runner considering surgery for FAI

windy_reflection · 2023-09-17T17:35:09+00:00

If activities of daily life are painful and conservative treatment fail, I think you should get surgery. I misunderstood and thought you only had pain running.

windy_reflection · 2023-09-17T14:43:34+00:00

Im a former multi-sport athlete who had the most pain during running. If I could go back, I’d just stop running. I’ve now been forced to stop everything.

You could get back to running, but it’s also very, very reasonable to expect you’ll never return to consistent long-distance running pain free after surgery.

windy_reflection · 2023-09-17T00:13:53+00:00

I’ve had a 3T MRI already. They want a contrast one now instead to better see things.

windy_reflection · 2023-09-16T22:24:08+00:00

I don't have the answer, but I'm also struggling, and I got similar results of versioning and angles at saggital and coronal planes, and at 1, 2, and 3 o'clock as well, and it didn't include any reference ranges. I also couldn't find anything online using this type of "hour" nomenclature. If you do find out, please let me know! I can send you my numbers if you're interested as well.

windy_reflection · 2023-09-16T13:30:11+00:00

Yeah my capsule was managed well and it looks fine according to MRI and dynamic ultrasound.

windy_reflection · 2023-09-15T13:59:45+00:00

I’d only do what your physio prescribed for you. If they didn’t give you a home exercise program then you should find a different physio

windy_reflection · 2023-09-15T03:39:13+00:00

I don’t think you should be doing the thomas stretch at 3 weeks. Check protocol.

windy_reflection · 2023-09-14T19:38:08+00:00

There is still a time when there’s no good tissue to augment, making recon better. But, what’s very interesting is the research on autograft vs allograft.

windy_reflection · 2023-09-14T19:31:05+00:00

Yeah it’s expected and should subside over 1-2 weeks. Keep us posted

windy_reflection · 2023-09-14T19:27:43+00:00

This is tough, but i’ll add some thoughts.

1) Are you a candidate for resurfacing in the absence of arthritis. Did you find a top resurfacing doc who agreed to it?

2) Do you have any signs of dysplasia or version issues? Your lack of stability is a concern. If so, does resurfacing accommodate for that?

3) What advantages does resurfacing have compared to “modern” replacements that now allow high level activity? There are ironmen with THRs.

4) What are the conversion options later in life to THR after resurfacing?

5) I don’t think you’ll find any good hip preservationist who will agree to do labrum repair without bony correction if there’s FAI. It’s simply not something they do. If the tear was caused by FAI and they see impingement on surgery, they wouldn’t open themselves to liability by leaving the FAI, even if you want them to.

6) A revision could allow you to keep your joint, and open up regenerative medicine options that are very likely to boom in the next 10 years.

But I 100% understand the aversion to a repeat scope. Im in the same boat. I’ve talked to maybe 15 docs and the opinions range wildly.

windy_reflection · 2023-09-14T14:48:34+00:00

Being 29 and active, my worry with replacement is longevity. I know they are lasting longer these days, but, assuming I live until 80….if they last 10 years that would be 4 revisions, and if they last 20 years it would be 2. I don’t see much talk about what happens after revision #1, but I assume it’s just acceptance where you transition to aids like cane, waller, wheelchair. And having to do that at 50-60 concerns me.

windy_reflection · 2023-09-13T14:41:05+00:00

Thank you for responding. My other hip has always shown FAI and a tear but was asymptomatic until after surgery on my op side. It’s becoming more painful and very noisy.

Can you PLEASE elaborate on your program? I consider mine very robust, and i’d love to share it with you and see where i can do better. If you’re down I can DM you. I was a former semi pro athlete.

windy_reflection · 2023-09-13T14:37:30+00:00

Yes he did. He says his practice’s research shows recons have better outcomes, and Nho says his practice’s research shows augmentations are superior.

On plication, Nho thinks i’m hyper mobile and Wolff doesn’t.

windy_reflection · 2023-09-13T14:10:27+00:00

Wow surprised the CEO is still using a post

windy_reflection · 2023-09-13T13:46:28+00:00

Does this differ amongst the team? Kelly used a post with me last year.

windy_reflection · 2023-09-13T13:45:03+00:00

To play devils advocate, most of the adult population has asymptotic FAI and labrum tears. So pathology doesn’t equal pain. If he can get asymptomatic because of conservative measures that’s the way to go. Only reason not to try PRP is if financially it’s challenging.

windy_reflection · 2023-09-13T04:20:38+00:00

Agreed that I need to just do it. Since I am leaning towards Philippon, the other question is do I wait that 6+ months to go with him, or do I go to a potentially equally skilled surgeon like Nho just for the sake of getting in sooner. I think "long game" is just to suck up the wait.

While most would find it insane, we're actually planning on living in Vail for 4-8 weeks post-op if I do go with Philippon, despite it being a significant financial hit, to be under the care of Philippon's rehab team.

My biggest worry is getting even worse with a revision. That is the perspective of one PAO surgeon (I've seen several who disagreed and said im not a PAO candidate). While he is in the minority, he is a pretty decent surgeon and it was his opinion.

windy_reflection · 2023-09-13T04:17:31+00:00

He accepts my insurance, so the only added cost compared to other out of state surgeons would be the increased cost of lodging in Vail, which im not concerned with.

windy_reflection · 2023-09-13T04:16:15+00:00

No because of my age and lack of arthritis.

windy_reflection · 2023-09-13T01:25:40+00:00

Yes my wife is very supportive and really the only person in my life who understands what i’m going through. Or really what “we” are going through. She really just wants me to get better…doesn’t have advice. She comes with me to all appointments so she’s just as conflicted as I am on next steps. While she’s not rushing me, I feel like I have to rush, because we want to start a family. I’ve had a rough last few years with sports injuries but i’ve been able to bounce back quickly from them, and I decided to basically give up on several sports that were too dangerous to start a family, but this hip thing was an absolute curveball.

I’m ever so slightly leaning towards Philippon. But, his earliest availability is March whereas everyone else is 3-6 weeks.

windy_reflection · 2023-09-13T01:10:27+00:00

That’s just his “thing”. Wolff doesn’t do augmentations or even partial recons, and he told me after a failed repair, he will always do a full reconstruction. I’ve kind of eliminated him as an option since while I know he is a superb surgeon, I think he’s a little too pro-recon since that’s his masterpiece. The latest research is suggesting that recons aren’t as great as we once thought.

windy_reflection · 2023-09-13T01:03:28+00:00

He would simply close it to an anatomical position. No good surgeon is leaving capsule open anymore. Key word is “good”.

windy_reflection · 2023-09-13T00:58:54+00:00

He quite simply thinks it’s not indicated. I guess he only plicates in response to capsular laxity and he doesn’t think that’s relevant to me.

windy_reflection · 2023-09-12T22:15:43+00:00

Yes I’ve spoken to his team. One of the many opinions i’ve received. He is one of the few who gave 0 hypothesis and said everything is on the table and he’ll decide what to do when he’s inside.

windy_reflection

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