Femoroacetabular Impingement Syndrome

Just a little life update!

For those who follow me on instagram, you probably know that I ended up having hip surgery recently after tearing my labrum. Crazy when you consider the fact that I’m only 26 and in-shape(ish). I’ve run half marathons (x4), rode my Peloton every day (almost) in June, and generally tried to move my body some way every day. Ultimately, a lot of it was do to an abnormality I had – Femorocacetabular Impingement Syndrome (FAI) – which of course I didn’t find out about until after the fact.

What is FAI?

Femorocacetabular Impingement Syndrome is not a super well understood condition in terms of why it happens, but it is abnormal contact, especially with range of motion (ROM), between the femur (ball) and acetabulum (socket) that leads to degeneration, injury to the labrum, and long term – arthritis. There are three different kinds of FAI:

1. Cam – the neck and/or head of the femur is abnormally broad, which causes cartilage degeneration and separation of the labrum. this occurs more commonly in young healthy males
2. Pincer – the acetabular bone/labrum overhang is too broad, which causes impingement when the femoral neck moves, and crushes the labrum. this occurs more commonly in middle-age, active females.
3. Combined Cam/Pincer – a combination of the two – in up to 80% of patients

A lot of times, people can be totally asymptomatic with this condition, until they’re not. Symptoms most commonly include groin vs hip pain, exacerbated with flexion (like difficulty sitting), mechanical clicking/popping, and even gluteal pain (from changes to their gait). Pain can be insidious in onset, until there is some sort of acute event that worsens pain

My Story:

For the last 3-4 years, I’ve been having this intermittent pain in my left hip. It was worse with running long distances, sitting for long periods of time, and felt like it was deep in my hip. Yet it went away just as easily as it came, and so I put it out of my mind, and made some adjustments to the kind of exercise I was doing. When I got my Peloton earlier this year, I had some initial worries it would exacerbate my pain, but I ended up having no problems cycling and really feel in love with it.

Then July 6th, I was cycling, transitioning from third position down to first (standing to sitting) and can only assume I was slightly off balance. I felt/heard a pop, and the rest is history. I started experiencing a much more constant, intense left sided hip pain. Everything I did bothered it, from sitting to lying down to standing and walking. I felt like I had this burning/pulling sensation deep in my groin. This was me tearing my labrum.

Of course, being an EM PA, I tried to diagnose myself. Went through and did the Anterior Labral Tear Test (this is a great video on it). Forced my significant other to repeat the test several times because I was insistent he was doing it wrong. Ultimately ended up going for an MRI – which did not show the tear, but a large portion of tears are missed on traditional MRIs and would need MR Arthogram (which involves injecting of contrast into the joint to better highlight the soft tissue). However, my orthopedic surgeon felt confident I had one based on my physical exam, and then also ended up diagnosing me with mild hip dysplasia.

What is hip dysplasia?

Most simply put, hip dysplasia is where the socket aspect (acetabulum) is more shallow, leaving not as good of a connection between the ball (femoral head) and the socket. This leads to hip instability, hyper flexibility, and can also cause long term problems like labrum tears. Hip dysplasia is tested for in infants as part of the infant physical exam, but more mild cases can easily be missed (like mine). As someone who had two shoulder surgeries in high school for hyper-laxity of their joints, it made a lot of sense. Also explains why I was so good at swimming and why when I ran long distance I felt like my left hip was going to dislocate.

The plan

Ultimately, my orthopedist recommended trialing physical therapy for at least 6 weeks prior to re-visiting the topic of surgery given my hip dysplasia. It put me at an increased risk of having my surgery fail – ie leaving me in more pain than what I started out at. Since they would have open my hip capsule in order to fix my labrum tear, there was concern it would leave my hip more unstable which could cause me to have more pain.

Unfortunately, things didn’t end up going exactly according to plan. I religiously went to PT and did my home exercises, but ended up just being in more pain as time went by, so I went back to my orthopedist and was scheduled for surgery.

Why did I chose to go through with surgery if it could fail?

Personally, I felt confident that my pain was coming from my FAI and labrum tear as opposed to my capsule instability. I did a lot of reading in regards to the signs and symptoms of FAI (perks of being a PA and having access to medical literature), and felt that I met a lot of the standard findings. I knew that I didn’t have the same kind of pain in my right hip which had signs of instability as well. I also could pinpoint the day that my injury happened and felt comfortable saying I felt like my acute pain was coming from the tear. And I had already had success with two shoulder labrum repairs (right then left) and so felt like I would benefit and not have more instability. For me personally, I felt like the benefits outweighed the risk of possible failure and I was willing to try!

So, while it’s still early to tell, but I’m hopeful to have a lot of relief from the surgery!

-ER