femoral acetabular impingement: an invisible illness

In April 2016 I was diagnosed with a condition called femoral acetabular impingement (FAI). 

FAI is a condition where the hip socket (the acetabulum) and the femur abnormally rub against each other when bending or rotating the hip, which can cause sharp pain and pinching of the labrum. The labrum is a layer of soft tissue that lines the hip socket; sometimes it can be damaged or torn due to FAI. In FAI bone spurs develop around the femoral head (the ball part of the hip joint) and/or on the acetabulum (the socket part of the hip joint). There are 3 different types of FAI: CAM (when bone spurs form on the femoral head), pincer (when bone spurs form on the acetabulum) or you can have both types, called mixed FAI. The abnormal shape of the femoral head or acetabulum can lead to joint damage and pain. Some people have FAI and never experience pain or any type of symptoms and may never know that they have it. However, when symptoms and pain do develop, this often indicates that there is damage to the labrum, which is likely to progress. I began to experience symptoms of FAI/labral tear in my right hip about 4 months before I was diagnosed. For me, the pain was not constant, but often I would have sharp pain in my groin; it felt like a catching sensation. Other times my groin would ache horribly. Sitting for long periods of time seemed to increase pain, as well as activities such as running. An MRI with arthrogram is the gold standard imaging test that will usually detect the presence of a labral tear. The pincer or CAM deformity will usually show up on x-ray and CT scans. In my case, it took a skilled orthopedic surgeon to detect the tear in the MRI arthrogram and the pincer FAI on my x-ray (in other words- it was not picked up by the radiologist). After my consult with the surgeon, I was told that I would require surgery to repair the labral tear and shave off the extra bone on my hip socket (or acetabulum)- the pincer type of FAI. Often, FAI will progress to osteoarthritis if it is not corrected by surgery. Also, because the labrum has little to no blood supply, most research concludes that it is impossible for the labrum to heal itself. Therefore, avoiding or prolonging surgery can inevitability lead to further damage to the labrum and osteoarthritis and therefore increased pain. I have been told by more people than I could count that I am too young to have hip problems. Unfortunately, it seems as though FAI is genetic for some people (my mom has it too), and so I was more than likely born with the bone deformity. So, no, I am not too young to have pain in my hips. Often times a person can be in quite a bit of pain if they have FAI and a labral tear, but are still physically capable of doing daily tasks even though they are in pain. This lead me to start calling FAI an invisible illness… one that I have come to learn that not too many people truly understand. 

I had arthroscopic hip surgery to correct the pincer FAI and labral tear in my right hip in May 2017. It was a same day surgery. My fantastic surgeon, Dr. Wong, first cleaned out the synovitis (all of the inflammation in my hip joint) so that he could actually see what was going on in there. He cut open my hip capsule and shaved and rounded my acetabulum (hip socket), he also put 4 anchors into my hip and used sutures to anchor my labrum back in place so that everything would be smooth again, he cut my psoas tendon (iliopsoas tenotomy) so that it would not rub against the newly repaired labrum, finally, he stitched my hip capsule closed tight. I have a video of my entire surgery where Dr. Wong himself explains what he is doing to my hip. This procedure is completely different than a total hip replacement and although it is a day surgery, the recovery time is much, much longer. Do I still have pain at 9 months post op… yes. I have been told it can take up to a year to heal and possibly up to 2 years for fully normal function of my hip. I have pincer FAI and a labral tear in my left hip that has not yet been fixed and so between my two hips I am battling constant compensation issues causing constant pain in one hip or the other. At this point the goal is to keep getting stronger and to continue with physiotherapy. It’s been a long 9 months. I am physically, emotionally and mentally exhausted. Could it be worse? Absolutely, I realize it could be much, much worse and I am thankful that it is not. 

So what’s the purpose of this post you might ask… it’s to spread awareness of this condition, femoral acetabular impingement and labral tears; to help people understand what myself and others may be going through, because most times, it may not appear as though anything is wrong, but often times it truly is a painful invisible illness.