When Melissa Fisher, 34, gave birth to her second child, the pain she felt during delivery was unlike anything she had ever experienced.

“I felt a lot of hip pain during delivery,” she said. “It made the process challenging.”

In the weeks to come, Melissa’s left hip felt weak. When she recovered from childbirth and tried to exercise, it became sore. She loved to run but couldn’t do it without pain, and even simple movements, like sitting or putting away groceries, became difficult. As a former UW-Oshkosh gymnast, Melissa didn’t want her active lifestyle to be cut short.

A Conservative Approach

At her yearly physical at the Froedtert & the Medical College of Wisconsin health network, Melissa described the pain to Sarah Gaglianello, MD, a family medicine physician. Exploring conservative treatments first, Dr. Gaglianello referred her for physical therapy at the Froedtert & MCW Sports Medicine Center.

Physical therapy helped but the pain persisted. Still searching for answers, Melissa made an appointment to receive a lidocaine injection in the hip joint to determine if it was, in fact, the source of her pain. Lidocaine is an anesthetic and when Melissa felt relief after the injection, an MRI was ordered to pinpoint the cause of the pain. The findings prompted a referral to refer Melissa to Demetrious Douros, MD, orthopaedic surgeon and MCW faculty member.

A Definitive Diagnosis

Melissa’s MRI revealed a hip condition known as a femoroacetabular impingement, as well as a labral tear. The hip is a ball and socket joint. Hip impingements occur when there is friction between the femur (the thighbone) and the acetabulum (part of the pelvis). The friction can tear the labrum, which is the ring of cartilage around the outside rim of the hip socket.

“This isn’t an acute injury,” Dr. Douros said. “The hip joint becomes structurally abnormal during development. Activities at a young age, particularly during the teenage years, that involve forceful flexion of the hip can lead to extra bone forming. In Melissa’s case, she had developed a cam lesion, which is a bony growth at the head of the femur. The cam lesion was causing the friction and eventually led to the labral tear.”

Melissa’s years as a competitive gymnast may have led to this condition, but the intense range of motion during labor may have contributed too.

“Hip impingements occur in men and women and in young, otherwise healthy, people without arthritis,” said Lauren Guhl, a physician assistant who works with Dr. Douros. “Within a year postpartum, we see a lot of women presenting with this vague, growing hip pain. It can be difficult to pinpoint and the findings on imaging are subtle. When conservative treatments fail, surgery is a good option. If left untreated, it can lead to arthritis.”

“I had been in pain for months, so I was happy to have a diagnosis,” Melissa said. “It was validating to know that the pain was real and I didn’t have to live with it.”

Minimally Invasive Hip Arthroscopy

Melissa’s surgery was in July 2019 at Froedtert Hospital. The arthroscopic procedure requires three small incisions around the hip to access the joint and uses a thin flexible tube to thread in a tiny camera. Dr. Douros removed the abnormal bone at the head of the femur and reshaped it, and then he and Guhl repaired the labrum.

“A hip arthroscopy is one of the most technically intensive arthroscopic procedures,” Dr. Douros said. “With this minimally invasive approach, people experience fewer complications and have a shorter recovery time.”

Melissa went home from the hospital the same day and then spent six weeks recovering in a brace, all the while doing physical therapy with Griffin Ewald, MPT, a physical therapist at the Sports Medicine Center.

“Griffin gave me exercises that helped with daily activities,” Melissa said. “Then, he helped me work my way up to getting active again.”

Melissa said her family provided essential support during her recovery, especially as a mother of three young children. But the challenges were well worth it to get back to her active lifestyle.

“I’m back to running, and I like to go hiking with my husband and kids,” she said. “It feels great to get moving.”