See, I understand you feeling that way Simkie but I also think something wasn’t right about your procedure or aftercare or PT or all 3. Thanks to you literally and I AM thankful, I had both hips operated on and neither were anywhere near as bad as you describe. You don’t strike me as a wimp when it comes to pain so something had to have gone wrong.
I will say that after the a few months after the first surgery I started having SI pain on both sides which prompted them to start diagnostics on my second hip. I completely understand not wanting to go through “that” again but I doubt it would be that bad the second time but you came this far, you might as well see it through. You can come stay with me and use my doctor if you want!
The something gone wrong can just be a tear that was pretty extensive with a repair hard to really ‘take’, or it can be that there was cartilage damage in the joint that wasn’t visible on x-ray…Or, or, or…
It’s not on the THR scale where they have the operation so down pat as to make it routine. It’s still kinda hit and miss…
My labrum, according to the surgeon, was ‘shredded’. That one cortisone didn’t help at all.
x-halt-salute, unfortunately, the cortisone is usually under live x-ray and done by n interventional radiologist. Sometimes the docs do it in the OR w/ light sleep (versed and propofol for mine). So it’s unlikely that you get something done the same day.
Also - it doesn’t really ‘fix’ it - more like ‘controls’ it…
If you can take celebrex that may also help quite a bit.
According to my surgeon the use of cadaver labrum is controversial and his research shows you are better off without it. I just wonder if that didn’t factor in to her awful recovery. I still say you have come this far, see it through to the end or it was a waste. Assuming the other hip is bad too of course.
did simike have that??? that’s a new one on me…
Resurfacing
Please look into resurfacing! I was bone on bone for several years (ouch) due to a genetic defect but was holding out because I did not like the statistics on total hip replacements (dislocation, no impact, have to be redone every 15 years …)
Found resurfacing, am 7 months out on having the second one done and oh, thank god, I have my life back! I’m running several miles most days, riding 3 horses including jumping two very wide-backed, hiking, yada yada yada. With NO PAIN. Ask Laurierace, we bombed around Vegas during the World Cup. I don’t limp and have NO PAIN.
Google “Surface Hippy” - that’s a great forum with a ton of information. My doctor is Thomas Gross in SC, with a phenomenal track record. The surgeries were a breeze, first one was by far the most damaged so I was on crutches for 6 weeks. Second one I was only on crutches a week. Second surgery was outpatient 
PM me if you want more info or I can answer any specific questions. Did I mention NO PAIN?
I had a labral reconstruction. The labrum is replaced with a piece of iliotibal band from a cadaver donor.
The doctor I saw told me later that he does more reconstructions than repairs because the research is showing better results with reconstruction.
I have no idea if there’s something wrong with the repair. It’s possible. The doctors here (I moved nearly a year ago, for those not in the know ;)) seem to be uninterested in figuring out what’s wrong, and I am seriously disinclined to go to surgery again.
[QUOTE=mbd;8222986]
Please look into resurfacing! I was bone on bone for several years (ouch) due to a genetic defect but was holding out because I did not like the statistics on total hip replacements (dislocation, no impact, have to be redone every 15 years …)
Found resurfacing, am 7 months out on having the second one done and oh, thank god, I have my life back! I’m running several miles most days, riding 3 horses including jumping two very wide-backed, hiking, yada yada yada. With NO PAIN. Ask Laurierace, we bombed around Vegas during the World Cup. I don’t limp and have NO PAIN.
Google “Surface Hippy” - that’s a great forum with a ton of information. My doctor is Thomas Gross in SC, with a phenomenal track record. The surgeries were a breeze, first one was by far the most damaged so I was on crutches for 6 weeks. Second one I was only on crutches a week. Second surgery was outpatient
PM me if you want more info or I can answer any specific questions. Did I mention NO PAIN?[/QUOTE]
Well truthfully you bombed around, I mostly waddled behind you!
Thank you all for sharing so much about your own messed up hips with me! I’m eager (? that word is not quite sinister enough to really convey what I’m feeling) to see what they say on Monday, and I’ll keep you all posted. There’s an excellent chance that I’ll be seeking yet more advice from those of you who’ve been through this before and have been kind enough to comment here.
simike - bummer…but i think that generally, esp. if you have FAI surgery done, too, the success rate of the surgery is about 70%…
or at least that is a number published shortly after i had had it done.
and really, truly - the THR is a LOT easier…
Well the results are in.
(… Drum roll …)
I have a torn labrum.
The bright side is that everything else in my joint looks pretty good on the MRI – no FAI, no arthritis.
I’ve opted to try a cortisone injection. Maybe I’ll get lucky and will be able to manage it that way.
If that fails to provide relief I’ve got to decide about surgical repair. This is affecting my sleep, my fitness, my every-day comfort, and of course my riding, so it’s hard to weigh the cautionary tales some of you have provided against the interference this is causing in my life.
I guess for now wish me luck with the injection!
Before proceeding with treatment (and particularly any kind of surgery), strongly recommend reading the complete text of the following article:
1 Like
If you don’t have any FAI and the tear isn’t horrible, then the cortisone might do you fine.
I also read this recently - spend time in a half lotus any time you are getting tight and sore. Feels GOOD and helps loosen the hip muscles up.
Also - roll that IT band a LOT - esp. if you are starting to hurt.
For me, too much quad work pulls the femur into the tear, so I have to do a lot of quad and psoas stretching…
[QUOTE=Lady Eboshi;8226462]
Before proceeding with treatment (and particularly any kind of surgery), strongly recommend reading the complete text of the following article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697339/[/QUOTE]
Thanks, Lady Eboshi!
[QUOTE=tollertwins;8226503]
If you don’t have any FAI and the tear isn’t horrible, then the cortisone might do you fine.
I also read this recently - spend time in a half lotus any time you are getting tight and sore. Feels GOOD and helps loosen the hip muscles up.
Also - roll that IT band a LOT - esp. if you are starting to hurt.
For me, too much quad work pulls the femur into the tear, so I have to do a lot of quad and psoas stretching…[/QUOTE]
Thanks! My IT bands have always been really loose, luckily, but my hip flexors, quads, hammies, and back love a little foam roller action. I’ve got plenty of good go-to psoas stretches (alas, when my achy hip keeps me up at night sometimes I get out of bed and stretch in a desperate attempt to reduce the pain).
The othopedist said he was unable to assess the morphology of the tear due to the relatively poor resolution of the standard MRI. Hopefully the steroids will work so we won’t have to find out how terrible the tear is!
[QUOTE=tollertwins;8223895]
simike - bummer…but i think that generally, esp. if you have FAI surgery done, too, the success rate of the surgery is about 70%…
or at least that is a number published shortly after i had had it done.
and really, truly - the THR is a LOT easier…[/QUOTE]
I was thinking about this cleaning stalls this evening (it’s my “thinkin time” :lol:) and I just can’t believe it’s possible to have an “across the board” success rate with this surgery. Totally discounting what I had done (recontruction + FAI rejiggering), there are multiple repair techniques and rehab protocols. Hell, there’s a guy back east who will do both hips AT THE SAME TIME. I cannot even imagine.
I suspect that this all is just too new for a predictable outcome…for a few reasons! Starting with the imaging issues. Even with MRA, there often seem to be a LOT of surprises when the scope hits the joint. Then factor in technique and skill and rehab…and man–who the hell knows what’s going to happen.
x-halt, I’m sorry for your dx, and I really hope the injections help. I looooooved my last injection, although for the wrong reason. If they could just keep infusing the block into the joint every, oh, 2 hours or so, I would be golden 
I would really, really encourage you to get a second opinion if you get to the point of going to surgery, perhaps from whoever is the “conservative” orthopod in your area I can’t tell from your post–did you have an MRA (with an interarticular injection of dye) or just a straight up MRI?
[QUOTE=Simkie;8227107]
x-halt, I’m sorry for your dx, and I really hope the injections help. I looooooved my last injection, although for the wrong reason. If they could just keep infusing the block into the joint every, oh, 2 hours or so, I would be golden I would really, really encourage you to get a second opinion if you get to the point of going to surgery, perhaps from whoever is the “conservative” orthopod in your area I can’t tell from your post–did you have an MRA (with an interarticular injection of dye) or just a straight up MRI?[/QUOTE]
Thanks Simkie!
They did a conventional MRI (I work at a university and their health center is equipped to do MRIs but not intraarticular hip injections). I really hope that if the cortisone doesn’t work they’d order an MRA before I’d have to make a decision about surgery.
The way my health care is covered I don’t have any choice in the doctors I see (the tradeoff is that pretty much everything is 100% covered, no deductible – the only out of pocket costs are $5 prescription and $100 surgical copays). I will start looking into orthopedists in the area, though, to figure out who I might want to talk to if the injection doesn’t work. They guy I saw seemed reasonably conservative, but it sounds like a big enough deal that it might be worth paying out of pocket to get a second opinion if it comes to that.
With my first hip injection it worked for about two weeks but that was enough that they considered that to be a positive response so they did the surgery. My other hip did not respond until about a week later which I found interesting but that one ended up being not only torn but when they pulled my hip apart it draped down completely away from the bone.
[QUOTE=x-halt-salute;8227517]
Thanks Simkie!
They did a conventional MRI (I work at a university and their health center is equipped to do MRIs but not intraarticular hip injections). I really hope that if the cortisone doesn’t work they’d order an MRA before I’d have to make a decision about surgery.
The way my health care is covered I don’t have any choice in the doctors I see (the tradeoff is that pretty much everything is 100% covered, no deductible – the only out of pocket costs are $5 prescription and $100 surgical copays). I will start looking into orthopedists in the area, though, to figure out who I might want to talk to if the injection doesn’t work. They guy I saw seemed reasonably conservative, but it sounds like a big enough deal that it might be worth paying out of pocket to get a second opinion if it comes to that.[/QUOTE]
The reason why they TRY to be conservative, leaving surgery for the course of last resort, is that the nerves between the hip, pelvic organs, and lower back are all entwined and bundled together and commonly refer pain all over the place. Trying to sort out whether the origin is truly the hip, or sciatic impingement, or IT Band Syndrome, etc. is like untying the Gordian knot.
The best that can be said is they get it right if they get lucky, SOME of the time.
Everyone has degenerative changes in their spine, especially, and hips–some as young as the age of 20! The difficulty in Dx is, however, that no matter what they can see on the various kinds of imagings, it’s still almost IMPOSSIBLE to pinpoint which (if any) is actually causing the pain you’re experiencing unless something obvious jumps out at them like a fracture.
The success rate for most of the spinal surgeries is frankly abysmal. Hip, short of total replacement, not much better. To the point where they’re getting reluctant to do a lot of them, and some insurance companies are even choking on doing advanced imaging, since it so seldom affects the outcome. One thing that jumped out at me in the study I linked above, is that “91 to 93% of cadavers dissected have some degree of labral tearing.” Most of which were asymptomatic! What this means in practical terms is even if you have a labral tear and they can find it and fix it, that may not even be what’s causing your pain! Which goes double for the lumbar spine. Best analogy I know of is a horse with wicked-bad navicular changes on X-ray, who’s going dead sound jumping 3’ 6". In a great many people, even advanced osteoarthritic changes cause no pain. And what’s causing your pain may NOT be the visible “damage.”
So basically, whatever they do is in the category of your vet nerve-blocking feet, hoping to at least narrow down what’s going on. From there, it’s a total crapshoot whether anything they operate on will solve the problem.
There is much in print today on whether re-framing “regional musculo-skeletal pain” as an actual “injury” is even a valid construct, given the mismatch between patho-anatomy and relative discomfort levels. Unfortunately, after years of intensive meta-analysis, the verdict is that no modality has yet made the scene that works better than low doses of NSAIDS–except total hip replacement. (Ref. Dr. Nortin M. Hadler, Stabbed In The Back, University of North Carolina Press, 2009, and Cochrane Collaboration studies).
OP, the above is what’s going through your MD’s head, and why he’s taking it one step at a time and not jumping right in to operating. You may want to discuss these issues with him.
We Boomers were sold the bill of goods that “fitness” would indefinitely forestall aging, but about now we’re getting the picture of how that worked out. I think we have to have realistic expectations, that just like a 24-year old horse coming off a lifetime of hard work, if your hips or back or knees are giving you hell maybe now running, hiking, CrossFit have to go. I gave up kenjutsu finally last year because the lunges were raising hell with my left hip flexor. Mask the pain so I can keep straining it? No thanks–the pain is trying to tell me I’m 55 years old, and I’m listening to it.
I’m just grateful it allows me to do the chores and ride sedately; being relatively unimpressed by what meta-analysis has to say for the outcomes, and VERY impressed with my $6K deductible, I’ve just kind of accepted Serviceably Sound, Sometimes. Call me “Lurch!” 
I was diagnosed with FAI several years ago. I had been in pain for 12 years before diagnosis. Walking, sleeping, sitting, driving the car–all pretty bad. And I also knew that riding was making it worse. My boyfriend, who is a doctor (and someone who very much believes, “heal with steal!”), advised me against the FAI surgery. He said it was too new, and that he didn’t think it would work. I was also young for a hip replacement (40 at the time). So Simkie–I am so sorry. It sounds wretched what you have been through.
BUT I GOT BETTER. WITHOUT SURGERY.
I started working with a new dressage coach, one who specializes in bio-mechanics. She helped me to take the arch out of my lower back, and line up the hips. She told me to imagine that my pelvis was a bowl filled with water, and to tip the bowl back, pouring the water out. This “lines” up the hips. Also imagine that your hips have flashlights attached to the front of them. Are the flashlights pointing up or down? Keep them pointing up. This work naturally engages the lower abs. When the bones are lined up, it helps to lengthen the hip flexors. Next, bring your rib cage forward, make sure that your spine is also lined-up.
I practiced this work on and off the horse. Whenever I got up from my desk at work to go to a meeting or to the bathroom, I practiced. Whenever I walked to the barn, I lined up my hips, poured the water out of the bowl.
I had no idea that this work would help fix my hip pain. I was just trying to improve my riding. Within 60 days, the pain in my hips had reduced by 75%. It was a complete and utter shock when I realized that I could sleep on my side rather easily. I could walk a fair distance, and it was no big deal. Driving the car became a piece of cake.
So, my advice to anyone reading this, is to seek out a first-rate PT–or a dressage teacher specializing in biomechanics–and try this before surgery. This work probably won’t help with the labrum tears, but for my basic FAI (big cam lump and pincers), it was a game-changer for me.
When I don’t keep up with this work, though, the pain returns. I still have a bit of lingering pain, but it’s very tolerable compared to what it was. Lining up the hips and spine is a life-time commitment, but for me it is worth it.
[QUOTE=Lady Eboshi;8227703]
OP, the above is what’s going through your MD’s head, and why he’s taking it one step at a time and not jumping right in to operating.[/QUOTE]
I understand all this. I don’t know what you’re trying to convince me of. I’ve followed a very logical and conservative pathway to this point (months of rest – NSAIDs – months of PT – soon steroids) and believe it or not am very capable of reading and understanding medical literature. Based on my reading of said scientific literature, I believe the odds are quite high that the labral tear identified on my MRI is the source of my pain, and that is enough for me to think about moving to the next step w.r.t. treatment (steroids).
I am decades younger than you and do not believe that my body is “trying to tell me” that I am too old to do any sort of activity that requires flexion of the hip. I guess I have not made it clear that I do not want surgery! :no: And I certainly am not looking for a less conservative orthopedist! But I’m also not willing to rule out surgery completely until either I get some measure of relief from a non-surgical option or I hear more from an MD familiar with my case, hopefully with better imaging to guide his/her recommendation. Call me crazy, but I’m not willing to roll over and accept a sedentary lifestyle and pain that keeps me up every single night without investigating the alternatives.
