If surgery doesn't work for my hip impingement, what next? The exact problem I have is called femoroacetabular impingement. I don't exactly know what the surgeon will do -- that will be decided when they get a good look inside there to see what's going on. I forgot to ask this question when I was in the office for my preop.
Impingement refers to some portion of the soft tissue around the hip socket 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.
Current understanding of this hip deformity has resulted in surgery to correct the deformity. The short-term goals are to relieve pain and improve function. The long-term goal is to prevent hip osteoarthritis. As you have found out, the exact surgical procedure depends on the type of impingement and location and severity of deformity. The surgeon will also decide whether the procedure can be done arthroscopically or if an open incision will be needed.
Failure is not always defined the same by different surgeons. And patients may view the results differently than surgeons do. In some cases, continued pain after surgery is considered a failure. Others count osteoarthritis requiring a joint replacement as a "what next"? kind of failure.
Some decisions depend on what type of complications might be present (e.g., infection, fracture, broken or bent screws, or loss of blood to the area). Revision surgery may be needed to address whatever problem develops. With complete failure, conversion to a total hip replacement may be an option.
Studies show that patients who already have severe arthritic changes at the time of surgery are the least likely to have a good result. Other pre-operative factors that could predict a poor result include older age and severe pain. Those findings suggest surgeons should give patients with these factors careful consideration before performing surgery to redesign the hip.
John C. Clohisy, MD, et al. Surgical Treatment of Femoroacetabular Impingement. In Clinical Orthopaedics and Related Research. February 2010. Vol. 468. Pp. 555-564.
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