Answers

The doctors PA rang me and we were on the phone for half an hour! I truly appreciate all of her time and patience on the phone. I did have quite a list and did get some answers. I tried to write down everything but it was hard so here are the q's and what her answers were (I've made them short and to the point though she was quite specific)...
In general she said the surgery should help with the pain, and also asked if I had ever been tested for a collagen disorder (not that I am aware). She is going to check w/ the dr to see if he thought I should and to recommend a rheumatologist that could do the testing. My main issue she said is the laxity I have.

Will these procedures help to “tighten” the tissues and muscles supporting the joint so that it will not be so lax? Will they help my “hyper mobility” in this joint? to an extent it will help but you cannot cure laxity.

What could have caused the labral tear? lax patients are more prone over time to develop tears. she said b/c of my laxity i can move my joints into positions that don't seem over extended for me, but over time it could wear on them.

Is FAI degenerative? yes

Is the underlying femoral neck misshapen and also causing the impingement or a result of the impingement? my FAI is believed to be mild, but I still have impingement. they can shave down the bones if they need to and get rid of any bony abnormality

For the PSOAS release, what is exactly done? Is it the muscle or tendon that is released? Would ART help rather than surgery for it? they release (cut) the tendon portion and only 10% of muscle, the part that is snapping over the acetabulum. Patients tend to do well and not snap after, but b/c of my laxity it is tricky b/c it is a stabilizer for my joint. the dr will decide in surgery, but if it is done i can expect to be weaker than patients that don't have laxity, and they will work on that in rehab. The ART is not recommended for me, again b/c of the laxity, and it would only be a temporary fix, so surgery in my situation is the way to go.

Is my IT band tight? Do you anticipate having to do a release for me? Would you lengthen the tendon or remove a section? my IT band is probably tight if it snaps, which it does. they will check this in surgery as well and if necessary will release it with a knife cut through the IT band, lengthening it.

Re: the trochanteric bursitis debridement, are you definitely removing the bursa or will it depend on what it looks like when you go in? if inflamed they will remove it, and there is a pretty good chance it will be removed. she said i should be ok w/o it because now it is only causing pain from inflammation as it's located between the bone and IT band.

Can you tell if I have any large chondral lesions? they can't really tell this on the MRI so will observe when in there. This is the articular cartilage (the type you have in your knee that is affected when you have chondromalacia), which is different from the labrum which is more like a meniscus cartilage.

Could the PT have made the FAI worse? yes it could hurt the tear, not the FAI, if the pt has been really working you hard and moving leg in extreme positions. i haven't been doing anything extreme so hopefully it didn't make it worse. basically so long as you listen to the pain and not do what causes you pain - though at this point walking and sitting cause pain!

What is the success rate you have had with these procedures? hard to say in a number value, but she feels most people who had a labral tear were glad they had the surgery, but it also depends on what caused the tear. The five categories are laxity, degenerative (arthritis), trauma, psoas and fai. She feels that I am in the laxity category which is one of the worst to be in, and that I will most likely not have 100% improvement, maybe 80%. At this point I'll take the 80! Also, b/c of my situation I really have no choice but to do surgery b/c w/ laxity the options are limited. I am not the best candidate, but at the same time forced into it b/c of the lack of other options. And this surprises me why?

How long for a full recovery, on average? four to six months, but up to 12 months.

After recovery, are there any restrictions? Can I ever ride again? granted the thought of riding at the moment is extremely unappealing, i would eventually like to be able to do this, and happily, she said that they do have patients that have gone back to riding, so after about 4 mos it should be fine. I'll wait longer but glad that i will be allowed to. on the other had, she said riding probably didn't help the situation, and though i haven't done it very much in the last few years, i did it a lot when i was younger, so i could have affected what is happening now.

What are the chances the surgery will need to be repeated? Dr. Kelly does not like to do surgery again, unless, in some cases, it's a revision b/c the tear did not stay repaired after they repaired it, as opposed to debridement it.

Does this surgery increase the chance of needing a hip replacement in the future? there's no data out there b/c this procedure is relatively new. A hip replacement would only help if there was an arthritic condition.