diagnosing FAI

When it comes to diagnosing FAI things can be tricky and take a very long time. I was undiagnosed for 14 months which in the grand scheme of things isn't too bad; some people live with the pain for years and years. FAI hasn't come onto the radar of most doctors yet and that may be why it is often overlooked when a patient presents hip pain symptoms. It wasn't until over a year after my symptoms started that an arthrogram was suggested to look for labral tears. (it just so happened that I had labral tears caused by FAI) It is my hope that as more and more cases are diagnosed, more doctors will learn about FAI and the need to find and treat it early in order to reduce joint damage. I am very lucky that my joints are in pretty good shape and that my surgeries were able to help me! During that year I was told some pretty interesting things that make me smile as I look back on them :)
Ty's Laundry List of possible chronic hip pain causes
Juvenile Rheumatoid arthritis
reflex sympathetic dystrophy
pain loop
endometriosis
fibromyalgia
angry chis (pronounced "angry cheese")
herniated lumbar disc
lyme disease

steroids for band geeks?

Yesterday I had my steroid shots at the sports medicine clinic. (no I don't play sports, I think the staff was slightly disappointed!) First, I had a complete evaluation with various motion tests done on my hips. Everything from knee to chest (ouch!) and left knee to right side of chest (double ouch!) plus some resistance tests thrown in for fun. After that and some chatting he decided to inject the bursa on the trochanter (side of hip) and also do an intra-articular injection (inside the joint.) First my hip was cleaned with iodine and alcohol and I was positioned on my back because the inra-articular injection was first. Next, a number was injected in to my joint. This burned and stung quite a bit. After that a very large needle was used to inject the steroid into my hip. This stung as the the needle went in and then there was pressure and discomfort as the steroid was injected which took about 45 seconds.
I have had a similar procedure done before in the OR with anesthesia. I think it may be that sports med likes to do it outpatient with ultrasound guidance no sedation and general ortho prefers OR sedation and flouroscopic (x-ray) guidance. There are definite pros and cons between the two procedures. The outpatient procedure is more painful but it only takes about 24 hours to recover from. I prefer the OR procedure because you aren't awake for the procedure but you do need to fast, have an IV and the anesthesia may leave you feeling off for a 3 days or so.
After that my bursa (fluid filled sac) was injected and I was flipped onto my right side and my hip was cleaned. Again, I felt the burning but it only took about 10 seconds to inject the medicine. Usually there is little discomfort after with a bursa injection. However, for about a few days or so after intra-articular I usually have a slight limp and some groin pain. This is due to having something (fluid) put in the joint that wasn't there before! Sometimes the steroid crystallizes which can be painful but frequent icing can usually help.

hip news

Hello! Because this blog is combination of my story and hip surgery here's a little note of what's going on with my hips right now. We saw my hip surgeon today who is sports medicine and did my arthroscopy last December. He was happy that I am crutchless at the moment (yay!) but this new pain in my left hip I've been having is making everyone confused. He determined that I have multiple "pain generators" including my iliotibial band (ITB) and something that's causing deep groin pain, pressure and the occasional locking or catching. My ITB has thickened  and snaps over my trochanter (the bone you feel on the side of your hip) The ITB runs over the trochanter and should glide smoothly, however when it thickens it snaps over the trochanter instead which can also cause knee pain because the ITB connects on the side of the knee. In order to diagnose what's exactly causing my pain I need to have a series of steroid injections. Though the screws from my open surgeries have been removed, my metal anchors holding my labrum together say in my hip for good. This means I can have an MRI but it won't be very much use because the metal of the anchors will cause artifact (blurriness). So, instead I am going to have steroid injections as soon as possible in both my ITB and inside my hip joint. If my pain completely goes away we leave it at that, if not, the same injections will be repeated. If that doesn't help either my surgeon will come up with a plan most likely involving a ITB release and possibly another arthroscopy. Fingers crossed that we get this on the first try!

MRI arthrogram

An arthrogram is usually the best way to diagnose labral tears (and in turn FAI) because it can show cartilage damage that a regular MRI or X-ray usually can't. There was a 14 month gap for me between symptom onset and my diagnosis of FAI and during that time I had multiple X-rays and MRIs of various parts of my hip and back that were all strangely normal. It wasn't until the arthrogram that everything became clear and we knew within minutes what was wrong with my hips! First I was lay down on a table similar to that of an operating table and my hips were cleaned. Then they brought the fluoroscope over the table. A fluoroscope is pretty nifty, it's essentially " real time X-ray " which means instead of still pictures it's a video of your bones. Which, I admit isn't all that nifty if all you're doing is lying on a table. BUT you do get to see the needle go into your joint and release the contrast fluid. First, you get a bit of number injected so you don't feel the needle (They told me it was just like getting Novocaine at the dentist. I had never done that before, so I was completely terrified the first time I got a filling after the arthrogram! In my opinion the number is the worst part as it can sting, but after that the hard part's over) Then the put in the contrast (BIG needle) which just felt like pressure to me. After that it was off to the scanner which is noisy (think woodpeckers with construction equipment) but painless. My joints felt a bit wobbly for a few hours after but that was about it.

open surgery

When it comes to surgery for FAI there are lots of options and many people go for the arthroscopic surgery. This surgery tends to have a shorter recovery time, is less risky and can usually be very effective. My surgeon, however, decided that an open dislocation surgery would be the best plan of treatment for me. It is always a good idea to have a long talk with your surgeon about having surgery and which surgery to have. If you don't 110% comfortable with your doctor's decision, get a second opinion! Here's a pro-con list for the two surgeries.
open-pro
-can be more effective!
- surgery is older and more trusted
open-con
-big scar (which I don't mind but some people might)
-looooong recovery
-more chance of complications
-hardware sometimes needs to be removed
arthroscopy-pro
-quicker recovery, less time on crutches
-itty bitty scars
-very little (if any) time spent in the hospital
arthroscopy-cons
-sometimes less effective
-much newer procedure

my surgeries!

Here's a little background about my hips, tomorrow I will start regular posts about hip surgery and FAI. If you have an idea for a post please let me know chances are if it has to do with hip surgery I can write a post on it :) I've read lots of great hip blogs but I haven't really seen too many about open surgery. My goal for this little blog is for it to be a good resource with posts about all aspects of having a hip injury or surgery (both open and arthroscopic) and not just my personal story (although there will be plenty of posts about that too!) So here goes-
April 2008-right hip open dislocation (7 hour procedure, 3 labral anchors, 3 trochanter screws)
July 2008- left hip open dislocation (same as right)
April 2009-right hip trochanter screw removal
December 2009-left hip arthroscopic labral repair combined with screw removal

Hi everyone!

Hello! I'm Katherine (but everyone calls me Ty) and I'm 16 and a Junior in high school, and this is my new little blog about having hip surgery. I hope to give good information about having the surgery for patients and families and also just to provide my thoughts and musings about living with FAI. Some posts may be geared more towards teens having hip surgery while others will be more for anybody at all :)I have bilateral FAI (hip impingement), which is, in a nutshell, a bone defect that that causes too much bone on the hip joint. This is usually seen as a "bump" on the top of the femur (cam impingement) or bone overhang on the "cup" (aka acetabulum) which is called pincer impingement. I happen to have both types! I have had four surgeries (2 open hip dislocations one hardware removal and one combo arthoscopy (hipscope) and hardware removal. In case you were wondering I did have a sort-of blog over at http://www.thetyteam.weebly.com/ (our fundraising page for Boston children's hospital) and I will still use that for major medical updates and fundraising news but this blog will be much more geared towards "hippies".
P.S. please say hi in the comments!