So What Happened to My Hips?
Surgery #1: March 4, 2010
-Diagnosis: Right hip labral tear, FAI (femoral acetabular impingement), Psoas Impingement
– Procedure: Right Hip Arthroscopy
-I was sick from the meds, which this was my first time on narcotics and it did not go well. The first month or so while I was on these I was sick and struggling, but it was my first surgery and things seemed to be going pretty good!
-On crutches for about 8 weeks, hip felt pretty good, much better than before surgery. Started to go downhill just a bit before my left surgery, but I figured that it was just because my left one was struggling and so the right had to start to pick up more than it could handle. It was my hope that once we got them both on the same page they would start to get better and I could resume most of what I loved to do in life.
Surgery #2: July 9,2010
-Diagnosis: Left hip degenerative labral tear, FAI, Psoas Impingement
– Procedure: Left Hip Arthroscopy
– For this surgery there were only 2 key holes, which was exciting since my first had had 3.
-I again spent the first few months struggling to regain control of my leg, and pretty sick
from the drugs which I never have faired well on. It is miserable to be sick and in pain.
– Following this surgery I had a lot more trouble trying to weight bear. I never was able to get off crutches and walk on it. This was quite concerning, and after a lot of debate and many surgical opinions and tests, as well as a lot of caution it led to surgery #3.
– I still had not gotten off crutches nor was I able to progress weight bearing at the time of the third surgery.
Surgery #3: March 10, 2011
– Diagnosis: Persistent left hip pain with internal derangement of the left hip, question of instability
– Surgical Procedures:
– Exam under anesthesia of the left hip
-left hip arthroscopy with synovectomy in the cotyloid fossa area
-Open capsulotomy with capsulorrhaphy
– Basically they tightened my hip joint capsule, to put it in simpler terms. He went through one of my old key holes from surgery one on my left (#2 above) and then he made the larger incision went through the other one.
– The larger incision is close to 4 inches long.
-This was a rougher recovery. I spent several weeks pretty sick and nauseous. The first 6 weeks we did no physical therapy and played it quite cautiously. At six weeks I had an awful feeling as I tried to start bearing just a fraction of my weight on the hip. I started physical therapy, and worked really hard at trying to get this left hip to function.
– Meanwhile both my left AND right hip were driving me insane, in pain nearly 100% of the time (still are). Despite many PT’s working with me and trying many different things, I seemed to be in a heightened level of pain. PT was stopped and caution has been put into place as we continued to figure out what our plan of action would be and what we were going to do next.
-Despite trying to stand on it, or trying to walk I was completely unsuccessful. I kept
pushing it trying everything from standing on it straight to standing on it completely turned out to the side. It was impossible to stand on it straight, but turning it all the way out, basically jamming my joint forward allowed me to stand on it. In combination with my right hip though this was NOT okay for walking and it was PAINFUL!
-We met with a few more surgeons, my surgeon asked around a bit more, I was in for more diagnostic tests from xrays to MRIs to CTs to functional xrays under fluoro, as well as an arthrogram just 6 days prior to surgery.
– At the end of all this we ended up at surgery #4 which is my recent struggle and by far my hardest surgery yet. Up to this surgery my right was getting worse and worse and I had to keep turning it out more to be able to walk on it, but I could still walk on it; the left was still hopeless and was not going to support me.
Procedure #4: September 14th, 2011
– I refer to this as a procedure, because although it was done in the OR and I was knocked out and all that stuff, I dont consider it an actual surgery (even though its listed in the record as one). I was in the recovery room for a period of time, and was not allowed to drive home because I was put out under general anesthesia
– It was simply a left hip arthrogram and exam under anesthesia of my hip. IV fluids were given, but there is no blood loss or anything of that nature.
-The procedure was done as a final evaluation of hip pathology, as well as to do an injection of ropivacaine to test if it would relieve my symptoms. They also wanted to look for impingement secondary to acetabular retroversion.
– Post this procedure we discussed that we would still be going forward with a reverse PAO… and that is just about the entirety of this very uneventful trip to the OR.
– A funny tid bit to add it though… in recovery the nurse said to me I guess you wont need your crutches as they decided not to do any major surgery… I laughed and said oh no I need my crutches its the only way that I can get around and the reason they didnt do anything is because they are doing a major surgery next week! She looked a bit shocked 🙂 And that brings me to the most major hip surgery that I would have… the reverse PAO on Sept 20th.
Surgery #5: LPAO September 20, 2011
Diagnosis: Acetabular retroversion and femoral acetabular impingment with instability status post hip arthroscopy
Procedures: Periacetabular Osteotomy, Reverse (anteverted) PAO with left hip arthrotomy repair.
-This surgery was much more involved and I was placed under general anestesia with epidural placement.
There were also two drains placed in at the end of surgery and a foley catheter. It was thought that this surgery was my best possible chance at some sort of improved mechanics in my joint.
-My psoas muscle was directed off the ilium and iliac wing (this is the largest bone in the pelvis), the abdominal muscles off the ilium and iliac wing, and you are also disrupting the tensor fascia latae and sartorius (which runs the length of your thigh). This gives you a small idea of what muscle damage is incurred as well, which only adds to recovery. The head of the rectus (the rectus femurs muscle is one of your 4 quadricep muscles) was reflected which means to cut one attachment of the muscle and fold it back on itself.
– The prior capsular repair was basically non existent. There were two large rents in the anterior capsule, and the integrity of my anterior capsule had been disrupted.
– Several cuts are made with a specific chisel allowing the ace tabular portion of my joint to be moved to a more ideal position (I could go through the bones with you, but it just is going to get confusing if you don’t have a hip model sitting in front of you!) The fragment can be manipulated until they have achieved the
desired correction. While doing this two pins are placed in through the ilium temporarily.
-The capsule was then repaired and tightened and then my surgeon placed the large screws that you can see in the post surgical X-ray, through my ilium into the fragment. There are 3 screws that you can identify that were drilled through the ilium. He repaired my rectus tendon through drill holes on the ASIS (anterior superior iliac spine). 2 Drains were placed in me. The ASIS fragment was then fixed back into place with another screw. Everything was then closed.
-Recovery was quite rough following this surgery and I would spend a week in the SICU, a week on the floor, and then 2 weeks in a rehab center. Even once going to live with a family friend I had a nurse and a PT that came to visit me in the home several days a week. It would not be until November that I would finally, for many reasons, chose to switch to out patient PT a bit before suggested.
-I wrote up a post on this surgery and have been following progress with my blog. If you would like to check this out links to these entries can be found on my “Links to past entries” page by the navigation tab at the top.
-The recovery for this surgery has been filled with unexpected turned that have made this journey more than interesting. It also make the prospective right hip surgery much more nerve wracking.
Surgery # 6: September 12, 2012
– On September 1st, I became ill and was unsure why. I woke up with the chills, shaking, sick, and feeling as though nothing wanted to move. It was very difficult to move all my joints and muscles. My hips were both extremely swollen and the left was bright tomato red and turning black and blue down the front. I was nervous and felt terrible. My surgeon was contacted and thankfully I was seeing him on the 5th but I could not be in any sooner. Why? Cause I was all the way out in Windsor, Canada two plane flights away from home.
– September 5th I saw my surgeon and he looked at me and said I really dont think that you are going to be going home. Sure enough my CRP came back elevated and the MRI or my left hip came back with fluid in it and everything.
– I was admitted on September 5th and would undergo much more testing to figure out what was happening. We knew that I had an infection but the question was (and still is) what is the cause. After debating whether or not to take out the screws we decided that we would be heading to the OR and getting the screws out
– Screw removal opened up about 4 inches of my original PAO incision. The screws were removed, and some tissue taken to see if we could figure out what the infection was. In recovery it hurt and I remember waking up O2 mask over my face just crying. Even though the surgery is not long taking only an hour and a half or so, I was still cut open and it still comes with all the pain of having an incision.
– I am doing well, it looks great. My surgeon took out some of the scar tissue as well and neatly closed up the part of my incision that he cut into.
– As of today, Sept 30th, it is still sore, has its good days and bad but I am very happy that we took the screws out! The strange thing is that I am VERY aware that they are out and gone.
– I went home 10 days later on the night of September 14th… just a little over 3 weeks before my upcoming reverse PAO on my right hip. This surgery was up in the air depending on how the recovery of my left went. But as of today we are moving forward.
Surgery #7: RPAO November 7th, 2012
– My right hip suffered as my left did. I do think that it is quite as lax on the capsule side of things, and I am struggling to walk on it, and it has the same instability as the left. It is tired and sore and is a major source of pain 24/7. It is making this left hip recovery an even greater challenge than it already is.
-We are still trying to figure out what the heck is going on with my left hip. This is making moving forward with the right hip a huge debate for my surgeon and I. Leave it to my hips to make life more complicated than it needs to be.
– My right is in for pretty much the same surgery, but the hard part is the left is just over a year out and not quite functioning. My left has certainly made gains especially in the past two months, however I am not meeting the criteria that my surgeon was hoping to be met. Before moving forward he wanted me to have full terminal extension of my left knee, and to be able to push off with my right foot.
– Although my left has not met the criteria we are still moving forward with the right. This has been a source of stress and still is a source of stress even with a week (its currently Sept 30th a I write this) left until surgery. With the condition of the right it is not an option to sit back, wait and do nothing. Rather we can continue forward with the reverse PAO or we can do a hip replacement. Unless I change my mind before surgery we are movin
Surgery #8: December 23, 2013
– Right screw removal and resolution of heterotopic ossification (H.O)
– This was likely the smoothest surgery that I had out of everything. It was a real bummer to have it over Christmas and new years, but it was great to finally have the screws out and to not have a big hunk of bone (the H.O. that had formed) in the way of the motion of my hip.
Many people have asked, why not replace the hips, after all this surgery can now be done with a much smaller incision, and many people have heard that this is a fairly easy recovery and people are walking in a relatively timely manner. This however, is not the solution to everything, and definitely not a viable one for a young person when there are other options to consider. It would involve many more revisions in my lifetime, and is just not a good option for someone my age. I wish it were this easy.