Femoroacetabular Impingement

Apparently, I’ve spent my entire life with a condition called “femoracetabular impingement.” The bones in my hips are deformed - the femoral neck is too thick and mis-shapen, and I have a “pincer” on my acetabum which restricts range of motion even further.

As a result, I wasn’t able to internally rotate my hips almost at all - I had a single degree range of motion (normal for the population is 45 degrees). I can get my knee to about 90 degrees, but that’s it - for my knees to come up any further, I need to flex my low back. This makes sitting, cycling, weightlifting, yoga, and, uh, pretty much everything a painful and difficult experience.

For a long time, I thought I just had “tight hamstrings,” and would occasionally get really into mobility exercises and stretching to try and improve it. Nothing ever worked. In fact, all of that stretching and mobilization was really stretching my low back, not my hamstrings, because the joint was already fully flexed - bone-on-bone contact.

And, yeah, bone-on-bone. From squatting, deadlifting, sitting in a chair and programming, and cycling, I’ve pretty much shredded the labrum on each side of my hip. Turns out, the weird aching pains in the front of my legs are hip arthritis.

I found out about all of this in such a roundabout way. Last year, my girlfriend wanted to join a bike racing team. She found a team ride/race for No Ride Around, which happened to be the team for my favorite local bike shop. I love cycling and wanted to support her, so I joined too, even though racing isn’t really my thing.

Being on a race team, especially a really supportive one, is a fantastic motivation. The team leader recommended Denver Fit Loft for a race bike fit. Charles Van Atta, the fitter, was surprised at my limited range of motion, and recommended that I consult an orthopedic surgeon for hip impingement.

Fortunately, Denver has a really great sports medicine scene. In my Google research, I found Dr. James Genuario, a world leading expert in exactly this sort of thing. Within a few weeks of the bicycle fitting, I had X-rays confirming a severe case of hip impingement. In a normal hip, there’s a number called the “alpha angle” that describes how round the femoral head is. A normal alpha angle is 45 degrees, and 50-55 degrees is considered “pathological” and warrants surgical intervention. My alpha angle is 69 degrees. Based on my current hip condition, I was looking at a total hip replacement in 5-15 years if I didn’t act quick.

Yet another fortunate coincidence - another member of my race team worked in medical device support, and knew many of the surgeons in the area. He gave me a bunch of advice, and spoke very well of Dr. Genuario.

I spent six weeks going to PT twice a week. Lots of weird stretches and exercises did - well, nothing at all. Insurance companies require six weeks of PT before they’ll pay for the MRI and CT scans required for surgery, much less the surgery itself. Apparently, about half of the folks that initially report these problems can resolve with stretching. Given my seriously messed up bone anatomy, I wish we could have skipped that step.

After six weeks, I got my MRI scan - and fortunately my connective tissue is good enough to warrant corrective surgery. A month of waiting, and I was able to get the CT scan, which provides a highly detailed 3D picture of my hip. The CT scan goes to Germany, where they construct (in software) a 3D model of a “healthy” version of my hip. This is the blueprint. The surgeon will use that to trim my bones to the right shape. What’s fun is that I found a video of this procedure on YouTube. They literally use a fancy dremel tool to shave the bone down.

On September 22nd, I received my first surgery. The doctor said that he wasn’t sure if he could repair the labrum, and I may need a reconstruction - which is a fancy way of saying “get a dead person’s labrum and stitch it in there.” Once I signed all the consent forms, they gave me a Valium, and started hooking me up to an IV. The nurse was jovial as I was being wheeled away - “we got you on the good drugs, it’s party time.” To which my drugged out self responded - “double fisting valium and whatever this is.” That’s my last memory before going under.

On waking up, the doctor said that he couldn’t repair the existing labrum - something about it looking like “crab meat.” Given that I was still high on the anesthesia, I said “hell yeah i’m part zombie.”

I was in a fog all that day, and for two days afterward, I was taking narcotics. I weaned myself off pretty quick, since I dislike the side effects, and they don’t work that great on me anyway. After a few days, my hip was feeling totally fine, but every single medication I was on otherwise had “constipation” as a side effect, including the anti-nausea medications. So when my stomach started to feel bad, I took all the nausea meds, which only made things worse. The 29th (my birthday) was the hardest day - I was completely laid up in bed. Once I determined the real cause of the stomach discomfort, it was pretty easy to manage.

I’m at two weeks post-op right now, and recovery is great. Dr. Genuario’s skill as a surgeon is remarkable - he was able to bring my alpha angle to 45 degrees. Despite removing so much bone, there is no pain at this point. I’m supposed to be weaning off of crutches starting next week, but truth be told, I’m only using a single crutch most of the time anyway. The range of motion in my operative leg is much better than the

My second surgery is scheduled for November 3rd. Another three weeks in crutches, and I’ll be able to walk unassisted for Thanksgiving. Another three weeks of recovery and PT, and I’ll be able to ride a bike outside - hopefully in time for the winter solstice (would hate to lose my Solstice Century streak). I should be back to full strength and regular activity by April.

I’m incredibly grateful for everyone involved in the process. But the person who has helped the most is my partner. She’s supported me through all of this, helped me with my physical therapy, and changed my wound dressings.