Derotational femoral osteotomy for FAI

[bethreads]

Barring any unforeseen circumstances, I have hip surgery scheduled at the Mayo Clinic on August 25 for surgical hip dislocation and derotational femoral osteotomy for my right hip. Basically, femoroacetabular impingement (FAI) wasn't corrected with the more typical athroscopy, so I'm going for a much more invasive surgery that I hope finally corrects the pain in my hip. Some of you may remember me from back in 2018 when I was in so much pain after arthroscopic surgery and PT, and you all helped me feel a lot better about quitting PT.

I'm wondering if anyone else has had this type of surgery, and anything you could share. I'll be on crutches for about six weeks, and off work for a recommended 12 weeks. I am also hoping my husband can be home with me for most of recovery since due to covid-19, he's working from home.

 

[Celle]

Hello @bethreads - and back.

I'm sorry you've had to come back because you need this major surgery, though.

I don't know a lot about femoral derotational osteotomy and I can't recall another member who has had it.

I hope your surgeon explained carefully to you what he/she intends to do, and why it is necessary.
While considering surgery, was the alternative of a Total Hip Replacement discussed at all? If it was, did your surgeon explain why the osteotomy was considered a better option?

I do know, from people who have had an osteotomy for other reasons, that the recovery can be long and slow, so do be prepared for this.

My best wishes for your surgery. I hope everything goes well.

 

[bethreads]

Yes, I've been warned recovery takes a year or so--that was also what I was told for arthroscopy. I don't need hip replacement because I'm 39 and I don't have arthritis or other degenerative problems with the joint, just essentially too much bone in the wrong places and the angle of my femur may also be causing limited movement and pain.

It was explained that I have both cam and pincer impingement, and my first surgeon only worked on the pincer. It's possible my surgeon won't need to derotate my femur, but that seems unlikely. I got a third opinion with another surgeon who is an expert in FAI and works with the Minnesota Vikings (American football) and he said he could fix the two types of impingement arthroscopically, but I might still need femoral derotation surgery. I don't love the idea of two more surgeries for my right hip, so hoping I can get it done in one surgery. My left hip has also started hurting in the same way in recent months, unfortunately.

I have been dealing with this pain and multiple misdiagnoses since 2016. :/

 

[Celle]

Thank you for explaining. I only asked because I have read of people who had a hip replacement specifically to deal with FAI.
I just wanted you to be sure what you are getting into.

We have had people on BoneSmart who have had and osteotomy and usually they find that recovery is harder than recovery from a joint replacement.

 

[bethreads]

I'm not sure I do know what I'm getting into! I only know what three different surgeons have told me about what is causing my pain and what needs to be done, and all three were different. That's kind of why I'm asking here. Were the folks who had hip replacement for FAI older than I am? Because I could see if I were in my 50s or 60s, a hip replacement might make more sense. But I'm a pretty active 39-year-old with no other health issues.

 

[Celle]

We have had people as young as their late teens who have had hip replacements - it all depends on what is wrong with your hips.

Hip replacements aren't just for old people any more. Ideally they should be done when your hips need them, not when you reach a certain age.

When artificial joints used to last for only about 10 years, there was a reason for waiting until a person was "old enough", but nowadays these artificial joints can last much longer.
Longevity of implants and revisions: How long will my new joint last?

 

[Jaycey]

@bethreads If your surgeon is basing the choice of your surgery on your age - I would quickly find another surgeon. As Celle has already said, there is no age discrimination with joint replacement. Granted - very old school surgeons still sight age as a factor. But implants have progressed significantly. Yes, you may need a revision many years down the line. But then again you may not.

 

[bethreads]

My surgeon didn’t say anything about age being a factor or hip replacement. I can ask specifically about replacement, but it wasn’t what he specified was needed for my case, pretty sure because I don’t have arthritis/degeneration in the joint.

 

[bethreads]

Oh and Dr. Sierra at the Mayo Clinic in Rochester is my surgeon: https://www.mayoclinic.org/biographies/sierra-rafael-j-m-d/bio-20054877 I don’t think I’d characterize him as old school. He spent more than an hour with me, reviewed records from my failed arthroscopy and reviewed the 3D CT scan of my hips and showed me why the first surgery failed and how much bone he would remove. I strongly suspect my labrum has re-torn but we shall see. I’ll ask about hip replacement. I have a few other questions I’ve been saving up so might as well toss in another!

 

[Celle]

I’ll ask about hip replacement. I have a few other questions I’ve been saving up so might as well toss in another

Write them all down, so you don't forget any of them.

 

[Jamie]

@bethreads .... You are certainly doing the right thing by getting multiple opinions and by seeing someone at the Mayo Clinic. Unfortunately it is not uncommon for each surgeon to have a different idea for treatment for something that is not so cut and dried as osteoarthritis. I can see why you're wondering what the right thing is to do. In cases like this, your best bet is to carefully weigh all the choices and the surgeons who gave them to you and pick what seems to make the most sense to you AND provides a surgeon you trust and are most comfortable with.

Since you have no signs of arthritis, I can understand why a surgeon would want to try something like this. But it would be wise, given the complicated procedure you're facing and the length of time for recovery, to get the surgeons you're considering to tell you why they feel this is a better option than just replacing your hip.

Please let us know how things go as you work through making your decision. And if you want to discuss any concerns, that's what we're here for.

 

[bethreads]

I just got off the phone with Dr. Sierra, who answered my many questions. He confirmed my guess that the reason hip replacement isn't what he recommends is that I do not have arthritis. I likely need correction of the femur angle due to retroversion. My hip joint has too much bone (both cam and pincer).

I am going to get at least one more opinion before I have surgery in August.

 

[Jamie]

I think you're approaching this the right way. Your surgeon's comments make sense to me. I look forward to hearing how things go in the coming month or so.

 

[bethreads]

I got the name of another hip preservationist in a Facebook group for femoral osteotomy support. I sent an email to Dr. Robert Kollmorgen in California and he wrote back to me about 10 hours later, on a Sunday of a holiday weekend (wow!!!) saying he'd be happy to review my imaging and give me his thoughts before my August 25 surgery.

 

[Jamie]

Wow....that is impressive. Here's hoping his comments will make your decision easier.