Tuesday, October 28, 2008

2 Days Later

As promised, here is an update on my "situation".
I did wake up pain free on Monday morning, as expected. Later in the day, I stupidly performed the same maneuver that had started this mess. I was kneeling down on one knee, with the other foot flat in front of me (right foot). When I went to get up, I practically had no strength in that leg again and began to have pain, all over again.

So clearly there is a major strength deficit in my right hip extensors with an imbalance that can explain why this is happening. Sadly, I will not even attempt to address this now as I am too overwhelmed with everything else going on. Hopefully it will resolve after the birth, or at least I can address it then in a calm fashion. The good news is the joint is still good!!!

Sunday, October 26, 2008

28 Weeks Pregnant

Just this morning I was thinking that I haven't blogged in a while, and how thrilled I have been with my hips throughout my pregnancy. Until today, the only time I have experienced hip pain was in conjunction with my SI joint issues, which do occasionally happen, and are common in pregnancy. The only other time I felt anything in my hips was after a 3 hour car ride. That's it, I really can't complain.

Then my luck changed! I don't know exactly what happened, or what is happening. I was sitting on the floor, building a kick-ass train track for Jk today. When I went to get up, I kneeled on my left knee and used my right foot to push up and something felt weird. From that point on, I began having right hip pain, all over again. It is not exactly groin pain, it is more of adductor/psoas/ joint capsule crap. The one thing that does reassure me though is that when I did my mini "hip test" if flexion and flexion/ adduction, it did not make the pain worse. So a huge sigh of relief. Most likely just some muscular things going on, due to the prganancy and hormones and change in weight and forces and all that fun stuff that comes with being months pregnant.

I will hopefully wake up in no pain tomorrow morning but will keep you updated on this sudden turn of events!

Thursday, October 16, 2008

My Other Blog

Life in the hip world is unusually calm these days, life in my house is not!!! Although I can't imagine that anyone with 2 1/2 kids, a job, a husband and a type A-ish personality ever has relative calm in their life! Today I started a second blog to document J's upcoming surgery (not hip) and my role in it (basically, do everything necessary up to the day of surgery since men can oftentimes be rather incompetent). It is a work in progress but I have a lot to say (shocker, I know) and will probably have many posts there in the coming days!http://myhusbandslapband.blogspot.com/

Repair Vs Debridement

I just came across this website today
Differences seen between repair vs. labral debridement for hip impingement at 1 year
Researchers saw a significant increase in radiographic degenerative changes in the debridement group.
By Gina Brockenbrough1st on the web (October 13, 2008)
October 2008
WASHINGTON — Research indicates that although there is no significant difference in the early clinical outcomes between arthroscopic labral debridement and labral repair for the treatment of femoroacetabular impingement, significant changes were seen between two treatment groups at 1-year-plus follow-up.
In a consecutive series of patients who underwent arthroscopic management for femoroacetabular impingement (FAI), Christopher M. Larson, MD, and colleagues compared the results of those who underwent labral refixation to those who underwent a labral debridement prior to performing any repairs.
The investigators discovered no significant differences between the groups regarding Harris Hip Scores, Visual Analog Scale (VAS) scores for pain, SF-12 scores and alpha angles on both anterior-posterior and lateral views with a minimum follow-up of 1 year. The analysis also revealed no significant differences in these outcomes among patients who had debridement, excisions with rim trimming or repair at that time.
Degenerative changes
However, “With further follow-up at 1 year and [beyond], there is a statistically significant increase in radiographic degenerative changes in the debridement group and statistically improved Harris Hip scoring in the labral group,” Larson recently told Orthopedics Today.
However, he noted that 5- to 10-year follow-up is needed to fully compare the outcomes and said that follow-up radiographs may detect changes earlier than clinical scores.
“It is a consecutive series, and management with this technique is evolving,” Larson said. “And if a difference does show up with time, the question will remain whether this relates to labral preservation or improved technique in managing impingement.”
Larson presented the study during the 27th Annual Meeting of the Arthroscopy Association of North America.
The investigators studied 80 hips; the labral debridement group included 37 consecutive hips that the researchers studied before performing repairs.
“All of these cases were reviewed and were felt to be repairable by current techniques,” Larson said. Patients in this group had a mean age of 31 years and a mean follow-up of 14 months.
The labral refixation group had a mean age of 27 years and a mean follow-up of 8 months. In both groups, most patients had minimal or no degenerative changes.
Patients with pincer impingement underwent a labral debridement, rim trimming and labral refixation with two to six suture anchors. Those with cam impingement had a capsulotomy and a proximal femoral osteochondroplasty.
Surgeons performed 29 femoral osteochondroplasties in the debridement group. Eighteen patients in the group underwent labral debridement without rim trimming and 19 had rim trimming with labral excision. In the refixation group, 36 patients also had a femoral osteochondroplasty and 40 patients underwent rim trimming.
Larson noted that the groups showed good and excellent results postoperatively and that the study investigated labral tears without significant degenerative changes.
“There are finite element models that have suggested that the labrum has a ceiling function,” he said. “In the absence of this sealing, strains within the cartilage matrix increase, which may increase those degenerative changes over time.”
For more information:
Christopher M. Larson, MD, can be reached at Minnesota Sports Medicine, 775 Prairie Center Drive, Suite 250, Eden Prairie, MN 55344; 952-944-2519; e-mail: Christopher_larson@med.unc.edu. He receives research or institutional support from Biomet, Omeros Corp., Arthrex Inc. and Zimmer and miscellaneous funding from Smith & Nephew.
Larson CM, Giveans M. Arthroscopic treatment of femoroacetabular impingement: Early outcomes evaluation of labral refixation/repair vs. debridement. Paper #SS-04. Presented at the 27th Annual Meeting of the Arthroscopy Association of North America. April 24-27, 2008. Washington.

This got me thinking about a few things. My first thought was "hmmm, I wonder what my hips look like now, radiographically, at almost 16 months and 12 months postop"? Being that I had to postpone my postop x-rays due to my current "situation", I will not know for some time.

It also got me thinking about how accurate the study could be. I don't know any type of detail, I only have read what I posted here, so I may be totally off base, but here it goes:
In the debridement group, the labrum was probably more damaged than in the repair group, meaning that they had either been dealing with the FAI and labral tear for a longer period of time, or had a more severe injury. The repair group had to have a labrum that was in essence "repairable", i.e. not as "far gone" as the debridement group. It would make sense that the group that had more damage would show more degeneration in a shorter amount of time.
Does this make sense?
Wouldn't the surgeons try to repair as many labrums as possible if they could, and not debride the "repairable" ones?
Just a thought......

Wednesday, October 8, 2008

Was I a Psychotic, Crazy Bitch for a Year?

Why am I posing this question now? (J, this is purely rhetorical, do not feel compelled to answer). While we were in Miami last week, my SI joint went out of whack for about a day and a half. It was most likely a posteriorly rotated inominate on the right, but I honestly don't remember anymore. When this happened, I had immediate right sided PSIS pain and right sided groin pain.

When the groin pain started, I immediately reverted into a bad mood, very irritable, and just downright annoyed. See, after 2 hipscopes, I don't care what the reason, there should be NO GROIN PAIN. Yes, I knew it had nothing to do with the labrum or FAI but it was the same pain all over again, and I was not a happy camper.

Being that this is my 3rd pregnancy, I have had plenty of experience with SI pain in the past, and it has never led to groin pain before, so in a way, yes, it is related to the labrum and FAI. IMHO, there is probably still healing going on, and the temporary change in geometry put pressure on areas that are not supposed to handle pressure, and instantly gave me pain and put me in a REALLY bad mood.

The good news is that it resolved quite easily and quickly. Once I had a moment, I used a self muscle energy technique to re-adjust the pelvic bones and voila, everything was back to status quo and I was once again happy!

This leads to my to digress for one quick moment. Many pregnant women suffer with SI pain for months and do not seek treatment. Sometimes the OB says it just "normal", sometimes they don't know something can be done. back pain in pregnancy is one of the least tapped resources in physical therapy, and one of the easiest and quickest things to fix in most cases.

A comment was posted this week on an old post asking if anyone has had a successful scope, being that most people don't read the old posts, I will say yes, I have had 2!!! If anyone would like to share a success story, please do so!