Anyone have a torn labrum and FIA leading to a THR?

[Ramp]

You are one of many that seem to have a bad arthro situation followed by a THR. I saw an orthopedic doctor today who told me I am in between. If my hip was better arthro would be an option for sure and if it was worse THR for sure. So Tuesday I have an appointment with the arthro surgeon to hear more about it. The recovery sounds pretty nasty. I want to have it better for the summer as I do a lot of walking. You live in my favorite city BTW, I have been going there and to Carlsbad every August for the last few years! I need my hip so I can walk Pacific Beach and Legoland!

 

[sandiegomom]

I just remembered -- my insurance tried to not pay my FAI surgery because my pre op MRI showed I had a 'full thickness cartilage loss' which means arthritis, and in that event, fixing the tear would not help and would just send me down the path to THR. I don't know why my surgeon suggested fixing it anyway. Argh. SO my question to you -- do you have straight up arthritis? bone on bone/full thickness loss? Had I known that piece of information prior I would have not gone through with the labral repair etc.

 

[sandiegomom]

oh, and one last tip -- there is this Dr. Philippon, at the Steadman Clinic (easily googled). He did A-Rod's labral repair, etc... I spoke with a guy who sells the hip hardware in So Cal (a medical device rep - so helpful in suggesting surgeons he liked!)...the device rep suggested I send all of my films and files to Philippon, and FOR FREE this blessed doctor gave me his opinion about what to do about my hip. It came back that I should get the THR, basically. That was the final straw in me scheduling it. If you want yet another opinion, consider this? GOOD LUCK! It is hard being 'in between.'

 

[Ramp]

Yes. I also have the full thickness arthritis thing. Actually in both hips. It's not severe but it is present and an issue. I do have a copy of my X-ray and 3D mri. So maybe I will contact that doctor. I still am in shock that all signs are pointing to a hip replacement. I am not bone on bone yet but it's deteriorating. Before July when I injured it. I never had a hip problem in my life. Now even my other hip gets sore when I do stairs. Thanks for the tips. Do I just call that doctors office or email their general mailbox? How did you connect with him?

 

[Ramp]

So I had my appointment with the first arthroscopic surgeon today and I have mixed emotions about it. He says that because the pain is mostly in the back and side of my hip that he does not think it is due to my torn labrum or cam impingement. He says most people have groin pain and that is his indicator. He seems to think that it could be some kind of lower back problem. He was also reluctant to do any kind of surgery on someone my age(42). He says because of some arthritis and my age that arthroscopic outcomes are usually not so good. He recommended that I try the injection and see if that works. If it does then its likely a hip issue and if it doesn't then its probably a back issue. He offered some anti inflammatories and not much else. Even though I have trouble walking and with stairs and in constant pain he did not seem too sympathetic or really to have a solution just to 'take it easy'. Of course I do not want surgery if it doesn't work but I was hoping there would be an answer to the pain. I can not move my leg inside or outside when getting in and out of a car or out of bed bed. I have to move them always both together which I am sure is the FAI hitting the labrum but he said maybe that will feel better once I have the injection. I know those are just temporary fixes though!

I am seeing another arthro shortly for a second opinion.

 

[Jaycey]

I am seeing another arthro shortly for a second opinion.

Good because I was going to recommend you see another surgeon. Anyone who uses the "you are too young" excuse is very old school. We have teenagers on this site who have had THR! There is no age discrimination with hip procedures. Living in pain for years waiting for that "golden age" is no longer needed.

 

[Bellydansr]

I too have a labral tear and arthritis. Mine occurred about 10 years ago. I thought I had a groin pull, then went the psoas route, finally went to the doctor after 10 years of intermittent pain. Gymnastics and cheerleading all the way through college. Yep, the way my hips are formed gives great flexibility, and very little space. Coaching HS cheer is how I tore the labrum and I never did anything about it. Now, I have been told I need both hips replaced. My left hip hasn't bothered me in a long time, so I'm not worried about it. I also have the same pain in the outside of my hips as you do. It's too late for arthroscopic and bc I am am afraid of needles, there is no way I'm going for cortisone shots which might or might not work. And if they do maybe for only 4-6 weeks??? No way!! So, I'm heading in for THR in a week. I definitely recommend a second opinion.

 

[Ramp]

Wow, so a much different result from my artho surgeon appointment today. I saw the second doctor. He also seemed very professional like the first but he took my Xray disk and came back a few minutes later and bluntly said that my hips are both terrible, it's no wonder I am having pain, I probably have labral tears on both sides and I will need new hips soon due to SEVERE arthritis (I'm 42!!?!). I can try a cortisone shot and see if that gives me relief.

He mentioning something fast about maybe I had some problem when I was young like 10 or 11 or something but I was not sure what that was. I have never had joint problems until this year.

The radiologist report says the OA is mild, and the first doctor didn't think it was so bad either... maybe he only read the report and didn't look at the actual photos. any Radiologists here? I have copies... ;)


Any thoughts on what to do with such conflicting results?

 

[Josephine]

Yes, post the xrays by all means!

I'm 42!!?!

So sound surprised! 40 is the new 60 as far as hip replacements are concerned! It's not at all uncommon to have 40 or even 30 and 20 yr olds have hip replacements these day. But if you're worried about it lasting, read these
Longevity of implants and revisions: how long will my new joint last
Hips that have lasted 32, 40, 41 and 45 years
67½ year old - the THRs, not the patient!

I can try a cortisone shot and see if that gives me relief.

It might but it will probably only last for a few weeks at best.

He mentioning something fast about maybe I had some problem when I was young like 10 or 11 or something but I was not sure what that was. I have never had joint problems until this year.

This is not at all uncommon. It's called dysplasia and is a congenital condition whereby the hip fails to form correctly. This gives problems to people at a huge variety of ages from infancy to the 60s. Some even get away with having no problems at all but we don't know how many, of course!

 

[Ramp]

Yes, I am ok knowing that lots of young people get THR, I am just wanting to make sure that I find out why both these doctors had such different opinions. If the arthritis is so bad then fine give it to me, but if it is mild then maybe I don't need to rush for one and I can manage it for a bit and look to fix other problems. Here are the two xrays that the radiologist and one doctor say are mild and the doctor today said was bad arthritis and that the radiologists 'didn't pay attention'. I think the word he used was 'terrible' ;(

I'm no radiologist but I have googled a ton of arthritic hips and ones without and I don't really see that mine is as bad as some of the ones I see online with almost no joint space and very white.

 

[thecraw]

I had Fai and tears in both hips. I had the athroscope and it was great for 6 years . I am 46 and have a thr next week . The arthroscopic procedure was excellent for me though and gave me an extra six years..

 

[Ramp]

It sounds like a similar issue to me. Do you think the 6 years was worth it or should you have just got the new hip so you didn't have to have a second surgery. Right now the doctors seem to ignore the option of fixing it because of arthritis and my age. Which is only 42. They want to give me the shot but I'm a little worried that if I can't feel anything I'll grind it up and when it wears off in a few months I'll be worse off than before. What's the recovery like for a labrum and fai repair? I almost feel like pushing for the repair but the one doctor that might do it said he wants to try the needle first to see if it's my back. Which I think is stupid because the MRI clearly shows the tear and fai and the problem started after it happened

 

[thecraw]

Ramp, I guess this is where I can only go off my experience...and for me it was a great option.

When I turned up 6 years later I knew what was coming and I guess I had already 'done what I could' to postpone it.

It will always be a decision though based upon what's happening with your hip whether the surgeon thinks it's going to be beneficial. Even this time he redid all the scans just to see whether another arthroscope would be worthwhile...

The arthroscopy, although probably more extensive then what I thought, was uneventful for me. One night in hospital from memory, some PT and was back into things pretty quickly. For me definitely worth it to get an extra 6 years..


Sent from my iPhone using broken link removed: https://r.tapatalk.com/byo?rid=75543

 

[Josephine]

Ramp, I've edited your images as they were mostly black! But they also have great definition so I was able to get a really good look at the state of your hips. These were very helpful and FWIW, this is my opinion

The cams show up really well on this image (red arrows) and are pretty large. The damage, aka arthritic changes, are also evident (blue arrows). As you said, it's pretty clear those are hips that need replacements not arthroscopic treatment.

I am just wanting to make sure that I find out why both these doctors had such different opinions. If the arthritis is so bad then fine give it to me, but if it is mild then maybe I don't need to rush for one and I can manage it for a bit and look to fix other problems.

I will tell you that the condition of your hips is not mild at all and in my professional opinion, is unlikely to be resolved by arthroscopic surgery.

However, it's not always about the xray findings. Very often over the years, I have seen xrays that were absolutely dreadful and yet the patients were getting around on them with only moderate pain and disability. At the same time, xrays that showed very limited damage were from patients who were in extreme pain and in desperate need of treatment. It's not about pain thresholds, it's about where the arthritis is and how it impacts on joint functions. To that end, I've attached a scoring chart to this post which you should print off and complete. The end results are for you alone though you could show them to your surgeon to enforce your case. They are based upon the traditional scoring tools that orthopaedic surgeons regularly use.

But I do urge you to get over the fact that you are 'so young' because that's no longer true. Hip replacements are no longer the sole arena of the septuagenarian! In fact, the numbers of people under 60 (sexagenarian) having hips replacements are steadily increasing and it won't be long before the numbers outstrip the septuagenarians and octogenarians!

 

[Ramp]

Thank you for your opinion. I'm having a bad day today painwise so it puts everything into focus. I looked at that chart. I'm sure I would score high. There are quite a few things I can not do with ease any more for sure. I guess the biggest problem I am having is that I had no pain symptoms before December. Other than my torn labrum in July that limited some movement. I was perfectly fine to run and dance and jog up until one day last month where i did a lot of stairs and carrying stuff and the next day my whole world changed. On both hips. It still baffles me how I went from normal to so much trouble so fast. I sat today on a hard chair for 5 minutes and it messed up my whole day. Have you ever heard of this happening so fast from being mobile to constant pain in just a few days? Do you think I should still try the needle in the worse hip? Someone told me once this could thin bone and you can't get surgery done on it for 3 months If you get it ?

Thanks

 

[oznut]

Hang in there! I think we all can agree this is life changing. My pain & immobility seemed to happen overnight or I was in major denial. It is exhausting physically & emotionally.

I have had 1 cortisone injection to try to bide time - the relief was immediate but only lasted about 2 weeks for me. I ended up having THR but did have to wait the 3 months after the injection before I could get a surgery date. I am scheduled to have another injection in the other hip to hopefully get me thru a long awaited vacation. I am planning to have the second THR this year for sure.

Now that I know what to expect, I am ready-ish forTHR #2. I can't wait until I am bilaterally bionic & pain free. You will be too!

 

[kaliella]

@Ramp, I had a similar experience regarding going from mild to severe pain in a flash. I had a restricted range of motion and pain in the groin when trying to move beyond that for more than 5 years in my hip. I have RA so I always thought it was arthritis. A rheumatologist told me a couple of years ago based on a hip x-ray that I would eventually need a hip replacement, but I thought that meant 30-40 years from now. In August of this past year, I suddenly started to experience severe pain in that hip after doing my normal activities. It was so bad I went to urgent care to get some pain medication and an x-ray since it was the weekend and I didn't want to wait several days to get into my rheumatologist's office. The radiologist's reading noted FAI, which nobody had ever mentioned to me. This started me down my research path and eventual trip into the orthopedic surgeon's office. I still don't know what triggered the sudden onset of the severe pain, but even after the worst of it subsided after a couple of weeks with rest and NSAIDs, my new baseline for pain in that hip was far worse than it had been before.

 

[Ramp]

Yes. It's very interesting for sure. The doctors want me to get the shot but I almost don't see the point if it is only going to delay surgery or last for a few months. I'd almost rather get the THR over and done with rather than thinking cortisone is going to give me some magic fix or 10 more years. From what I understand you can get a few weeks to maybe 4-6 months of relief and then it's back to the same pain or sometimes worse. So why delay unless you have a far off surgery date I suppose. I often wonder if I never tore my labrum if I would have gone on with my life and never noticed this for many more years. As I lay here on my heating pad popping pills. ;). Thank goodness for iPads I tell ya.

 

[Ramp]

Someone on here had recommended that I contact one of the top arthro doctors in the US. Doctor Phillipon at the Stedman clinic. It cost me $250 but it was interesting never the less. He believes that my arthritis is not that bad yet and that if he can resurface the femoral head and repair the labrum then there is a 75% chance that I will get 10 years out of it according to their statistics. I also had my x-rays reviewed by a top radiologist here who came up with the same opinion. I have around 2mm of cartilage left apparently so that is the cut off for the surgery. My problem and pain is coming from both my femoral heads on either sides being quite misshapen and banging around in the socket. If left this way I suspect my condition will continue to decline fast.

Two arthro doctors in my city both said they would not touch it because of the OA and said I need to get a THR.

I guess there is not really a wrong or right answer here as I will likely need THR anyway in both in 8-12 years but I think that is a good enough window that I would take if possible to put it off. But so far no one wants to do it here which is frustrating. Of course the clinic price to get it done is like wow.

Just more confusion... ;) Also the waits for surgery could be a long time. One arthro I just called had an 18 month wait!!! that's just to see him...

 

[oznut]

Has anyone looked into stem cell treatment for severe OA? I assume it is quite expensive but....

Today I have an acupuncture appointment for my non-bionic hip & then I plan to get in the pool at the gym to walk around a bit. Stay tuned....