Three Hip CAM/Pincer FAI Surgeries and still Hip Pain?
As you likely know from my previous posts, I’m not a huge fan of hip CAM/Pincer or FAI surgery for most patients. This concept began about a decade ago and was developed to treat elite athletes involved in sports where their constant extreme range of motion caused impingement in those with misshapen hips. Yet somehow, what made sense for a small group of hip pain patients performing extreme feats has now been translated to the wider population of younger patients with hip pain. A patient I evaluated this week in clinic is a great example of what happens when you apply a concept that works in a thin slice of patients with hip pain and try to apply it to everyone.
The patient is a 26 year old woman who has had three failed hip CAM/Pincer FAI surgeries on the right and still has disabling hip pain. She initially began with groin pain that began one night while sleeping. She was initially operated solely because of the impingement, despite studies showing that depending on the criteria, almost everybody has FAI hip impingement. She then underwent two additional surgeries, trying to more completely decompress the hip. The result? At 26 years of age she can’t vacuum or exercise. What’s really wrong with her now? Some additional history found that in high school, she fell onto her backside after not being caught while a cheerleading flyer. At that point she injured her back, but she had also had back pain earlier, going back to early childhood. Her exam showed that not only does she have pretty severe SI joint instability (the joint just one up from the hip), but also irritated low back nerves. What’s telling is that when I perform a test of nerve stretch, I can turn her hip pain on or off simply by bending her ankle-indicating that this is clearly not a hip problem, but instead a nerve problem. Our goal now is to get more info on her low back and focus on tightening the damaged ligaments around her SI joint (the ones that got inured in the fall). The most interesting thing is that her SI joint problem could have easily mimicked all of the symptoms that were presumed to be coming from the hip FAI-groin pain, pain in the buttocks area, and pain in the side of the hip. The upshot? We’re firmly in the middle of hip CAM/Pincer FAI surgeries mania. Make sure that all of the other myriad causes of hip pain are ruled out before you get your hip socket surgically reshaped!