Femoroacetabular impingement or FAI is a condition of too much friction in the hip joint. Basically, the ball (femoral head) and socket rub abnormally creating damage to the hip joint. In my case, there was extra bone on my spherical head of my femur bone (it is called the neck of the femur bone) (larger than the size of a chickpea) that was tearing away at my hip socket. In fact, when my surgeon Dr. Parvizi went inside, he said my extra bone area was larger than the MRI images projected. Also, if I understand this right, at the time of surgery I had two surgical screws inserted inside me for holding my formerly torn labrum in place that disintegrated with time. I had a large cyst on my cartilage removed as well. Luckily, Dr. Parvizi found no serious cartilage damage - he smoothed out the mild cartridge damage and I have now have a smooth hip acetabulum and femur head region in my right hip. I count my blessings that I found out what was wrong in about 8 months. I have FAI in my left hip too, but I do not feel a thing. Dr. Parvizi hopes my left hip will not become an issue because I have a lot2 of joint space and my left leg is not my dominant one.
I am a 34 year old male that has been running, bicycling, and swing dancing at various levels of intensity for 18 years including competitive. Nevertheless, I believe this condition congenital - (thanks mom - thanks dad) - I was born with it. I guess that my outdoor activity levels were so high that my FAI came out on my early 30's instead of my mid-50's. I suppose a really sedentary person may never be diagnosed with it. I did a lot of roller skating and I played some soccer before I was twelve - I guess I could have done this myself at a young age, but it's more fun to blame mom and dad.
First off, let me say that I never knew how serious my condition was until I got my official diagnosis in May 2010. Signs of my condition started in August 2009 during marathon training. I saw a Penn Sports medicine doctor who told me to take a couple weeks off the training. It made sense to me - more mileage than I ever ran, I've probably tightened my sacroiliac joint. I was given a list of stretches and the symptoms subsided a bit. I continued training for the marathon - I won a 25K road race during the early stages of my condition. It was still just a major irritant at this time. I ran a great marathon four weeks later (2:59:10). I remember saying to myself afterwards that maybe I finally strengthened the weak muscle that was causing the pain because I could barely feel the mysterious pain after the Philadelphia Marathon. One week or so later I tried to ride my bike feeling optimistic that this mysterious pain was abating. I tore my hip open again on the bike (although I did not know what was wrong at the time) while commuting a mile to work. This one event made me give up bike riding. A week or so later, I went to my gym to do some easy miles on the elliptical machine. I tore my hip socket open again. I did not know the pain was coming from tearing inside my hip at this time. I avoided the elliptical machine. Ultimately I checked myself into physical therapy. By time I started physical therapy in January 2010, I had stopped biking and running all together. My physical therapists knew I had a lot of strength, and they could not figure out what was wrong. They thought it could be nerve damage. I found swimming the only sport I could do comfortably with my FAI condition. After a couple of months of what seemed like up and downs my physical therapists sent me to another sports medicine specialist, the British born Dr. Maenpaa. He gave me hope, telling me he seen worse and we would get to the bottom of it. I had some x-rays done. I found out I had leg length discrepancy and Dr. Maenpaa sent me to get orthotics from the Philadelphia Eagles and 76ers professional sports teams specialist. I admit, the orthotics helped a bit with my FAI symptoms. On Easter I did some short dashes chasing my niece making me think my body was getting better. However, that evening my hopes were dashed due to the burning in my hip, groin, and gluteus on my right side. Eventually, my third visit to Dr. Maenpaa led him to request an MRI which revealed the problem. As far as I know, everyone has to get an MRI of their hip to check for tears. Basically, the medical staff put a numbing agent with another type of fluid in my hip that increased its visibility. I told the MRI doctor right at that time that my pain seemed to have stopped, but I could not even believe it myself at that time. He told me there was definitely something wrong with my hip if the numbing agent was removing my pain. A week later, it was confirmed. My MRI report said, "Complex tear of the labrum, symptoms consistent with those of cam type impingement of FAI." Dr. Maenpaa recommended I take cortisone shots and wait as long as possible until the surgery was mature (FAI has only been diagnosed and performed in the past 10 years). After a couple weeks of discussing my options with myself and my various mentors, I decided that I'm young and I don't want to lead a sedentary lifestyle and this is the best chance I have to control my fate.
My pain started in the right side of my lower back. I remember telling a co-worker that it spread to the front, which was my hip and groin. I would say it typically was 2-3 out of 10 on a pain scale. Eventually, I could flare my pain up to a 8-9 when I rode a bike, but not every time I was on a bike. Sometimes I would have some mild pain. I tried to run 3 miles near the end of my 2 months of physical therapy. My hip, groin and lower back all burned with pain for several hours after I stopped. My pain was bearable while I ran, but when I stopped, I will never forget it.
I had a simple choice: Get busy living or get busy dying. I could try cortisone shots hoping the steroid wouldn't destroy my bones as I tore more of my hip apart or I could have the relatively new surgery to try my chances at what may be a full recovery. It became simple for me the more my mind coaxed over it: Nothing ventured - nothing gained.
I put together this web page to give you meaningful information about my FAI recovery. I felt like I could not find any resources or blogs that truly explained what FAI recovery might be like. FAI was a mystery to me - a condition I never heard of any human being ever having. Being physically healthy means everything to me. Health is wealth! I am an anxious person, so every setback I had was communicated in my weekly thoughts below. When I felt a hip/groin/or back pain, I generally stopped all activity until I was pain-free. Eventually, after seeing Dr. Parvizi for a checkup after 6 1/2 months, he told me to push through the remaining pain and do my lunges. I recovered to be able to run outdoor mileage again much more quickly. Nevertheless, all the physical therapists I saw said, 'let pain be your guide.' If I was not so afraid of hurting my hip, I believe I could have recovered more quickly. Nevertheless, I am back to pre-FAI normal. I hope your own journey through FAI recovery goes quicker and less stressfully than my own. All the best - Allen!
I felt better than I expected. I spent one night in the hospital, mainly to recover from the anesthesia. My overnight stay in the Bucks County Specialty hospital was a pleasurable experience. I found the staff wonderful and attentive. I felt quite good on the Endromorphine they treated me with on-site. My pain was 1 or a 2 maybe overall. When you get in the car for the ride home from the hospital, that's when your recovery condition really hits you. Nevertheless, when I came home and went on weaker medicines, the real pain started!
My surgeon performed osteoplasty on my femur bone making it spherical shaped. He said there was more bone that needed to be removed than my MRI showed. He removed a big cyst that had formed in my right hip joint. Also, he sewed my labrum back together and held it in place with two surgical screws which should disintegrate with time. [edit three years later] I have two metal surgical screws holding my labrum in place. They were detected by security in my airport recently. Also, my MRI doctor in February 2013 told me they were there when an imaging scan had some trouble with pictures in that area.
During the first week or so, I felt burning pain in the center to the right center of my thigh near the right hip. Also, I feel pain my my left knee, left tricep, and right calf from compensating for keeping weight on my left. My pain continued to change with time. During the third week, most of my pain is in the lumbar section of my back and occasional sharp shooting pain near the incision area of my hip.
I had a mostly arthroscopic procedure. My incision starts about one inch below my underwear line. It is 2 1/2 inches long. My external stitches naturally decayed probably within 2 weeks. (I never examined my external stitches. When I took off the dressing from the hospital after 2 1/2 weeks, my stitches were gone). My internal labrum stitches will naturally deteriorate.
My recovery plan is NOT what my surgeon alluded to before surgery, but I do not mind. I have only one chance to heal right... I have six weeks of complete rest, but I can walk on crutches as much as I can tolerate.
Without health insurance, here are the costs of my CAM impingement/labral tear surgery in the Philadelphia, PA metropolitan area below:
My body was getting really fed up by my new muscle uses by this time. My foot turned blue once from lack of movement. My hip started hurting more because I assume it was healing. I found week 2 harder than week one. I'm a little bit more flexible than last week. I have been waking up from the pain sometimes at night. I hope it's healing! I could not imagine going through this without the support of my wife. Please consider temporarily moving in with someone who has a lot of patience with you if you live alone.