A year and a shiny new hip!

Well that turned out to not be the final surgery by any means.

Unfortunately the groin pain returned with avengance around January 2011. After a series of steroid injections over 10 weeks with reducing benefit, I was referred to a different surgeon in the group (Mr Norton) for an arthroscopy to remove likely scar tissue.

On looking at my xrays, he felt that the acetabulum might be in the wrong place, but on MRI scanning it looked to be orientated ok and there was scar tissue visible. Therefore he recommended a scope to clear out the joint.

I had this in August, which showed grade II/III arthritis on the femoral head and acetabulum as well as dense adhesions in the joint and particularly between the capsule and femoral neck area which were all removed. Nice easy recovery, only used crutches for a day. But, again, no significant improvement in the pain at all. In fact, it just seemed to get worse and worse. At my 6 week check up, I was offerred a total hip replacement if things were not improved in 3 more months. As my pain got worse, I booked the THR surgery for december (plus work were desperate to know when I was going to have it).

However, I was lucky enough to get a cancellation and I am now 13 days post LTHR! All went very well, although it turns out his initial thoughts were correct as he discovered my hip was still severely retroverted (10-15 degrees) and the femoral head was subluxing out the socket backwards... therefore my previous pelvic osteotomy surgery was a gigantic failure. The arthritis wasn't actually much different from august, so the pain was mechanical from the femur bashing into the acetabulum while it was still in completely the wrong place! My new ceramic on ceramic hip is facing 20 degrees anteverted and in the right position finally.

Anyhoo, this surgery has been great so far, rough start with pain over the first 24-48 hours but now nothing more than discomfort. I am already using only one crutch in the house - I have to use two outside until my checkup at week 7 because of the risk of falling with the rain/snow. I can fully weight bear and I am able to move a lot more than any of the previous major surgeries. I am going to start going to the pool soon and start doing more advanced physio exercises there to continue to build strength.

Looking good that this might just be the actual final surgery for a long time!! Heres to a good hip year for 2012.

Fingers crossed Final Surgery done!

I had my surgery on the left hip on tuesday. It was supposed to be screw removal and a look into the joint capsule with a tidying up on any adhesions in the joint. In the end, he did a lot of work: the screw was sticking out a bit and had developed a bursa over it, which was inflammed and causing inflammation of the psoas as it passed over the top. The psoas needed to be peeled off the joint capsule, where it was stuck. There was bone growth in my rectus femoris tendon, which was excised. My acetabulum was trimmed back too. Then my labrum was completely scarred and calcified so had to be cut out. My femoral head was pivoting on this as it was solid. Although there was no explanation as to why it went from a small anterior tear 9 months ago during the PAO/debridement surgery and now is so badly damanged... The good news is the joint itself looks clean and now that the solid labrum has been removed, it articulates much more smoothly.

I stayed overnight in hospital and had the CPM machine to try and get my joint moving. I also had a painbuster line in, but that was oozing all over the place, so it got removed yesterday before I was discharged. My original PAO scar was reopened about 8cm, so just waiting for that to heal before I can get in the pool. I have to concentrate on keeping the joint moving, so I don't scar up anymore. I have been advised to use crutches for a couple of weeks, but I can fully weight bear and will be heading to physio to help maintain ROM.

All in all, fingers crossed this is the final hurdle and the pain will be significantly reduced/gone from now. Just got to heal and balance resting with keeping moving!

Steroid and more surgery coming up...

I haven't posted for a while as there was nothing to report. I was plodding along, with no real improvement at all, struggling to keep up with a 5 day week and pretty limited in what I could do. However, I did complete my 5 years at medical school and am now an officially qualified doctor - woohoo!

So I am now 8.5 months postop and I had a steroid injection 3 weeks ago before I started work in the hope that it might make it a bit easier to do long shifts. It did indeed work well for 2 of those weeks but is now wearing off. In fact, I realised it was working when I hadn't taken any painkillers all day - because for the first time in months and months, I didn't need too! It didn't give me a 100% pain free time, so we know that the remaining screw is causing some of the pain. I can feel it under my skin in my groin and its quite tender over that area.

I saw my surgeon today who would like to remove the remaining screw, then through the same incision (rather than proper ones) he will do a scope to see if there is scar tissue or labral damage within the joint and debride as necessary. He will also trim some more of the acetabulum off to get a better shape as there is a bit that is still sticking out. It will be an overnight stay, but no crutches luckily.

Not looking forward to be in the bed once again, geting used to being at the side now! fingers crossed its the last surgery for a long time and I will be pain free afterwards. Hopefully it will be early september time, but no date as yet.

Frustration! long recovery continues..

I had my 6 week followup after my screw removal today. I am about 10 days from being 6 months post my PAO/debridement surgery. Although that sounds like a long time, in terms of full recovery its about half way there!

I have had a definite increase in pain over the past 3 weeks, with pain mainly on weight bearing, but also more recently on rest too. If I lie on my left side, I get a build up of pain from my groin going all the way to my ankle over about 5-10 minutes. It gets so sore that I have to turn over and it takes a while to go after that. My walking tolerance is about a supermarket shop (30-45 mins), before I am limping badly and need to stop. I know other PAO ladies who seem to be completely back to normal at this stage, so getting a bit frustrated I am not one of them!

Mr F isn't really sure why I am getting such pain, my xrays look good, all osteotomies are well healed - although I still have some impingement on the left side, as the acetabulum has a weird wave like bit that sticks out over the femoral head. This could well be why I cannot get more than 95 degrees flexion and may never get more than this. In terms of coverage, my left hip is worse than my right now, but to remove any more acetabulum would make me even more dysplastic. He doesn't think this is bad enough to be causing the pain though anyway, nor is the screw still left in the pelvis (it was too awkward to remove). He thinks the pain when lying on my side might well be a joint effusion and that when the femoral head is pushed into the joint, it is causing the fluid to make the capsule bulge and stretch, referring pain all down my leg. The anterior groin pain is probably just massive inflammation from the scar tissue all contracting down. He wondered whether imaging would be useful, but thinks the screw would obscure any decent MRI images and I don't want a CT, as I have already had two on my pelvis.

So the verdict was to rest more and take more painkillers, see how things go for the next 3 months - how frustrating. I am happy there is nothing serious bony wise going on, but wish I had more of an idea what the next few months hold. I have only 4 weeks left at med school, then I start work at the end of july and I have to be functioning enough to cope for long days, as I don't get any sick pay for the first 4 months and I cannot afford to take time off for these hips. If I am still getting a lot of pain in 3 months, he thinks perhaps a hip arthroscopy to get rid of scar tissue in the joint would help. I am really not keen on this as I think I have had enough surgery in the past 3 years, but I may have a different view if I am still struggling in 3 months. Fingers crossed, it slowly improves by itself...

5 months post PAO and open debridement, 1 month post screw removal

I am now 5 months postop from my combined PAO and open debridement surgery, and 1 month out from my screw removal/steroid injection.

My hole has closed up nicely, but now there is a bit of suture sticking out of the other end of the incision! Leaving it to just be reabsorbed by itself, but keeping an eye out for infection.

I am still limping and getting a lot of pain in my groin area on weight bearing mainly. Sitting is much more comfortable since the screws have come out, as long as I don't lean over my hip, which then hurts. Sitting in the car, which was one of the problems before the screw removal is now ok, although long journies are still uncomfortable, it is actually my right hip that complains more. My gait is more even, although I still limp, I can't feel the screws rubbing on my abductors as I swing through to walk.

I am still on full dose paracetamol and ibuprofen each day. I have tried to cut them down, but woke up overnight in lots of pain each time. My walking tolerance is about 30-45 minutes at a slow pace before I really need to stop as I am limping very badly.

On the plus side, my ROM is definitely improving. Abduction has come on leaps since the screws are out and I am not getting the sharp rubbing pain over my trochanter area anymore woohoo! I can now move my leg about a foot off my other knee when doing a clam, compared to just an inch a month ago. Unfortunately my flexion is still an issue, and in fact, I realised that I had been cheating. When trying to hug my knee to my chest, I had been flattening my pelvis into the bed, thus reducing the anterior tilt I have and letting me get more flexion. However, when the physio does it on the hard couch and I don't cheat, we can't get more than 95 degrees between us. I am not really sure why it is, but there seems to be something preventing it.

I have started hydro again for another 6 weeks, with the same exercises but adding in water floats attached to my ankles to give more resistance and start strengthening rather than just building the muscles up. Plus my physio has given me lots of new exercises to improve core stability (bridging, standing on one leg with eyes closed and squats) as well as stretching out the quads and hamstrings.

Next followup in 2 weeks, hopefully see some more progress by then.

oozy wound and antibiotics - not for the squeamish!

For some reason, the more minor the op I have, the more problems it has with healing! The strange black 1cm section of my lateral wound (where the trochanteric screws were removed from) popped open on friday ngiht. I had noticed during the day that it seemed to be bulging a bit, but put that down to me standing in theatre all morning and it was getting pretty sore. Serous, yellow blood stained fluid started to dribble out, so I dressed it and left it, hoping it would stop. Unfortunately it filled up the dressing overnight and was still flowing the next morning. I gave it a bit of a squeeze, thinking that if I could get most of the pocket of fluid out, then there is less risk of an infection developping. I actually managed to squirt it all over Rich instead! haha, he wasn't too impressed.

I rang the lovely nurses at the Duchy for advice, as if I was nearby I would just pop in and get them to check it. They said I needed to go get it looked at, so cue a phone call to devon docs. I actually worked with the GP who was on call (how embarrassing) and he just gave me a script for flucloxacillin and penicillin V to cover any infection, and left some steri strips for me to collect and close the hole with. He didn't want to see it, but has advised me to go back if it gets red or more wound opens up and I will be sent to the orthopods for review (as its so close to bone and potentially disasterous should any infection get in there).

I thought it was slowing down yesterday evening, after another dressing change, but overnight I have oozed out over all the bedding... yuck. So who knows how much more is in there!! Keeping a close eye for any pus or infection symptoms and just hoping it will stop soon. It also means that I can't now do hydro on monday, so will ahve to postpone that for a week or two.

On the plus side, its a beautiful weekend so we are going to have a bbq on the beach for lunch xx

18 weeks post op - screws out

I am 18 weeks postop (PAO and debridement surgery) and 1 week post op from the screw removal, EUA and steroid injection. I stopped using the crutch three weeks ago now and was finding it ok, though looking for somewhere to sit most of the day. I am also back at work fulltime now and surviving, though falling asleep on the sofa most evenings around 9pm! I am only on paracetamol and ibuprofen now, with a bit of tramadol to get me through the first two days after the screw removal.

Both my trochanteric and my pelvic screws were removed last tuesday (except possibly one screw that goes upwards into the pelvis, which was quite difficult to access). There are two incisions about 2-3 inches each over the original scars. It was done as a daycase and then we drove back to hampshire for 4 hours, not very advisable! My lateral wound was very oozy and the dressing was changed once and then repadded before I left the hospital. Unfortunately it continued to bleed and then oozed out over my trousers and the sofa, but soon settled with another dressing change.

I have been surprisingly sore for the last week and had today and yesterday off to rest (luckily last week was our easter hol anyway). My thigh is quite swollen, particularly just above my knee, which is pretty uncomfortable. After my screws were removed on the right, I over did walking and moving within the first few days and caused a secondary haemorrhage and opened my internal sutures, which led to lots of pain on weight bearing, so I am trying to be extra careful this time. The pain is fine on sitting, but definitely bad on weight bearing at the moment. As the steroid is in, I want to try and get stretching the leg out, but equally have to be careful. I have to return to work tomorrow for the rest of the week, so I will just try to take it easy and see how I go.

I am going to be starting another 6 weeks of hydro next week and the physio has given me some more stretches and exercises to increase my ROM and muscle strength. Particularly concentrating on abduction and flexion, as these are the two areas that are weakest and most sore. Hoping once the pain settles from the screw removal, I will be moving forwards with the recovery much quicker.