at making inferences about how the human body operates and I think it should instead rely on statistically significant evidence.

Matt Marino · · Georgetown, MA · Joined Jan 2010 · Points: 10

I had surgery for FAI with a Labral tear 5 months ago. I had a significant tear in the right labrum and a prominent cam impingement on that hip as well. The surgeon cleaned up and repaired the labrum and shaved the bone down so that the tear is not likely to reoccur. Before the surgery I had to get a contrast MRI which required a cortisone shot for the contrast dye to work properly. Just getting the shot did a little for the pain but my range of motion was still terrible.

I'm 5 months post surgery now and feel like I'm almost 100% again in terms of mobility and the strength of the joint. I did PT for the first 2 months but I could use an indoor bike at 3-4 weeks and swim at 6 weeks. Started lifting and running again at about 3 months. I'm also noticing that the issues with my back are gone as that was likely caused by imbalance in my hips. Compared to where I was I'd have to say the surgery was well worth it and I'd recommend the surgery for anyone that has significant pain, and definitely has a tear with a hip impingement that is causing more ware and tear on the joint.

If you do go the surgery route try to find a Surgeon that specializes in sports medicine and understands what you want to get back to, not someone that does hip surgery for the elderly. My Dr. specialized in this procedure and had reams of material and protocols for me to bring to PT with me.

On the other hand... I have the same thing to a much lesser degree on my right side. I have a slight cam impingement on the right hip and a possible tear in the labrum (MRI inconclusive) and all I've had for that one is a cortisone shot. The funny thing is the shot itself did help but the real fix was after surgery on my left side I noticed my right side getting better. The Dr thinks it's likely I was relying to much on my "good" hip so now as things even out the pain is getting to a level that is tolerable and as mobility isn't impacted I'm opting to not get surgery on that side.

So if the condition has progressed to the pain that it affects mobility I'd go with the surgery, if it's livable I'd wait and see if you can mitigate with PT, ice, OTC drugs ect... My two cents, on the internet, take it for what it's worth.

Nate Manson · · San Diego, CA · Joined Jun 2010 · Points: 135
Matt Marino wrote:I had surgery for FAI with a Labral tear 5 months ago.
It sounds like you're a runner, obviously the FAI was the mechanism, but was it the repetitive activity that caused the injury? Your cam impingement was pretty significant then?

Glad to hear your good news!
Matt Marino · · Georgetown, MA · Joined Jan 2010 · Points: 10
alleyehave wrote: It sounds like you're a runner, obviously the FAI was the mechanism, but was it the repetitive activity that caused the injury? Your cam impingement was pretty significant then? Glad to hear your good news!
If you have FAI then everything you do is the cause really. You have an abnormal shape to the bone so you're constantly grinding into the labrum. If I had to guess the primary offenders based on my Dr's inputs I'd say running is high on the list because of the repetitive grinding but I think high impact weight training was the worst thing for it (think deep squats followed by box jumps) because it coupled dynamic impact movements while simultaneously stressing the limits of my range of motion. My brother and sister both have the same condition and they run marathons and have not had anything tear. They do however go through ice like it's running out of style.
Cody W. · · Denver, CO · Joined Oct 2011 · Points: 15

Wondering if anyone in the Denver area has recommendations for surgeons?

I was scheduled with Dr. Brian White, but have now been getting the run around from my insurance company for over 5 months. I know that he and Dr. Phillipon are both considered out of network, so I am trying to find an in-network provider.

Please let me know if you've had a good experience with anyone else. Thanks!

J. Broussard · · CordryCorner · Joined Feb 2011 · Points: 50

I used White, everyone said he was the best.
If I had to do it again, I'd just go to Laurie Fulkerson.
Once you meet her, you'll know why.

Cody W. · · Denver, CO · Joined Oct 2011 · Points: 15

Thanks for the recommendation J. Broussard. I just looked up Dr. Fulkerson and she is actually in-network for me. Can you provide any more specifics on why you recommend her? This whole process of finding a doctor has been a nightmare, so I would be psyched to find a good one.

J. Broussard · · CordryCorner · Joined Feb 2011 · Points: 50

PM sent

Stephen Burns · · Telluride, CO · Joined Jul 2010 · Points: 25

The people I were seeing were with the Steadman Hawkings clinic and they seemed to be pretty dialed in. That being said, after about eight months after first experiencing symptoms, than getting diagnosed (contrast mri and such) The pain has subsided, I can now fully function, climb, and do it all. No surgery. Psyched to of not got cut.

J. Broussard · · CordryCorner · Joined Feb 2011 · Points: 50
Stephen Burns wrote:The people I were seeing were with the Steadman Hawkings clinic and they seemed to be pretty dialed in. That being said, after about eight months after first experiencing symptoms, than getting diagnosed (contrast mri and such) The pain has subsided, I can now fully function, climb, and do it all. No surgery. Psyched to of not got cut.
That's awesome dude.
I had been living with the pain for over 2 years when I finally went under the knife. And it wasn't a nag that I finally decided to deal with. It was a crippling pain that would flair up when I'd least expect it. Usually when just walking.
Derek · · Unknown Hometown · Joined Oct 2012 · Points: 0

I am 4 months out from surgery to address FAI and a torn labrum. Suffered for around 18 months before pulling the trigger on surgery. Still up in the air on whether it was the right call. I was fully functional before surgery, just a lot of pain. I haven't started running or lead climbing yet, but hope to in the next week. Still pretty sore most days, but the pain isn't as intense as it used to be. Happy to hear that it worked out well for most people that went through with it. Doc still says it can take 6 months, but with each passing day I get a little more nervous it won't stop hurting.

One item of note is the traction they put you in for the surgery. That is almost as serious the surgery itself. I still haven't regained total feeling in my feet. Not really sure what you can do to make sure the doctor relieves traction for a rest if the surgery runs long, lots of pressure to cram cases into a surgery day. I would see it as a red flag if the doctor doesn't warn you of the risk traction possess.

Stephen Burns · · Telluride, CO · Joined Jul 2010 · Points: 25
J. Broussard wrote: That's awesome dude. I had been living with the pain for over 2 years when I finally went under the knife. And it wasn't a nag that I finally decided to deal with. It was a crippling pain that would flair up when I'd least expect it. Usually when just walking.
When it was at its worst it was terrible. Pain to walk, pain to sleep. Docs said I had FAI with a labrum tear, Full on pincer and the other kind of lesion. It didn't sound good. I did lots of yoga, stopped bouldering, and started crack climbing. For some reason the movement of crack climbing never bothered it.
marty funkhouser · · Unknown Hometown · Joined Dec 2007 · Points: 20

These FAI surgeries are relatively new and likely performed far too often. A recent Scandanavian study showed that the prevalence of FAI is extremely high in the uninjured population. I wouldn't be surprised if the same is true of labral tears.

Be sure and do your homework before agreeing to go under the knife. For me that would be a year or more of aggressive PT and a lot of time reading randomized controlled trials.

Folks think they need 100% perfect anatomy to function normally and be painfree. This type of thinking couldn't be further from the truth. Far more important are healthy, uninhibited muscles and a nonsensitized nervous system. These things take a lot of effort to regain after an injury and are often easier to obtain without surgery.

Alyssa K · · South Lake Tahoe · Joined Mar 2014 · Points: 46

I had my right hip repaired back in 2008 and just had my left hip repaired about 3 weeks ago.

It's worth pointing out that labral tears aren't always caused by FAI; mine was triggered by general joint instability. So in addition to repairing the labrum my surgeon (Dr. Safran at Stanford) also did a capsular placation--basically tightened the hip socket. This seems to be a pretty new procedure, since it wasn't an option for my first surgery 6 years ago and I don't recall anyone even testing my hip for instability. So that may be worth looking into, although there are only a few surgeons that have really done a lot of these.

Recovery really isn't as bad as most of the horror stories that are floating around online. First week was a miserable Vicodin-addled blur, but started weaning myself off crutches at 10 days and now at 3.5 weeks can walk about a mile with no limp and very minimal pain. And virtually no pain unless I push it too hard or twist it at a funky angle.

Cody W. · · Denver, CO · Joined Oct 2011 · Points: 15

It is good to hear that some people have had success with the surgery. For me, the risk of developing arthritis later in life is outweighing the risk of surgery. Not to mention that the pain has reached the point where car rides and daily tasks are difficult.

I have narrowed it down to 3 potential surgeons in Colorado:

Dr. Omer Mei-Dan
Dr. Brian Larkin
Dr. Michael Huang

Has anyone had any experience with any of these doctors? Any feedback?

MeghannL · · Unknown Hometown · Joined Oct 2014 · Points: 0

I'm really surprised to hear that everyone is recovering so quickly from this surgery. When I met with the surgeon, I was told that I would be in an ice bath for 2 weeks and need to keep almost 100% of the weight of that leg for 4 weeks, maybe some exercise (mostly PT?) after 8-12 weeks. That was all very discouraging to me. Did you guys just get lucky with the recovery time or was this quick recovery expected?

J. Broussard · · CordryCorner · Joined Feb 2011 · Points: 50

If you have to have the micro fracturing (bleeding of the joint to encourage cartilage growth) you won't walk for 3 months. Then 6 months of rehab and hating on your friends as they actually get to go climbing. YMMV

Alyssa K · · South Lake Tahoe · Joined Mar 2014 · Points: 46
MeghannL wrote:Did you guys just get lucky with the recovery time or was this quick recovery expected?
My recovery so far is lining up with what my surgeon told me to expect, but I didn't have a microfracture so I guess that helps. Never hurts to get a second opinion though.
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