Labral Hip Tear with Impingement

Adam Jacobs wrote:

Would love to get out to do some short approach TRing for my birthday (Jan 30), which is just over 3 months post-op. how did kicking those front-points feel at the 3 month mark? I also have some great late Winter/early Spring alpine climbs nearby that usually last through all of March and into early April... but they all involve multi-mile approaches w/ a fair amount of elevation gain. totally understanding that my mileage will vary, do you think you would've been able to follow multi-pitch WI3 w/ a couple miles and a few thousand feet of gain approach at the 5 month mark? 

The actual ice climbing movement is probably the part that's easiest on the hip, since you're basically staying in a single up/down plane of motion. Which is also why I returned to ice earlier than rock. Approaches over unstable/slippery terrain with a heavy pack is definitely the hard part. Elevation is fine, but I really had to protect my hip from high impact and unexpected torsion. But my experience was that the hip joint is pretty robust/stable (compared to shoulders/knees, at least), so partial return to non-impact sports can happen a bit quicker than you would think. The *full* return does take awhile. It was probably a year before I felt 100% confident about my hip on unstable terrain with a pack. I definitely would have been able to do your proposed climb at 5 months, though. 

I had my left labrum reconstructed in March of 2021 with Dr. Brian White at Western Orthopedic in Denver, CO. He also did some bone work to reduce the FAI (cam and pincer). I was fortunate in that he was able to fully remove some arthritis that had developed. The recovery was absolutely epic for me. 8 years of compensatory muscle use had decimated much of my glutes and obliques, and wired my TFL as the primary mover. In terms of where Im at now, I am magnitudes better then the 3 or so years prior to the surgery. I climbed WI4 last winter, skied several big lines in RMNP, and got up the Diamond this past summer. Just plan on sticking with it through the discouraging times and savoring every major milestone. For every 3 to 5 steps forward, it seemed like I always took one step back. I would say it was about a year before my strength was at 100%. Still working on getting my endurance back to previous levels, but its coming along.

I chose Dr. White because his style of reconstruction had much better outcomes then the traditional repair surgeries. I have a completely new labrum from cadaver IT band tissue. Pretty psyched at this point. I cant recommend him enough. That said, PT is everything in terms of recovery and long term outcomes. Good luck!

Adam B wrote:

I had my left labrum reconstructed in March of 2021 with Dr. Brian White at Western Orthopedic in Denver, CO. He also did some bone work to reduce the FAI (cam and pincer). I was fortunate in that he was able to fully remove some arthritis that had developed. The recovery was absolutely epic for me. 8 years of compensatory muscle use had decimated much of my glutes and obliques, and wired my TFL as the primary mover. In terms of where Im at now, I am magnitudes better then the 3 or so years prior to the surgery. I climbed WI4 last winter, skied several big lines in RMNP, and got up the Diamond this past summer. Just plan on sticking with it through the discouraging times and savoring every major milestone. For every 3 to 5 steps forward, it seemed like I always took one step back. I would say it was about a year before my strength was at 100%. Still working on getting my endurance back to previous levels, but its coming along.

I chose Dr. White because his style of reconstruction had much better outcomes then the traditional repair surgeries. I have a completely new labrum from cadaver IT band tissue. Pretty psyched at this point. I cant recommend him enough. That said, PT is everything in terms of recovery and long term outcomes. Good luck!

Thanks for the information Adam, thats encouraging to hear.

I have my surgery scheduled for Nov. 15. I just reached out to my surgeon to ask about the reconstruction technique. He mentioned it to me initially but as more of a worst case scenario if the existing labrum is completely shot. Does the reconstruction have a longer recovery time than the traditional surgery?

Also, how were you a few months post-op? At what point were you able to do some basic hiking & climbing again? 

Hi everyone, I've been following this thread for a while and was wondering if anyone has had an experience of osteitis pubis along with FAI? Or trouble getting a clear FAI diagnosis? I got imaging last year due to worsening hip pain with running. I was diagnosed with possible mild FAI and a supposedly intact labrum, but they found pretty severe osteitis pubis. I've seen a couple different orthopedic doctors without much luck in addressing the hip pain. My hip symptoms all match FAI (difficulty bending down to tie shoes, compensatory muscle use, etc) but because my imaging looks "pretty good", none of them have focused on the hip. I'm thinking to ask for repeat imaging with additional angles to get a better idea of the hip. I suspect something off with the hip alignment is driving the osteitis pubis as the hip pain arrived years earlier. My weekly mileage has gradually decreased as hip and groin pain increased and is down from 30-40 miles with at least one 15+ miler per week to 3-10 miles per week with pain after 3 miles. I'd love to hear others experiences either with how to chase down a clear picture of hip functioning and/or dealing with it along with osteitis pubis. Thank you!

vwall wrote:

Hi everyone, I've been following this thread for a while and was wondering if anyone has had an experience of osteitis pubis along with FAI? Or trouble getting a clear FAI diagnosis? I got imaging last year due to worsening hip pain with running. I was diagnosed with possible mild FAI and a supposedly intact labrum, but they found pretty severe osteitis pubis. I've seen a couple different orthopedic doctors without much luck in addressing the hip pain. My hip symptoms all match FAI (difficulty bending down to tie shoes, compensatory muscle use, etc) but because my imaging looks "pretty good", none of them have focused on the hip. I'm thinking to ask for repeat imaging with additional angles to get a better idea of the hip. I suspect something off with the hip alignment is driving the osteitis pubis as the hip pain arrived years earlier. My weekly mileage has gradually decreased as hip and groin pain increased and is down from 30-40 miles with at least one 15+ miler per week to 3-10 miles per week with pain after 3 miles. I'd love to hear others experiences either with how to chase down a clear picture of hip functioning and/or dealing with it along with osteitis pubis. Thank you!

I did almost a year of PT before even seeing an orthopedist. looking back on it, that maybe feels like a mistake but both orthos I saw said they would’ve sent me to PT for a while to treat it more conservatively to begin with anyway. Every “big day” I’ve done in the past year has been meticulously planned to cut weight at every opportunity and even then - I needed about a week to recover afterwards because of the pain. After a year and 2 rounds of PT plus daily home exercise, stretch and strength training didn’t resolve the issue - I got an x-ray, then an MRI, then a cortisone injection. They all confirmed FAI and the Ortho I saw for second opinion agreed I was a good surgery candidate. Only 3 days post-op right now so can’t offer any info beyond that but hopeful this gets me back to being able to tolerate long mileage days out in the mountains.

Did anyone find a good PT protocol w/ some sport specific focus on climbing/hiking/general uphill action?

Adam Jacobs wrote:

Did anyone find a good PT protocol w/ some sport specific focus on climbing/hiking/general uphill action?

I just replied to your PM but adding this here for anyone else interested: focus on finding a PT who’s skilled in and willing to really do the work of manual therapy and intense joint mobilizations. The strength comes back and any PT can get you on a plan for that, but you have a narrow window to get the mobility back and it really requires some heavy lifting from your PT. In my experience, most are not able or interested in putting in the manual therapy work — it’s easier to just walk you through a basic strengthening plan. 

Throwing in my own recovery timeline for folks who are curious. I had a labrum repair on my right hip in Feb 2021. Overall, surgery was a success and I was off crutches within a month and hiking by mid May. While I was not able to do multiple days in a row, I was proud that I did a big hike in the Tetons in the middle of June, about 6 miles 3k. Climbing was harder to get back, but I mostly crack climb and I am in the creek a lot and that is hard on the hips in general. Hiking to the cliffs in the creek with a moderate pack (rope, water, lunch, clothes) was no problem and I didn't need poles. It was also at this time (October-ish) I started to get back into running. Easy touring in late October and early November caused no pain. 

Around December of '21 I noticed my left hip started getting the same pain in my right pre surgery and my surgeon confirmed it was another tear and FAI and recommended surgery when I was ready. I decided that once I lost an activity (climbing, snowboarding, touring) I would get the surgery. I elected to stop running at this time to try and save some of the other activities. I had surgery in March of this year. 

Recovery from my second surgery was slower. I was still not 100% in my right hip and over the past year had been HEAVILY compensating with my left leg and hip to get back to activities (this is also probably why it deteriorated so quickly). Since I could not compensate, recovery was slower. 

It has only been in the past two months, about 7-8months post op, that I have gotten back into full activity. Steep hiking was difficult until this fall. Easy sport climbing was my bread and butter over the summer and easy backpacking. I did do a 3 day backpacking trip in the Wind's this summer, and weight was fine, but the whole hike was flat. 

I echo a lot of folks in saying, find a good PT!! I think part of the reason the past two months have been great for recovery is because I found a PT who is not just focused on getting my hip recovered from surgery, but getting me back to activity and taking a more holistic approach. It also helps they are a climber and skier. My PT also does not want me running much at all until a year post op. 

Now, that I am 8 months post op on my left hip and 20 months post op on my right hip, I would say I am still only about 65-70% where I was pre surgery/ pre pain. 

I hope my recovery timeline helps some folks and I am happy to provide more info and answer questions. 

My uncle also underwent hip replacement surgery and had the same state of mind as you. But after surgery and rehabilitation treatment for hip mobility, he is fine. You will need to put your shoulder in a sling for three to four weeks following surgery. You must perform mobility and flexibility exercises when the splint is removed and eventually start building up. Additionally, your physician will advise modest, passive range-of-motion exercises. Athletes can usually begin sports-specific activities after twelve weeks, yet it will take the shoulder around six months to fully recover.  

stationary bikes: who used them as part of their recovery? how soon and how often? 

I'm approaching the 4week post-op and started using a bike w/ no resistance at my PT appointments end of week 2 (2x per week) but I just bought a recumbent bike for use at home. My surgeon's recovery protocols was a single-page list of exercises by week, so my PT and I have been using this much more detailed PT protocol from Dr. Andrew B. Wolff @ Washington Orthopedics and Sports Medicine. It says stationary bike once a day for 20min, so I was thinking I'd start working my way up to that.

Just curious what people thought? I made sure the seat is in the correct position for my height, and I'm already past most my initial ROM restrictions. Just wondering what others have done RE: bikes and whether folks think I probably should've been doing this from the beginning... hard to imagine I would've been able to do 20min on a bike my first week based on how much swelling/pain I had, but maybe not.

FWIW - I had arthroscopy 10/20 for combined cam/pincer impingement on my right hip and had labral repair at 12, 1, and 3. No cadaver tissue needed and per my surgeon (University of Vermont Orthopedics), all went according to plan.

I’m 1.5 years post op, bilateral cam type in pigment osteoplasty and labral repair. Best shape of my life. Was crushing big mtn objectives confidently roughly 8 months out. Dr. Burleson Beacon Orthopedics Cincy. Recovery was so stressful. Main two obstacles was a incredibly painful tearing feeling week 6ish, we think it was just scar tissue… scared me a lot at the time. Biggest hurdle though was it seemed like I plateaued in PT at about 4 months and had lots of pain with running strides. PT never could figure it out, but through desperation and experimentation I did. Incredibly tight hip flexors. Did lunge stretches and variations religiously, pain lessened then went away.

Take aways: recovery is incredibly stressful. Be ready for a journey. You will have to put in a shit load of work, no easy way around it. 

back to the well of mountain athlete info: how about cross-country skiing? I see elliptical on my PT schedule for a few weeks out from now, which is kindof like XC skiing. anybody have experience recovering from hip arthroscopy and getting back to XC? being able to tour some hills would be cool, but I’d even settle for some flat forest service roads. slow start to winter in New England so this would be several weeks from now anyway (currently 6-weeks post surgery and mostly off crutches)

Hi everyone,

I'm about a month post-op on my right hip at the moment and am trying to figure out when to schedule surgery for my other hip. From the beginning I've been set on getting them over with as quickly as possible, fortunately my wife and my work are very supportive.

I have the option of having the second surgery in a few weeks (about 6 weeks between surgeries), or waiting another month or so (about 12 weeks between surgeries). 

My PT and surgeon said the main benefit of doing them 6 weeks apart is being to able to rehab/PT both hips at the same time, provided I take it VERY easy the first few weeks to not overload the hip I operated on first. Having another month or so to recover sounds a little less stressful but I don't want my first hip to regress too much while it waits for the other to catch up, since it will be about 3 months post-op at that point.

Does anyone have experience having their surgeries close together? Any info is appreciated.

Phil A wrote:

Hi everyone,

I'm about a month post-op on my right hip at the moment and am trying to figure out when to schedule surgery for my other hip. From the beginning I've been set on getting them over with as quickly as possible, fortunately my wife and my work are very supportive.

I have the option of having the second surgery in a few weeks (about 6 weeks between surgeries), or waiting another month or so (about 12 weeks between surgeries). 

My PT and surgeon said the main benefit of doing them 6 weeks apart is being to able to rehab/PT both hips at the same time, provided I take it VERY easy the first few weeks to not overload the hip I operated on first. Having another month or so to recover sounds a little less stressful but I don't want my first hip to regress too much while it waits for the other to catch up, since it will be about 3 months post-op at that point.

Hey Phil,

While I did not have my hip surgeries close together- they were about a year apart from eachother- my current recovery is very much focused on both hips and I am about 8 month post op from my last surgery. 

Personally, I think I would have preferred my surgeries closer together to avoid a very long and drawn out recovery process. 

For me, three months post op was about the time I could start 'real' pt where going to a session felt physically challenging rather than limited by pain or by my pt. It was at that time I started hiking more regularly and could do some top roping, but my general activity still felt limited. For my recovery, the three month difference would not have made a big difference, I think. 

These are just some of my thoughts about my own recovery on both hips. 

Hope your recovery goes well! 

3.5 months into surgery recovery and have not been making the progress I’d hoped to by now. I had some setbacks in January when I pulled some back muscles - probably because I’d been compensating and also hauling around a 22lb infant a bunch. The pinching sensation has gotten worse from pre-surgery and hoping this is a normal part of recovery. I’ve been diligently sticking to PT and other than childcare, I’ve been taking it really easy but I still can’t really walk a flat mile w/o pain flaring up. I recently started going to a 2nd PT who focuses on posture restoration to address imbalances in how I walk, sit or do other things around the house hoping that might make some incremental improvement. I got out for some zero approach ice TRing on my birthday last week because my soul needed it… wasn’t too sore afterwards but I don’t think I’m in a place where I can make a habit of that just yet - which is a bummer.

If anyone who’s had surgery and had continued pinching in the groin area after a few months in but later made a full recovery could give me a light at the end of the tunnel here that would be awesome. Also just venting here 

FWIW I had the surgery to correct FAI, a torn labrum, and (unbeknownst to us at the time) the deep lesions that had formed in my articular cartilage. Recovery was super gnarly and not linear. I just had knee surgery to fix up a torn meniscus and it was a total walk in the park compared to the hip surgey. Granted, they were not able to do any cartilage repairs on the knee, but just wanted to tell those in the thread that the hip recovery is a super gnarly process, even compared to other joint surgeries. The numbness and having to sleep with the CPM machine were the worst for me. 

It isn't linear. To the guy above me who has back pain, I still have back pain (actually my QL muscles) if I have periods of increased sustained activity. This is apparently because the glute on the opposite side turns off, and both my hamstrings and glutes are weak. I don't have pinching or pain after the surgery, but I definitely have random pops that indicate the surface probably isn't 100% perfect, and I had a very experienced doctor.

Echoing the sentiment that a great PT who works 1:1 with you is important for this one.

Sprinkle McSparklecams wrote:

FWIW I had the surgery to correct FAI, a torn labrum, and (unbeknownst to us at the time) the deep lesions that had formed in my articular cartilage. Recovery was super gnarly and not linear. I just had knee surgery to fix up a torn meniscus and it was a total walk in the park compared to the hip surgey. Granted, they were not able to do any cartilage repairs on the knee, but just wanted to tell those in the thread that the hip recovery is a super gnarly process, even compared to other joint surgeries. The numbness and having to sleep with the CPM machine were the worst for me. 

It isn't linear. To the guy above me who has back pain, I still have back pain (actually my QL muscles) if I have periods of increased sustained activity. This is apparently because the glute on the opposite side turns off, and both my hamstrings and glutes are weak. I don't have pinching or pain after the surgery, but I definitely have random pops that indicate the surface probably isn't 100% perfect, and I had a very experienced doctor.

Echoing the sentiment that a great PT who works 1:1 with you is important for this one.

Definitely agree this recovery rough. Just wasn’t sure if intense pain worse than any point pre-surgery is a normal part of said shitty recovery… I kindof thought things would get better or plateau but wasn’t expecting a dramatic dropping off a cliff at around 3 months

I’m a doctor of physical therapy and we treat these issues fairly often. If you have the means to, I’d try to schedule with a physical therapist and see if they can help with a conservative approach first. 

Wyatt Spithaler wrote:

I’m a doctor of physical therapy and we treat these issues fairly often. If you have the means to, I’d try to schedule with a physical therapist and see if they can help with a conservative approach first. 

I was in PT for a year before surgery which is why the Ortho I saw recommended surgery. I’m now focused on recovery from the surgery I already had back in October. Recently started going to a 2nd PT who focuses on posture restoration so I dont load up my operated side too much or create poor compensations 

A V wrote:

You sure the pops aren’t your hip flexor articulating over the femoral head? Thats what mine were, they told me they are common and harmless

Certainly also possible. My articular cartilage was somehow "10/10 worst 26 year old hip [the doctor] has seen," despite being almost exclusively a trad leader who has fallen ~2x in five years?

To the other guy, I wouldn't ever really call my hip pain extreme, and I did it without any of the opiates they gave you. However, I did experience an issue ~5 months post op where my hip got unexpectedly tweaked by a punchy reef wave at the wrong angle. I had to stop surfing/climbing after that and focus on more rehab, but I wouldn't have called the pain "extreme." For sure worth dialing up the ortho/PT for that. When I told them about the incident, they just said "nothing we can do other than more rehab and it's hard to know whether you've torn anything, don't do it again!"

I am now one week post-op with the knee and nearly 1 year, 5 months post-op on the hip.