Hip/SI joint issues; radiologist compared to surgeon

[Fluffysmom]

I discovered that I have a hip labral tear in my right hip, and went to see a surgeon about having it repaired arthroscopically.  I was told that my hip arthritis was to advanced to have a good outcome and I would be needing a hip replacement, and should wait until then.  

Her chart notes said that I have " hip symptoms consistent with femoral acetabular impingement and arthritis.  The MRI arthrogram also shows diffuse articular thinning.  I think she would get minimal lasting relief from arthroscopic intervention.  We plan to proceed with therapeutic intraarticular steroid injection" ( which didn't help).

Her comments on my X-ray:  Standing AP pelvis and frog lateral bilateral hip:  mild joint space narrowing left, moderate right.  On standing Xray there is less than 2mm jointspace (Philippon criteria) and decreased femoral head/neck junction offset.

On the same chart notes, there was a radiologist's interpretation of the Xrays:

Findings:  The visualized osseous structures are intact without acute fracture or focal destructive lesions.  There is periarticular sclerosis and spurring involving both sacroiliac joints.  There are bilateral iliac with enthesopathy.  The joint spaces of both hips are mantained and within normal limits.  The femoral head contours are smooth bilaterally.  No soft tissue abnormality is identified.

Impression:  Degenerative joint disease involving both sacroiliac joints.  

My question is; Aren't these two reports somewhat different?  Isn't one saying I have decreased joint space, while the other is saying that the joint space is normal?

I understand that recovery from a hip arthroscopy might be difficult with all the other stuff going on there, but is there truly hip arthritis to the point where I will be needing a replacement in the near future?  I know that you haven't seen the imaging, but I'm at a loss as to what to think or do.

I'm seeing my Sports and Spine medicine doctor today, who sent me to see the surgeon after his xray and arthrogram showed the hip labral tear.  He and my PCP thought that repairing that tear could greatly reduce my pain level.  Hopefully he can offer me some clarity.  

If anyone out there has any ideas, please chime in!

Thanks

[Fluffysmom]

It's very nice to hear of your good experience!  I had given up, thinking that my multiple issues would discourage anyone from trying a repair, but it sounds like Dr. Kao is a surgeon that doesn't turn away from a challenge!

I wonder if I sent him my records with a cover letter explaining my issues he would agree to consult with me about my chances.  It sure wouldn't hurt to try.

As for a hip replacement, maybe he can recommend someone that you can feel as confident with as with Dr. Kao.

Wishing you a Happy New Year with less pain and more fun.  

Take care,

Kathy

[Scootie125]

I had a hip arthroscopy by Dr. John Kao. He is the nicest surgeon I have ever met, and did a really excellent job.  He did his residency at Stanford, and is very well trained.  I have pretty advanced damage in the joint, due to hip dysplasia, labral tear, and loose bodies, but he's helped me enough so I can hope to avoid hip replacement for a year or two or maybe more.  I had surgery in Feb. 08.  My left hip isn't great (dysplasia) and I hope to have Dr. Kao do an arthroscopy to fix any labral tears before the stuff gets inside the joint to do damage.  He is really great; I would recommend him to anyone.  I wish he did hip replacements- I would be less scared if I knew he was the one doing it.
Lisa

[Fluffysmom]

Wow, thank you, spirithorse, for responding and with such great information!  I did a brief search on the Philippon criteria when I got that report, and just came up with mathematical formulas, basically. Maybe I spelled it wrong.  It is nice to hear of the actual doctor that the criteria is named after.

I'm eager to look at the links you have provided.  I've been living with the pain and just trying to deal with life, and I'm not one that likes to give up.  

Thanks again, and please keep me posted with developments in your quest to find a technique to help you, and then possibly, me.  I have friends in the Bay Area that I could stay with if one of the CA doctors can help, and I have a friend with a timeshare in Vail that I could stay at if Dr. Philippon becomes an option.

Kathy

[spirithorse17]

Hi, Fluffysmom - I don't have any opinions but am curious about your situation because I have the exact same deal.  I have seen Dr. John Kao in California (www.soarmedical.com), will be seeing Dr. Thomas Sampson in San Francisco (who teaches this special technique) and hopefully, also Dr. Marc Philippon (who is named in your report and is in Vail, Colorado at www.steadman-hawkins.org).  I hope we both are able to avoid the hip replacement and personally am hoping that one of these experts has some technique that can save me.  By the way, there are some great articles about Dr. Philippon online, and I like his overall philosophy about avoiding the hip replacement for patients like us.