My suggestion is to have the best surgeon in your area to do the surgery.
Hip stuff is not for swiss army knife type surgeons who operate on all sorts of joints.

Agreed with bootsie. This is a highly specialized surgery. How were you dx? It's not common to have both ischiofemroal and acetabular (hip labrum) impingement. Have you undergone any less invasive tx such as injections? This would rule in/out exact dysfunction that is contributing to your pain.
I have work post-op with pt who have undergone sx and recovery has gone well. Although the end results is the same, but mechanism of injury is telling on recovery process and expected outcomes.

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My YouTube channel- https://www.youtube.com/ksquaredcycling
Time RXR Super Record | Cipollini Bond Campgnolo EPS | Specialized Shiv TT SWorks Super Record | Colnago C59 SR-EPS | Colnago EPS Super Record | Colnago Prestige Ui2

I appreciate both of your responses! Final diagnosis made with MRI. I've tried rest, PT, and cortisone injection followed by more PT. There is no doubt that in addition to my anatomy I have weaknesses and deficits that need to be addressed. I've been committed to my PT and do see differences in my posture and habits while sitting and standing, but I am still having nagging discomfort/pain. I've been trying to sort this out for close to a year. I'm not taking this decision lightly. If there is anything else you recommend I try, I'm listening.

Injections serve a dual purpose: diagnostic and therapeutic. So if there is no relief (even if temporary) in the target injection area, then it was likely not the culprit. Not to discount the skills of a surgeon, but unless an injection is guided radiographically, they there is guarantee that the injection reached the target area.
PT should have been able to help gain you temporary relief whether it be short lived if the clinician is skilled in hip pathology. Hip related impingement dysfunction is still relatively new.

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My YouTube channel- https://www.youtube.com/ksquaredcycling
Time RXR Super Record | Cipollini Bond Campgnolo EPS | Specialized Shiv TT SWorks Super Record | Colnago C59 SR-EPS | Colnago EPS Super Record | Colnago Prestige Ui2

The injection was done after the MRI diagnosis and several months of PT. It was ultrasound guided into the hip joint to see if it relieved some of the anterior/groin discomfort attributed to the labral tear. It did temporarily. The PT response has been mixed and hasn't really done anything for the posterior pain/discomfort which I've been told is attributable to the impingement. Despite being the second ortho that I'd seen, this guy has at least seemed to put me through other options before offering surgery (more PT, the injection). That doesn't mean I should have it done, but I have felt like he wasn't trying to rush me into the OR.

Where are you located?

That is good to hear. It does sounds like conservative management has been exercised appropriately. Find somebody who has a lot of sx experience in hip impingement. Unfortunately, there is a point where sx is warranted and you sound like you may have reached that point.
Good luck and keep us updated.

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My YouTube channel- https://www.youtube.com/ksquaredcycling
Time RXR Super Record | Cipollini Bond Campgnolo EPS | Specialized Shiv TT SWorks Super Record | Colnago C59 SR-EPS | Colnago EPS Super Record | Colnago Prestige Ui2

New York City

https://myfaihippain.blogspot.com/...ai-hip-surgeons.html

NEW YORK, NY: Brian Kelly, ditto above: http://bryankellymd.com/

NEW YORK, NY: Robert Buly, Another pioneering FAI Hip Surgeon:
http://www.hss.edu/...ians_buly-robert.asp

Sound advice to talk to a hip specialist.

I had that procedure done in 2013.
Cam impingement, labral tear but mostly major OA (Osteoarthritis) at the head of the femur (mosaicplasty for me, look it up it is gross)

It took some time to heal and PT helped a lot. So did water running and cross-training (xc skiing for me)

In my case, while waiting for surgery I had an ultrasound guided Synvisc injection (viscosupplementation, hyaluronic acid) Think of it like a lubricant to avoid too much friction, OA and pain.

Gave me 6 months of relief before surgery.

Look up hyaluronic acid supplementation and Synvisc (it is a brand, there must be others) and how relevant it could be for you.
One benefit is that it does not promote more damage the way Cortisone can do.

It is pricey, but private insurance could cover it.

Feel free to contact me directly if you have questions, I'd be glad to help.

Good luck and keep us posted.

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Only fools never change their minds and I'll never change my mind about that.

avoid kelly. he's arrogant, treats you like a slab of meat and completely botched one of my hip surgeries to the point that coleman had to redo it a year later. i strongly recommend coleman (he wound up doing my other hip too). the initial recovery is a breeze -- little to no pain, on a stationary bike the day after surgery and a real bike for a loop in the park 7 days after surgery. the harder part (at least for me) was getting my hips working properly to run hard without getting injured. it took a few years and a lot of pt but my hips are as good as new now.

I saw Kelly in 2013 but after 3 injections into the joint (by different providers, each person felt the prior one must not have done it correctly) I felt we had not demonstrated my pain came from the labral tear. I wonder if what I was feeling was from muscle over use due to poor form. I got stronger with PT #1 (before seeing Kelly) but it did not alleviate pain, which was very random in when/where it presented. PT #2 (after Kelly) was helpful (the exercises were much harder) but I also feel like they missed finding my weak link - something still felt off and eventually pain ticked back up.

Saw a physiatrist, was eval'd for hernia, SI joint dysfunction, and was called a hypochondriac. Was dx'd with leg length discrepancy (8 mm) and found relief for some time (almost 2.5 years) using a shim for the short side. Still I felt something was off.

Anyway, end of 2016 I had an strong uptick in sensation right in hip area and decided to go for the repair that it seems I had long danced around. I saw Coleman instead of Kelly b/c Coleman also works out of Vincera in Philly so I could save myself the hassels of getting to Manhatten (I live outside Philly).

I'm 11 days post op for labrum repair, acetab-plasty and femero-plasty. Happy to answer any questions.

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To breathe, to feel, to know I'm alive.

Now you are several weeks post surgery, can you share how you are recovering?

offbeat advice, FWIW --

my hip mechanics have improved a great deal by standing one-legged on impinged side and using muscles to straighten femur so its head sits more squarely in socket. This activated lateral hip muscles and relieved pressure on medial structures. (other foot raised off the ground while doing so)

7 Week Post OP Report. As far as day-to-day life inside my house goes, most things are back to normal. I’ve done 4” and 6” step up repeats at PT, unfortunately the stairs in my house are more like 8” and I don’t have a hand rail. So I still do most stair climbing as step-and-match, or take an elevator (which I normally would not do). Yesterday I walked 2 miles; the first 1.75 were great but the last 0.25 qualify as having over done it slightly. A week ago I over did it by walking 0.5 mi, hitting a wall at 0.3 mi and really struggling to make it back to my car; my hip muscles had tightened up so much I could barely move.

As far as exercise goes – and from the POV of an ST’er – I’m really limited. I got agreement from my surgeon to do pull sets in the pool once my stitches were out (day 11). Unfortunately one of my incisions opened which then kept me out of the water another week. I still have not been cleared to do any kicking. Biking: I’m cleared for up to 40 min daily, up to 60 W and 70 rpm, but I’ve strayed…

I feel a bizarre combo of stronger in some ways (back, core, calves) and clearly weaker in others (eg finding a half mile walk brutally hard). According to my generic PT protocol, “active swimming” and elliptical can begin at 8 weeks, jogging at 12 weeks. I hope to get more latitude for stationary biking ASAP.

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To breathe, to feel, to know I'm alive.

Thank you for the thorough update. Can you foresee a time when you are back to "normal"? Exercising at a high level? Or is it too soon to think that far ahead?

I can foresee trying, but yeah, pretty much too soon to have an idea for how it'll all feel.

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To breathe, to feel, to know I'm alive.

Has anyone struggled with insurance wanting to pay for FAI surgery?

My insurance covered everything, once I hit my deductible.

For what it's worth, FAI surgery on 12/27, I'm training around 10 hours a week now. My average run is 6 miles long and my run times are close to where they were last year.

Insurance. Oh the joy.

My 3 procedures were cleared by my insurance provider before hand - I've got the paperwork to say so. Then the claim posted and 2 procedures were denied (the labrum repair and one of the plasty's). Reason listed - these procedures are not usually done on the same day. What??? I believe that was what was noted on the surgeon's claim. On the surgery center's claim the text eventually read something to the effect of: as a member of the network there is agreement the negotiated price covers the multiple procedures.

By this time I have 27 visits to the physical therapist. Only the first one - the day prior to surgery - has processed correctly. The others came up "more info needed: reason for PT and progress notes from last 5 visits required". Can we talk about the idiocy of them needing a reason for PT when they've already paid the surgery center for the procedure? My concern has been, with the labrum repair "not covered", that perhaps PT isn't deemed warranted for the plasty that was done. Like maybe the codes won't line up right or something.

Anyway, the PT claims eventually updated to "we asked for more info and if we don't get it in 15 days this will be denied" and then to "Denied". I've followed up multiple times with the PT biller, who states that these requests for info and updates of denied claims aren't reaching her from Aetna.

Last year I had PT for scapular stabilization. Those folks were very on top of the insurance claims, telling me that future visits would be denied so we wrapped things up so I wouldn't be paying out of pocket. Contrast Vincera. There are thousands of dollars of difference between these visits being covered as Vincera has said they should be, vs if all the visits (save the pre-surgery one) get denied. (Each appt is billing at $450-725.)

I should probably conclude my rant by stating, while frustrating as hell, insurance has covered a giant portion of my surgery fees thus far. And luckily my surgeon was willing to strike a deal since he's out of my insurance network. As for PT, this remains to be seen.

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To breathe, to feel, to know I'm alive.

How is your recovery going?

I have a nagging hip issue that I've had for 12+ years. It was less of an issue doing tris, but now I'm playing more racquet sports again, it's flaring up. Wondering if I may need some kind of surgery to fix it once and for all, but given I can still play most sports competitively (mostly tennis), I'm afraid of how athletic I would be post-op.

Am thinking of seeing Buly and Coleman.

My apologies for the delayed response. I think I'll have no specific restrictions going forward, but Coleman and my PT have somehow been surprised with the amount of things I've already tried to do. I talked with Dr. Coleman pre-op about getting in the pool, without kicking, as soon as my stitches came out. My physical therapist knew I was swimming in the local river, and she cleared me for biking an hour up to a certain wattage (as of end of week 7). But a week ago (11 weeks PO) when I recapped what I could do comfortably and asked about adding additional biking time/wattage, how long before I could ride my TT bike or skate, I didn't get clear answers on those things but rather a bunch of shock over how much I was already doing. They were floored I biked 16 miles (end of week 9), which I didn't understand b/c biking an hour at the allowed wattage made it a foregone conclusion I'd hit that distance on a flat bike trail. They also didn't like that I swam 1.2 mi in open water, saying it was a bit much at that point, though again, I hadn't kept my swimming in the river a secret so don't understand. When I asked my PT person what she thought a reasonable bike ride was, her answer was they recommend most people try ~2 miles. Two miles? I wouldn't even dirty my tires for 2 miles. She said that was her normal recommendation but she'd stretch it to 5 miles for me, not 16.

In speaking with other patients I get the idea there remains a disconnect between what they tell you pre-op you'll be able to do after surgery, and what they actually want you to do after surgery. Patients seems to agree it's about a year before things seem so normal that they don't think about it anymore. But I would also recommend taking care of your hip sooner rather than later, as you don't want to do irreversible damage.

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To breathe, to feel, to know I'm alive.

appreciate the feedback. glad the recovery is going well. first appt next week...

Glad you are doing well. I had a Cam-Type Impingement and absolutely shredded labrum in the right side compounded by a 15degree retroversion and shallow socket. I have a similar but not as severe condition on the left side that needs correction. I started local and ended up at Hospital for Special Surgery. The degree of my impingement (described as well into the high 90th percentile) and combination of factors made me a "textbook case", which is not what you want to hear. The entire panel of hip surgeons there consulted on my course of treatment. In August 2016 they did a labral repair (not much could be saved) and reshaped the femur. We all agreed to leave the retroversion in place in an attempt to avoid an osteotomy.

The experience at HSS was amazing - they made a crummy situation the best it could be. The lead up to the surgery was excruciating, I was barely walking the month before and had abandoned all exercise in March 2016 due to the pain. To TSUNAMI - my insurance was a nightmare and it took a lawyer to sort it all out.

I was weight bearing at 10% from the second I came out of surgery. I started physical therapy a week later. I started in the pool in October but had to quit as it was too soon. I had a couple of starts and stops in trying to get physically active but returned to full activity in March 2017 - about 7 months out. Last week I put in 6 hours of training. I am slower than I was and it's going to take time. I'd say I'm at about 90%. That Six Hours amounted to three rides, three runs (one 10k at 8:20pace) and a swim.

I have a tear and impingement in the left side that has to be repaired and preferably while I'm young (40), so we are talking this December. I get soreness but in the last month it has really faded but I am aware of my limitations and gait. I get a slight burn in the left side but my surgeon says as long as it isn't pain to enjoy the summer and we will get to business when I'm ready. I am hoping to run MCM this year but I know that I probably can't but I will attempt it in my training.

Anyway, I am happy to share my experience with anyone having these issues. I found info to be inconsistent and sparse. My main advice having in the end gotten 10 opinions: Go to a specialist, travel if necessary, experience and volume pays dividends - this is a highly specialized and relatively new course of treatment and you are able to be seen by the people that either invented or innovated the procedures so make the investment and get in with them.

Good luck to all of you.