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Hip Arthroscopy Pros and cons of steroid injection for labral tear v arthroscopy for FAI

waddler

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Hi All, I wonder if you could help me? I am 50 years old and had been relatively active but diminishing over time with symptoms.

I have been troubled with groin pain for about 30 years which has deteriorated over time. I have only recently had a diagnosis from 2 specialist hip surgeons, following various imaging, as a cam and pincer impingement and labral tear, so femoral acetabular impingement (FAI). I have been told my situation isn't so bad for THR to be currently indicated. I was initially advised to go straight to having arthroscopic repair, but have now been offered the option of having a steroid injection first. The logic would be to check and confirm that the groin pain is really caused by the labral tear and possibly to give me relief from pain for a short while to anything up to 2-3 years. This check would avoid the risk of having arthroscopy when in fact it turns out my groin pain is not due to the labral tear, and the risk of scar tissue from the arthroscopy reducing the prospects of later successful hip replacement.

Initially the thought of avoiding the arthroscopy (from which I was told it can take up to 2 years to recover from) and having the injection and a period of pain relief was appealing, but now I'm wondering whether I wouldn't be better to "bite the bullet" and have the arthroscopy. My thinking is that only then would the labrum possibly be repaired (rather than temporary palliative relief from the injection) and if my pain is relieved but the labrum hasn't been repaired and the cam and pincer impingements remain won't I be asking for arthritis, increasing my activity when the underlying cause of the original damage hasn't been addressed.

I hope that makes sense and I know ultimately there doesn't tend to be a right or wrong answer but your wise counsel would be appreciated.

Best wishes to you all,

Waddler
 

Jaycey

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@waddler Tough situation for you. If labral tear and FAI has been confirmed why would you need an injection to confirm the groin pain is due to them? Injections are a bit hit and miss. Some people see great results for several months post injection. For others the injection does nothing.
the risk of scar tissue from the arthroscopy reducing the prospects of later successful hip replacement.
Please note this is not a factor at all. Many of our members go from arthroscopy to THR with no issues.

Having said the above, is there an option for THR now? At least your surgeon is setting your expectations. Recovery from arthroscopy is often more complicated and painful than from THR. If your surgeon is hesitant to do THR based on your age, find someone a bit more open to working with younger patients with arthritis. We are living more active lives these days. The average age for THR is no longer 70-80 years old.

I can only say what I would do given your diagnosis. I'd go for THR.
 

Celle

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Fifty is rapidly becoming the average age for hip replacements, since current replacement hardware can be expected to last for about 30 years. That means you are far less likely to need a revision late in life.
That being said, there is no need to wait until you are considered "old enough".
So search for a surgeon who is prepared to look at the state of your hip and not at your age.

You have FAI which is going to need a THR to fix it, as well as a labral tear that needs fixing. Why go for an arthroscopy now, which will only do half the job and may take up to 2 years to recover from, leaving you still needing a THR?
Don't waste time on a temporary fix. Go for the THR as soon as you can. Do it once, do it right.
 

Mojo333

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:wave:and:welome:
I have brand new, get me wherever I need to go, bionic hips and happy to have them.
Back to a very physical job, active weekends, and comfortable sleep.
I was a very old feeling 53 year old when I had bilateral hip replacement.
Healthy and happy now!
 

Hip4life

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I’m joining the group of why would you go through a half, temporary measure with a sometimes much tougher recovery than a full measure fix with, in most cases, a faster recovery and back to an active life sooner. The hitch, as mentioned, is finding an OS who will work with you. It seems the orthopedic world is changing its perspectives and advancing at a very rapidly pace. I sincerely hope that works in your favor. I wish you the best.
 
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waddler

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Wow guys, first of all thank you so much for taking the time to provide your kind welcome and guidance. Great to hear your positive stories. I'm so pleased things worked out well for you.

Second of all though, I am so confused!

The surgeon I just saw, Jon Conroy, has a great reputation (including on this forum). He does THRs and arthroscopies. He told that me that sometimes he sees patients from the first one I saw (who only does athroscopies and other procedures but not THRs) who should have gone straight to THR but I was not one of them, and the arthroscopy was the correct approach for me. Why would he say that if THR is better for me? I don't think he declined the idea of THR due to my age. I suspect it was because I wasn't saying I was in constant disabling pain, but had got to the stage I couldn't do any sport or physical exercise, and/or that the imaging indicated my pathology wasn't so severe. Having said all that, I hear what you are saying.

My physio, who again is a specialist, has cautioned me that the outcomes of arthroscopies for FAI are a lottery whereas those for THR seem to be far more predictable. I'm struggling to understand why the surgeon who does arthroscopies and THRs (who is the expert after all) wouldn't recommend THR if it was the best option.

What proportion of people have positive stories about arthroscopy for FAI? I am concerned that anecdotal histories on the internet seem to be far less upbeat than the research published by surgeons, who I fear have a vested interest in promoting arthroscopy as that is their trade.

I'm wondering how to reconcile your advice with the advice of the surgeons. I will talk it through with my physio on Monday.

Ultimately, I am resolved to give something a try to escape my limbo of enforced inactivity.

Thank you all again.
 

Pumpkln

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I have a labral tear, and mild arthritis in the hip joint.
I opted to have a steroid injection a year and a half ago, do core strengthening and stretching which is keeping the groin pain at bay.
I was given the option of a labral repair.
In discussion with my surgeon about the mild arthritis progressing and needing a THR eventually, I will have a THR when I am ready.

If you have arthritis in your hip joint, you might want to consider a THR.
 
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waddler

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Hi @Pumpkln

Thanks for your input.

Did you have any impingements identified in your hip?

Also did the injection make a significant difference to your pain level?

What would your plan be if/when the pain returns?
 
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Jaycey

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@waddler Conroy is indeed one of the best in this area. We are not disputing his recommendation. We are only giving you input based on what we see here in the forum.

Your PT is right - arthroscopy outcomes are very unpredictable. But then no procedure is predictable. We have no idea how you will react to surgery.
I'm struggling to understand why the surgeon who does arthroscopies and THRs (who is the expert after all) wouldn't recommend THR if it was the best option.
He may indeed think this is the best option for you. After all, he has seen the x-ray and analysed the extent of damage that would need repairing.
What proportion of people have positive stories about arthroscopy for FAI?
The nature of a forum like this means we probably see a greater degree of dissatisfaction. Those who have a good result might post just after their procedure and then go off and live life again. Those members with a problem will stay to get the support they need.

Ultimately the decision is yours. It does sound like Conroy has given you a realistic expectation of recovery - something that is very often missing for arthroscopic patients.

Please keep us updated!
 
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waddler

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Thanks @Jaycey. Everything you say make sense. I think I'm going to ask Mr Conroy again why he recommends arthroscopy over THR. I will feed back to the forum, as I think this might help others navigate this confusing path.
 

Pumpkln

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Did you have any impingements identified in your hip?
I would have to go back and look at the report, I think there was a cam impingement.
Also did the injection make a significant difference to your pain level?
Yes, I had the injection 18 months ago.
What would your plan be if/when the pain returns?
When the pain returns I stretch and do core stabilization exercises, it goes away. I need to do these exercises and stretching every other day. They are part of my exercise routine.

If the stretching and core stabilization exercises no longer work I will have a discussion with my surgeon, and see how the arthritis is progressing. I would probably have another injection, if it works good, if not a THR would be indicated.
It is a hard decision to make, you have to look at all your options and decide what is best for you and your hip.
Write down all your options pros and cons, it may help you see what the best option is for you.
 

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