Upcoming Hip Arthroscopy

[BadAngle41]

Having finished up the competitive season, it's finally time to get some things fixed. Before I go into what I'm having done and all the medical jargon let me describe what I was feeling...

• Significant reduced range of motion in my left hip (like there is a doorstop keeping me from outward extension/rotation)
• Increased soreness in my left knee (worth noting is that I have had an ACL reconstruction and scoping to remove radial tears to the medial meniscus in this knee)
• Increased soreness in my left ankle and a more pronounced "pigeon toe"

I had gone to an ortho who had most recently scoped my right knee which also had some radial medial meniscus tears about 18 months ago, who suggested some physical therapy after viewing some xrays. Didn't help at all and I just wasn't confident in their understanding of what I was feeling. They kept focusing on my knees and I just knew that wasn't the issue. So I went to another ortho group for a second opinion. After more initial xrays, an MRI, and yet one last round of xrays... met with a surgeon who walked me through this batch of imaging. Turns out my doorstop analogy for what I was feeling was correct. Knee and ankle soreness were (as I tried to tell the first ortho) the result of over compensating for the lack of hip movement.

Turns out I have what is called a Combined Femoroacetabular Impingement. Essentially I have issues w/ both the ball and the socket in my hip. Largely a genetic predisposition, having been athletically inclined most of my life I have had more wear and tear on the location as well as an increased awareness of body. I have enough labrum to make hip arthroscopy a viable option to extend the time before I will have to do inevitable... full hip replacements. I mean I'm only 39. The right side has signs of the same issue, but has yet to be a problem so we'll let sleeping dogs lie until we have to address it. My biggest concern and reason for being aggressive in choosing a surgical treatment is that I'm hyper aware of muscle imbalances and the issues they can cause if left unaddressed. I want to fend off any issues and retrain my hip to do hip work, and not continue to allow my knees and pelvis to make up for a bad hip. Anyway, I just wanted to throw this out there for anyone else who may be having similar symptoms. Links below to general information. If anyone else has had this done... share your experience.

https://www.orthoinfo.org/en/diseases--conditions/femoroacetabular-impingement/

https://www.orthoinfo.org/en/treatment/hip-arthroscopy/

[SaveByRichter35]

Fuck.  I've been having a similar problem with my right hip, with pain also developing in my right knee.  I've been experiencing radiating pain when at rest and a sharp pain when in motion, with some movements, not all movement.  Sitting down into my car and getting up out of it, bending straight down and then pushing back up, etc.  It kept me out of my playoff game over the weekend.  Worst part is I have no idea how it even happen.  I don't recall doing anything that made me all of a sudden think "wow that hurt."  Strangely enough I don't even remember when I started to feel it.  I know it was after Easter weekend, sometime last week.  It actually woke me up in the middle of the night last night.  Tossed for almost an hour before I finally decided to take some Aleve.  I was hoping it would go away on its own but so far it has not subsided any.  Guess I should call a Dr and get it looked at.

[BadAngle41]

19 minutes ago, SaveByRichter35 said:

Fuck.  I've been having a similar problem with my right hip, with pain also developing in my right knee.  I've been experiencing radiating pain when at rest and a sharp pain when in motion, with some movements, not all movement.  Sitting down into my car and getting up out of it, bending straight down and then pushing back up, etc.  It kept me out of my playoff game over the weekend.  Worst part is I have no idea how it even happen.  I don't recall doing anything that made me all of a sudden think "wow that hurt."  Strangely enough I don't even remember when I started to feel it.  I know it was after Easter weekend, sometime last week.  It actually woke me up in the middle of the night last night.  Tossed for almost an hour before I finally decided to take some Aleve.  I was hoping it would go away on its own but so far it has not subsided any.  Guess I should call a Dr and get it looked at.

Very similar situation to the discomfort I've been experiencing. Long periods of rest (sleeping or sitting at my desk) make it real stiff... and activities like hockey tend to give me more sharp pain. It wasn't caused by a single impact or anything... just occurred over time.Per the surgeon I'll be using, the procedure should take what could be a 6-8 on the pain scale during activities down to a more dull 2-4... and take the 2-4 from rest to a relative 0. Again, it's just buying time for a full replacement... but i just need it to function better to avoid creating other problems. Worth getting it checked out. I waited quite a while and sorta wish I hadn't.

[Mroy31]

I've got combined FAI in my right hip and pincer in my left.  MRI and x-rays suggested it's not bad enough to recommend surgery over physio, since surgery can have it's own negative side effects.  I'll never be as bendy as Kiprusoff, but most of my issue is muscle imbalance.  Currently trying to undo quad dominance on the right side that makes it feel like my hip flexor is tight, but it's basically just the quad being so overworked for such a long time.  Also a slight nerve issue in the right side, contributing to glute activation issues.

My pain level is more like a 4-5 after hockey, not so much during hockey any more.  4 years ago I could barely play once/week.  It was so bad afterwards I was limping because the muscles around my right hip were just giving out, and spent the next 2 days before I could walk without feeling tight.  Now I'm good 2-3 times/week, with my limits more related to fitness.

[BadAngle41]

2 minutes ago, Mroy31 said:

I've got combined FAI in my right hip and pincer in my left.  MRI and x-rays suggested it's not bad enough to recommend surgery over physio, since surgery can have it's own negative side effects.  I'll never be as bendy as Kiprusoff, but most of my issue is muscle imbalance.  Currently trying to undo quad dominance on the right side that makes it feel like my hip flexor is tight, but it's basically just the quad being so overworked for such a long time.  Also a slight nerve issue in the right side, contributing to glute activation issues.

My pain level is more like a 4-5 after hockey, not so much during hockey any more.  4 years ago I could barely play once/week.  It was so bad afterwards I was limping because the muscles around my right hip were just giving out, and spent the next 2 days before I could walk without feeling tight.  Now I'm good 2-3 times/week, with my limits more related to fitness.

That's great physio has been working out!! Always better to try and solve it w/o having to go under the knife (and anesthesia.) Muscle imbalance is such a tough thing to adequately address on your own. Really does take a physio to help work through those. 

[Goalline]

BA41 - I had this type of operation done at HSS in NYC.  I had an FAI CAM I or II impingement (forget which one) and torn labrum on the left side.  They shaved down bone spur in the ball part of the socket and fixed up the tear.  I did not have the pincer issue.  In fact, i have the opposite of a pincer issue, which gives me good flare in the butterfly, but means that the muscles in my hips need to be extra strong.  At any rate, I stopped playing for about 5 years because of my hip / combined with being busy at work (i am in my low 30s now).  While i did not specifically have the related knee/ankle problems you mention, after that amount of time of not dealing with my hip, I did have significant muscle issues and general soreness on both sides.  For example, it was difficult to walk more than a half mile without everything getting inflamed and in pain.  Power was essentially being re-routed through my core/back/legs to work around the injury in the hip, and all of the muscles directly around the hip were weak.  Amazing how the body does this automatically.  I am now about 1 year post-opp and am back to playing (lightly) for several months now (which is a great feeling!), but not playing multiple times per week yet.  That is my goal over the next couple months.  I will say that the general soreness I had just from walking is now gone, and my lower back feels much better.  This part alone was worth it for me (I was also was in PT for about a year spanning both pre- and post-opp to strengthen everything up).  In terms of playing hockey, I am still working on my getting my game-to-game recovery time down, breaking down some of the scar tissue, etc.  This part has been slower than I expected in all honesty, and sometimes it is hard to remain optimistic, but you just have to keep at it and keep trusting your instincts.  Retraining the muscles to work properly has been a long road for me, but everyone is different.  There's definitely a spectrum of potential outcomes that is hard to predict when you're pre-operation.  Just don't go into it thinking you can recover like the pro's can in 3-4 months.  They have individual 1-1 PTs every day if they want/need it , all the equipment, massages, etc.  For what it's worth, early on, I did have another surgeon tell me that I needed a double hip replacement and that i should never play hockey again bc of my anatomy.  This was when I was in my mid 20s and turned out to be total BS.  I eventually found the right network of docs and the rest is history.  Always trust your instinct with this stuff and get multiple opinions until you are comfortable.  I am not a doctor, but based on your description of the issues and also my own experience, my opinion is that doing the operation will alleviate the other problems you are experiencing, and may buy you some years before the eventual replacement is needed (and, i hope for you, cause the replacement not to be needed at all!).  Good luck in your process and keep us all posted!  

[BadAngle41]

2 hours ago, Goalline said:

BA41 - I had this type of operation done at HSS in NYC.  I had an FAI CAM I or II impingement (forget which one) and torn labrum on the left side.  They shaved down bone spur in the ball part of the socket and fixed up the tear.  I did not have the pincer issue.  In fact, i have the opposite of a pincer issue, which gives me good flare in the butterfly, but means that the muscles in my hips need to be extra strong.  At any rate, I stopped playing for about 5 years because of my hip / combined with being busy at work (i am in my low 30s now).  While i did not specifically have the related knee/ankle problems you mention, after that amount of time of not dealing with my hip, I did have significant muscle issues and general soreness on both sides.  For example, it was difficult to walk more than a half mile without everything getting inflamed and in pain.  Power was essentially being re-routed through my core/back/legs to work around the injury in the hip, and all of the muscles directly around the hip were weak.  Amazing how the body does this automatically.  I am now about 1 year post-opp and am back to playing (lightly) for several months now (which is a great feeling!), but not playing multiple times per week yet.  That is my goal over the next couple months.  I will say that the general soreness I had just from walking is now gone, and my lower back feels much better.  This part alone was worth it for me (I was also was in PT for about a year spanning both pre- and post-opp to strengthen everything up).  In terms of playing hockey, I am still working on my getting my game-to-game recovery time down, breaking down some of the scar tissue, etc.  This part has been slower than I expected in all honesty, and sometimes it is hard to remain optimistic, but you just have to keep at it and keep trusting your instincts.  Retraining the muscles to work properly has been a long road for me, but everyone is different.  There's definitely a spectrum of potential outcomes that is hard to predict when you're pre-operation.  Just don't go into it thinking you can recover like the pro's can in 3-4 months.  They have individual 1-1 PTs every day if they want/need it , all the equipment, massages, etc.  For what it's worth, early on, I did have another surgeon tell me that I needed a double hip replacement and that i should never play hockey again bc of my anatomy.  This was when I was in my mid 20s and turned out to be total BS.  I eventually found the right network of docs and the rest is history.  Always trust your instinct with this stuff and get multiple opinions until you are comfortable.  I am not a doctor, but based on your description of the issues and also my own experience, my opinion is that doing the operation will alleviate the other problems you are experiencing, and may buy you some years before the eventual replacement is needed (and, i hope for you, cause the replacement not to be needed at all!).  Good luck in your process and keep us all posted!  

I appreciate you sharing your experience. The recovery piece is what I'm anxious to start. I was told an expected timeline would be 2 weeks on crutches... 3 months to feel "normal" in daily activities... and could be up to a year until I feel fully back to normal in athletics. As you mention the retraining of muscles will be the biggest focus and will take time. Of course I'll want to push that so I can get back and play ASAP... but i also have twins turning 3 in July and I want to make sure I take the time to heal properly so I can enjoy things w/ them. Canes are for old people and pimps... I'm neither.

[Goalline]

that seems fast, but i hope they are right!

[coopaloop1234]

Bummer to hear. Though at least you're getting it treated.

I'm mostly bummed you won't be able to show any sweet scars. two dots and a slit isn't exactly the manliest thing to show off at bars. (now if you were female...)

[Fullright]

Get better, BA.

[BadAngle41]

2 hours ago, Fullright said:

Get better, BA.

Thanks. I’m hoping to be back on the ice by August (or earlier.) Losing championships waits for no man. 

[bunnyman666]

Hope your upcoming surgery and recovery is swift and successful!!!!

[BadAngle41]

8 minutes ago, bunnyman666 said:

Hope your upcoming surgery and recovery is swift and successful!!!!

Thanks!! 10 days away now... anxious to get on the mend. 

[MTH]

You have a will?

Can you will me something? Anything. Old Sher-Wood stick in the garage will do.

I'm not a doctor or a comedian. But less dangerous for people if I try being funny.

[BadAngle41]

28 minutes ago, MTH said:

You have a will?

Can you will me something? Anything. Old Sher-Wood stick in the garage will do.

I'm not a doctor or a comedian. But less dangerous for people if I try being funny.

I do have a will already... and as you might guess... the HHOF gets first crack at my gear... then the boy... but whatever is left after that you're welcome to pick through. 

[bunnyman666]

On 4/30/2018 at 12:34 PM, BadAngle41 said:

Thanks!! 10 days away now... anxious to get on the mend. 

I pray for a  swift recovery my man!

[Goalline]

On 4/30/2018 at 1:34 PM, BadAngle41 said:

Thanks!! 10 days away now... anxious to get on the mend. 

Other thread on injuries reminded me.  How you feeling man?  how'd the operation go?  u doing the cpm + ice machine?

[BadAngle41]

51 minutes ago, Goalline said:

Other thread on injuries reminded me.  How you feeling man?  how'd the operation go?  u doing the cpm + ice machine?

Ha. Thanks! Doing well. No need for CPM or a Polar. Actually moving around pretty well already. Following protocols of course still in terms of limiting range of motion (not going beyond 90 dgrees etc), mindful of how long i'm in any one position, and letting pain be my guide. The toughest part has been sleeping actually. Getting comfortable and staying asleep w/o waking of from pain or stiffness. Still feels like someone took a bat to my leg; charlie horse in my thigh, some healing around the incisions, and generally sore.

I just had my follow up with the surgeon this afternoon. He said he cleaned up more than he initially anticipated. Had a pretty severe rip where the cartilage meets the labrum caused by a significant sized piece of bone which was also removed. Told me if I had waited another 12-18 months I probably would have had to have a whole hip replacement.  

He says I'm progressing very well though and ahead of schedule. Being in decent shape prior to surgery helps tremendously. If I stay at this pace. at the 3 month mark he said we could likely start introducing hockey specific training. Excited for that... but also not rushing it.

Here are the before and after X-Rays for comparison... easy to spot the cam issue. I have more endoscope images, which until today I couldn't have told you what was what but have a better understanding after speaking with the surgeon today, if anyone is interested I'll post.

     

[Matt30]

I had the same procedure done on my right hip in 2014. No issues since. I also had a speedy recovery, but I took a full season off of hockey to be safe. Glad to hear you're doing well!

[BadAngle41]

On 5/29/2018 at 6:22 PM, Matt30 said:

I had the same procedure done on my right hip in 2014. No issues since. I also had a speedy recovery, but I took a full season off of hockey to be safe. Glad to hear you're doing well!

You're far more patient than me. Itching to get back on the ice and it's only been 3 weeks. Obviously taking the summer off but I'd love to be back on the ice in the fall.

[Matt30]

Oh....I was itching to get back in the game for sure!

i chose to wait because I had to wait 2.5 years for the surgery. I wanted a 100% recovery, I wasn’t about to go through another 2.5 years of agony.

However, I was able to return to physical activity at work after about a month, I was still supposed to be on crutches but the recovery went so well I couldn’t bare with them anymore. I think us as goalies tend to get back on our feet quicker due to more lower body strength than most.

What was your wait time from diagnosis to surgery? I didn’t read the entire thread, sorry.

[BadAngle41]

4 hours ago, Matt30 said:

Oh....I was itching to get back in the game for sure!

i chose to wait because I had to wait 2.5 years for the surgery. I wanted a 100% recovery, I wasn’t about to go through another 2.5 years of agony.

However, I was able to return to physical activity at work after about a month, I was still supposed to be on crutches but the recovery went so well I couldn’t bare with them anymore. I think us as goalies tend to get back on our feet quicker due to more lower body strength than most.

What was your wait time from diagnosis to surgery? I didn’t read the entire thread, sorry.

My protocol had me on crutches for 2 weeks... but i barely made it past 1 with them. 3 weeks now and it's bearing body weight no problem. Sitting in a chair normally is getting more comfortable.

I'd agree with the reason for quicker recovery in that our lower body and core tend to be in a better place than most. 

As for diagnosis to surgery... 3-4 weeks I think. It had been painful for quite some time which is why I went in the first place. First surgeon I went to (probably around the beginning of this year) I dropped pretty quick as I just didn't like how he was going about diagnosis and treatment. Wrong on both fronts in spite of what I was telling him. Second surgeon was good, but sent me to a colleague because he took a look at images and knew what I needed and he just didn't perform this particular surgery. This last one came in after looking at my images and told me based on them what I must be feeling... damn near spot on. After that appointment it was 3-4 weeks before surgery. Could have done a week earlier but had one last tournament I could play in if I pushed it out so I did. I mean already going in anyway, what's the difference of a few more games?

I know I'll end up needing hip replacements (in both hips) at some point. Left was the first to get real bad, but FAI should give me 15+ years before complete replacement. Right hip may eventually need FAI during that time as it is showing signs of the same impingement and degeneration, but hopefully not. 

[BadAngle41]

So I've been meaning to update this post and just hadn't. The healing hasn't been that painful... really more a deep sore; bone healing etc. that icing just can't reach. Rehab is going REALLY well. What has been interesting in the rehab process is discovering how much my pelvis, back, and knee had been compensating for this bad hip for so long. 

I didn't have much in the way of atrophy after surgery, but my abductor strength on the surgically repaired hip is definitely behind the "good one." That is largely due to how much compensation I had been doing with other muscle groups. When isolating the abductors and how weak they are on the surgical side I'm actually pretty amazed how I managed to play (decently IMO) for as long as I did with the impingements. The trick now is to elongate hip flexors and groin tissues to get me greater range of motion, while at the same time strengthening abductors (and other supporting muscle groups.)

At last visit (about a month ago) the surgeon cleared me to actually skate... and commented I'd likely be ready for my normal activities in 2 months time (early September.) My plan is to continue focusing on range of motion and strength (it will be my new daily normal) off the ice, and hit a couple stick and puck sessions to get my skating legs back under me. Towards the end of this month (once I get all my equipment back from the various places I have sent it off to for modifications/repairs) get between the pipes in some lighter skates and work my way back into the normal routine. I should only miss 1 or 2 league games with my team

Side note: I had a dream last night that I got to the rink and forgot what order to put my stuff on. I clearly have hockey on my mind and it's been WAY TOO LONG since I last played.

[coopaloop1234]

9 minutes ago, BadAngle41 said:

At last visit (about a month ago) the surgeon cleared me to actually skate... and commented I'd likely be ready for my normal activities in 2 months time (early September.) My plan is to continue focusing on range of motion and strength (it will be my new daily normal) off the ice, and hit a couple stick and puck sessions to get my skating legs back under me. Towards the end of this month (once I get all my equipment back from the various places I have sent it off to for modifications/repairs) get between the pipes in some lighter skates and work my way back into the normal routine. I should only miss 1 or 2 league games with my team

Side note: I had a dream last night that I got to the rink and forgot what order to put my stuff on. I clearly have hockey on my mind and it's been WAY TOO LONG since I last played.

Glad to see things have been working out.

I've been off the ice for 2 weeks now and I'm getting the shakes, going as long as you have would be absolute torture.

Here's hoping your next season is injury free.

[SaveByRichter35]

Good luck!