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  • Hip arthroscopy for acetabular retroversion and labral tear

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    Old 06-28-2013, 06:45 AM   #1
    Frayed Silence
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    Hip arthroscopy for acetabular retroversion and labral tear

    Hi all

    I am new here and have joined this board as it looks much more active than many others I have seen.

    I am 25 years of age and have acetabular retroversion of my hip with a labral tear and suspected hip impingement. I have been offered a hip arthroscopy but am unsure whether to go ahead as I have seen many others who this has not worked on and they have ended up either having it repeated about 4-5 times or having to have bigger surgery (i.e. peri-acetabular osteotomy or hip replacements) anyway when they could have been offered it first and been over with so they can carry on with their lives.

    The other thing that concerns me is it not correcting my acetabular retroversion and therefore my tear coming back anyway and getting arthritis in my 30s so this arthroscopy being only a sticking plaster to last about a year or two and then back at square one... This is another scenario I have seen many times on others.

    Has anyone here got any experience of what I am currently going through or experienced these problems? Is this arthroscopy just always given out first rather than the other surgery which may only then be needed once and last for longer? What has others' surgeons or doctors told them with regard to these concerns? Did they offer other forms of treatment or surgery or always an arthroscopy (key hole surgery)?

    I would be very grateful for any of your messages, opinions or experiences. Thanks in advance.

    Kind regards

     
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    Old 08-03-2013, 01:54 PM   #2
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    Re: Hip arthroscopy for acetabular retroversion and labral tear

    Hi there -- I have been having some problems w/ my password but got them squared away to respond to your post. I have had three hip scopes for a labral tear and to correct impingement. I wish I had never had my first surgery, as it was performed by a general orthopedic surgeon, and did not address the impingement issues.

    So -- let's see -- I would absolutely shy away from a hip replacement at your age. Hip replacements are lasting longer with technological improvements, but they have a finite lifespan and revisions are difficult and require taking a little more bone each time.

    That said, if you can resolve some of your issues with an arthroscopic surgery, it offers the benefit of less blood loss, less risk of infection, and less scar tissue -- which is not just an issue of aesthetics but can be very painful. Most doctors will try the least invasive potential solution, whether it's an injection, therapy, or some form of surgery. You can always go up the scale, but you can't go backward.

    That said, if I would certainly not recommend a fourth or fifth arthroscopic surgery, if you don't get relief from the first or second! My current, awesome surgeon said he would do no more than three on one hip. I would also encourage you to find a hip-only surgeon and to request second and third opinions before proceeding with any form of surgery.

     
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    Old 08-14-2013, 12:44 PM   #3
    Frayed Silence
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    Re: Hip arthroscopy for acetabular retroversion and labral tear

    Hi SweetPeainSF

    Thanks for your reply. It seems you're the only one with any advice on this and I appreciate your reply. It is hard to get any advice on what to do really. I am still hesitant with regards arthroscopy as I know others who feel they would have preferred to have had other surgery that worked on them instead of having to keep having it done or suffer continued pain. I have also heard arthroscopies are actually very painful due to the traction required. I know someone who said they had arthroscopy on their hip and then hip replacement as it did not work and the arthrsopy was worse and more painful than the straighforward hip replacement. Just because it is keyhole does not mean it is less risky and less painful, could be worse it seems...

    There are other options otther than hip replacement and arthroscopies though?

    That said, you make a good point and I will see what other surgeons I could see as I would like to see a few more before deciding on what is best for me, and make sure they are specialist hip surgeons.

    Many thanks

    Kind regards

     
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    Old 08-18-2013, 10:57 AM   #4
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    Re: Hip arthroscopy for acetabular retroversion and labral tear

    I agree that the traction is awful. One point I forgot to mention is to talk to your surgeon about the traction and his options for getting into the joint when considering arthroscopic surgery. My first surgeon forced his way into a very tight joint. It took four hours to do what should have been two hours at most. My second surgeon, who does hips only (not general ortho) does a hybrid approach in that the exterior incisions are keyhole, but he often cuts into the hip capsule which helps to minimize some of the force required. He also releases traction when he is not actively working in the joint.

    There is a very good discussion of this issue that I have run into in the past, between my hip surgeon (Thomas Sampson) and some other practitioners online. If you do an internet search for Thomas Sampson joint capsule, you can find a power point for a presentation that he gave in April 2013 that has an outline of his approach along with lots of surgery pictures. If you are super-squeamish, this might be a little much, though!

    By the way, hip replacements tend to have an easier recovery than hip-preserving surgeries. I have come to accept that I will probably need further work down the road and plan to investigate hip resurfacing before opting for a replacement. I have one hip that had a torn labrum and floating flap of cartilage (three surgeries) and one that has worse FAI (no surgeries). They both hurt, but my only regret is going to the wrong surgeon first.

     
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    Old 09-06-2013, 01:01 PM   #5
    Frayed Silence
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    Re: Hip arthroscopy for acetabular retroversion and labral tear

    Hi SweetPeainSF

    Thanks for your reply.

    The surgeon I am seeing only does hips too. However, he never told me about his approaches to traction, etc. He does not seem particularly open like that. I do not want traction as it is the worst part and would prefer another procedure or way of doing it. I have also been advised against traction due to a possible neurological problem yet this other surgeon seems not worried about this but I am. I was originally referred for open hip impingement surgery with labral repair, now changed to debridement which I am also not happy about as I have heard and seen many people do better with repair as it has better results than debridement and much less risk of giving me hip arthritis which debridement of labrum can due to it being required to stabalise the hip which is what a labrum is for and without it or little of it, degeneration and arthritis can and does occur.

    If you do not mind me asking, did they debride your labrum or repair it? It seems surgeons are all different so results are different. Did they also shave your bone down for impingement or just do the tear? My surgeon has ignored my impingement so far and just goes on about labral debridement.

    I am certainly thinking about getting more surgeons' opinions to make sure I am getting the right surgery for me and my particular problem.

    It seems your surgeon that only does hips is very up-to-date with regards surgical techniques and traction or alternatives.

    Also, thanks for your link and info. I will take a look at it.

    Kind regards

    Frayed

     
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    Old 09-29-2013, 07:21 PM   #6
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    Re: Hip arthroscopy for acetabular retroversion and labral tear

    Hi there -- sorry for the delay in responding to your questions. My first surgery was only a labral debridement, and it was a waste of time and served only to make my symptoms worse. My second surgery was mostly reshaping the hip joint, lots of arthroplasty and a synovectomy. The third surgery involved performing microfracture under the cartilage and reattaching the edge of the labrum using three plastic anchors, plus lots of clean up of scar tissue.

    I wholeheartedly agree that only addressing the symptom (labral tear) without fixing the underlying problem is likely only to result in further surgeries. I don't think it's possible to complete an arthroscopy without some traction, but a good surgeon can minimize the problems from traction. I would continue pushing for additional opinions and options until you find someone with whom you are comfortable.

     
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    Old 09-30-2013, 02:35 PM   #7
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    Re: Hip arthroscopy for acetabular retroversion and labral tear

    Hi SweetPeainSF

    Many thanks for your reply. No problem with regards late reply. I too am late at times as I get really busy and am currently studying a few courses at once so have quite a few assignments to hand in.

    It looks like you had to undergo three surgeries after your first one was just a labral debridement via a general orthopaedic surgeon, so I can understand what you mean with regards recommending a specialist orthopaedic hip surgeon rather than general orthopaedic surgeon as you have had to have more surgeries afterwards. I am hoping to find a surgeon who will not just do the labral debridement (would prefer - and it is better - to have labral repair) but also do the bony bit that is impinging or even ideally sort my retroversion out that could be causing the impingement and labral tear as this is the best way, from what I have read by surgeons, to correct it completely. So far my surgeon (specialist hip surgeon) is offering just the labral debridement, which is why I am unsure and do not want to jump into things as I know once it is debrided I cannot go back or replace my labrum easily, unless I had a graft which I have not seen offered in the UK.

    Debridement of the labrum it says in surgeon's literature/research is not the best or ideal option for young people or active people, which is why I am questioning being offered it. I would like to be offered the best option for a young and athletic person who wishes to be active once again, especially as this is the whole idea of having such a surgery - to get the person back on their feet and able to function normally, including at work. I do not wish to have a surgery that will still limit what I can do as there does not seem much point to having it, apart from pain relief, which I have read also is not as good with labral debridement as it is with repair. Repair is the option that is the best. I am not sure how to break this to my surgeon as I do not want him to be offended by a patient knowing things that maybe he does not or has not thought about. I know they can and do feel like that and it puts me off but this would be a reason why I would find another surgeon as I would hope they would be willing to at least talk it through and the reasons for why he is offering me debridement not repair.

    I would ideally like a surgery that can fix or help it in one surgery rather than going through loads or having something done that was not the right thing and that I could have had the repair instead if I had found a better surgeon who offered these more up-to-date treatments. I will not be able to work and keep having time off for multiple surgeries because they did not do the right or best option first time around. I am surprised a specialist hip surgeon would offer a debridement still when there are many other better ways of treating a tear i.e. repair. I will definitely be getting more surgeon opinions as one of them at least will hopefully offer the right treatment or repair and bony reconstruction too.

    The problem is I am high risk for traction which is why my other surgeon (I have seen two) referred me to this other one as he refused to treat me as he believes traction will leave me in a wheelchair or worse off in some way. This is why I am looking for options other than arthroscopy as that uses traction which I have been advised against having as it could make me worse. I am ideally after a surgeon in the UK who does open impingement surgery or open labral repairs, etc. This would avoid the problem with regards the traction. I was referred to this other surgeon for open surgery but this surgeon has not got the idea from the letter as the letter was badly written not making it clear this was why I was referred so now this surgeon is offering me the same surgery with traction/arthroscopy I was told I should not have as it could put me in a wheelchair. He does not understand my worries either when I tell him and said everyone could have risks from traction - the only thing is he does not understand I have higher risks of being put in a wheelchair from this traction and that I need it done open not arthroscopically.

    It is so difficult to find surgeons in the UK that do anything other than hip arthroscopy for impingement and labral tears as it has become big business and the cult thing to do right now in the UK. It leaves me with not much choice, unless I go abroad where they still do open hip impingement surgery, which is a problem as I cannot travel far due to pain.

    Hope your surgery has helped you and that you are not in too much or no pain at all.

    Best wishes

    Many thanks for your help and time. It is much appreciated.

    Kind regards

    Frayed

     
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    Old 01-06-2014, 05:51 PM   #8
    Mandap
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    Re: Hip arthroscopy for acetabular retroversion and labral tear

    Quote:
    Originally Posted by Frayed Silence View Post
    Hi all

    I am new here and have joined this board as it looks much more active than many others I have seen.

    I am 25 years of age and have acetabular retroversion of my hip with a labral tear and suspected hip impingement. I have been offered a hip arthroscopy but am unsure whether to go ahead as I have seen many others who this has not worked on and they have ended up either having it repeated about 4-5 times or having to have bigger surgery (i.e. peri-acetabular osteotomy or hip replacements) anyway when they could have been offered it first and been over with so they can carry on with their lives.

    The other thing that concerns me is it not correcting my acetabular retroversion and therefore my tear coming back anyway and getting arthritis in my 30s so this arthroscopy being only a sticking plaster to last about a year or two and then back at square one... This is another scenario I have seen many times on others.

    Has anyone here got any experience of what I am currently going through or experienced these problems? Is this arthroscopy just always given out first rather than the other surgery which may only then be needed once and last for longer? What has others' surgeons or doctors told them with regard to these concerns? Did they offer other forms of treatment or surgery or always an arthroscopy (key hole surgery)?

    I would be very grateful for any of your messages, opinions or experiences. Thanks in advance.

    Kind regards
    I am currently 22 and have undergone 2 arthroscopes and ended up having to have an acetabular osteotomy. I was down to bone on bone in both of my hips and had no other choice but to have the operation. It was really not as bad as it sounds. Granted it was no walk in the park, but it was well worth it. The amount of pain it took away in just the first week was incredible
    I had the operation in August of 2013 and in November I was back to work,attending therapy three times a week. The arthroscope is more to diagnose what you have going on in your hip and to inject a pain med to see if that will work and push a surgery out more. For me it did not work and I opted for surgery right away. It was definitely worth it for me. So much so that I'm going to have my other hip done this coming fall. I hope if you decided to have it done that you found it as succussful!

     
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