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Scar tissue / Adhesion Complications after Impingement Surgery on the Hip

Fortunately, complications after hip arthroscopy are quite rare. Others have reported in the medical literature their experience with infection, blood clot, persistent pain, fractures, stiffness or numbness. You may or may not know, however, that similar complications, and even perhaps more problems, can be observed after OPEN surgery for hip impingement (aka Femoral Acetabular Impingement). Open surgery involves a large incision over the hip

and requires the hip be dislocated fully out of the socket during surgery. Some surgeons still perform this procedure.

In a recent article in the Journal of Arthroscopy, March 2011, a significant number of patients who had persistent groin pain after open hip osteochondroplasty (shaving of the bone/cartilage on the neck of the femur for CAM impingement) had adhesions/scar tissue build up inside their hip joint. The surgeons went back in to their hips, but

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this time with arthroscopic surgery, and cleaned out the scar tissue and adhesions between the capsule and the bone. 18 out

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of 21 of those specific patients got better.

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37 Responses to Scar tissue / Adhesion Complications after Impingement Surgery on the Hip

  1. Ken McCrindle says:

    I am 18 months post arthroscopic debridement of labrum, decomression and microfracture. I am worse now than before the surgery iro a pain in the groin and difficulty walking (in the stride stretch phase) – standing long is also problematic. MRI indicates capsular adhesion but also a hypersensitive labrum and fissures in the cartilage. I don’t want to have another procedure as the first one took many months to recover from and what is to stop the scar tissue forming a second time. I have heard of these procedures not being effective as well. Is there not another way to address this scar tissue problem?

    • JonHyman says:

      There are too many unknowns to really address this properly. Most importantly, how big was the lesion that underwent microfracture and why was the cartilage lesion there in the first place?

      Was the microfracture on the femoral head or in the acetabular socket? Is there deformity of the bone?

      Was it due to a CAM impingement lesion, a traumatic event, or underlying degeneration in the joint. Degeneration has a poorer prognosis and may not respond well to microfracture.

      More importantly, was the MRI after surgery done with local anesthetic injected inside of the hip joint? That is very important in determining the cause of the hip pain and helps inform us as to what to do next: injection, PT, more surgery, a different approach altogether.


  2. Nova Gerlach says:

    Hi, I’m 28 and had Arthoscopic hip surgery (left hip) in August last year. It included a labral debridement, FAI bone shaving, a Bursectomy, and a psoas tendon release. The hip has struggled to heal and at about 6 months post op I still walk with a cane and have horrible swelling and pain after PT, walking longer then a block or so, or sitting upright for longer then an hour at a time. I had a less complicated but similar surgery on the right hip 3 months after the left with much better results. Now, my doctor and I are trying to decide if the hip will heal and It is just taking a longer time, or if the joint has scare tissue or another inflamed bursa that needs a re-operation. It is difficult for me to know when enough is enough and it should be feeling better by now.

    As I understand all of this came about because I had a genetic issue, the bones were shaped “badly” and so the labarums tore and the pain began. The left hip went undiagnosed for almost 2 years thought the cartilage looks good and the joint didn’t suffer any major degeneration. and the right only began after the left was operated on.

    I am wondering if maybe the problem now is scar tissue. The recent MRI arthrogram did not show any scar tissue, would it have if that is the problem? and what would scar tissue feel like? I have a swelling pattern on the hip that looks like I stuffed a small loaf of bread under my skin. Sound weird I know. Thanks a lot for the info.

    • JonHyman says:

      Your left hip recovery sounds quite unusual. Sorry about that. It seems like there is swelling that should not be there at this point. Considerations are: heterotopic bone (need x-rays to see that), leakage of fluid from the joint capsule (should have shown up on the MRI arthrogram), scar tissue (which usually does NOT show up well on MRIs, but may appear as thicker or ‘hypertrophic’ tissue)… or swelling from rare issues like seroma/sinus/granuloma/hematoma/cyst/abscess – which should show up on MRI.

      Very concerned about your cane use, possible weakness from your iliopsoas release and significant swelling. Between ultrasound and MRI, the cause for swelling should be more apparent.

  3. Nova Gerlach says:

    Thank you for your reply. I have actually yet to get an ex-ray of the joint since the operation and have therefore not yet ruled out heterotropic bone or bone ossification around the joint. I am still in a waiting period. PT is become more and more painful and so, I am doing less of it. I am doing some walking in the water to unload the weight on the joint, and that has been tolerable. I’m told to listen to my body and not “over-do” it. But, the regular routine of PT over does it. Really the only thing on my agenda is getting off of the cane, however on good days when the swelling has gone down a bit, I have tried it with bad results. I’ll only do very short walks just to try it out. But, both the swelling and the pain come back with a vengeance. I also have what seems like nerve issues that radiate down the leg at times. I have now resolved to keep the cane and baby the hip so as not to increase whatever damage is being cause by these flare ups. In any case, I can not undergo surgery again until May. Do you think that is too long to wait? could I be making the situation worse just by day to day living? I really appreciate your taking the time to talk with me over this issue.

    • JonHyman says:

      When the swelling has come back ‘with a vengeance’ I would encourage you to consider taking a tape measure and measuring the circumference of your swollen leg, both mid thigh and mid calf,
      and comparing it to the other leg. That will help objectively document your problem. There may be more of a nerve issue at hand, especially with radiating pain in your leg, and objective measurements
      can be useful. EMG/NCS (nerve conduction testing) can help assess ‘nerve issues’ more carefully, and should be discussed with your physician.

      • Melanie Stevens says:

        Hi. I had both hips operated on in 2008 labral debridement, FAI bone shaving due to hip inpingment of deep narrow hip sockets. My left hip is superb but the right still gives me the same pain as described by JonHyman. I don’t have swelling but i have a very deep dip in the scar area which is very tender to touch. If i bend over a desk/worktop etc for too long my hip locks completely. My consultant has x-rayed several times but i never get to see him, just his understudies and they refuses to accept there is anything wrong. they have now struck me off the register because i refuse to be seen by them. Surley my consultant should deal with my issue. I am not a rude difficult patient.

        • JonHyman says:

          That is very frustrating. Sometimes people don’t want to see what they don’t understand. It’s a temptation we have to resist, especially when dealing with patients. Perhaps they can refer you to someone for a second opinion. If you feel comfortable with it, you can post a photo of this ‘deep dip’ in the scar area, or you can send it privately via email, and Dr. Hyman can review it. Either way, it sounds like adhesion, scar tissue and perhaps some fatty atrophy in your scar. If there are nerve endings caught up in it, it can be painful. Often such issues are treated with one or more of the following: cortisone injections, dry needling, Lidoderm patches, Voltaren gel, TENS unit, ultrasound, iontopheresis or in rare cases, surgical revision of the scar.

  4. HollyDolly says:

    I’m 14 wks post-op of rt hip arthroscopy w/ labral debribement, shaving of pincer impingement, psoas release and “clean up” of bruising on acetabulem. I feel fairly ok except for what I consider severe pain with internal/external rotation of hip. The groin pain is worse than pre-op and radiates to my knee when stretching to these positions. I’ve never felt true relief of pre-op symptoms since surgery. My surgeon tells me that my recovery is normal except for having these symptoms, probably related to scarring down of the capsule. My joint was injected w/ steroids 2 wks ago and have felt NO relief. PT has been helpful to regain strength but the stretching has not changed the decrease ROM. This is very frustrating because now such intensive therapy is causing my back to flare up. I am generally a very healthy, active person and am tired of being in pain. My concerns are does this really seem like scarring of the capsule, should these things have helped by now, what can I do to help release the capsule, is this decreased ROM normal? I feel like my surgeon just wants me to come in and say it worked, I’m better.

    • JonHyman says:

      Scarring of the capsule is normal, but it usually occurs without a lot of pain or restricted ROM. Doing a diagnostic and therapeutic injection of anesthetic and cortisone in/around the capsule should help considerably IF the capsule is the problem. If it has no effect on the pain, the pain is likely coming from another source. If the range of motion is poor, I would think that a careful physical exam and correlation with a new set of xrays (a new MRI may be premature at this point) would be important. There’s a lot of healing going on at 14 weeks, so there is still hope, but based upon your lack of pain relief thus far, I am suspicious as to whether or not the diagnosis was correct before surgery. Severe pain at this stage is not usual, though of course everyone’s pain threshold is different. Of course I cannot give you medical advice through this medium, and I’m not, but I can tell you what considerations I might have if I was facing this situation.

      • HollyDolly says:

        Thanks for your response.Saw surgeon yest and he feels I have some scar tissue developing across hip flexor. This is causing the decreased ROM. He feels the groin pain is a muscle issue. He’s sending me back to PT for continued work on glute strengthening and break-up of scar tissue. I do feel better, both mentally and physically, from the time of my original post. My surgeon listened well yest and agrees that I’m not where he’d like me to be but I “haven’t fallen off the curve”. It’s a long process, and anyone going through this definitely needs to remain patient and positive.

        • JonHyman says:

          Thank you for the update on your experience. Glad you are feeling better. The scar tissue response you described is not uncommon. Hopefully you
          will continue to improve with time and work.

  5. Connie says:

    I had open left hip surgery 5 years ago for an acetabular impingement. The posterior aspect of the scar is exquisitely tender and swells at times. I had a hematoma the size of a grapefruit post operatively but no infection. When I lay on my right side you can feel ditch of sorts under the skin. The surgeon does not really want to address it. I am not sure what to do as it painful on a daily basis. Any thoughts?

    • JonHyman says:

      A large hematoma like that suggests that there was not good bleeding control…and / or poor closure of the tissue/poor healing and it may have left a small hernia/opening in the fascia. Without seeing the ‘ditch’ or the indentation, it’s hard to know. It may be atrophy of muscle or fatty tissue or a weakening in the muscle fascia. All of the these could lead to hypersensitivity and/or pain.

  6. John Doe says:

    Hi, I’m 28 months post-op of rt hip arthroscopy w/ mixed type FAI. Labral tear debridement, refixation with 4 anchors, synovectomy, rim decompression and cam decompression were done.

    First 4 months post-op, my physical therapist did much strengthening, and VERY LITTLE rom exercises and scar tissue management. Then I got a steroid injection in the hip flexors and capsule as well as changing PTs because I did not have pain-free ROM in extension and did not have pain-free weight bearing with rotation. I started to be able to use public transportation with many stairs and a lot of standing up following the injection, in conjunction with increased PT.

    Then I had to get out of the country and not come back for 1 year, in which time I continued PT but it was in vain. When I came back, I got one more steroid injection and started seeing a chiropractor for myofascial therapy and very agressive strengthening. There is now progress in strength, but pain-free ROM is never there in extension and with weight bearing.

    MRA shows ‘thickening/scarring’ of the capsule, but I am starting to have doubts that this is a capsular adhesion problem like my surgeon thinks. A second opinion claims that there might be residual bone in the femur neck still causing impingement, but my surgeon says there’s never a perfect shape, the only way to find that out is shave some more off and see. For now, one more injection is suggested, and if that does not improve things in 3 months, going back in and releasing the capsular adhesions/scarring is the next course of action. What do you think? Thank you very much in advance.

    • JonHyman says:

      John Doe, sorry for your difficulty. Capsular adhesions sounds likely. There may be a soft tissue component outside the hip, or some other predisposing factor. If your ROM was limited preop, it doesn’t always come back post op. That said, consider a 3D CT to better assess the amount of resection and current bony anatomy. Also, we must exercise caution with the number of injections of cortisone, as there can be dose dependent toxicity over time.

  7. Nick says:

    Hi, Im 12 weeks post op for a cam resection and labral debridement in my left hip (the tear was at the chondrolabral junction and had a small patch of grade 3 arthritis). There was also significant synovitis, though this was left as inflammation rather than diseased tissue. Everything was going well until 4 weeks post op when the groin pain suddenly returned, along with a small band of swelling at the op of my thigh. I had an MR at 6 weeks, which showed fluid on the joint and a partial tear of the rectus femoris straight head insertion. At 8 weeks, i had an ultrasound scan which resulted in a depromedrol shot into the capsule as it showed lots of fluid and synovial thickening; this gave some relief but I still had pain in the groin – particularly on sitting and walking.

    Another ultrasound was done at twelve weeks, and the radiologist reckoned that there was no longer joint effusion and that the only inflammed structure was the rectus femoris insertion, which was also injected. I am still experiencing groin pain that radiates down my leg and feel that the rec fem cannot be the problem as the pain is about an inch medial to its insertion site. I still don’t have an answer for the lump at the top of my thigh (its in the area of the femoral triangle) and can only speculate that perhaps psoas bursitis would cause the swelling? There is no pain on resisted flexion, but it aches and throbs all the time and only ice brings relief. I still cannot sit for long or walk very far… What do you think? Have you seen this kind of swelling before? The radiologist said the scar tissue was minimal 2/10 and that there were no signs of infection, so I am at a loss…

    Thanks for reading.

    • JonHyman says:

      Sorry for your difficulty. Partial tears can be 1% torn or 99% torn so w/o knowing how bad that is, it’s diff to tell. The deep head rectus tendon insertion can be elevated slightly in a pincer osteoplasty or extensive labral repair but you had neither do it is a little perplexing.

      What effect the the injection of the rectus femoris have?

      Re:the lump at the top of your thigh…maybe Hernia? Cyst from fluid leakage from sinus/fistula from joint capsule? Painful lymph node? Bad tendinitis?

      Hard to speculate w/o seeing you or your data. Your grade 3 chondromalacia arthritis could be one source of ongoing pain, but your problems sound more complex than that. These things may resolve but we understand that waiting in pain is not reassuring. Please discuss your concerns thoroughly with your surgeon.

      • Nick says:

        Dr Jon, thanks for your reply. I know my rectus femoris is tight and shortened from the thomas test (this really hurts) but i am not convinced that this is solely responsible for the pain.

        Would rectus femoris tendinitis present as swelling in the top of the thigh? The injection was performed a week ago, but as yet no result or relief, though I guess it is too early to tell. My rom is almost back to nornal, but still feel that i am worse now than before the op.

        Thanks for your help, it is much appreciated.

        • JonHyman says:

          Rectus femoris tendinitis does not typically have visible swelling associated with it. The lack of response to injection could mean the pain is coming from another location.

  8. Stephanie says:

    Hi Dr. Hyman. I am 12 months post op of the left hip. I had acetabuloplasty with labral refixation, chondroplasty, debridement, and femoroplasty. I did 16 weeks of PT. I have been very pleased with the results in the joint, However, I am having much tightness, particularly in the groin, and restricted ROM. I thought that might be normal, but I started playing tennis 2 months ago and the situation has worsened instead of improved. I have a mild to moderate level of pain every day. Could this be a scar tissue problem? Do I return to my surgeon or a PT? Thank you so much. This is a wonderful resource.

    • Stephanie says:

      Additionally, if I sleep on my left side, I will wake with pain that extends from the top of the buttock down to almost the knee. My range of motion has diminished to the pre-surgery point. My PT concentrated more on strength building than range of motion. Thank you again.

      • JonHyman says:

        Your symptoms are concerning. I would definitely see your surgeon and let him/her examine you and take xrays to assess the integrity of your joint. It may be scar tissue and capsular contracture, but it may also be deterioration of the joint or incomplete healing of the labral refixation. While more stretching/strengthening in PT may be the answer, typically 4 months of PT is sufficient and you should be more improved by now.

  9. Gina Hoffman says:

    About 2 years ago I had a left hip arthroscopy-labral tear repair, IT band release, bursectomy and acetabuloplasty. The results were fantastic. The hip is 100%. This past February I had the right side done( my hips are not shaped properly thus the need for sx). Any way on the right side, all that was done was a labral tear repair. The tear was large and the surgeon used 4 suture anchors. I did PT for almost 4 months and was “released” from my surgeon’s care in June. It is now 8 months post op and I have more pain now than preoperatively. I saw my surgeon and he siad I have regressed since my June appoinment. I have severe hip and groin pain. It hurts when I sit, it hurts when I exercise and sleep is non existant. I asked my surgeon if I had AVN as I know thats a traction complication and I understand they had difficulty keeping me in traction as I am very short and my foot is small. He told me AVN was not likely since my post op x-ray did not indicate any problems and scheduled me for an MRA. My concern is that when I had an MRA before my sx, it showed nothing. I had to wait a few months while I tried a cortisone shot which didn’t help-before I convinced my surgeon that it didn’t matter what the MRA showed, there was a problem. Now I worry about that again. I understand scar tissue does not show up on an MRA. Could scar tissue cause this much pain? And how do you know if it is indeed scar tissue causing the pain? I feel that at 8 motnhs, I should be fairly recovered. How/why would I have regressed in my recovery?
    Thank you for any insight you can supply.

    • JonHyman says:

      Scar tissue is unlikely to cause severe hip and groin pain; Traction is unlikely to cause AVN. There are many, many reasons for regression of progress and they need to be evaluated by your surgeon.

  10. Julie says:

    I had two procedures on my left hip this year. The first was to remove a benign tumor which sat on my greater trochanteric bursa and included an injection into the bursa. Two months later, I had arthroscopy and a bursectomy which included labral tear repair and repair of a teres tear. I am now 5 months post-op from the second surgery and have new symptoms…though neither surgery resolved my pain in the first place. I now have groin and lower back pain, feel that my hip is unstable and have spasms in my quad, knee pain and numbness in that foot. I have had a steroids injection into the hip joint since the surgeries which did nothing. They also did a back MRI which revealed one small disc bulge in the lower thoracic spine, which my doctor doesn’t think is an issue. I have also done PT. I got a second opinion and neither doctor knows what to do for me. The plan is “live with it.” I feel like my hip is not moving right and the surgical sites are still painful. Who do I see now? I feel like they think I’m making this up, but this is really messing with my life.

    • JonHyman says:

      It doesn’t sound like the HIP JOINT is still an issue, but the tissue around your hip, ie bursa, tendon, etc may be an issue. Injection there may prove informative. Additionally, you may have some nerve irritability or referred pain into the hip/leg area. The numbness in your foot is concerning…as are your other symptoms. Sounds like you need to see another hip specialist and / or a spine specialist.

  11. Pam says:

    Hi!! I’m so glad I came across your blog! What state are you in? I just had FAI repair (mixed) , three anchors & repaired cartridge . I’m 5&1/2 weeks post op. things seem to be going well minus the patella tracking & swelling issue, but a brace seems to Hel that now. My concern is my groin pain, it’s almost worse thN pre op(although my hip DoES feel much much stronger) my groin is not:-( I went undiagnosed for almost three years. I had bilateral sports hernia repair in 2010, they never checked for FAI. I am beyond frustrated & annoyed. I am a former national level athlete & personal trainer & my life has completely turned upside down . I have another FAI surgery scheduled in 6 weeks for my left side. This one that I just had was 90% torn when I went in, again I feel stronger in the hip area, but the groin is very bothersome. After my hernia surgery I was never able to rehab because of my undiagnosed FAI. I ended up having a granuloma right over a nerve & that bothered me but never this bad. My PT thinks it’s my SI joint causing the groin pain, but I’m not convinced. Any suggestions? The groin pain started a week & 1/2 post op.
    thanks in advance for your time & for your blog!!!
    Pam G

    • JonHyman says:

      we are based in Atlanta, GA. Groin pain is non-specific and the causes can be multi-factorial. There are too many possibilities to list here. It sounds like you need a careful physical examination and some updated xrays, at a minimum. A selective injection either in your hip joint or SI joint, or both, could be quite useful in determining the location of your pain generator.

  12. Pam says:

    Hi!! I’m so glad I came across your blog! What state are you in? I just had FAI repair (mixed) , three anchors & repaired cartridge . I’m 5&1/2 weeks post op. things seem to be going well minus the patella tracking & swelling issue, but a brace seems to Hel that now. My concern is my groin pain, it’s almost worse thN pre op(although my hip DoES feel much much stronger) my groin is not:-( I went undiagnosed for almost three years. I had bilateral sports hernia repair in 2010, they never checked for FAI. I am beyond frustrated & annoyed. I am a former national level athlete & personal trainer & my life has completely turned upside down . I have another FAI surgery scheduled in 6 weeks for my left side. This one that I just had was 90% torn when I went in, again I feel stronger in the hip area, but the groin is very bothersome. After my hernia surgery I was never able to rehab because of my undiagnosed FAI. I ended up having a granuloma right over a nerve & that bothered me but never this bad. My PT thinks it’s my SI joint causing the groin pain, but I’m not convinced. Any suggestions? The groin pain started a week & 1/2 post op.

  13. Nick says:

    Thanks for the informative responses, Dr Hyman and team!

    I’m 2 years post-op by one of the more experienced hip scope surgeons for FAI osteoplasty and labral repair (2 anchors) with partial labral debridement. The sharper pinching groin I felt prior to surgery has decreased, but I still feel a duller groin ache with flexion and, since the procedure, the same pain particularly with extension (walking back-stride), as well as lying prone and on the affected side. I’ve had a MRA and fluro-guided cortisone injection that both largely anesthetized the pain momentarily. My OS noted acetabular chondral softening during my initial procedure (where microfracture was not performed), but moreso suspects adhesions (and likely further labral pathology as a result of the adhesions) as the source of my localized anterior groin pain.

    Would you have any suggestions on what might distinguish adhesions/labral pathology, clinically, from cartilage delamination? As you noted in the above post, adhesions don’t really visualize well by MRI, so I’m concerned once the OS goes back in with the scope, we find cartilage defects that are beyond repair, rather than just adhesions…

    Any advice appreciated! Thank you

    • JonHyman says:

      Difficult to say Nick. Big adhesions can show up on MRI, but most do not. Best case, you could get a 3Tesla MRI or dGEMRIC MRI to look at your cartilage before going back in. Cartilage lesions can be hard to see on conventional MRIs, these latter types are not readily available.

      Age and cartilage vitality can be big factors in healing these lesions.

  14. Steven Scullion says:

    Hi Jon

    First I would just like to say thanks for this blog, even reading your responses to other peoples problems helps somewhat with my own.

    I am 8 months post op – removal of CAM impingement and partial labral debridement in my right hip. No damage to the cartlidge was evident.

    Prior to the op I had pain for c3 years, treated by two pain killing injections, which helped to some extent, but surgery was really the only option in the end. Though during this time I developed some bad habits in terms of walking (limping) and was beginning to have a lot of trouble with my left hamstring tightening due to this leg being overused.

    Post-op I was very surprised at how quickly my hip was recovering – I was off crutches after a few days, really getting into the rehab exercises and after about 4 weeks everything seemed great. Then I started developing pain in my groin doing certain exercises (mainly lying on my back and raising the leg) which my physio diagnosed as Bursitis. A period of rest and anti inflamatories ensued, but the pain didn’t recede. Since then I have went through cyclical periods of strengthening exercises and periods of enforced rest. All the while I have felt the burning pain in my groin increasing, to the extent that walking is now difficult.

    I seen my surgeon two months ago and he advised that I may have overdone the early rehab and advised me to do nothing but 20 mins resistance free cycling and 20 mins of aqua walking (as opposed to aqua jogging) and over the last month I have developed a clicking and general unsteadiness in my hip (no associated pain with the clicking, just the normal groin pain) when walking and aqua walking.

    I seen my referring orthapaedic consultant a couple of weeks ago and he said there was still quite a bit of pinching in my hip joint (when tested) and said it could be a number of things including recurrent labrum tear and scar tissue. Just wondering if you had any ideas so that I will know what to ask the surgeon when I next see him.

    Thanks in advance for your time


    • JonHyman says:

      Thank you sir. Almost by definition, CAM lesions generally result in ace tabular cartilage damage moreso than labral damage, so your findings of no cartilage damage and labral damage beyond repair are a little perplexing.

      They may consider a steroid dose pack or cortisone injection in the presumptive area of bursitis, prior to getting more invasive studies.

  15. MotherMort says:

    Dr. Hyman,
    I am a 51 y.o. healthy female who walks 5-7 miles a day. I have been dealing with a right hip issue for over a year. I have periodically come to check in here and see what you have been telling people which has helped me in my path to having a better hip. My story is not unusual or complicated, but definitely took many twists and turns. I wanted to share it not for advise, but to let folks know that sometimes things DO get better.

    The first few months of my “catching” I ignored because I thought it was a “groin muscle” (who here hasn’t heard that before?) One day the catch was so bad my leg gave out from under me, but still I waited (after all, my mother who was battling lymphoma took priority). Finally in April of 2012, after having had an MRI that showed an extensive labral tear, I started physical therapy, but to no avail. I just wasn’t seeing ANY improvements.

    August 2012 I had my FIRST (yes, my first) arthroscopic surgery for an osteoplast of the femoral neck and labral debridement. Fairly routine, no surprises. Back to P/T only to discover after getting off my crutches 4 weeks post op that I was still getting “catching” (which we now know was actually snapping of the iliopsoas tendon) as well as hip joint pain with internal rotation during hip flexion. Two steroid injections later, first one in the hip joint that did nothing for my pain and two weeks later into the IP tendon which helped for one week and then the snapping returned. Both injections were diagnostic and helped my surgeon decide my course of treatment. On Nov. 21st he went back in for my second arthroscopic surgery, did an FAI osteoplast for CAM and pincer impingement , as well as a bit more smoothing of the labrum, and a 40% iliopsoas tendon release near the hip joint (where the tendon and the bone cross the joint).

    I am now 2 weeks post-op and feel so much better and different (in a good way) than I did after my first surgery. I still have a long way to go, but I do feel so positive about this surgery’s outcome. I am still on crutches and I have to baby my hip flexors for two more weeks before I go back to p/t to get my muscles built back up so it is too soon to tell the final outcome. I have nothing but positive feelings this time. My surgeon has been GREAT working with me in trying to figure this all out! My heart breaks for the folks who have surgeons who “write them off” or don’t understand. They need to find a new surgeon if you ask me.

    So, that very long story leads me to the end and to my “thank you” for helping us all try to find solutions to our many challenges. This is a great blog!
    Mother Mort

  16. Sam Quinn says:

    HI Jon,

    I am a nineteen year old college football player who had bilateral labral reconstructions about 15 months ago with a noted hip surgeon. I love to lightweights, train and play football but so far I have not been able to do these things back on due to groin pain. I also had an adductor tendon release about a year post op but that did not help. My biggest issues are groin pain with faber position, abduction and resisted abduction, deep flexion, sitting for a long time, internal rotation and lateral movement. There is also a lot of popping and crunching in my groin/anterior hip. I have had post op mri’s that have not shown anything. My doctor has not been able to say what is going on. I have investigated sports hernia injuries and I am unsure whether or not this is my case and neither is my doctor. I completed over a year of physical therapy and tried chiropractic, massage, and just about all conservative methods under the sun. I constantly am exercising and stretching and I have no real strength or flexibility issues besides with my groin due to the pain. I also focused extremely hard on posterior chain strength and overall flexibility. My question is do you think I could have scar tissue problems because it does not show up on an MRI, a sports hernia (I only have occasional abdominal pain), some other hip problem or both. Also could it be a gluteus medius tear if I feel groin pain?

    Thanks for your time and this blog,

    • JonHyman says:

      We have recently been inundated with requests from patients for explanations and insights into their hip pain after surgery. Most patients have had hip arthroscopy and are having persistent pain, though many have had hip replacement surgery and are having persistent pain. The sheer volume of these inquiries strongly suggests a few observations are valid:
      1. Pain after surgery is not an uncommon phenomenon.
      2. Many patients do not have adequate communication and correspondence with their operating surgeon.
      3. Patients are seeking information online without adequately being able to share all of the salient and relevant points that could help illicit a qualified response.

      There are many reasons why your pain may be persisting after surgery. I thought I would list some of the more common reasons so that you may consider these and discuss them with your surgeon in detail.
      1. Technical errors or complications during surgery. These will be hard to discern and will require integrity and honesty on the part of your surgeon.
      2. Realizing that the healing process is an extended one. For example, after a labral repair, it is common to still feel the symptoms of a labral tear for a few months after the surgery because the labrum has not healed yet and sometimes takes 3, even 4, months to heal fully after surgery. Therefore, since there is still technically a labral tear after surgery, although it is sutured, it is not fully healed and therefore one should not necessarily expect the pain of the labral tear to be gone until after it is fully healed. Cartilage, ligament, bone, muscle, tendon, synovial membrane, etc, all heal at different rates and will likely cause different symptoms along the postoperative recovery process.
      3. Possible infection. This is a rare complication, but it is at least one worth discussing.
      4. Tendonitis or bursitis from over zealous rehabilitation or physical therapy. This could be due to over exertion on the part of the therapist, or due to over exertion on part of the patient.
      5. Too rapid a return to exercise or activity. Many patients don’t have adequate guidance as to when they can return to certain types of activities and they may be premature in doing so, thus aggravating their hip or condition, and causing recurrent inflammation or persistent problems.
      6. Physiology and metabolism. Obviously, we are not all the same, and some people heal at slower rates or to varying degrees. Your diet, your metabolism, your genetics that you inherited from Mom and Dad, your immune system, possibly your stress level and attitude and perspective, can all have an influence on your experience of your pain.
      7. The pain generator or source of pain may not have been fully identified or addressed. Many patients have more pathology or problems than just the hip joint and if those other things are still active after surgery, there can be persistent pain. These things might include but are not limited to:
      1. Low back dysfunction
      2. Cartilage, ligament, or capsule dysfunction
      3. Persistent impingement or bony irregularity, muscle, tendon tightness or inflammation
      4. Scar tissue, like a keloid scar that some people form, but internally
      5. Neuromechanical dysfunction with nerve irritation from traction, pressure, stress, or a hyper sensitive nervous system.
      8. Recurrent synovitis, which is redness or inflammation in the joint. This could respond, as could tendonitis or bursitis, to a short course of non-steroidal anti-inflammatories, or a Medrol Dose Pack or two, or a cortisone injection in the inflamed tissue area or in the joint. You would need to discuss which medications, if any, were appropriate, with your physician.
      9. Re-injury
      10. Failure of repair or anchor fixation. Loose anchors or sutures.
      11. Muscle imbalance, asymmetry, or weakness.
      12. Leg length discrepancy
      13. Traction issues or problems that were not detected before surgery that are worsened after surgery due to the use of crutches or abnormal walking for extended periods of time in the postoperative phase.

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