FAI / Labral tears...PLEASE HELP

I've had both hips worked on for FAI (CAM-type) w/labral tears. It took me over a year to get diagnosed as this was back in 2006/2007, and it wasn't as commonly known at that point.

1. I had my first hip worked on in February 2008 at the age of 28. I was back racing in the Fall of 2008, and ran a 4:17 indoor mile (with 3 or 4 other 4:19/4:20s), 1:09 half-marathon, and a 2:34 (disappointing performance for me) at Boston, all within a couple of months of one another in February-April 2009. (Nick Willis had this surgery as well, and he made a full recovery.)

I had the other hip done in July 2010 (30 years old, going on 31). I was back running 100 miles/week by January 2011. I ran into an ankle issue that required a much more serious surgery and recovery, and I've actually just gotten back into racing again this year. If it hadn't been for the ankle problem, I would have been back racing at the same level as pre-surgery in Winter/Spring 2011.

Return to full recovery (and when) is dependent on the amount of damage the ortho finds in the hip when he/she gets in there.

2. Outpatient procedure, general anesthesia. Both operations lasted about 90 minutes each, but tack on an hour or two before hand for sitting around and prep, and another hour or two after you wake up before you go home. I had arthroscopic surgery both times. If it's a more complex surgery and they have to perform an open surgery, you'd be in the hospital for a few days. Most cases are arthroscopic. As for scarring, I have a few tiny little scars on the side of each hips. Smaller than the size of a dime to start with, now they've faded and are even smaller. The ankle scar - that's a different story!

Pain is not that bad. The worst is the first night/second day, when the heavy drugs have worn off. They'll give you something like percocets to take for a week or so. I only needed them for a few days before transitioning completely to ibuprofen. Listen to the doctor when he tells you to stay ahead of the pain (i.e., start taking the percs BEFORE the stuff they gave you in surgery wears off). It's really not that bad at all.

3. There's no way to rehab FAI without surgery. The longer you wait, the more likely you'll have arthritis in the hip. The hope of FAI correction to delay or hopefully prevent the need for a hip replacement down the line. There's no way around surgery.

If you have any additional questions, feel free to leave an email address in this thread and I'll write you back.

Good luck! Life is so much better once you've recovered from the surgery. I have fully functioning hips for the first time in my life!

I've had to deal with FAI issues twice, I have it in both hips. The first time the orthopedic surgeon I spoke with couldn't wait to open me up and operate. I was a little concerned with how little he addressed other options. (The second time I saw him, 3 years later, he told me surgery isn't a guaranteed fix and seemed very hesitant)

I opted for physical therapy first and spent 6 months strengthening my adductors and abductors (I can't believe how weak they actually were) and after 2 or 3 months I was able to run pain free again and build back up. It's been three and a half years and no problems in that side of the hip.

The second time was the other side, it took months and an MRI with contrast to figure out I had a torn labrum. I went to the best hip specialist I could find out here. She recommended a cortisone shot first and said it resolves pain in 75% of cases. The cortisone worked, after a week or two. Inflammation went down and I've been running mostly pain free for a year and am back in PR shape. I also committed to my PT exercises and strengthening and stretching my hips. I still have a torn labrum, but it's actually very common, most people just don't know they've torn theirs. It doesn't hurt anymore.

The downside is, unless you have the surgery you're always going to have FAI. They can't fix it without shaving the bone. The surgeon told me it's a toss up when it comes to runners, because if they don't shave it absolutely perfectly, all the stress and forces from running will cause issues. She said it's not a F to an A, it's usually an F to a B or C. We'll still have to deal with a high possibility of arthritis, even after the surgery. It's a lot of downtime if you're going to have both hips done (they don't do them at the same time).

Good luck!

Wow...thanks guys. Two great, detailed responses, but very different approaches.

My ortho told me that my left side FAI is "moderate" and the right side is "slight." The MRIs also revealed a pelvic stress fracture, which my ortho said was due to FAI issues compounded with weak glutes and adductors. He said it's possible the pain has been from the stress fractures and not labral tears, but he seemed confident that the MRA was going to show them.

Do you think that if by some miracle I DON'T have torn labrums, I could PT my way out of this mess?

20 Second PR makes some great points. If you're able to rehab your way around surgery, and you can get back to running by doing so, go for it.

The issue is less the torn labrums and more the impingements (the underlying structural issue causing the tears, and subsequent cartilage damage). I tried formal PT and rehabbing before both surgeries, and I simply could not run without having the surgeries. In my case, I went from an F to a A+ (no running to better than ever). My hips have been amazing 6 years after my first surgery.

Whether you end up going down the road to surgery, or rehabbing, do one VERY IMPORTANT thing. Find an orthopedic surgeon who is 1) extremely familiar with FAI, and 2) deals with athletes. That is critical. I had one of the top FAI guys in Massachusetts, who also happened to be the chief of sports medicine, a division 1 athlete himself back in the day, and the doctor for several major sports teams. He understood that I wanted to race again. At all times in the process, he was working to get me back to my prior level of running/racing.

Once again, thank you for the response.

What kind of pain did you have before surgery? How many weeks of zero activity were required after surgery? I've been very fortunate to have only had two injuries that required significant time off in 18 years of running, but both times I was able to cross train and came back possibly more fit than pre-injury. The idea of taking several weeks off is daunting to say the least.

As far as the list in your final paragraph, my doctor is covered on all fronts. He's also the team orthopedic surgeon for two professional sports teams (NFL and MLS).

Best of luck to you.

As a side note, why are people hesitant to name the names of good doctors on this site? I think it would be helpful to others who are in your same situation, of which I am sure there are many.

I assume you're talking about Dr. Philippon?

Thanks.

FAI \ labral tears have the potential to be justa red herring

Ask your surgeon on the prevalence of FAI \ labral tears in the asymptomatic population.

Also ask your surgeon regarding the long term outcomes following this procedure.

Surgeons love this procedure as it is relatively quick, easy and appears to address a structual anomoly (although on mri it is more common to have these findings than not in a symptomatic population.) The science behind the thinking of these procedures though currently does not stack up.

Hey-Ii'm a female distance runner who is 4 weeks post op from FAI and labral repair from the amazing Dr.Philippon. It took 7 years for me to get properly diagnosed. 10 plus MRI's, 100 physios and 30+ docs later I'm finally on the mend tag and to Dr. Philippon being so proactive w/me. I had my 11th MRI in January. The radiologists and general ortho docs had missed the reading all along. Dr. P saw it right away and I was booked for surgery 4 weeks later.

I have it on the other side as well. I go in for hip 2 on June 30. Don't waste anytime w/mucking around w/ pt's trying to fix u. I did it for 7 years and as soon as I'd hit big training volumes I'd fall apart. The labrum doesn't repair itself and as long as you are active w/out getting surgery you are putting yourself at risk for osteoarthritis later in life.

I missed 7 years of competitive running. Was on top of my running career before falling apart w/this hip debacle. 15:20, 32:09 twin cities marathon champ. Etc etc. the first few days after surgery are the worst. After that you are progressing quickly.

Any other ? Just contact me. Happy to help anyone out dealing w/this as I know first hand how frustrating if can be.

34545 wrote:

Best of luck to you.

As a side note, why are people hesitant to name the names of good doctors on this site? I think it would be helpful to others who are in your same situation, of which I am sure there are many.

I assume you're talking about Dr. Philippon?

Thanks.

I've named him several times on this site. Dr. Brian Busconi. UMASS Memorial in Worcester, MA.

I think the moral of this tale is, don't neglect your glutes and adductors.

Good luck with your recovery.

I'm sorry you had to deal with this issue for so long, especially considering how fast you are. Your situation makes the 10 months I've been dealing with this not seem so bad. Do you have an email address I can contact?

Agreed.To often runners jump into having surgery instead of dealing with injuries conservatively. Many will argue that without the surgery they are more predisposed to further degeneration/arthritis/pain but this is not exactly the case.The evidence now suggests that most adults the OP's age have clinical labral tears. We now understand this to be NORMAL in adults (even young adults). In fact surgery could predispose you to a worse long term prognosis. So when should you consider surgery? The OP hasn't given enough info but surgery should only be considered if you have locking/decreased range of motion in the hip/with or without significant pain. Long story short, I would avoid the surgery at all costs. Take off for running for a while (maybe even a year, oh my!) and perhaps your body will thank you later.

6666ttt5rddfghbh wrote:

FAI labral tears have the potential to be justa red herring

Ask your surgeon on the prevalence of FAI labral tears in the asymptomatic population.

Also ask your surgeon regarding the long term outcomes following this procedure.

Surgeons love this procedure as it is relatively quick, easy and appears to address a structual anomoly (although on mri it is more common to have these findings than not in a symptomatic population.) The science behind the thinking of these procedures though currently does not stack up.

I've been emailing/speaking to numerous people over the weekend who have dealt with this issue, and it's an almost 50/50 split between pro-surgery and anti-surgery for FAI. Several people have told me that since I don't have constant pain, I should seek non-surgical treatment. Others have said that there is no way around it.

I've been sent this article by three different people...it's a little old, though:

I have had runners with FAI where the orthos themselves say don't do surgery. If you have just a tear, success is much higher post surgical than if you have a tear with cartilage damage. I wouldn't have one if I had cartilage damage but probably would for just the labral tear. You can ask your ortho if your hop shows signs of damage to the cartilage.

One more thing...all this talk about "renowned" specialists is absurd. As long as you have the same procedure, you will get the same surgery. I have had 2 patients who flew out to see Dr. Phillipon and both failed with his surgery. Just saying... oh, and physicians often pay money to get recognized as team physicians in pro sports.

Haven't had time to read your article, but I will later, and this is a rushed reply.

Again I will say that you should try to avoid the surgery unless you have locking or constant significant pain, as the current evidence suggests that the long term prognosis is the SAME whether you have surgery or not.

HOWEVER, it could be argued (and very well might be true) that there may be some type of placebo effect with this surgery. So it's not to say that people do not benefit but it's probably not because they are actually benefiting from repairing the labrum....

For example, most runners do not take off significant time off of exercise when they get hurt. But for this surgery you have a 10-12 WEEK!!! rehab period where you are forced to stay off your legs. We don't know if the surgery or the time off of an individuals feet is the reason for success. And there are many other similar factors to consider.

But again to the OP, unless you have locking/decreased ROM/significant pain I would suggest you reconsider. And as some have suggested, surgeons will always be there to perform a surgery/ take your money if you want later.

Also for motivation Mo Farah has a labral tear in his hip but he has avoided surgery and it doesn't seem to stop him :)

Anyone else have experience with this injury?

Had surgery on one hip, made full recovery. Fairly long rehab but definitely worth it. Ask yourself if you're willing to risk arthritis to try to limp through another few years of running and doing PT.

Kliner wrote:

Anyone else have experience with this injury?

I just had surgery to repair my labrum last week, and immediately post-op felt better. I'd had significant pain for years, that suddenly culminated in excruciating pinching pain.

For those with questions about post-op, many people complain of severe pain, but in my experience it was not bad at all; I did not need anything for pain.

I can't speak to long-term success, but my pain was too great with running and walking to consider not treating the tear. So I took my chances. I started PT to rehab today and felt fabulous; ROM good to excellent; strength excellent; pain nonexistent.

My question to others who've had the procedure: Did the pain get worse when you returned to weight-bearing? I'm only a week post-op, so I have two more weeks of babying this thing.

Hey Kilner,

sorry, I've been MIA. Just had hip #2 done. Here is my email. Feel free to message me anytime with any questions!!! Hip #2 has proven to be rehabbing even quicker then hip #1 if you need encouragement.

nicaish@icloud.com