Friday, May 24, 2013

Why You Need an FAI Surgeon Who’s Specialized in Hip Impingement: All Orthopedic Surgeons Are Not Equal

Recently, I met someone who had seen an orthopedic surgeon who told his patient that the labrum fills no function whatsoever. He would just cut it out, and the patient was told she would walk out of the operating room like it is nobody’s business. Doctors like this scare me because they clearly do not understand femoroacetabular impingement (FAI or hip impingement) but are happy to slice and dice their patients.

I say it in my book, but it is so important that I want to put it out here on the Internet for the world to read. Just because someone is a board certified orthopedic surgeon does not mean he/she is qualified to perform surgery to remove hip impingement and treat hip labral tears.

Doctors may argue whether labral debridement or labral repair is the right thing. In my book I provide a thorough discussion of terminology and the research on the topic so that patients can make an educated decision. However, that is not what this article is about, but rather what patients should look for in an FAI surgeon.

Unfortunately, there are surgeons out there who are willing to take your hips lightly. Don’t give them the chance, but learn as much as you can about hip impingement and labral tears that you can ask all the right questions (in my book there is a list of questions to ask a surgeon). When it comes to your hips and pain, there are many possible scenarios.

A qualified FAI surgeon should not just send you out for an MRI and treat according to the radiologist’s report. Rather, should an FAI surgeon be able to read the imaging, look for not just CAM and pincer impingement, but all measurements to detect hip dysplasia, acetabular and femoral retroversion, anteversion etc.

It is important to find out exactly what the state is of your hips and what causes your pain as the treatment may vary. Everyone is not a candidate for arthroscopic surgery. Sometimes, open hip surgery is the only way to treat large CAM lesions, retroversion or hip dysplasia (something that is increasingly recognized even among arthroscopic hip surgeons).

A general orthopedic surgeon without training in treating femoroacetabular impingement will likely miss impingement and leave you with untreated impingement lesions which can lead to repeat labral tears. A general orthopedic surgeon is likely not familiar with an appropriate post-surgical hip arthroscopy physical therapy protocol. Remember, just because someone advertises themselves as an arthroscopic hip impingement, FAI, surgeon does not mean that they have the necessary experience, or training.

Ask detailed open ended questions and let the surgeon explain exactly how they will go about the surgery and change the biomechanics of the hip. Hip impingement may be the latest scream in sports journalism (follow the money), but your hips are yours for the rest of your life. Make sure your surgeon takes them just as seriously as you do.

Ps! I haven’t forgotten that I promised you an article on Neurokinetic Therapy (NKT). Actually, I have something really great coming for you – a physical therapist guest blogger who practices neurokinetic therapy. Check back soon!

1 comment:

  1. Hi Anna-Lena,

    This is a great post. I wholeheartedly agree that each individual should take better control of their own healthcare. With regards to your post: Medicine is becoming more and more specialized. There are even fellowship trained hip surgeons (let alone general ortho surgeons) who may not be fully up to date on FAI.

    I am a radiologist and I am very familiar with FAI, its consequences, and its treatments. I established (along with the HSS trained ortho hip surgeon - Dr. Asheesh Bedi) an imaging protocol at the University of Michigan for evaluation and pre-op planning of FAI. That being said, there are fellowship trained MSK radiologists (along with the aforementioned surgeons) that will not be familiar with the entity of FAI, let alone the reading of an MRI, CT, or XR for FAI.

    The best case scenario is that the appropriate imaging is performed (with an optimized protocol specifically for FAI), the reader is a fellowship trained Ortho rad (WITH familiarity of FAI), and you are seeing an orthopedist who has specific training in the treatment of FAI. Ideally, the orthopod and the radiologist are working together to come to a final diagnosis by combining the clinical and imaging findings.

    To all of your blog readers: Good luck on your journey to well being.


    Dr. Brian Sabb