21 September 2012
Surgery was more than 2.5 years ago (where does the time go?!) and I’m so happy with the outcome. In the past 12-18 months I’ve started to get back into sport, and, as of last week, have returned to playing tennis… a sport I used to love before having hip problems, and one I thought I’d never be able to do again.
Is my hip perfect? No. It gets stiff, it can ache from time to time, and I’m constantly mindful of things that could upset it. Am I happy with how things have turned out? Absolutely. For so long it felt like this problem would never be resolved and that I’d have to live with a life-restricting problem, but I don’t any longer. I genuinely don’t mind that it aches or gets stiff, because I’m able to lead a normal and active life. Sure, if my friends invite me on 20-mile walk across the moor, I might think twice about it, and I certainly can’t dive around the tennis court like I used to, but I’m mobile, active and happy. Compared to how things were, what more could I ask for?
I’ve had my ups and downs. That pesky pain in my glute/piriformis bothered me now and again, but that hasn’t happened for some time now. Also, I’d done a couple of very short jogs (maybe 1.5km at most) without any problems, but I went for a longer one in Brighton one weekend earlier this year… about 5km. My hip held up fine but my IT Band on both sides just above the knee was excruciating and I couldn’t walk for a day or two afterwards. It was agony. I guess that’s through lack of use in this way, but I’m sure that’ll improve in time. I never much liked running anyway :)
Anyway, as far as I’m concerned it’s a happy ending. Many thanks to those who’ve read and commented over the past few years… according to the stats, the blog has had over 23,000 page views! Incredible stuff. I do hope it’s been useful to some and not just a place for me to offload. I also hope each of you is on the road to recovery and/or looking forward to when your problems will be rectified, at least so you’re able to lead a normal life again.
All the best,
As a side note, my company is trying to build its online/social media presence, so if you use facebook and fancy liking a page, go to www.sure-languages.com and hit ‘Like’ at the top. Thanks!
23 December 2010
The big test starts just after Christmas when I'll be putting my hip through its paces in Austria. I'm nervous about skiing again and I'll no doubt be far more cautious than usual, but I'm so happy to be doing it again. Oh, and today is exactly 1 year since the operation... What a different a year makes!
Off topic, here's a nice festive snowy picture taken from my house this week:
More in 2011! Merry Christmas and happy New Year.
9 November 2010
I love skiing/snowboarding but, for obvious reasons, haven’t done it for a couple of years. This time last year I thought I’d never be able to do it again… Well, I’m booked up for my first ski trip post-op and in 7 weeks I’ll be putting my hip to the test in a full-on way.
I’m hugely excited about hitting the snow again and spending New Year abroad, but I’m filled with trepidation about how my hip will feel and whether I’ll hurt it. My muscles still feel very weak so I’m working to increase strength and stamina, but I really can’t predict how it’ll hold up after long days on the mountain. Eeek!
What’s more, that horrid pain the butt I mentioned a year ago has returned. Totally unrelated to my hips it seems, but possibly due to being sat down for too long and maybe directly attributable to a month of long hours and full weekends sat at my desk. I really don’t know how to get rid of it either, so I’m stretching this and exercising that in the hope it’ll disappear again. Humph.
31 October 2010
Someone posted a comment on this blog a few days ago wanting to know if anyone has had this operation, if it was successful and whether having it was a good decision? My responses to these questions:
Was it successful? The original problem - the deep posterior catching and pain – has gone. Was the op a good decision? This time last year my hip controlled my life and now it’s not a big concern. Sure, it’s not perfect, but it’s infinitely better than was pre-op. I’m even returning to skiing this winter (woo hoo) and I thought that would never happen. Will it ever be perfect again? I don’t know, but I don’t mind.
Good decision? Yes. Successful? Successful enough :-)
20 August 2010
Post op the inside of my joint hurt a little but it was never anything worth noting. However, lunging about on the badminton court has given me quite moderate pain in the joint on the anterior side (not where my original problem was, but where the surgeon did stuff). I’ve had a fairly constant dull ache for nearly 5 days now with little zips of sharp pain. It hurts to sit, as I think it puts pressure on the part of my joint I’ve hurt, and it hurts when my leg is at extension when walking.
Jumping around was a huge amount of impact on my joint, so I’m hoping it’s just sore and tender after not having done anything like it for a couple of years (although, the left hip hasn’t done anything either and that feels fine). If I’m honest, and knowing my own body, it feels like something more notable is wrong and that it’s not something that will just get better :-(
Hopefully my next post will disprove these suspicions. Until then...
4 June 2010
Progress has been good over last few months and life is returning to normal. The biggest change is that I’m able to walk wherever I like without having to worry about my hip. I go to work on foot most days and can walk around the town for a couple of hours without having to be anxious about pain or catching. That said, it’s not perfect; I still have a very slight limp – especially when walking uphill – and I get some minor discomfort after walking for an hour or more. My sporting activities are still limited and I also have a little tightness around the anterior portal site at extension, but I’m hopeful that all of these things will gradually improve over time.
Generally speaking, I’m still conscious of my hip and how it feels with every step; partly because it feels different to my non-operated side but mostly because this 2-year episode has been so mentally consuming. It’ll take some time for me to be psychologically confident that my hip is fixed, even if physically I’m well on the way.
Progress is definitely logarithmic with any improvements taking longer now than they did in the first couple of months, but I guess that’s to be expected. To put things in perspective though, 6 months ago I could hardly walk anywhere without mild to major pain, causing considerable disruption to so many aspects of my life. I now walk around, cycle with my friends and even do a bit of salsa dancing! It’s a dramatic contrast and I can’t grumble at all. I might even return to snowboarding this winter!
I’ll post again in 2-3 months, by which time my hip will be so good I’ll probably be the world break-dancing champion or something. Ok, maybe not :-)
As one chapter in my life draws to an end, another begins: I’ve just had teeth removed (3 days ago) ready for mouthful of Radiance braces, as I’m entering the world of adult orthodontics... maybe I should start another blog?!
Have a great summer everyone,
4 March 2010
Firstly we addressed the pain over the greater trochanter. A few exercises and stretches pretty much sorted that out in a week or two. We then focused on my walking, how it had changed and how to fix it. We’re now stretching and strengthening with a few ultrasound treatments thrown in for good measure.
I’ve been out on a few cycle rides. Fairly gentle stuff to start with and not huge distances but it’s a start. I’ve also walked to and from work (1km each way) on three consecutive days this week… maybe a fourth tomorrow. That may not sound like much, but I’ve not been able to walk so well for quite some time so for me it’s a pretty big deal.
I’m feeling great at the moment :-)
9 February 2010
I mentioned in earlier posts that I started getting a problem in my leg… a sharp pain just under the skin around the greater trochanter, after what felt like a rub or snap in the side of my leg. I mentioned this to my surgeon on the 29th Jan but he wasn’t concerned about it. He said that if the inflammation doesn’t settle, a shot of cortisone should calm things down. I went to the physio department afterwards (they weren’t expecting me) and was given some stretches (one for the IT band, which helped a lot), but that’s pretty much all the physio I’ve been given since the operation. Surely that can’t be enough?
Taking matters into my own hands, I decided to make an appointment to see a physio locally. I had my first appointment early last week, with the painful problem around the GT the main area of focus (stretching, strengthening and ultrasound). Since then, I’ve not had the sharp pain back so it’s definitely going in the right direction, but I’m tight, have restricted movement, and this problem has caused other issues.
I’ve started to walk differently. I’m now walking in a way that stops my leg from hurting, kinda kicking it out to the side slightly to stop any rub over the GT. I now can’t not do it! Walking normally is almost impossible. It’s ironic really, as the reason I started to get that problem was because I walked differently to prevent my hip from hurting post surgery. So we’re trying to fix my walking and gait problems. I’ve been given new exercises and things to focus on, which I’m finding really difficult. My right leg just doesn’t work like it should. My glutes are useless too.
On the plus side, I’m able to cycle a little. I’ve been using the exercise bike often and managed to get out for a short ride by the river on Saturday afternoon. Twas lovely.
24 January 2010
The two incision wounds have healed and all that remains are quite minor pinky scars, which will soon be almost invisible anyway (having hairy legs has its benefits). The scar tissue beneath the skin is a little lumpy, particularly at the anterior portal, but it’s only noticeable when you apply pressure so it’s no big deal.
I still can’t be sure, but I’m feeling more and more confident that the original problem still exists. Particular sensations prior to surgery, like a feeling I get when turning in bed, have semi returned. Also, I went into the attic yesterday (yes, I’m well enough to climb a ladder… kinda) and I thought I felt the old problem. Things still aren’t 100% right after the traction stretching though, which is why I’m not certain about whether or not the old issue is still there. As I said in my last post, and as I have to keep reminding myself, it's too early to know for sure.
Last weekend the new post-surgery issue in my leg returned for a second time. In a way, I’m glad it did as it’s given me valuable information. Since this has happened a second time, I’m confident that the feeling is the same as what I get in/around my hip, just in a different place. If we’re able to find out what the leg problem is, I have hope that they’ll find the hip problem. There are a few possibilities to investigate with physio (ITBS and Snapping Hip Syndrome, for example) at my next appointment.
I’m really looking forward to talking things over with my surgeon and chatting with physiotherapists who know a lot about these things (I’m pretty sure the last lot didn’t). My appointment is on Friday (29th Jan) at the Duchy Hospital and I’ll post an update shortly afterwards.
Get well soon, Louise.
13 January 2010
- The surgeon found no damage posteriorly. This is where my pain is.
- I’m pretty sure I can still feel the problem.
- I’ve started to get a new issue in my leg (probably from the stretching during surgery) that feels just like the problem in/around my hip. Coincidence?
Generally speaking, my recovery has been going really well. My ROM has improved so much since the last post and my walking is starting to look and feel more normal again, but I’ve still got a looong way to go before I have normal flexion and extension. I can just about sit cross-legged and can lie on the operated side for a short while, although it’s not yet comfortable enough to do either for any length of time.
The hospital called yesterday to ask how I was feeling and if there were any issues or complications. I like that they did that. I have a follow-up appointment with my surgeon at the end of the month, straight after which I’ll be whisked down to physio. I hope they’ll give me new and different exercises to do. I’m getting a bit bored of the current set!
5 January 2010
30 December 2009
However, today I’ve been reminded why my consultant says a full recovery can take 3 months. I’m getting a very dull and downright painful ache deep in my groin, which has put me a step back from how I was feeling yesterday. As I’d been making what seemed like excellent progress I started to believe that my recovery would be speedy, but this is the most pain and discomfort I’ve had since the op and a lesson that the small cuts on the outside don’t accurately reflect what’s happened on the inside.
An eventful year is almost over. Happy New Year everyone :-)
27 December 2009
For the first few days I needed help to wash my lower legs and feet, and I couldn’t put my underwear, jeans or socks on, but as of today I can do all of those things. Around the house I’m down to one crutch but still need two if I venture outside. I daren’t attempt to lead up any stairs on my operated side but I hope it won’t be long before I can.
Here’s the surgeon’s operation report:
Operation Sheet - Arthroscopy of the Hip (Right)
This was a primary procedure. Major symptoms were of posterior hip pain.
He was positioned supine on the table. The traction device used was the standard Smith & Nephew hip distractor. The portals used were lateral and antero-lateral. A cocktail of two antibiotics given as prophylaxis. The joint was “inflated” and maintained at pressure using an arthroscopic pump Arthrocare system set at 60 mm/Hg. Very tight hip with difficult access – but no chondral damage caused by instruments on entry. The arthroscopic tools used were: the Arthrocare RF “wand” and an arthroscopic burr.
The arthroscopic inspection revealed normal synovium, a normal ligamentum and no loose bodies. The abnormal findings included severe labral damage with anterolateral acetabular overhang impingement in the hip flexion. The acetabular cartilage appeared normal apart from very small posterior articular cartilage damage – grade 2 for 10 x 10 mm, there was no medial wall osteophyte and the ligament Teres was normal. The acetabular labrum had sustained what appeared to be a traumatic tear, there was no sign of degeneration. The labral tear was 10 – 15 mm in size located superiorly and antero-superior. There was minor antero-lateral chondral carpet damage adjacent to this tear.
The femur was not treated in any way. The acetabulum treatment included debridement of the area of degeneration. The labrum was debrided back to stable articular cartilage and the anterior acetabular rim was burred back to reduce anterior impingement. The hip was moved into 90 flexion with 10 IR and no impingement was noted.
Estimated blood loss was minimal. Prior to closure haemostasis was not specifically addressed. The surgery took between 1 ½ and 2 hours. The portals were closed with an interrupted 3-0 nylon suture. Removal at 10 days by the GP practice. The procedure was performed under image guidance. Photographs were taken of the joint intra-op. For pain management the joint was injected with 20ml 0.5% marcaine into joint.
For antibiotic prophylaxis Flucloxacillin 1 gm given intravenously at induction but need not be given again post operatively. In addition Gentamicin 120 mg given intravenously at induction but need not be given again post operatively.
Post surgery no immobilisation was required. His rehabilitation can commence as soon as he is comfortable. Discharge today or tomorrow, once mobile and safe. He will be reviewed in 6 weeks in the outpatient clinic. He will be mobilised as FWB (full weight bearing) as tolerated.
24 December 2009
I arrived at the hospital at 1130 and was taken to my room, where I went through the usual pre-op checks and questions. The physiotherapist came to deliver a pair of crutches and talked me through some post-op exercises. A nurse left a Flowtron DVT prophylaxis machine and leg sleeves at the end of my bed, but I wasn’t asked to put them on yet. I showered with some pre-surgery antibacterial soap and waited nervously for the anaesthetist in a fetching hospital gown.
He arrived at 1230, asked a few questions and talked me through what would happen. He said that he wouldn’t use an epidural (unless I really wanted it) and would just use morphine, as two thirds of patients (of this type of operation) wake up comfortably in recovery this way. My surgeon then visited, talked me through a few things, asked me to sign a couple of forms and marked my leg with a big arrow and the word 'scope'.
Shortly before 2pm I was wheeled off to a little room just outside theatre and had a small cannula put in my left hand (I didn’t feel a thing). I was first given a clear fluid, which I vaguely remember was to prevent sickness, followed by something else that made me tingle all over. The third and final syringe contained a white fluid. As it was administered, I was asked how I was feeling, to which I replied something like ‘I can taste the anaesthetic and...’ I then woke up in recovery some 2 hours later!
I came to without any notable pain, but with a horrendously itchy nose! A kind lady beside my bed said I’d been scratching and rubbing it for ages, although I thought I’d just woken up. I looked around the room and saw a lady in another bed. Her whole body was shaking and I asked the lady with me if she was ok. I can’t remember her reply. My surgeon came to speak with me, showed me some images of the inside of my hip and told me what had happened on the operating table, but I quickly forgot what he told me… much to my frustration!
Back in my room my parents were waiting. I was still quite groggy from the GA and did my best to talk coherently, but I wasn’t fully with it and kept losing my train of thought. Along with my itchy nose, my legs and feet were also itchy, so my devoted mother provided a welcome leg-scratching service. Maybe it was a reaction to the GA? It also made me feel quite sick, which didn’t ease off until the evening.
After a couple of hours in my room I started to feel more human. My surgeon visited and talked me through what had happened: Posteriorly, which is where I have pain and catching, he found no problems. It was as it should be. Damn... Not the news I wanted. However, and very surprisingly, on the anterior side he found ‘severe’ labral damage. My operation sheet says:
“The abnormal findings included severe labral damage with anterolateral acetabular overhang impinging in the hip flexion” and “The acetabulum labrum has sustained what appeared to be a traumatic tear… The labral tear was 10 – 15mm in size located superiorly and antero-superior.” (I’ll add the full report another time when I feel like typing it out!)
I had 5mm of bone removed from the anterior acetabulum rim and the labrum was debrided back to stable articular cartilage. I have about 5 nylon stitches, which will need to be removed in 10 days.
My surgeon said it’s unlikely that the anterior labral damage is the problem I (only) get posteriorly, but he can’t say for sure. Only time will tell. It certainly wasn’t the initial outcome I was expecting though.
So how do I feel now? Not too bad! I came home late this morning (exactly 24 hours in hospital) and have been in and out of bed, pottering around the house chatting with family. My hip is sore but the pain meds are keeping me comfortable. It’s particularly sore around the anterior portal and even slight stretching of that hip flexor makes me wince, but it’s not that bad. Anticipation of the surgery and post-op pain was far worse than the reality.
That’s all for now. I’ll post again in a few days (after Santa has been) with an update on progress and a transcript of the surgeon’s operation report :-)
23 December 2009
Thanks to those of you who’ve sent messages of support. I’ll post an update in the next day or two with all the gory details.
18 December 2009
I’m not looking forward to the after effects of the GA. The last times I had it (following two sinus operations about 8 years ago) I suffered from mild post-operative depression. It didn’t last all that long, maybe 2 weeks or so, but it made me quite down and teary, and wasn’t particularly nice. I’ll be out of hospital on Christmas Eve and moving back to the family nest for while, so I’m hoping festivities and family will keep me chipper.
Good news (for me anyway) is that my butt is on the mend. After a deep sports massage, increased stretching and walking more often, the pain and discomfort has started to fade and it’s slowly returning to normal. This episode lasted for about a month and really was dreadful… I’m just glad it’s eased off so that I won’t have the problem while recovering from surgery next week.
8 December 2009
I had my blood samples taken at thehospital last week to save me driving down again before the op. I also had more MRSA swabs rubbed around my armpits and thrust up my nostrils. Bleah.
I’m asking Santa for a new bottom this year. The nerve problem has been driving me crazy, delivering constant aching and pain. Although my hips can hurt and catch, this problem is far worse as there’s no let-up. In an attempt to get some relief, I had a deep massage yesterday in my bum, legs and back. It’s was quite painful at the time but gradually became more comfortable. I felt great afterwards, but unfortunately it only lasted a short while. Back at my desk it soon flared up again.
I’m walking more than before, trying to keep everything moving. I also bought a rubber ring (not for water frolicking, sadly), which I’m going to sit on to take pressure off my glute and piriformis muscles. Maybe that'll help. I'll be forced to rest in a couple of weeks anyway - I'm hoping that'll help too.
I’m counting down the days now… It’s 15 days to go until the operation. 17 until Santa brings me my new bum.
3 December 2009
Although the tear, if one is found, will be sorted out with this method, arthroscopy makes it harder to address the underlying cause – hence why the open procedure is preferred. If indeed the underlying problem cannot be rectified, open surgery may be required at a later date. I’m hoping that won’t be required, but if it did, at least I’d know it was to address a problem seen through the arthroscope.
I’m reaaaally happy with this decision. I’ll be out of hospital in a day or so and fully recovered in 3 months. It’s still quite a procedure and will involve partial hip dislocation, but it’s significantly less invasive than the open procedure.
Hip Arthroscopy Information
Oh, and this morning I got a call to say the procedure will now take place a week later on the 23rd December. My surgeon is already performing an arthroscopy on the 16th and he doesn’t do two arthroscopic surgeries one the same day.
30 November 2009
- My usual hip problem returned at the weekend after a rain-avoiding dash in Sainsbury’s car park. Considering I’ve had the hip block, should I have felt this as I did? Could the cortisone effects have worn off so soon or does this indicate a different problem?
- As I can almost touch the point that catches/causes pain on the posterior side of the greater trochanter, is open surgery the right thing to do?
- My anterior impingement and anterior atrophied labrum are all well and good (they’re not of course), but given that all pain and discomfort is posterior, is open surgery the right thing for me? Is this going a fix a problem that isn’t the real problem?
- Is it possible to inspect the acetabulum rim/labrum area without removal of the greater trochanter (in order to eliminate other possibilities before the osteotomy and dislocation)?
- I read in your literature that movements do not usually return to ‘normal’ after open hip surgery. What does this mean for me and what might it stop me doing?
- I’ve had moderate to downright painful aching deep in both glutes for over three weeks now. My legs feel like they’re not supporting me and, when it’s at its worst, it’s too painful to sit down. Why might I be getting this? Is it Piriformis Syndrome or maybe a sciatic nerve problem? Is it related to my hips? How do I/we fix it?
- I’m concerned that my left hip will give me problems when I’m on crutches post operatively. Would it be a good idea to have a hip block on that side to help?
24 November 2009
In a funny kind of way, I really wanted the MRA to show a dirty great labral tear. That would’ve at least identified a true source of pain. Instead, we have a mild cam anterior impingement with no anterior pain. None whatsoever! The sharp pain when stepping in a certain way or walking up a stair is solely posterior. Maybe my minor impingement is not an/the issue?
The hip block injection seems to have eased the problem, I fairly sure of that. However, I can’t be completely sure. I’ve had spells in the past where days and weeks have passed without any catching or snagging, allowing me to lead a completely normal life without any pain. I didn’t have a hip block then, so maybe that’s what I’m experiencing now? It’s unlikely, given the gradual worsening of my hip problem, but it’s a possibility. I’m still trying to flare it up, but the other problem of pain in my glutes has taken a more prominent position of late, forcing me to lead a very sedentary lifestyle.
As the operation is just over 3 weeks away, maybe this is just a bout of pre-op nerves, or maybe I have genuine cause for concern. What is certain is that my consultant is going to get a lot of questions at my appointment next week.
20 November 2009
I have requested another consultation before the op, just to run over a few questions and to voice my concerns. That's booked for early December.
So, it's happening! My stomach has twisted itself into knots a couple of times this afternoon at the prospect of what lies ahead, but I'm sure it'll be fine. Pre-op nerves!
I’m now trying to arrange things with my consultant to discuss the results and next steps, but am not having much luck. The operation is scheduled for less than four weeks time and I’m yet to know for sure if I’m having it! I hope I get a follow-up appointment soon.
This time a week ago I started to get pain and discomfort from deep in my buttocks. Not from the hips so unrelated to hip block, but deep in both glutes. So sore was my behind that it was too painful to sit down or lay on my back, so the only relief was to lie face down on the floor! Just what I needed.
I did a little research and read about something called Piriformis Syndrome, which seems to hit the nail on the head. I’ve been stretching out my piriformis muscles and it’s getting better, although I’m still unable to sit for long periods of time without a deep pain and burning feeling… a nightmare considering I spend most of my time sat at my desk. Ho hum.
A final note of thanks those who’ve posted comments on this blog to share stories, thoughts and experiences. Keep ‘em coming.
10 November 2009
Firstly I was given a local anaesthetic to numb the area, which was little more than a scratch. Then, as with the arthrogram injection, contrast dye was injected so that the final cortisone injection could be guided with fluoroscopy. It was all painless, with just a tight or full feeling after the contrast and cortisone injections.
On Saturday and Sunday I took it easy. The hip was a little tender after the injection so I chose not to test whether the block had worked. On Monday, I decided to walk to my office, which is about ¾ mile up hill. I intentionally walked briskly taking large strides - things that would often (but not always) flare things up. I didn’t have any discomfort or snagging and managed to walk home too. I’ve also been taking large steps and twisting my torso as I walk. Apart from looking rather foolish, these are usually easy ways to cause irritation but I’ve not had any of the usual symptoms. It all feels a bit odd!
I’ll keep doing things that could cause my hip to flare up. If indeed the hip block has given relief to the problem as it initially seems, I’ll be going into hospital in a little over 5 weeks time for surgery. I have butterflies in my stomach just thinking about it.
21 October 2009
About 2 weeks ago I started to get the same symptoms in my left hip, which I couldn’t believe. I felt pretty unlucky to have a problem in one of my hips at 30 years old, so a bilateral complaint was all I needed! The problem in my left hip is identical to the one in my right, with exactly the same triggers and symptoms. Given my limited activity over the last few months, is it likely that I’ve torn the labrum on that side too? I’m not so sure.
I’m now worried that I don’t have a tear on either side and that this is some other issue, but we won’t know until the hip block in a couple of weeks. On the plus side, if one side is successfully diagnosed, at least the other will be too. And at least dodgy hips didn’t stop me rolling down a hill in a giant bouncy ball last weekend! Weeeeeee!
I had the opportunity to have a coffee with a lady called Janet recently. She’s had open hip surgery for FAI, and told me about the op and how she felt in the weeks and months afterwards. Her hip problems make mine feel quite insignificant in comparison, and it was inspiring to hear her speak so positively about the open procedure, the consultant and hospital.
Janet also had a look over my scans (as a medical professional) and could decipher them far better than I could. What was interesting and confusing was that my impingement and atrophic labrum are anterior, yet the pain and discomfort is only posterior. Shouldn’t people with anterior FAI and tears have groin pain? I certainly don’t and have never felt a thing on that side. It has always been, in more ways than one, a pain in the backside.
That’s all for this post. More after the hip block in 2 weeks time. A final word to Janet to wish her well for her next operation later this month :-)
19 September 2009
"This is therefore a very difficult decision making process. To try and help in this process I have offered to perform a diagnostic hip block with an intra articular local anaesthetic to see whether this would temporarily relieve Paul’s symptoms. If it does, this would tend to confirm that his symptoms are from the joint itself rather than from any of the tissues surrounding the joint or a referred pain from the back, for example. I think that if the local anaesthetic injection does resolve his symptoms for 6 hours post operatively, it would be worth considering open surgery to reshape the femur and explore the hip in more detail, and repair any other damage which might have been caused.
"I will book Paul for inter articular hip injection on the right side and I will review him thereafter to see what sort of benefit he has had temporarily from that injection."