Failed Labral Tear Surgery

Hi Andy,

Great ck list before dr. appt. I have had 3 THR due to osteoarthritis first in in my early 40'. 

Once you get thru the whole process it's really over in a flash and your life is back! Staying positive and mindfulness helped me a lot.

Hope xxxx

 

Thank you for your quick response!  I'm laying in bed trying to sleep but in pain and feeling extremely frustrated and sorry for myself😁. Not feelings I'm proud of.  I'm going on 10 months of not being able to walk. I'd kick myself if I could (lol) for not getting the hip replacement in June. My Doctor felt the arthoscopy surgery I did have might put off the THR by a few years. If I had listened to my gut I'd be well on my way to recovery.  I appreciate your tips. I think it's a very good idea to try and get in the best shape possible before instead of waiting until it's over. Thanks for listening to me vent!  I actually feel a bit better. No one can understand this unless they are going through it. 

Thanks again!

Hello Andy- 

My daughter is only 26- but has been one and half years of sig pain with sitting / standing / walking since arthroscopic surgery Cam fem .

How bad was your arthristis ( on a scale grade 1 ,2 ,3 or bone on bone ) before your arthroscopy ? How about before your hip surgery ? Like you - her condition worsened terribly AFTER the labral repair . 

Thankyou - desperte for help 

Hello,

I saw your post and I am 29 just and had similar procedure. 

My op was in October so I’m still in early days so I’m told. Don’t feel it’s worked and am increasingly getting depressed as was very active and now am not and gaining weight. Seeing my consultant on Friday so see what he has to say... 

Hope your daughter has improved ...

Thank you for your response. It is a relief to know I'm not alone!  Good luck in your continuing recovery. 

GGAZ😊

Hello and thank you!  You must be a youngster with 3 little ones. I am amazed the more I research this, how many people are faced with this condition at much younger ages. I really thought at 59 I was too young!

Thanks for the encouraging words and all the best to you!

🌞🌍☀️

Oh my!!  How uplifting to hear!  It's wonderful you have your life back after this horrible experience.  I pray for that day to come. I can't even remember how it feels to walk like a normal person. The one thing that does worry me is how long do you have restrictions on being able to bend over?  I read about the danger of dislocating the new hip and it freaks me out!!! 

Thanks for for your thoughts and encouragement !

🌎

Restrictions run for 6 weeks, but you soon become used to them. I had my surgery at Spire Yate in Wrexham. I too was concerned about the prospect of dislocation, so asked the nursing staff how frequently dislocations occurred. In the 9 years that they've been performing this particular procedure, there have been a total of NO dislocations.

Don't worry!

That's a relief to hear. Thank you😀

Hello Neil, when you determined to have ceramic left hip fitted, do you mean that was a total hip replacement?  Or hip resurfacing?

When you decided to have that surgery did your hip have significant arthritis at that point?

I ask because after my failed hip scope, followed by 3 years of severe pain, my hip joint shows only mild arthritis.  And I'm already 58, so I it's sort of ironic to have had FAI and labral tear, then failed hip scope, and still only "mild" arthritis?

Anyway, 2 hip replacement surgeons are telling me they don't want to perform total hip replacement for me because the best indicator of successful replacement is when a patient already has moderate-severe arthritis.

Thanks for any feedback about your level of arthritis just before your new ceramic hip was fitted.

Hi. I wanted to ask what you have decided to do, or whether you've received additional insight from doctors. I ask because I'm in almost the exact same situation. I'm 55 and18 months out from hip arthroscopy for labral tear and FAI. I haven't had a day without pain. Continuous problems with pain at hip, buttocks and down front of leg. Because I have no arthritis there is no option for a THR, or at least it's not something the orthos will recommend. Quality of life significantly affected! :-(

Hi Helaine,

Sorry to hear about what you're going through.

Here's my my update:

1. Early Fall 2016 2 of 3 hip replacement surgeons I consulted with recommended another hip scope to look for evidence to explain the chronic pain. They said this is a less invasive, safer surgery than to go straight to THR. (I'd asked for this for years, but got stonewalled.)

2. Hip scope scheduled for Feb 14, 2017.

3. If surgeon finds something easy to repair, like a floating or pinched piece of something, he'll do that. If he finds lots of arthritis, or other conditions that make my hip joint "doomed", I told him to please NOT do anything, just close me up and let me recover from the surgery. (If he sees a problem that qualifies me for successful THR then I don't want unnecessary work done in the joint. That would just mean more pain and longer recovery)

4. Review findings from the surgery, and maybe schedule THR.

I'm still nervous about the weak correlation of low-arthritis + good outcome of THR. I keep asking THR surgeons "Why?" Is the implant designed for hips that are worn down to bone-on-bone?

I will post again when I have another update. Good luck with your case, Helaine.  Let us know how things progress (hopefully, there will be progress!)

 

I have the same question re: why the only indication for THR is severe arthritis. Certainly if we've had labral tears and impingement, then went on to have bone shaving and suturing up of the labrum with anchors, our hips are "not shiny new" (using a term from one of the hip orthos I saw). Couldn't this alone mean we have a compromised hip? I certainly do not think anyone should jump into a joint replacement if grasping at straws, but if there is clear indication the hip is the source of pain, I think it should be strongly considered ..especially when one has given up quality of life for 5 years. The challenge is making sure that the hip is the source of pain. I think the surgeons are following a protocol with arthritis being a prerequisite as it lessens their risk in proper patient selection. Meantime we suffer in pain :-(.

Please keep me posted on how you do with your upcoming visits and I wish you well!

Hi Glynell, have you actually seen studies about the THR outcomes after failed hip scopes? (You mentioned earlier that THR surgeons tell you this...) I have had one failed, one successful. The one that failed had mild arthritis but not enough for THR...I understand the reluctance of replacing a hip without major cartlage wear but are there such studies? I have been to quite a few forums and seen how people struggle after scopes, even with minor arthritis. And they get THR and move on with their lives. I am in a cycle of injections and rehab, functioning but quite limited...I have the same hesitations...at 54, but told no revision since likelyhood it being success is minimal...surprised to hear that somebody is willing to do an investigational scope...how much cartilage do you have in mm? or is your arthritis limited to certain area of the joint? 

Hi please keep us all updated on your situation. I find myself facing a similar scenario - I had surgery for Labrador tear a year ago. At that time Xrays should mild arthritis and Labral tear and I had arthroscopic surgery. I'm 60 and have had several major surgeries including a two level fusion of lumbar disks but this labral tear surgery has been the worse! There was much worse damage than was evident on Xray or MRI. After 7 - 8 months pain was increasing and my activity was decreasing substantially. I just saw my arthroscopic surgeon today and new Xray show increased arthritis. He has referred me to his colleague for possible THR. I am hoping to hold off for 3 - 4 months to lose a little more weight. After reading g everyone's posts I think I'll also consider pre-surgery PT.

Good luck!

Hi Nashi,

I did find some studies online about THR outcomes after failed hip scopes. Those studies did mention "absence of joint degradation", and "low level of arthritis" as indicators that THR would not be as successful. That the highest indication of good outcome for THR after failed hip scope is advanced or severe arthritis. I can go back to my browsing history and get some links.

But I still wonder WHY is this the case. I'd expect some technical explanation, such as the hip replacement device is designed for ??? - something along those lines.  Can't find anything or anybody to answer that question.  Maybe there is no answer - yet.  Things are still evolving with this labral tear/FAI diagnosis & treatment. It is still considered a "newer" area in orthopedics, especially for us older folks!

You asked: "how much cartilage do you have in mm? or is your arthritis limited to certain area of the joint?"

     Answer: I don't know, but I've been told that the undamaged cartilage looked really good in my hip scope of 2013, and multiple MRIs 2013-2016 also showed an even layer of thick cartilage. In the hip scope about 2.5 cm of damaged cartilage was removed.

              Answer #2: Joint space measured at 4 mm in Sept 2016. In the hip scope in 2013 surgeon said he found Grade 4 arthritis limited to 1 certain area in the joint.

Hip Scope #2 is scheduled for Feb 14. I'm meeting with the surgeon on Jan 26 to review scenarios - i.e., if he finds lots of arthritis, just close me up and I'll move on to THR. If he finds pinched or floating tissue, or bone spur, remove it - but don't do a lot of repair, as it will likely fail and will give me a longer recovery time. Who knows? Maybe this hip scope will accelerate arthritis quickly and I can get the THR soon.

I'll post an update by 3rd week of Feb, after my hip scope.

Hi Jody,

Here's my update: Hip Scope #2 is scheduled for Feb 14. I'm meeting with the surgeon on Jan 26 to review scenarios - i.e., if he finds lots of arthritis, just close me up and I'll move on to THR. If he finds pinched or floating tissue, or bone spur, remove it - but don't do a lot of repair, as it will likely fail and will give me a longer recovery time. Who knows? Maybe this hip scope will accelerate arthritis quickly and I can get the THR soon.

I'll post an update by 3rd week of Feb, after my hip scope.

For your case: Have you tried a steroid injection into the hip joint? If yes, did it help you?

I'm glad you are referred for possible THR. You've been through enough, with all the spine surgery and hip scope. I think the THR will get you to a much better place.  If the arthritis keeps increasing in your hip, it will cause more pain, of course, but gets you on the road for THR faster.

If you haven't already scheduled appointment with THR surgeon, go ahead and do it (and try to find a VERY experienced surgeon who has a GREAT track record). It's good to develop a relationship with the surgeon and his staff.

Keep us posted!

Thanks for your response, I really appreciate it, since I am in a similar situation. Curious to find out what they see once inside the joint. No x-ray or MRI can compare to the surgeon actually probing the cartilage. I guess in your case it's critical what area of the joint was that grade 4 arthritis and how that is affected during loading. Unfortunately a scope and prolonged pain will affect muscles and nerves a lot and it could be difficult to tell what comes from the joint and what it's caused by lack of proper muscle actions. I hope you get a clear answer and can move on. I get by with injections and rehab for now and I am still trying to figure this out. Every time the injection starts to wear off, at about 6 month mark, I get more pain and it takes quite a bit rehab to return to even limited functional level. It's as if my muscles get some kind of amnesia, they totally forget how to work even when the pain eases. I have to go back to very basic exercises to re-learn neuro muscular control in order to improve further, to be comfortable, yet limited in my activity level. I have grown quite patient but sometimes I get very frustrated and wish this could be fixed with THR. But I know that even with Hip replacement it could be a while and require a long period of rehab. I read a study about psoas atrophy and how that affects outcome of THR. People with long-term pain will have an atrophied psoas muscle and probably need longer term rehab. Maybe this is one of the reasons why previously scoped patients don't do so well? But the good news is that it can be addressed with proper rehab. From my own experience, it's hard to find a good PT Who makes sure that all the building blocks of neuromuscular control are in place before progressing to a more dynamic phase of the  rehab. If this is not done right compensating muscles can cause lot of pain and dysfunction. I wish you courage and patience in your hip journey and I am eager to follow it. Keep your spirits up, that's the most important part.

Hi Nashi,

I am curious about why THR may not have good outcomes for people with previous (failed) scopes.  That would be me.  I also have dysplasia and am not a THR candidate yet according to the replacement drs.  Too much cartiledge.  Limping around and waiting for the day.....but in the meantime I would love to read up more on this subject if you can recommend any articles.  I want to do everything in my power to ensure a proper outcome.  (starting PT after a 3 week resting period with hard core antiinflammatories--fingers crossed)

Since you have known hip dysplasia, scope might not have been the the right solution for your hip pain, depending what they did during the scope. I know of a facebook group, I think it's called Young THR, there are lot of people in your situation, maybe join one of those groups to hear other people's stories. With dysplasia your labrum is put to lot of stress, having to stabilize the joint where there is not enough bony coverage in your hip socket. If you are 55 and have dysplastic hip you don't seem young for THR. Different doctors have different opinions. Find people who can pont you to the right direction. Doing PT is always a good idea, good luck with rehab and may we all have a future with a pain free hip, one way or the other. Cortisone or  Synvisc (hyaloronic acid) might help too, while figuring it all out. 

Thanks for the response. The surgery found impingement a deformed femural neck, mild arthritis and a labral tear. At this point it sure seems like I shouldn't have the surgery but I couldn't walk and no Dr. would do a THR so I felt I had to take the option. But now, after the failure, I wonder. Thanks for the info. I appreciate it.

Nashi, thank you for the detailed reply. You know so much more than I do (and probably more than some surgeons do). I'm printing your message to take with me to appt with my surgeon!

*sigh* I think it's CRAZY how many of us after failed scopes seem to be floundering, and have to do so much work & research on our own.

But, yes, I hear you about keeping my spirits up. I'm pretty good about that, it does make a big difference.

If I'm able to go for walks I find that is good PT. I have always been good with stretching exercises. I'm worried about the psoas, as most of my worst pain is right where the psoas tendon attaches. Years and years of pain and inflammation. However, for a couple of months after my 1st hip scope in 2013 that pain and inflammation decreased and I felt my  muscles in butt and abdominals "firing" and getting stronger. So I'm hoping that will be the case again with 2nd scope and/or with future THR

I'll ask my surgeon to note details of area(s) of arthritis in the joint during this upcoming scope.

Thanks for your support. I will begin a search for PT who does what you indicated.

[sorry I replied in the wrong place in the thread, so this is a duplicate reply from glynell to Nashi's message]

Nashi, thank you for the detailed reply. You know so much more than I do (and probably more than some surgeons do). I'm printing your message to take with me to appt with my surgeon!

*sigh* I think it's CRAZY how many of us after failed scopes seem to be floundering, and have to do so much work & research on our own.

But, yes, I hear you about keeping my spirits up. I'm pretty good about that, it does make a big difference.

If I'm able to go for walks I find that is good PT. I have always been good with stretching exercises. I'm worried about the psoas, as most of my worst pain is right where the psoas tendon attaches. Years and years of pain and inflammation. However, for a couple of months after my 1st hip scope in 2013 that pain and inflammation decreased and I felt my  muscles in butt and abdominals "firing" and getting stronger. So I'm hoping that will be the case again with 2nd scope and/or with future THR

I'll ask my surgeon to note details of area(s) of arthritis in the joint during this upcoming scope.

Thanks for your support. I will begin a search for PT who does what you indicated.

I really feel our injuries are similar. Do you have fantastic pain in the anterior thigh? I would like to follow your journey. I hope the scope goes well, I hope you visit this board with an update 😉😉

Yes, I do have profound pain in anterior thigh, especially felt where adductor tendon attaches to pubic bone. Groin pain is constant, especially if I sit.

I use cold/frozen gel packs to numb it. Helps a lot.

3 years ago I finally had to resort to low-dose morphine, which got me back to my life. Other opiates made me feel stoned, and didn't really blunt the pain much. Thank goodness my primary care MD has lots of experience with chronic pain patients, and has been wonderful with helping me manage the pain. After the 1st 2 weeks of taking 1 15mg morphine pill every day I was able to reduce it to 1 tablet every other day. I've never felt any addiction/withdrawal, I can take it as needed. It didn't remove the pain, but got me back to driving, walking, working, socializing. I just keep a small ice chest in my car, and take frozen gel packs everywhere.

I was scared to take opiates, but I really didn't have a choice, nothing else for pain management worked. And I had tried everything for years.

In my case, when I do PT strengthening exercises for the hip, even gently, I have pain afterwards. I hoped that would go away after sticking with it for a few months, but it didn't. That's just me - I'm sure others have a different experience. For me, doing my own combo of stretching and walking (when my hip isn't screaming in pain) works better.

Enough about me!!

Diane, are you going to see a new surgeon do evaluate you for THR? I agree with nashi - that with known dysplasia, and other problems found during the hip scope + your age: it seems you would qualify for THR. I hope this will be the case, sooner rather than later, so you can lose the pain and get back to your life.

Best wishes!

On April 3 2017 I had 2nd hip scope, surgeon found "a bit" of calcification and scar tissue at front of the joint.  He suspected it was under the labrum in one area, so he peeled it up, cleaned away the bad stuff, then reattached the labrum with 3 little anchors.

He says it *may* explain some of the pain I had after the 1st hip scope, but he's not sure. He found no significant arthritis.  (therefore, I'm still not a great candidate for THR!)  I was actually hoping for bad arthritis, as that would set up a more definite plan. Anyway...

Recovery is much easier this time. The real test will be how i feel in 6 months, then 1-2 years from now...  I'm following the PT protocol, hoping the tendonitis & pain that occurs when sitting will subside. I don't know if/when I'll be able to ride an exercise bike, sitting and pedaling will hurt, but I want to try it.

I'll post again in a few weeks.

Hi glynell, thanks for the follow-up and best wishes for a recovery. My best advice is to rehab is to take a long term perspective. It's not going to be a speedy recovery, proceed very gradually (PT's call it "graded exposure, talk to your PT about it" and  when you have a flare, don't stop, ease off little bit but keep going. There will be bumps on the way. Study resources you can find about about pain theory. Google "explain pain" by Mosely and Butler, there are podcasts and ted talks to get some ideas on how to challenge your pain. I am personally working on both physical rehab and the mental part, and I have realized the mental part is just as important. My reactions to pain (worry/fear/frustration) have changed and even if I still have some pain I am much better now and pretty confident that I will be ok again. I am more patient and I have stopped worrying if it's arthritis/labrum /any physical structure that is causing the pain. I still catch myself thinking this way, but at least I am aware of it. my psoas is still quite angry if I try to do too much but it's getting better. So, be patient, and be confident that you will be ok. It's easy to say, harder to do, I know. But worrying and speculating about it will not help you to a good start on your recovery. I hope you have a good PT who takes into consideration that you have been in pain for a long time. He/she needs to remind you that it will take time get rid of that pain too. 

I don't know how that smiley face got in there...

My daughter - 26 years - in same boat . Mild grade 2 hip arthritis - but severe debilitating disease . 

Looking for hip replacement to end pain . Did you get one ??