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Re: Any Canadians with/had a hip labral tear here? [2tired] [ In reply to ]
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2tired wrote:
Dr. Murnaghan is a pediatric orthopaedic surgeon. He will see up to the university aged athlete. He may be able to give you the name of a surgeon that treats adults beyond that age group.
My high level KOS son has seen him for follow up of an osteochondritis dissecans of his knee. He is a nice guy and has done triathlons himself. Good luck!
edited to add link
http://www.sickkids.ca/...ff%20Profile%20.html

Surgery is scheduled for Sept 27th with Lucas Murnaghan. He required an X-Ray (Dunn View) to confirm FAI as well as a high powered (3T) MRI to get some more detail of joint, labral tears, etc. I believe I got my referral for L. Murnaghan around April 10th, May 25th was my first appt., 2nd appt in mid July and Surgery is Sept 27. About 6 month total time from referral to surgery. I certainly didn't conclude that L. Murnaghan was my best choice based on his schedule but from everything I have read, that is a pretty short period of time from referral to surgery (in Ontario Canada). I am happy with that.

Dr. Gavin Wood in Kingston was one of my first choices, based on my early research. His location is about 3 hours from me so that was a bit of a deterrent but i was will to travel as it is extremely important to me to get this problem fixed. With some additional research or resources, I decided and concluded that Dr. L. Murnaghan would provide an equivalent level of experience/expertise as Dr Wood (How do you compare surgeons? It is impossible, in my opinion, to say one doc is better than another assuming both are competent and experienced with the specific surgery. Good doctors have surgical failures too). The ability and experience of doing labral repairs/refixations was key for me and I believe Dr Wood is experienced with refixations (as is Murnaghan). As I understand it, refixations is a more complicated surgery vs. a labral debridement (but what the heck do I know, I'm no surgeon). I wanted to know that my surgeon had the skills to both repair the labrum, if possible (assuming my torn labrum is still repairable) or to debride or shave off the scraps of labrum that are un-repairable. As I understand it, shaving off the labral tear is an easier surgery than repairing the labrum and the training involved with learning the labral repair is more specialized. From that (right or wrong) I concluded that whoever had labral repair training was more skilled and experienced at fixing hip labrums.
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Re: Any Canadians with/had a hip labral tear here? [Hutch] [ In reply to ]
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Best of luck with your surgery! You are in good hands!
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Re: Any Canadians with/had a hip labral tear here? [Hutch] [ In reply to ]
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Hi, how did your surgery go? I am waiting to see Dr Murnaghan for similar problem. Can you share your post surgery experience? Thanks
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Re: Any Canadians with/had a hip labral tear here? [EG] [ In reply to ]
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I am 12 weeks post op. I had a labral resection (labrum was shredded too much for a refixation but he can do that, if possible), shaved down femur for FAI (Cam) and since I had chondral damage, he did a microfracture on the hip. The microfracture adds a significant amount of time off of weight bearing and the precautions are a lot more strict. Cross your fingers for no microfracture but if you get it, the results (eventually...) seem to be quite positive.

I did the CPM for 4-8 hours per day post op for 6 weeks. 6 weeks toe touch weight bearing (10 lbs or less on foot) with crutches, almost 2-3 weeks of using a cane after that. I was on my bike within 4 days post op, I believe. (Stationary, not a road bike, no resistance, 25 rpm was all a could handle at first,10-20 min, it is really just like the CPM machine). I was very diligent doing 30-90 minutes of physio type rehab daily plus 4-8 hours on the CPM plus 90 minutes of swimming daily with pull buoys, no wall push off/single leg wall push off/no flip turns for about 6-7 weeks. I have had pretty steady improvements all the way through. No major set backs. I am 12 weeks in 2 days and I can walk without a limp now but I will limp a bit when I am tired or when I initially get going. It is a long road. Be prepared for a pretty significant reduction in lifestyle the first several weeks, especially if you have the microfracture and he won't know until he gets in there for the microfracture.

My biking has improved each week. Where I used to max out at 250w for my avg. half IM bike power, now I can only handle 200w for 1 minute intervals (LOL). My basic power is about 120-150w now. I didn't/wasn't allowed to add resistance until 6 weeks post op. So in 6 weeks I have moved from 50w to 150w steady riding. I am riding outside now...in the snow and cold for up to 90 minutes (staying away from aggressively positioned road or TT bikes).

Dr Murnaghan is great, in my opinion. My wife liked him too but shes a tramp (jokes!!!). I did a ton of research and in the end, I felt very, very comfortable with how he handled everything. He is young but he is a pro. In my opinion, you are seeing the right orthopod in Ontario. His surgical times are reasonable, his appt times are reasonable and he isn't in and out in 2.5 minutes...he will take the time to discuss the specifics if that's what you want (I don't think it matters much because he's going to do the right thing anyways. Make sure he knows your level of commitment before the surgery regarding rehab). Obviously, the most important part is how he performs the surgery, his surgical skill I suppose? That you don't really know until the surgery is done and there are no guarantees. Fortunately, a friend of mine is in the arthroscopy sales field, specializes in hip scopes and equipment, knows all the surgeons with that specialty and felt Lucas M. was the right guy. Not to mention, some of the others had a 9 month wait for an appt, then a few months to get any required tests (ie. MRA or Dunn View X ray) and then 9 months from then for a surgical date. That helped make my decision, as did all the other factors I mentioned.

I have also accepted a couple of things. I probably shouldn't ever run again (I absolutely love running, have done a hundred km running weeks and I did a 1:20 half marathon 6 months before I started feeling hip pain) but it is possible if I want to take that risk, and I have also accepted that this hip surgery isn't my last hip surgery. It isn't a permanent fix. With my activity level, I will likely need my other hip done and at some point in my like, I will likely need hip resurfacing and likely a total hip replacement. I am not scared of either as I know of people who have had terrific results with both. I am 41 years old, 160-170 lbs, 20 years of triathlon, running, cycling, etc. and hopefully more surgeries are many, many years off, especially after going through this lengthy rehab (total hip replacement can have a shorter rehab!!).

PM me and we can communicate via email if you want or just reply here as others may have similar questions?
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Re: Any Canadians with/had a hip labral tear here? [Hutch] [ In reply to ]
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Thanks Hutch for the quick reply. I am glad you are getting better without setbacks. I am also 41 years old. I am nervous about the surgery. I probably need resurfacing in the future, hopefully many years from now. I heard with resurfacing you can do all sports. Who are you seeing for post rehab? Can you recommend him/her? Who else did you see other than Dr Murnaghan? Thanks again.
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Re: Any Canadians with/had a hip labral tear here? [soya] [ In reply to ]
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Hi,

I worked with Dr Mike Gilbart a few years ago as a medical student.
He works out of ubc hospital in Vancouver.

Great guy and one of the few who does hip arthroscopy.
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Re: Any Canadians with/had a hip labral tear here? [EG] [ In reply to ]
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Steve Hill is my physio. He is in Brampton. Kings Cross Physiotherapy 905 796 2000. He is very good. Works with lots of triathletes, elite athletes, etc. I got kind of nervous the days leading up to the surgery. I then just took the attitude, 'whatever happens, happens.' I did as much research and digging as I could. I felt I was in good hands and whatever cards I was dealt post op, than I would accept that. A friend of mine had been in major hiop pain for 9 years with no good diagnosis, torn labrum eventually diagnosed, took another 2 years for surgery (labral debridement), doc (not Murnaghan but a well known, good reputation doc) said everything went fine and within 12 months post op he was in great pain again and now is being told he has extensive arthritis. He is now going through the resurfacing route, likely another year or so before surgery. He is an awesome athlete and has lost his entire 40's to hip pain. I don't want to go that route. So far, so good.

I didn't see anyone else. The only doc that had good experience with hip arthroscopy and a short waiting list was Dr Gavin Wood in Kingston, Ontario. At my last appt with Murnaghan, there was a resident who had trained at Phillippon's clinic in Vail.

At some point, you just gotta get over it because there is no such thing as DIY hip arthroscopy.
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Re: Any Canadians with/had a hip labral tear here? [Hutch] [ In reply to ]
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What is the name of the resident who had a fellowship under Marc Phillippon in Colorado?

I need to find some new hip orthopods in Ontario that can fix my hip. I got FAI that needs a revision, as well as a labral repair.
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Re: Any Canadians with/had a hip labral tear here? [hip_guy] [ In reply to ]
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No idea what his name is. Women's College Hospital is a teaching hospital because Dr. L Murnaghan always has somebody working with him. Why would you want a student doing the work when you could have Murnaghan or others? I included a list of the orthpods in Ontario earlier in this thread that had experience with hip arthroscopy and likely had the skills needed to do a refixation.

There are some good rehabilitation protocols online and I have a good one. PM me if anyone want a copy of it.
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Re: Any Canadians with/had a hip labral tear here? [Hutch] [ In reply to ]
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I already had 1 surgery done by Dr. Murnaghan. 1 year post, he tells me that the FAI came back and I also found out that he didn't do anything to my labral tear. Studies have shown that people who had labral repair had better long-term outcomes than those with labral debridements. My labrum is inn bad shape so I'd rather find someone who knows how to do both a repair and a labral reconstruction via IT band graft like the article Dr. Phillippon posted this year. Therefore, I need to find the fresh hip orthopods that have had their fellowship done with Dr. Phillippon.
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Re: Any Canadians with/had a hip labral tear here? [hip_guy] [ In reply to ]
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FAI came back? The cam on your femur grew back? I wasn't aware that could happen. Repair is better than debridement which is why I choose Murnaghan (and he is a freshly graduated/trained OS) as he is trained in repairs/refixations. Dr Murnaghan said that my labrum was too messed (decarpeted or something like that) up to repair. I trusted his judgement during the surgery. It is my understanding that, currently, not all labrums can be repaired (it sounds like Phillippon is trying to change that?). I have heard about the grafting/labral reconstruction. Perhaps that is something Dr Murnaghan is investigating however I never discussed that with him.

To my knowledge no one in Ontario is doing that kind of surgery but I have another resource and I will check with him.

Question : if all the trouble with FAI, why not just go for the hip resurfacing so you can get back at it and get your life back? If you are way under 40, than I see your logic/thinking. Perhaps I am underestimating the advances that Phillippon is making but it is my impression all that stuff is really new and experimental and perhaps you will miss out on a lot of potentially active years waiting for a solution...which may end up being hip resurfacing in the end. Don't get me wrong, from what I read, I really wanted a refixation/repair (if possible) and I trust that Dr Lucas Murnaghan made the right decision during my surgery. It is my understanding that he has the skills to do a much more advanced surgical repair on my labrum but there was just nothing there to work with or what was there was insufficient for a repair. Hopefully the grafting is a potential game changer to help people in our position.
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Re: Any Canadians with/had a hip labral tear here? [Hutch] [ In reply to ]
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I wasn't aware that FAI can come back either. But the MRI confirmed it on my femur.

I just turned 26 years old and I am fairly active playing basketball, volleyball, and strength training. I only have issues when I play 2-3 days in a row or whenever I go heavy lower-body training (e.g. squats, lunges). I also had microfracture surgery in the scope secondary to an articular cartilage lesion so I know I could get arthritis earlier than expected. But if I get my labrum debrided, I know that would really mess up the long-term health of my hip joint, which is probably why Dr. Murnaghan didn't know anything with the labral tear.

So I'm willing to wait a few years for Canadian surgeons to learn this new labral repair/reconstruction technique that Dr. Phillippon has published this year. I'm just getting a little anxious... heh
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Re: Any Canadians with/had a hip labral tear here? [hip_guy] [ In reply to ]
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hutch and hip guy, I've had both hips scoped this year, and one of the first questions I asked prior to surgery was if the FAI could grow back ? Answer was yes. My surgeon in So. California, Dr. Snibbe, gives his patients a 1 month dose of Naproxen a week after surgery to combat this problem (hope it works). I also had the pleasure of getting the IT Band graft that you are referring to on the second hip surgery. Not fun at all. My labrum was basically not there anymore- it had calcified- turned into the bone on the hip socket. So, they harvested a 2cm x 4cm piece from my IT Band out of my thigh in an open operation during the scope surgery. I have had a much more difficult time healing from the harvesting than the FAI/ labural repair. Its been 4 weeks and just starting to feel normal and the swelling has finally gone away. As for the graft itself, the surgeon said it was the best new procedure available and should be better than ever. They stitch each end of the graft to what is left of healthy tissue, then used 4 anchors to pull it back to the bone. They are also able to do this w/ a cadaver graft if they know in advance (how they know this is very difficult i imagine). So far my Surgeon has only preformed 30 or so of these grafts and learned it from Dr. Phillipon also. Otherwise, if they cannot do a reattachment and only do a debridement I believe the patient will be looking at a hip resurface / replacement a lot sooner than planned. In my case I had no knowledge of this new procedure (and was asleep when the decision was made) but it was the best available plan for my long term recovery. My Surgeon is one of the best in the country and at the forefront of any new technology. I feel very fortunate to have found him (through Slowtwitch) in my home here in Los Angeles. Anthony
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Re: Any Canadians with/had a hip labral tear here? [MAGGBO] [ In reply to ]
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Hi Anthony,

Thanks for the detailed description on your surgeries because that's exactly what I'm looking for in Canada. At first, I was contemplating about going to the States, but I just started my career and I don't want to take an extended break due to surgery until I need to since I have no hip problems with work activities. If you know Canadian surgeons who have done this type of surgery, please let me know. I'd appreciate it greatly!

If anyone asks why I'm so eagered to try this, it's because I'm all about hip preservation. Not short-term fixes.

My 1st MRI showed degenerative tearing of the anterior-superior labrum with CAM type FAI.
My surgery consisted of osteoplasty for the CAM type FAI, microfracture for the articular cartilage lesion, and debridement of a "large actebular rim fracture"
My 2nd MRI 1 year post showed "anterior superior labral tearing" and CAM type FAI again :(

I wonder if anyone in Canada is also in this situation :/
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Re: Any Canadians with/had a hip labral tear here? [hip_guy] [ In reply to ]
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Hello there everyone!

I have a few questions for all you with hip labral tear(s). How big are your tears? What is said about your tear(s) Do you guys use crutches/cane(s)?

About me. Im 26 yrs young female. I have had extreme hip pain since a fall I had when i was 9 months pregnant. ..days away from my due date :( The fall has brought on the worse time of my life. I have just found out that i do have a tear on both left and right hip plus tons of soft tissue damage .. It has been 2 yrs since the fall and i have just gotten answers, however I'm kind of lost. I saw Dr Brain who told me i was severely disabled which wasn't what I was thinking. . .i know i have major problems with movement (walking, running. .etc) however i dont consider myself that bad off. Anyways he said he couldnt help me and that he would send me to Dr Gilbart. I have seen Dr gilbart but he suggested that surgery isn't for me as i have too much soft tissue damage that could become worse. . .if he was me he wouldnt do surgery. However at that point i only knew for sure I had the one tear but now i have both tears and i would like to be fixed. . . i am limited to what I can and can not do. . . .which at 26 with 3 children isnt what I ever had never dreamed off in my life. My one Dr who is not a surgeon but a

Physical Medicine and Rehabilitation said that for my soft tissue to even start to get better is to have the surgery. . .so Now im waiting to

hear back from Dr Gilbarts office. I want

to be normal again. . . i use a cane or crutches when needed. . . i should be using a cane 100 % of the time but its a hard with young

kids. . . Anywho I have found this all vary helpful. . .thank you everyone for posting. Please let me know how big are your tears im just

wondering as im not getting much about sizes of tears.
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Re: Any Canadians with/had a hip labral tear here? [soya] [ In reply to ]
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OK so I'm just creeping this thread. As many of you may know, I'm a knee specialist in the GTA. Couldn't help but comment on hip arthroscopy. The real reason very few Canadians do the surgery (and the reason Marc Phillipon, a Canadian, went to the US) is that the payment here is horrible. We used to get $300 to do the surgery while Marc charges $12,000. Welcome to socialized healthcare!
The pay schedule just changed and Ontario surgeons are now getting up to $1000 for the surgery so more guys are doing it.
The guys with the most experience with hip scopes in southern Ontario are Doug Naudie in London, Femi Ayeni in Hamilton and Mark Ginty in Oakville. I don't know about Dr Murnaghans hip scope training, but he is an overall superb surgeon technically (and he is a nice guy too).
Hope that helps somewhat.
Last edited by: Deak: Jan 25, 12 13:17
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Re: Any Canadians with/had a hip labral tear here? [Deak] [ In reply to ]
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Deak - Thank you very much for the information. Now I understand why there are very few surgeons in Canada that offer hip arthroscopy. If my previous posts seemed like I was bashing Dr. Murnaghan, I didn't mean to. He is a very nice person and even offered to refer me to other hip specialists if I felt that I wanted a 2nd opinion because he proposed to another hip scope to fix my CAM impingement again. Based on the follow-up, he didn't say much about my labrum so I got the impression he had no plans to treat it. I plan to look up and potentially book an appointment to see the other hip orthopods that you mentioned. Do you know if any of them have done hip labral reconstructions too? Thanks again!
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Re: Any Canadians with/had a hip labral tear here? [soya] [ In reply to ]
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soya wrote:
Hi, in order to get a MRI with contrast, only an orthopedic surgeon can order this. So before I wait another 2-3 months for an ortho surgeon that doesn't have a lot of experience with this, I'd rather get it right the first time. Thanks for the info though, good to know UVic has a med school, at least it's close to home!
Thanks

Not true, my wife was referred by her chiro who is a medical doctor for a contrast mri last week, got mri two days ago (where she does indeed have a labral tear) and has an appointment with Jack Taunton this week..............we are lucky we know the right people. Will know a little more after her appointment as to what procedure is and how long recovery.

sean
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Re: Any Canadians with/had a hip labral tear here? [canwi] [ In reply to ]
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There is an MRI machine called the T3. This is a very high resolution machine which is an alternative to an MRI with dye (arthrogram). My daughter reacted to the dye for her first MRI, so for the second one, a T3 was used and it yielded an excellent and clear result. A GP can order an MRI as well (at least in Ottawa that is the case).
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Re: Any Canadians with/had a hip labral tear here? [Hutch] [ In reply to ]
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A few things here...I had a FAI with a shredded labrum. My first surgery was done in 05, a debrisment and microfracture. I then had another debrisment and a osteotomy in 09, where my FAI came back, with osteophytes. In 10 i had a fairly large graft/transplant that didn't work one bit. I am not blamming the surgeon, he did the best he could but once you start working on the hip, it never seems to go back to normal. The longest I was pain free was 1.5 years. I was able to do Louisville but it hurt. Now I am scheduled to have a resurfacing done. My current Dr stated that once you start tearing down the integrity of the hip, it doesn't really work the same. He does both Arthroscopic surgeries and open hip resurfacing and total hips. He has warned me off doing triathlons any more, but say's its my hip and i can do what i want after one year's time. From what I gather, a torn labrum is usually a good fix, and a debrisment and FAI is eventually going to need more surgery or lifestyle change.
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Re: Any Canadians with/had a hip labral tear here? [Deak] [ In reply to ]
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1/ Phillipon must get more than $12k for the surgery. $30k sounds closer especially if rehab is included but what the heck do I know.
2/ Murnaghan/Cdn surgeons must get more than $1k!! If it is even close to that, than it is a crime. I think he did his arthroscopy training out at UBC. Last time I was in to see Murnaghan, there was a resident who had just come through Phillipons program.
3/ Naudie, Ayeni and Ginty were all on my list and have good reputations. Ginty had about 9 month first appt wait, then wait for MRI/xrays, and a follow up appt., then another 9 month wait for surgery, total of almost 2 years. Ayeni is in Hamilton, something was going on with transitioning to a children's hospital and he was only having appt. either 1 day/week maybe even 1/month? Lots of his surgeries were being cancelled due to the transition to a children's hospital (that's what I was told at the time) and I did get in touch with Naudie's secretary but I can't recall the outcome.
4/ I am just over 4 months post op. I am biking daily (30-120 min), still almost entirely under 200w where 200w used to be a long easy ride for me. My swimming has progressed to being able to push off with both feet, but I still try to do >50% on my good leg. Running...mild nausea even thinking about it. Not even close to running probably never should. I can see my biking coming back though. Starting to think about some mild half shots for golf.
5/ Brandt Snedeker has his labrum repaired (not sure of exact details) via Phillipon in early Nov 2011 and about 3 months post op he won a PGA tour event at Torrey Pines last weekend. I believe his other hip was done a year or two ago. Good success story.
6/ Hip resurfacing sounds enticing but I haven't done much research on it yet. I can't picture myself going through another rehab on my other hip, which Murnaghan commented that it is even worse than the hip his operated on but there is no associated pain with it. That being the case, running isn't a great option.

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Re: Any Canadians with/had a hip labral tear here? [rgjhrf73] [ In reply to ]
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Wow, I just came across this thread and it's filled with all kinds of helpful tips.

I have been diagnosed with Femoroacetabular Impingement with a pincer lesion and labral tear or degeneration.


I am a Canadian citizen based out of Montreal working overseas, and thus, will need to be treated privately.

One of the members here was kind enough to compile a list of doctors who can repair labral tears, which is an important part of treating Femoroacetabular Impingement:


Dr. Douglas Naudie, London, Ontario
Dr. Dan Whalen, St. Michaels, Toronto
Dr Gavin Wood, Kingston, ON
Dr. Lucas Murnaghan, Sick Kids/Womans College Hospital
Dr Olufemi Ayeni, McMaster, Hamilton
Dr Rajev Gandhi, Toronto
Dr. Ginty, Oakville
Dr. Veillette or Dr. Ogilvie-Harris, Toronto (same clinic).
Dr. Paul Beaule, Ottawa



This list is good for me as it is in the Quebec/Ontario region, unlike Dr Gilbart who does treat patients privately, but is at the other end of the country.


Does anyone know of any doctors I can contact from Eastern or central Canada who treat Femoroacetabular Impingement privately? I need to re-enter Canada, pay for the treatment, get operated on, recover, and then leave the country as soon as possible.


Many thanks...
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Re: Any Canadians with/had a hip labral tear here? [skatemomrose4] [ In reply to ]
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Thank you for your input.

I just received a reply from Dr Wood, and he told me that private practice is not allowed in Ontario.

He also told me that he thinks Dr. Paul Beaule has a clinic in Quebec, so that would be ideal for me. I have Googled his name and only come up with what seems to be a personal website, but nothing about a clinic here or anywhere else:

http://www.conservativehipsolutions.com

Thanks again, and I will surely ask anyone I do decide to go with if they actually do the repair.
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