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405614 tn?1329147714

Hip/SI joint issues, questions

I also posted this in the Orthopedic community.  I would appreciate any input.

I discovered that I have a hip labral tear in my right hip, and went to see a surgeon about having it repaired arthroscopically.  I was told that my hip arthritis was to advanced to have a good outcome and I would be needing a hip replacement, and should wait until then.  

Her chart notes said that I have " hip symptoms consistent with femoral acetabular impingement and arthritis.  The MRI arthrogram also shows diffuse articular thinning.  I think she would get minimal lasting relief from arthroscopic intervention.  We plan to proceed with therapeutic intraarticular steroid injection" ( which didn't help).

Her comments on my X-ray:  Standing AP pelvis and frog lateral bilateral hip:  mild joint space narrowing left, moderate right.  On standing Xray there is less than 2mm jointspace (Philippon criteria) and decreased femoral head/neck junction offset.

On the same chart notes, there was a radiologist's interpretation of the Xrays:

Findings:  The visualized osseous structures are intact without acute fracture or focal destructive lesions.  There is periarticular sclerosis and spurring involving both sacroiliac joints.  There are bilateral iliac with enthesopathy.  The joint spaces of both hips are mantained and within normal limits.  The femoral head contours are smooth bilaterally.  No soft tissue abnormality is identified.

Impression:  Degenerative joint disease involving both sacroiliac joints.  

My question is; Aren't these two reports somewhat different?  Isn't one saying I have decreased joint space, while the other is saying that the joint space is normal?

I understand that recovery from a hip arthroscopy might be difficult with all the other stuff going on there, but is there truly hip arthritis to the point where I will be needing a replacement in the near future?  I know that you haven't seen the imaging, but I'm at a loss as to what to think or do.

I'm seeing my Sports and Spine medicine doctor today, who sent me to see the surgeon after his xray and arthrogram showed the hip labral tear.  He and my PCP thought that repairing that tear could greatly reduce my pain level.  Hopefully he can offer me some clarity.  

If anyone out there has any ideas, please chime in!

6 Responses
469901 tn?1276567223
My impression is that your dr was looking at your hips and the radiologist was looking at everything.  Do you know what type of arthritis you have?  Do you have a rheumatologist?  It sounds like you need some one to look at the whole forest instead of focusing on a tree or two.
405614 tn?1329147714
I've seen a rheumatologist, and he didn't do much.  I'm sure I have osteoarthritis, tests showed nothing else.  Both parents had it.

My sports and spine doc is referring me to another surgeon for a second opinion about my hip; I don't think he thought the arthritis was that bad there yet, and said it was encouraging that the lidocaine and buvipicaine relieved most of my hip pain.

Now that more arthritis is developing, it probably would be a good idea to see a rheumatologist again.  

Thanks for your input.
422104 tn?1209767504
I work for an Orthopaedic Surgeon and I agree with txsilver.  Get a second opinion, see the rheumy again.  The fact that the radiologist and the doc are interpreting your x-ray differently is reason enough to see someone else.  Let them take another set of x-rays as well.  The radiologist is saying there is no problem with joint space, the doc is saying there is.  Just keep in mind that Ortho Surgeons "thing" is to do surgery, I'm not saying yours is wrong or trying to pass judgement, just be sure the person whose care you are in has your best interest at heart and not theirs.  My doc is one of those that will tell you straight out, "you don't need now" or "you do".   Please let us know how you make out and best of luck to you.

405614 tn?1329147714
Hi Sue,

I had a fairly recent Xray before the one that the surgeon did, as well as the arthrogram.  There was no mention of thinning cartilage or signs of arthritis on either of those reports.

I would definitely prefer not to have surgery, having had plenty, but I would also like to reduce my pain if possible.  My sports and spine doc is recommending doctors that are good at hip arthroscopies; I want someone with plenty of experience with that procedure if I do have it done.

The same surgeon saw my sister (3 years older than me) who also has a hip labral tear, and my sister was told that she could have the surgery if she would lose 50 pounds.  It seems like this surgeon likes to have a good outcome to her surgeries, and perhaps she thought with my SI Joint issues my outcome wouldn't be so great.  

My other doctor's office is scheduling my appointment with the new surgeon, and I hope it will be soon. I'll keep you posted.  Thanks for your good and kind advice.


405614 tn?1329147714
Update; my sports and spine doctor never followed through on the referral to the other doctor for the second opinion.  The last time I saw him (after a lumbar discography, more bad news), he said that the first surgeon he referred me to knows the inside of knees better than he does, but he'd have the staff work on the referral.

Maybe it's just that my lower back / hip area is just too complicated.  The lumbar discography showed the dye leaking through large annular tears at every level, and the CT afterwards showed the same in more detail.  

An MRI from April of this years shows "varying degrees of disk desiccation throughout the lumbar spine...along with mild disk space narrowing throughout.  Scattered Schmorl's nodes are seen.

Diffuse nonstenosing posterior disk bulges are evident at multiple levels including L3-4, L4-5, and L5-S1.  There is mild left neural foraminal narrowing at the L4-5 level  where the disk bulge is asymmetric to the left.  There is mild facet arthropathy throughout the lumbar spine".

And, last , from an X-ray in February of this year:  "There is mild grade-1 anterolithesis of L4 on L5 which is probably degenerative in nature....mild disk spce narrowing at L1-2, L2-3, and L3-4".

Does anyone know of a good neurosurgeon to consult with in the Portland OR area?  Please PM me if you do.  I suppose that is the next step, though I've been putting it off.  

I have radiculopathy down the same leg that has the hip labral tear on it.  I also banged the ankle on that side and got a deep bone bruise and possible peroneal tendonitis, or possible hairline fracture that didn't show up on the first X-ray.  I'm limping, while trying very hard not too, as that makes my back hurt worse.

But, to end on a happy note, I just got back from a trip from San Diego with a friend who had to go down on business.  We visited the San Diego Zoo, which was pretty cool.  We took a bus tour first, rode a skytram up to wear the polar bears were, and wandered until my ankle ached and it was time to catch our flight home.  

So, life is good, even with the bad aches and such.  


3157939 tn?1343586334
i have radiculopathy, mild disc bulge, facet joint arthropathy, bilateral neuroforaminal narrowing, mild distaloxonal paynewopalhy, spinal stenosis, widely patent spinal canal and neural foraminal, pain and weakness in my spine and legs and with fire and pain and other.
you need a copy of your MRI to go to 4-7 doctor to get the right answer
and all the report will not said the same!!!
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