Hip Arthroscopy

[Boots]

Hi all. I haven't posted here in a while but I have been checking in from time to time to read up and learn from all your great questions and advice! Now I've got a question of my own.

 

I’m scheduled to have a hip arthroscopy in July to confirm/treat a suspected tear in the labrum of my right hip (the labrum is the ring of cartilage that goes around the edge of the hip socket). On the one hand I’m relieved because I’ve finally got a diagnosis after 2 years of frustration with pain, stiffness and loss of rotation in my hip. On the other hand – eek!!! I don’t want to stop dancing! I know that full recovery is going to take several months, but I’m wondering what the likelihood is that I will be able to get back into “low-impact”, lighter work relatively quickly. How soon before I could do, for example, floor barre, or a beginning level barre (minus things like grand battements and developes)?

 

I’ve spoken with a dancer friend who is a physical therapist and she says it’s hard to know until I’ve had the arthroscopy done and they can see the extent of the problem, but most likely I won’t be able to do grand plies or any movement that involves deep flexion of the hip for quite some time. She’s got me nervous!! Over the last year I’ve been working a lot in modern and have had several performances recently. Aside from this chronic hip problem, I’m feeling pretty strong and I hate the thought of losing a lot of strength and flexibility (and flexibility is something I have to fight for every day! ), not to mention time -- I think as adults we all sometimes feel that every moment in class or rehearsal is precious. I DO want to take care of this problem now, since ignoring it could lead to much more serious problems down the road, but I hate the thought of not being able to rehearse and take class. The idea of not moving is really depressing.

 

Does anyone know anyone who’s had this procedure done (or had other hip work done?) Any advice? Thanks!

[Victoria Leigh]

Interestingly enough, Boots, I had never heard of this until recently, and your the THIRD person I know who is having this procedure. The other two have already had the surgery. One is a 16 year old, and she is doing very, very well. The other is a teacher, not as young, and the damage was much more extensive. Therefore I think it is going to take quite a lot of time. Don't really know how long, but, as your friend said, it will depend on how much damage there is. Good luck to you, and keep us informed about it!

[Boots]

Thanks for the response Ms. Leigh. I think the reason you're suddenly hearing about more cases is because improvements in arthroscopy mean more people are being properly diagnosed. Unfortunately a tear in the labrum just doesn't show up in the kind of diagnostic tests that you would normally go through (bone scans, MRI, etc.), and if a doctor isn't familiar with the symptoms, people just go undiagnosed. I recently read an article that said the typical length of time for diagnosis for this is about 24 months - just about the time it took for mine.

 

My friends have been trying to reassure me that I'm relatively young (31) and hopefully will heal quickly. I'm hoping they're right. I'll keep you posted.

[Victoria Leigh]

It doesn't show up on an MRI? How is it diagnosed then? Not questioning your information, just surprised, and wondering how they finally come to this assessment.

[Boots]

According to my orthopedist and the reading I've done, the majority of cases won't show up on a regular MRI. There is a form of MRI where they inject some type of dye into the hip socket -- it *may* show up then, but again, in some cases it won't.

 

It is diagnosed ultimately by the arthroscopy itself. In my case the orthopedist felt I had classic symptoms and that there was no need to do the dye-injection variety of MRI (I had x-rays, a bone scan and a regular MRI). So the arthroscopy will either confirm it (and they fix/shave off the tear then) or we go back to the drawing board

 

FYI - my "classic" symptoms were:

 

Sudden, unexplained onset of stiffness, pain and noticable loss of rotation in my hip (I sat down to stretch one day in the butterfly stretch - feet together, knees out - and my right hip was about 6 inches higher than the left and very sore)

A "stuck" sensation (actually - more than a sensation - I really couldn't open it past a certain point for a while!)

A pinching sensation in the groin area when trying to do certain stretches that require pulling the knee in toward the chest (like the piriformis stretch that was described on this board a while back)

Build- up of tension in the joint and associated cracking and popping with some relief of tension

Sharp pain with certain, weight-bearing, lateral or twisting movements (getting out of a car for instance)

 

My condition improved a lot after the initial onset, but my hip has not felt "normal" for 2 years now, and it achey on a regular basis. I have episodes where it's worse (apparently this is when the torn piece cartilage slides into the joint and is blocking things). I've done a LOT of body rolling, stretching and yoga for the surrounding muscle groups and that does help quite a bit.

[pirouettes2001]

I've never had hip arthroscopy, but I've had my ankle done. It might be a good idea to get idea to get a MRI with a second opinion. In my case, my orthopedist told me that there was cartilage damage from the MRI, but he saw quite a bit of damage during surgery.

 

After surgery, I got my MRI films and the report. The radiologist saw something funny on the cartilage, but he didn't say it was damage because there were no loose bodies (cartilage fragments). I saw the damaged area myself on the film. I looked a bit unusual.

 

It was an inflammatory/autoimmune arthritis that became an osteoarthritis when the inflamed synovium started eating away at the cartilage. Now I see a rheumatologist. I don't want to lose any more cartilage. I'm only 24.

[Boots]

Unfortunately, the cost of an MRI, even with insurance, is *quite* high , so there's just no way I can get another. Plus, I've done a lot of research and I've gone to a few different orthopedists and I'm confident that this is what I want.

 

And - it's too late anyway 'cause I had the surgery last Tuesday! It was exactly what they suspected - a tear in the labrum. They shaved off the torn bit and that's it. The joint surfaces in my hip looked good (no signs of arthritis) and the rest of the cartilage is ok. I was a bit nervous going into the surgery. Even after all my research and talking with several doctors, and trying a number of approaches to relieving my symptoms, I started to second guess myself and think maybe I should hold off on surgery. But I'm glad now that I did it. If left untreated, the cartilage could have torn more, and that eventually could mean severe problems in the joint.

 

After more than two years of an extemely frustrating blocked and pinching sensation in my hip, I am really looking forward to recovering and getting back into class after a while!!! I go back to the doctor tomorrow for follow up and hopefully they'll tell me that I can get rid of these crutches...

[Guest Lizzie 37]

Well, bless your heart. [We say that a great deal here in Ga.] Since your procedure went well, you are on your way. Please don't rush your rehab. Your ortho doc's advice should be followed closely , particularly for the first 4 weeks. Often these docs employ NPs, PAs or certified trainers who do a lot of the followup. Chat up one of them for ways you can modify ballet exercises so you can begin to feel more in the swing of things. Glad you have no apparent arthritic changes. Good luck.

[Boots]

Lizzie - thanks very much for the good wishes. After a week of sitting and crutching around I am anxious to start moving, but yes, I will listen to the doctor -- I just got fixed and I don't want to mess things up again! It will be a challenge though. I'm itching to move...

 

And Ms. Leigh, I wanted to let you know that I went to the physical therapist that you recommended (on the Health and Nutrition board) and she is wonderful. I think she is going to be a great help in my recovering. Thanks again for the recommendation.

[Victoria Leigh]

Boots, I'm glad you were able to go and that you liked it! Mary told me tonight that she had worked with you.