Aa
A
A
A
Close
Orthopedics Community
12.6k Members
Avatar universal

FAI/Hip Arthritis

I tried to post this question to the experts area but was unable to. I get the message that the area was closed to new comments. Am I doing something wrong?

Hello,
Thanks in advance for your help. Sorry for the lengthy narrative but I am trying to include as much info as possible.

I have been having right hip pain for about 5 months. It started out fairly mild but has been increasing steadily. I am a 59 year old male with a 35 year history of strenuous athletic activity. I am 6 feet 220# and was a ski patroller, snowboarder, professional mountain biker and have ridden my road bike 6000 miles a year every year for the last decade or so. I gave up downhill skiing and snowboarding years ago because of knee problems and now concentrate on road biking and XC skiing.

The pain started out as a sharp sudden pain if I moved the wrong way mostly involving hip flexion and rotation. Cycling was not painful at all. I was being treated for a groin pull and was told that it was OK to to continue with my routine of cycling around 225 miles a week. I did 8 weeks of physical therapy which helped with range of motion. The sharp sudden pain subsided but now has been replaced with a dull ache in the groin.

I will put my questions here and then elaborate below:

Is hip replacement my only option if I am unable to manage the pain conservatively?
Will I be able to continue with my level of activity if I do have a replacement.
Will a replacement last long enough given my age and activity level?
Should I continue to cycle and XC ski?

Based on how I am understanding my test results most of my pain is from hip impingement, not necessarily osteoarthritis. I am uncomfortable sitting for long periods, and recently (last month or so) riding my bike has become occasionally painful both during and after the ride. I have been prescribed meloxicam 15mg daily. I have been taking it for about a week without much relief.

I have been told that at my age the plan should be to manage the pain as best as I can until it becomes necessary to have a total hip replacement and because of my age I am not a candidate for hip preservation surgery, i.e. arthroscopic remodeling of the femoral head, labrum repair or debridement, etc.

I have also been told that cycling is OK as tolerated because it is a closed cycle activity. I also XC ski in the winter.

I have recently had xrays and an MRI. which I believe show good joint space and cartilage loss mostly immediately adjacent to the labral damage.

I have an appointment with the hip replacement surgeon but wasn't able to get in until almost 7 weeks from now.

Here are my MRI and Xray imaging reports:

Clinical History

Right hip pain. s/p 11/6/14 hip injection with relief x10 days.

Comparison
11/06/2014.

Technique
MR images of the pelvis and right hip were acquired in multiple planes without
contrast.

Findings
No acute osseous injury or acute muscle injury is identified. There is no free
fluid in the pelvis.
Disc degeneration is present in the lower lumbar spine.
No sacroiliac disease or symphysis pubis arthropathy is identified.
No large effusion is seen in either hip. There are no bone marrow signal
abnormalities.
The sciatic nerve is normal in appearance bilaterally.

At the right hip no large effusion or filling defect is apparent. There is a
small amount of increased signal intensity within the ligamentum teres which
may reflect the presence of tendinopathy.

The AP pelvis film is consistent with over coverage of the acetabulum and the
images in a symmetric fashion bilaterally.
The femoral head neck junction is prominent and I measure an alpha angle of
approximately 75 degrees.

The labrum is abnormal. Degenerative tearing is seen at the anterior and
superior lateral aspect of the acetabulum. This is associated with focal
defects in the immediately adjacent articular cartilage of the femoral head and
the acetabulum.

Impression

1. Osteoarthritis of the right hip characterized by degenerative tearing
of the labrum and focal defects in the articular cartilage.
2. The contour of the femoral head and the appearance of the acetabulum on
the pelvis x-ray suggests that the patient is likely impinging due to both
pincer and CAM type morphology.

Clinical History

RIGHT HIP PAIN

Comparison
Standing alignment radiographs from 03/23/2007.

Technique
AP view of the pelvis and 2 views of the right hip, AP and lateral.

Findings
There are very mild osteoarthritic changes of the bilateral hips consisting of
marginal osteophytes. Joint spaces are well preserved. No fracture is
identified. Small enthesophyte is present at the right greater trochanter.
Small unchanged sclerotic focus is seen in the left acetabulum, consistent with
a benign bone island. No suspicious osseous lesions.

Impression
Mild osteoarthritic changes of the bilateral hips.
No fracture.
Small enthesophyte at the right greater trochanter at the gluteal tendon
attachment.



2 Responses
7721494 tn?1431631564
Sorry to hear of your loss.

I am not going to give medical advice here. I advise you to follow the lead of your doctors.

Do you understand that you have both degenerative changes plus a possible injury to the hip joint (the tear). You also have lumbar degenerative changes that may be adding to the pain (pain is always additive.)

If I were you, I'd cut back on my activity. Inflammation comes with injury and disease and is probably causing pain. Exercise is one treatment for inflammation (it increases blood flow), however, you don't want to exacerbate the injury.

Again, please ask your doctor for more precise instruction on this. He/she's the one who's looking at your film.

Best wishes.
Avatar universal
Thanks for the response. The PA at the surgeons office is telling me that cycling is OK as tolerated. It feels a little sore after I ride but to be honest it feels just as sore if not more when I take a few days off. The lumbar degeneration is not news, I had a herniation in 1998 and have no pain related to that. I guess I'm just looking for a little insight from someone who may have had/has a similar issue. I was hoping I might be a candidate for some sort of joint preservation procedure like arthroscopic labral debridement/microfracture but evidently not. I had microfracture done on my right knee almost 10 years ago and have been doing great with that.
Have an Answer?
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Find out if PRP therapy right for you.
Tips for preventing one of the most common types of knee injury.
Tips and moves to ease backaches
How to bounce back fast from an ankle sprain - and stay pain free.
Patellofemoral pain and what to do about it.
A list of national and international resources and hotlines to help connect you to needed health and medical services.