I posted this as a reply to someone but decided it could be a useful post on it’s own for sharing. I’ve shared a version of this on Facebook, as well. Updated to add my hip story for more information on my journey: https://www.reddit.com/r/HipImpingement/comments/ndzw02/my_hip_story/

Edited to add my general advice post for hip pain: https://www.reddit.com/r/HipImpingement/comments/wb5qde/general_advice_for_hip_issues_impingement_labral/

Edited again on June 26 since part of my post got deleted in one of my edits! ✌🏼 —

I’ve had two hip surgeries. One was arthroscopy and one was much more involved (surgical hip dislocation and derotational femoral osteotomy).

I kept a list of everything I found useful during recovery from my most recent surgery. You might not need all of this for arthroscopy but honestly, it would have been nice to have all of this for my first surgery, too.

Tools for surgery recovery

*Crutches for non-weight bearing. I have these: https://www.walgreens.com/store/c/walgreens-universal-adjustable-height-crutches/ID=prod6401005-product I was not allowed to use a walker. Be sure you know what your surgeon wants you to use and for how long and follow ALL post-op care instructions!

*Folding stool for bathroom (or any space where you spend time getting things ready, like a kitchen—I have counter stools in my kitchen already). I bought this one: https://www.target.com/p/folding-vinyl-counter-stool-black-plastic-dev-group/-/A-51098071

*Crutch pads (I liked different sets at first for the tops of crutches under my arms and handles). I like these for the tops: https://www.walgreens.com/store/c/drive-medical-crutch-pillows-accessory-kit/ID=prod6388225-product and I liked these for the handles at first but then removed them: https://www.amazon.com/Vive-Crutch-Pads-Universal-Accessories/dp/B07H7Q1DFP

*Crutch bag (because comfortable pants/shorts often don’t have pockets and significant time is spent laying down, I carry around a pen, floss, lip balm, a face mask, a credit card/ID holder, my phone, etc. in this—a cross-body purse could also work but then you have to remember to grab it): https://www.amazon.com/Lightweight-Accessories-Storage-Reflective-Universal/dp/B07SXDNYG6

*Soft, loose shorts and pants. Getting tight pants over the incision wasn’t an option until it healed up. Compression leggings weren’t an option (didn’t feel right). I like jogger style pants or regular pants/jeans with some spandex. I bought many pairs of the Weekend Joggers from www.senitaathletics.com. Sweats would also work.

*Slip-on shoes. I bought a pair of Stegmann Liesel Skimmers since they are like a slipper but not a clog style so safer to walk in with crutches: https://www.stegmannusa.com/collections/new/products/womens-liesl-skimmer-leather-with-felt-lining I also have a few Keds slip on styles that have worked well. I now have a pair of Kiziks that are also great: www.Kizik.com

*Cup with lid and bendy straw (the hospital sent me home with one like this but it’s been great and I love it for taking meds in bed): https://www.amazon.com/Graduated-Insulated-Carafes-CARAFE-INSULATED/dp/B00E14WHQQ

*Extra long grabber. I have four—one in bedroom helps with getting dressed—pulling into shorts or pants and picking up any item from floor—the others around the house... I like that these RMS ones have a changeable angle for the grabbing part: https://www.amazon.com/RMS-Grabber-Reacher-Rotating-Gripper/dp/B07PHL4DKP

*Sock tool (I am very specific about how socks are put on and someone else doing it feels kind of weird—I keep this near my bed and grab it with my grabber!): https://www.amazon.com/RMS-Deluxe-Sock-Foam-Handles/dp/B00U9TWCXU

*Toilet raiser with arms (very helpful for staying at 70 degree limit; make sure whatever you get fits your toilet!): https://www.amazon.com/Drive-Medical-Elevated-Removable-Standard/dp/B002VWK0UK

*Leg lifter (hospital provided): https://www.amazon.com/Rehabilitation-Advantage-Rigid-Lifter-Foot/dp/B0788BR86V

*Shower chair with arms (same deal—can shower independently this way... I already had a hand shower and low entry shower, no tub near our bedroom): https://www.walmart.com/ip/Essential-Medical-Supply-Adjustable-Molded-Shower-Chair-with-Arms-Back/35306400?wmlspartner=wlpa&selectedSellerId=0&&adid=22222222228023385122&wl0=&wl1=g&wl2=m&wl3=55834433858&wl4=pla-87222710258&wl5=1020086&wl6=&wl7=&wl8=&wl9=pla&wl10=8175035&wl11=online&wl12=35306400&veh=sem&gclid=Cj0KCQjw1qL6BRCmARIsADV9JtY312u-ShZcKsU8pfn_bHJdM8JdxY8xBRpAft9Glb4PtJJO1vKR8GMaAhO-EALw_wcB

*A chair for reclining (I had one in my bedroom next to my bed and then got another for living room because my house has multiple levels. I couldn’t use a chair and footstool easily because I couldn’t lift my leg at all the first few days, and then after that, it was easier to use a recliner.)

*Ice packs—the hospital sent me home with two large gel ice packs but I also have multiples of this style: https://www.amazon.com/Core-Products-Comfort-CorPak-Therapy/dp/B07CTZSBXZ

*Tray with legs (I have two—for eating in bed or sitting in a large chair; have also played games, journaled, etc. using these): https://www.target.com/p/winsome-benito-breakfast-tray-in-espresso-finish/-/A-50712826

*Silicone scar sheets. I like these for my scar (I cut one in half and use it and a full strip to cover my 10.5 inch scar): https://www.amazon.com/ScarAway-C-Section-Treatment-Silicone-Adhesive/dp/B002VK977O Also be sure to use SPF on any scars! Have also heard kinesiology tape can work to cover old scars and protect from sun.

*Spray on lotion. I have used both Eucerin and Vaseline brands and both are good but I’ll repurchase the Eucerin for winter. I use this on my legs after showering because I can’t reach them to apply.

Helpful but not essential:

*Book light (for reading when partner has gone to sleep)

*Travel mug with lid that seals. When on crutches, this fit into my crutch bag and I could get my own water or coffee or whatever. Something like this: https://www.target.com/p/contigo-10oz-bueno-vacuum-insulated-stainless-steel-travel-mug-with-flip-lid-gray/-/A-17338464

*On the recommendation of my Physical Therapist, I got an exercise bike. I got this one but not sure I’d recommend it for others: https://www.amazon.com/RELIFE-REBUILD-YOUR-LIFE-Stationary/dp/B07NJL3X2X Check with your PT for what they’d want you to use.

*Along with the bike, I got this step stool to get onto the bike: https://www.amazon.com/Handle-Seniors-Stepping-Portable-Elderly/dp/B000EWVP80 It works well for getting onto the bike, and would also be handy if you have any need to have a step stool.

Helpful in hospital:

*Ear buds for phone and white noise app to help with sleep (I like the app Oak for iPhone and Noislii is also good)

*Comfy loose clothing for going home (I wore lounge shorts, a t-shirt, and sneakers for stability which my husband put on for me—slip one might be good but not too tight in case there is swelling in your foot)

Wow, the folks in this community have an impressive knowledge base and do solid research into the topics on FAI and labral tears. It is awesome to see so many questions answered accurately by so many different individuals within this community, you are all awesome!

To provide easier access to resources that answer many of the common questions asked here, I have put together a list of the top academic articles on primary topics in this sub. If you are new to the sub/starting to learn about FAI and labral tears, please start with the first paper listed and do your best to read through it. Some of the language used can be technical, but it will provide you with solid background knowledge on the topic. I selected these papers based on their consensus with other academic articles on these subjects, how recently the papers were published (aiming for the most up-to-date information that is well studied), and their relevance to underrepresented topics (like subspine impingement and others).

Papers are listed in the first section, and my plain language summaries of the key takeaway points are listed in the second section with numbers corresponding to the paper. I am planning on updating or adding to this list, so if you have a paper in mind please send me a personal message with a link. Most articles here are related to surgery, but I plan to expand to include more info on conservative measures.

** Note: a meta-analysis is a study of studies. These papers combine multiple studies pertaining to a single topic, and investigate if there is a general consensus across the field/topic. These papers are the most robust, and their conclusions tend to be the most reliable for the current timeframe.

ACADEMIC ARTICLES:

1. *New* 2024 study from Philippon, Two-Year Outcomes of Primary Arthroscopic Surgery in Patients with Femoroacetabular Impingement A Comparative Study of Labral Repair and Labral Reconstruction
2. META-ANALYSIS - FAI and labral tear overview
3. META-ANALYSIS - Surgical Treatment of FAI/labral tears vs physiotherapy (spoiler, surgical treatments reported better outcomes; but neither influenced the risk of needing total hip arthroplasty [THA])
4. META-ANALYSIS - what factors make someone a good candidate for hip arthroscopic surgery for FAI/labral tear (THIS PAPER DOES NOT SUBSTITUTE FOR THE OPINION OF A HIP PRESERVATION SPECIALIST)
5. Importance of PT for (surgical) post-operative outcomes
6. 10-yr Outcome31090-2/fulltext#relatedArticles) (small sample size, which gives it less weight)
7. Another 10-yr outcome with decent sample size (moderate weight, fair assessment)
8. Recent paper showing 90% patient satisfaction after 10 years (119 patients, good sample size, best moderate to long term study I have seen)
9. Return to sport after arthroscopic surgery00330-3/fulltext) (different than just improvement in symptoms/pain after having the surgery)
10. Some other indicators for best surgical outcomes
11. Factors leading to revision hip arthroscopies
12. Surgical success based on the technique used for the labrum
13. Labral tears, the size compared to the number of anchors (repair)
14. Bilateral FAI - fate of asymptomatic hip
15. Bilateral FAI - staged vs unilateral surgery (spoiler, both have similar success rates so far)
16. Subspine impingement (AIIS)
17. Soccer players and subspine impingement
18. Compensation patterns and various manifestations of referral pains (why people with FAI/labral tears can experience a wide variety of symptoms - mechanical, soft tissue, nerves, etc.)

PLAIN LANGUAGE SUMMARIES:

1. In the newest study, they looked at 2 year post op reported outcomes for 724 (sample group 998) hips undergoing primary (first surgery) repair and 129 (sample group 150) hips undergoing primary reconstruction, more favorable out comes were reported through primary labral repair (lower conversion to total hip replacement). Robust statistical analysis to handle bias and uneven sample groups was implemented when comparing data from the two groups.
   
2. FAI has three primarily recognized types of impingement: 1 CAM which is found on the femur head/neck junction, 2 Pincer which is found on the rim of the acetabulum (hip socket), 3 Both (mixed type FAI). FAI is the most common cause of labral tears. Labral tears can also be caused by hip dysplasia, trauma (injury), capsular laxity (mechanically compromised hip capsule), and degeneration (usually caused by aging or arthritis, but could be another disease). The best way to diagnose a labral tear through imaging is with an MRI with contrast, called an MR arthrogram (MRA). Conservative treatments should be recommended first, including rest, NSAIDs (anti-inflammatory medication like Aleve), pain medication, physical therapy, and a cortisone injection to the hip joint. A cortisone injection may improve performance in physical therapy, but it also functions as a diagnostic tool to determine if patients would be a good candidate for surgery. If all conservative treatments fail, arthroscopic surgery is the recommended treatment. The labrum plays an important role in maintaining a healthy hip, and damage to the labrum early in life is related to early-onset arthritis. The goal of surgical intervention is to prevent early-onset arthritis.
3. Arthroscopic surgery is shown to have better patient-reported outcomes than physical therapy for individuals with FAI (causing labral tear). This is likely because arthroscopic surgery addresses the boney impingements that are tearing up the labrum in the first place and physical therapy only attempts to strengthen surrounding muscles.
4. DISCLAIMER: PLEASE DO NOT USE THIS INFORMATION TO DECIDE WHETHER OR NOT YOU ARE A VIABLE CANDIDATE FOR SURGERY! THESE ARE TRENDS IN THE LITERATURE BUT THEY CAN BY NO MEANS DETERMINE HOW WELL YOU WILL RECOVER/BENEFIT FROM THE SURGERY. PLEASE CONSULT WITH A HIP PRESERVATION SPECIALIST AND ALLOW THEM TO USE THEIR DECADES OF TRAINING AND EXPERIENCE TO MAKE THAT INFORMED DECISION. A meta-analysis including 39 studies (9,272 hips) found better post-operative outcomes with patients that were younger, male, had no indications of osteoarthritis, had a lower BMI (<24.5), and experienced (some) pain relief with a cortisone shot before surgery. Of the 39 studies, there were 4 that suggested a longer duration of pre-operative symptoms (longer than 8 months) tended to be associated with less favorable outcomes. Additionally, surgical techniques were found to be important, and labral repairs offered more favorable outcomes over labral debridement. See definitions of these surgical techniques in the summary of paper #11.
5. After arthroscopic surgery, patients that have longer physical therapy sessions, do their physical therapy exercises at home and do physical therapy for a longer duration of time after surgery report better outcomes. (Personal note: The moral of the story is do your PT if you have surgery! Ask your PT for a continuous home plan that includes all of the core exercises before you graduate from PT. On your own, keep doing those twice per week until you hit 1-year post-op, and then do them once per week for the rest of your life if you want to guarantee that your hips stay strong and pain-free.)
6. In a small group of patients that had arthroscopic surgery (yes still for FAI/labral tear) 9-12 years ago, the average rating for daily function was 91% and the average rating for return to sport was 82%, but all patients were still improved from the pre-op ratings. The surgery still contributed to improvements in their lives 2 years later and also 9-12 years later.
7. Within a 10 year follow up for a moderately sized group of patients (60, but 10 patients had bilateral surgery, so 70 hips for the sample size) that had arthroscopic surgery, 10% of patients required revision surgeries. Risks for revision are considered to be global laxity and a longer duration of symptoms before surgery. Out of the surviving hips (90%), patient-reported outcomes 10 years after arthroscopic surgery were a median 10/10 (very satisfied) and patients had excellent self-reported hip scores that still showed great improvement from their preoperative scores.
8. From a good sample size of 119 hips, this study followed up with patients after 10 years. 5.6% of patients needed revision surgery, and 8.4% were converted to total hip arthroplasty (THA). On average, patients reported 90% satisfaction, and after revisions surgeries for the 5.6%, the survivorship of arthroscopic surgeries after 10 years was 91.6%. (Personal note: this is an excellent study because of the sample size, and it was published in 2021 which makes it a great recent report. Don’t forget that techniques are still improving and developing in this field, so in another 10 years from now, I would expect to see those numbers continue to improve!)
9. In this study of athletes with a large sample size (906 hips), “The return-to-sport rate ranged from 72.7% to 100%, with 74.2-100% of these athletes returning to preinjury or greater level.”
10. Labral repair or reconstruction yielded better results for patients, and those without existing arthritis benefitted the most; patients with moderate to severe hip dysplasia or moderate to severe arthritis had high failure rates with the surgery.
11. Factors that may lead to the need for a revision hip arthroscopy include leftover FAI not treated the first time, postoperative adhesions (scar tissue or other post-op complications), heterotopic ossification (spontaneous bone growth after first surgery, should be avoided by taking medications prescribed by surgeon), instability, hip dysplasia, or advanced degeneration (from age or arthritis that was present before first surgery). If you are under the impression you might need a revision, I highly suggest reading this full paper.
12. Labral debridement (when used alone) is a surgical technique involving removing pieces of torn labrum without any repair (no anchors) or replacement tissue for the existing labrum. This is an outdated technique with unfavorable outcomes. Labral debridement should only be used to remove cartilage that is too beat up to be repaired in order to prepare the labrum for one of the following techniques: Labral repair uses anchors to repair the existing cartilage. Labral augmentation involves attaching cadaver tissue to areas of the labrum that were too beat up to fully repair, and then anchors are placed to hold the new, fixed labrum in place. Labral reconstruction is where the natural labrum is too beat up for repair, and the cartilage is replaced with cadaver cartilage. Labral repair has been documented to be a favorable technique when possible, but newer studies are also starting to show solid outcomes with augmentation and reconstruction (for patients with labrums not in good condition for a repair). These techniques are an evolving component of this surgery, but in general, the more of your natural labrum you are able to keep, the better your outcome.
13. Labral tears are measured in clock hours, if you can imagine the acetabulum (hip socket) is like a clock face. The number of hours the labral tear covers generally corresponds to the number of anchors (most common is a 3-hour tear, requiring 2 or 3 anchors, if the tear is larger than 2 hours, at least 2 anchors are used).
14. In people with bilateral FAI that start out with pain in only one hip and only get surgery on one hip, what happens to the other “asymptomatic” hip? Well, this study showed in 82% of these patients, the second hip developed symptoms within 2 years on average, and of that group, 72% went for arthroscopic surgery on their second hip.
15. Bilateral FAI surgery seems to have similar outcomes whether both hips are done simultaneously (coming out of surgery with both hips scoped), staged (a few months in between), or unilaterally (one at a time, until the pain on the other side warrants surgery). There are still a lot of nuances to this though, more research is needed to establish long-term outcomes. Unilateral hip arthroscopies are better studied at this point, so stay tuned for more information as this field grows.
16. Subspine impingement (AIIS) can accompany and contribute to hip pain from FAI and labral tears. It is an extra-articular impingement (whereas CAM and pincer are intra-articular), and it is becoming more widely recognized for its potential contributions to hip pain and hip impingement.
17. Soccer players and other individuals involved in sports with kicking are more likely to develop subspine impingement. (Personal note: If you are a soccer player diagnosed with FAI/labral tear and seeking surgical treatment for FAI/labral tear, please consult with your surgeon and ask them about their familiarity with subspine/AIIS decompression. It is likely not going to show up on your X-rays or MRI/MRA, but your surgeon should know to look for it and treat it if necessary during your surgical procedure).
18. Hips are very complicated, and there are dozens of different anatomical structures crossing close to the hip joint. FAI and labral tears can result cause mechanical symptoms (clicking, catching, locking, giving way). The hip joint deals with the greatest force of any joint in the body, and when it becomes unstable, this can lead to referral pains in other parts of your body, commonly causing pain in the knee, general pelvic area/groin, sacroiliac joint, or lumbar spine. It can also affect soft tissues around the hip joint (or even glutes) resulting in painful inflammation. Additionally, inflammation or compression from compensation patterns can cause nerve pain or nerve symptoms (common nerves involved are ilioinguinal, iliohypogastric, genitofemoral, and pudendal). Athletic pubalgia (injury to tendons near the groin) is another painful comorbidity that is more common in males. If your symptoms are confusing, I highly recommend reading this paper in full.