I am really grumpy about what happened to me. You may not have an answer for my problem but I appreciate anything you can offer. I had surgery last year for a hip problem called femoroacetabular impingement. It didn't work. Now I'm faced with a hip replacement. Could this have been avoided? Should I have gone for the hip replacement in the first place?

Femoroacetabular impingement (FAI) of the hip is a condition in which some portion of the soft tissue around the hip socket is getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket).

There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs. Surgical treatment is often recommended, especially when conservative (nonoperative) care does not reduce the painful symptoms or improve function.

Hip replacement is much more invasive and obviously does not preserve the bone and joint like the reshaping procedure you have had done. But studies show that in about one-third of the patients, attempts to surgically repair the problem are unsuccessful. Like you, those patients end up converting to a total hip arthroplasty (replacement).

There aren't a lot of large studies to help identify the most optimal treatment for each patient with femoroacetabular impingement. Those who are the least likely to benefit from a repair procedure have severe joint damage and advanced osteoarthritis. But because just as many patients with these findings have good results with the repair/reshaping surgery, we don't know yet who should go straight to the replacement procedure and who would benefit from the intermediate step of surgical repair.

Based on what we do know, your treatment was according to the standard protocol. For whatever reason(s), you fell into the 30 per cent who don't have a positive outcome. Fortunately, there is a "rescue" operation available in the joint replacement procedure.

Reference: 

Vincent Y. Ng, MD, et al. Efficacy of Surgery for Femoroacetabular Impingement. A Systematic Review. In The American Journal of Sports Medicine. November 2010. Vol. 38. No. 11. Pp. 2337-2345.

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