thanks for you reply. I've had 2 MRIs - one of the spine, one of the SI joints...neither showed anything. also cross table xray of hip that didn't show. but not an MRI of hip. so I'm not nervous about MRI tube, just an injection into my tender hip!!! my pain is around SI joints, hip, down the thigh - sometimes to calf and foot. started w/ sharp pain in front of hip bone.
I'll post back here after I have MRI. its not scheduled yet. I was told my neuro doc that he is referring me to an orthopedic sports medicine guy...he is the doc for our local hockey team.
Good luck. One other thing. I watched a you-tube video posted from The Hospital for Special Surgery in NYC (one of the leading Ortho hospitals) and they were doing a hip exam. The Dr. said that generally if the pain is from your waist down it's the hip, waist up it'swith the back.
Don't be too nervous, they will give you an injection of lidocaine before putting the needle in that goes into the joint. It just felt wierd, not too painful.
I want to chime in again because I am concerned about you and am hoping that I can help to motivate you to quickly move to the next step. Your situation sounds very similar to where I was a few years ago. Based on what you have already mentioned, I am worried that if you postpone treatment on your better hip, that you will lose your window of opportunity for further arthroscopic interventions. If you are like me, your bad hip is probably forcing you to load more weight on your better hip and because of that, it is likely that your better hip with the untreated cam impingement will degrade quicker than someone with problems in just one. I am not a doctor, but I can confirm that this happened to me. It is much easier and perhaps more effective to do post-surgical hip rehabilitation if you have the option of working on just one hip at a time. Let's see if we can make that happen.
Since you are asking about signal loss at the L/4-L/5 level, I will address this first. It sounds like you have some mild disk degeneration. This is a relatively common finding in our age range. As we age, our lower disks lose moisture content, they even sometimes protrude a bit. Since you are asking about your back, I am guessing that you are having some back pain and even possibly some nerve pain radiating into your legs. Prior to my hip diagnoses, I had nerve pain running down the back of both legs and was receiving epidural steroid injections 3-4x per year for a couple of years to calm that inflammation down. I still had hip pain, though. After my hip arthroscopies and rehab, my nerve pain disappeared. What I learned is that when you are walking with a limp, it will aggravate a mild underlying back condition and make it may appear much worse than it really is. My advise is to stay away from the back surgeons. You already know that your hips are bad and the last thing you need is to have an unnecessary back surgery that won't permanently fix the problem and might even make you worse. However, the back issue may be another good reason to consider hip resurfacing in your bad hip over hip replacement because hip replacement often produces a leg length difference that can make a pre-existing back issue worse. I just read a book that I think would be helpful to you that among other things, addresses hip/spine syndrome. It is called Hip Replacement or Hip Resurfacing: A Story of Choices by Peggy Gabriel. The author is another young hip resurfacing patient and the book is available on Amazon.
I do not live in your area, so I really have no idea about the surgeons that you are asking about. Since you have mentioned Dr. Kelly a couple of times and other people have said good things about him, I would suggest that you find out who does the rehab for his post-surgical patients and make an appointment with that therapist. The physical therapist might be able to provide patient references and perhaps even suggest another surgeon if there is a personality mismatch or an insurance issue. Plus, it will give you the opportunity to find out about the equipment you will need to get in advance at home to successfully rehab. I am under the impression that like me, most of your normal activities are outside. I had quite a shopping list, some of which I already had on hand -- upright indoor spin bike (I bought used), interval cycling DVD's, yoga mat, exercise ball, medicine ball, balance ball, and foam roller as well as a couple of large medical grade flexible reusable hot/cold packs) and I am glad that I purchased those things in advance. In the long run, it saved me both time and money because having those things on hand allowed me to attend rehab sessions just once a week versus a 2-3x per week schedule that others in my area were doing.
Have you had the opportunity to meet with Dr. Su? If so, what did he say? All other things being equal, he may prefer working with one surgeon over another. Obviously you want a very technically proficient surgeon who does a high volume of these surgeries. It is also good to have someone that you feel you communicate well with and someone that you just like. Of course, most of us are also limited by our insurance. In my opinion, choice of surgeon is very personal. One patient's personality may just clash with a particular surgeon, but you may find that you get along just fine under similar circumstances. We are all human. Personality mismatches just happen, and in many cases complaints about bedside manner are not really reflective of the proficiency of a surgeon or even a reliable indication of what you will experience under that surgeon's care.
Hope this helps
i appreciate your help very much. i would have scheduled surgery this past summer but i developed a shoulder issue. there is no way i can use crutches with the shoulder problem. booo!
so i am working on the shoulders now via prolotherapy and pt.
by the time feb or march rolls around, i should hopefully be good to go with the crutches.
i did see dr su, in september. he said i am not a resurfacing candidate, lack of arthritis on standing xray, and great joint space. so i guess that is good news.
but i had my hips' mri's 2 weeks ago. the results are mild thinning of cartilage in a couple of spots + big impingements + osteophytes + loose bodies. so from what i can tell, i have arthritis. i see dr kelly next week to go over it all, and to see if he will accept my insurance. otherwise, i cannot afford to get surgery. as you can imagine, i am so sick and tired of our medical system.
i was an outdoor enthusiast. i hope to be again.
i do have most pt/rehab things you suggest, minus the cool packs. i have bands, swiss ball, balance board/wobble, upright bike (not very good but it was free), yoga mat with blocks, and so on. but no roller, i will work on getting one.
i don't THINK i have back issues, but i am not so sure, and i don't wanna jinx myself. i know that i have major weakness in the gluteals, and of course lots of compensation. i guess i have a limp of sorts, some days, but overall i can walk for hours without problems. today i walked a bunch and did some stairs climbing as well.
my better hip, though, is having more bad days than it used to. it's weird because it only tends to hurt in the anterior side, and when it does, it hurts badly. but it tends to go away anywhere from 15 minutes to 3 hours. and it only happens once per week, to maybe three times a week.
the left, which is the more dysfunctional and painful, hurts in the hip, sij, buttocks, sit bone, perineum, etc. so i think i will get that side operated on first!
dr kelly says that i can get the other one done 4 weeks after the first, but i think that is nuts and will probably wait 4 or 5 months, depending how i heal. i am going to supplement it all with classical homeopathy to allow the nerves and tissues to heal better.
when i see dr kelly next week i will get him to refer me to pt for pre-op training. a few visits should cover it since i have lots of pt experience and am diligent.
i really think if these shoulders weren't in the way i'd be on a better path.
but i am also concerned about the arthritis that is in there. i guess dr kelly will let me know what he thinks, even though i already know his answer.
i am going to have the mri's forwarded to dr su as well just cuz i think it would be wise.
but, i do know, if you can keep your bone, it is a better option more often than not.
either way, it is all a bit confusing and i can only hope for the best outcome. mentally i am pretty ready to go under the knife, but of course with fear that i won't come out better. maybe even worse?
thank you again
Dealing with the shoulder first makes a lot of sense. I am both glad and relieved to hear that you have a plan of action! I hope that Dr. Kelly can fix the posterior tear. Mine was too large to fix and even with a capsular plication in the front, I have ongoing problems with hip instability and lack of function. I continue to have significant limping as well as groin and thigh pain in the front of that hip. Your outcome in the worst hip will probably depend on how stable your surgeon and physical therapist can make that joint. Hopefully it is in better shape than mine was. Sometimes they don't know until they go in. Despite that, if your pain level and lack of function is anything like mine was before the hip arthroscopies, I really think that you will be very pleased with the outcome when they are done -- even with mild arthritis.
I am totally with you on giving yourself adequate time to recuperate from the first arthroscopy before doing the other one. I found that it took me about 3 months of pretty hard work to get my muscle strength back to the point that I could fully trust the first leg to take over for the other one. Keep in mind that I was in really bad shape -- even with ongoing physical therapy -- and using a cane for about a year before I had my first arthroscopy. I have to admit that I am still a bit steamed with just how long my diagnosis took. You probably will recover that strength quicker than I did. I actually waited an average of 6 months between my surgeries. It is really nice to know, though, that your surgeon is willing to plan the surgeries sooner if you feel ready for them.
I am very happy that I pursued conservative care for my back. When both hips are problematic, it can just throw all sorts of other things off. When you were asking about loss of signal intensity on a back MRI, I was wondering if your doctors were pressuring you to do a back surgery first. They usually won't do a back MRI unless they suspect serious problems. I am learning that it is not uncommon to be given back surgery as the first suggestion and I wonder how many people are being thrown into this old school style treatment plan and suffering, or just not improving, as a result. From reading other people's posts, I admit that my case was probably more extreme than others. I just really couldn't walk before the hip surgeries. I respond to posts because I would never want anyone else to go through what I experienced. Significantly delayed treatment in a good candidate can be devastating. If I am turning you into a hypochondriac, please forgive me. It is not my intention. I just want to make sure that you are getting the care that you need.
Good luck and keep us posted!
Does anyone know of a doctor in the Southeast that does this hip arthroscopy or specialize w/ hip impingement or tears? My primary doctor thinks more and mroe this is the hip. She is looking for an ortho doc around here to refer me to in order to confirm or check this out but she doesn't think anyone around here knows much about this condition. I'm scared to death. I have insurance but don't have a lot of money if I can't find someone that doesn't take mine. not to mention the thought of having this type of surgery. and I'm 37 years old - just got married last year - and wanted to have a baby before I'm too old. neither my hubby or myself have any kids. this is too much.
Your Dr. is right, proportionatly there aren't many ortho surgeons who specialize in hip scopes. You can find some that 'do' them, but finding someone who does them regularly is more difficult. They're more involved than other scopes and the testing and diagnostics is relatively new.
In North Carolina, try
This group is Dr. Hawkins group sort of originating from the Vail CO group of Dr. Phillopon. He's the guru of hip scopes. I know nothing else about this group or the Dr's.
In Tennessee, try
Dr. JW Byrd
Dr. Byrd is from what I've seen, heard and read one of the best,probably one of the few who've been doing it for decades. When I called last week he had a 5 month wait. If you call them they can tell you if he is participating with your insurance.
Honestly, I've looked alot to find the best simply because if I'm being cut into I want the guy with the biggest repertoire of knowledge and those are the guys teaching the classes...not taking the classes if you know what I mean.
Try The Hospital for Special Surgery in New York too. Hope this jump starts your search.
Also, try this site to look for a hip scope Dr. in the southeast. It takes digging but obviously it's worth it.
thank you for the post reply. no you are not making me a hypochondriac! you are very kind in looking out for me and others like me. i hope i am not too far out for the hips being scoped. i had a few things get in the way- first lyme disease, and then the shoulders. but luckily i am out and about. the only thing i wonder is if i can get by in life without the surgeries. and i can- but limited with things regarding crouching, bending, etc...and of course, any kind of sports. ultimately i want to get back in my kayaks. so i guess i will just have to go through it and see how things turn out. my doc has done about 1800 of these so that is a good number to go by, i hope.
i have weak little legs at the moment, and i hope that won't prevent me from getting better. i have a strong will so i expect that will only help. and, already having 7 surgeries under my belt, i know by now to take it slow with recovery and not do too much too early!
i think that at the moment if i do some things to push myself with pre-op, and deal with the pains, i can be only that much stronger. i think that i also confuse muscle weakness and pain with the hip stuff at times, thus i don't try to do too much with my flexors at this time. but i might try to.
i take no pain medications, and refuse nsaids always. nsaids are bad news for the healing of tendons and ligaments!!!
i guess dr kelly will answer my questions in a week. i won't leave his office till he answers all of them!
These are my final thoughts for the moment. It sounds like you still have options. Take advantage of that before it's too late. Like it or not, some things are just bigger than us. In my mind, avoiding these surgeries is kind of like playing chicken with a semi. If you don't try to avert the crisis, you know what your outcome will be. If you do try but land in the ditch, well, those are the breaks. At least you tried and even though you are in the ditch, you are still probably better off than if you did nothing.
Even though you may want to do the bad hip first, I would ask your surgeon what he thinks is best. It is easy to lose confidence and motivation when you have a lesser than desired outcome. My better hip turned into my good hip. My bad hip is still bad. At least I know that I tried.
Please don't refuse to take an anti-inflammatory if your surgeon prescribes one. It sounds like you need a lot of bone shaving. Depending on the extent, it can hurt like a broken bone for the first week. In my experience, the narcotic pain killers just don't cut that pain effectively on their own. The anti-inflammatories can also help with acute post-surgical swelling which can really be a problem if they are doing a lot of work in there. My tendons and ligaments are just fine -- yours will be too! The risk of undermedicating your acute post-surgical pain is a slow recovery. Sometimes the brain just can't seem to shut those nerve fibers down if they get too out of control and the pain can interfere with the therapy.
Please be very honest with your surgeon and his team about any herbal preparations, supplements or other substances that you are taking. They can interfere with anesthesia -- and you will probably be down for awhile because they have a lot of work to do -- and other medications that you receive in the hospital and even the ones that they send you home with. They don't always think to ask, and things that we think are relatively innocuous can be outright dangerous in the surgical arena.
Get Better, and soon!
I hear where you are coming from. I am 39 and sufferign with hip pain that has been diagnosed as a labral tear and FAI of the Cam type. I have done a ton of research on all of this to understand what the best next move should be. I have suffered through intermittent pain that has slowly become worse. Unfortunately, I think I did myself a dis-servise waiting so long to do something about it (2 years). I am schedule to get my hip scoped and hopefully this will releive enough of the pain that I can keep on going for a while longer before I need any replacement parts (resurfacing / replacing).
I strongly suggest you see a doctor with extensive experience with this problem and the associated fix. The more times he has done it the better. Dr. Byrd seems to be one of those experts. I will keep you posted on how this all turns out.
Looks like you have done your homework and have identified all of the same "rock-stars" that I have tracked down. I am scheduled to get my hip scoped by Dr. Byrd in Tenn. I will keep everyone posted on the process adn the procedure.
I have a few questions...
Did you have your hip scoped yet? If so, how did it go? I am very interested in understanding what it is I can do to help make this surgery a success. I can not control the doctors hand or his ability to do the best job possible. I have to pick the guy who has the highest probability to do the best job and then just roll the dice. After the surgery though I have some confusion over what I should do. Weight off the leg, /move hip around or keep it from moving? Do I need to get a passive motion machine or a Phillipon/Bledsoe brace? I am hoping that I get some good guidance after the surgery from the Doc and the PT personel. I assume what has to be done is dependednt on what the doc does to the hip. I just want to make sure that if Phillipon feels there is benefit to a brace or a motion machine that I get a chance to benefit from it even thouh I may not have seen him.
What is you condition like now after the surgery? How long ago did you get it scoped and who did it?
Thanks for posting your thoughts on this great site. As you know it feels real good to chat about somethign that takes up sooo much of your "mindshare".
I like you post... My take is that Phillopon is the rock star and Byrd is the Godfather! From all that I've read and been told you have a very very capable surgeon in Dr. Byrd. I would have scheduled with him but i didn't want to wait 5 months. What I did was start identifying who is teaching the procedure to newer docs and then looking into each of them to make a decision.
I have not had the surgery yet. I'm scheduled for January with Dr. Carlos Guanche is Van Nuys CA. You are so right about not being able to control certain things but that is why you find the most qualified surgeon and I definitely think Dr. Byrd is on the short list, whatever he finds once he gets you on the table (literally!) Some of them (not any of these guys mentioned) can only handle a simple tear or cam impingement but it's considered more complicated if you get into pincer impingements and cysts (from what I've read) amongst other things I have no idea of! You just want a guy with a full repertoire of experience and Dr. Byrd is THE guy teaching the other guys what to do when...
It seems that rehab varies alot if it is a repair vs. a removal, if there is a microfracture procedure etc. Phillopon and his extensions like Dr. Kelly in NYC use the braces. I asked about it and Guanche doesn't use them, but I'm not sure about Byrd. They will give you a therapy protocal specific to the things addressed in your surgery. You won't really know until he goes in!
I hope I answered your questions. I had my MRA in late October and i could have had the scope by now but I am waiting for 2010 to exhaust my deductible right away! One other thing...do some 'pre'hab getting your upper body strong. From what I hear the crutches can be killers.
When are your scheduled?
finally bit the bullet and decided to have surgery. i'm in nyc and tried to get b. kelly to do the surgery but my insurance won't cover him. i actually can't see anyone at the hospital for special surgery (which is upsetting). my internist sent me to michael kang at insall, scott, kelly. he's affiliated with lenox hill hospital. i don't know anything about him other than he seemed nice and competent. does anyone know any other info on dr. kang???? i'm scared to get this surgery and really want a doctor who knows all the ins and outs of this procedure.
any and all help in greatly appreciated!