Just When Things Were Getting Ugly.....

If you don't have a lot of time to read this post, I will post the gist of my visit with Dr K yesterday in one line:

"I think I need to go in and look around to see what is going on"

If you have the time, here are the details:

I had the PRP injection into the joint capsule about 3 1/2 weeks ago. It has not helped a bit. I am still having pain with walking, walking uphill etc (same as always)
As is the topic of many posts on my blog as well as responses to comments and personal emails, hip arthoscopy is very specialized and has a steep learning curve. What he is finding is that as his technique has changed slightly, patients are doing a lot better. He is not having any trouble from the "newer" patients, but the "older" patients are having issues. He did say that he knows a lot more now than he did when he did my surgeries (great!) One of the differences now is that he is stitching the capsule closed after he cuts it, instead of just approximating the edges. This was one of the things I learned when I observed him operating on one of my patients last year. I just re-read that post, he had mentioned that it puts less stress on the anterior structures and reduces tendonitis.

He has said from the beginning that he thought it was the capsule, I didn't agree. He thinks so bc I was in external rotation and that puts pressure on the anterior capsule. My MRI shows something wrong with the capsule, so did my ultrasound (during the PRP injection), my clinical signs do not. I have pain with flexion, pain with adduction, pain with internal rotation. No pain with external rotation, very little and seldomly pain in the posterior part of the joint. If I had pain in the posterior part he would think it could be ligamentum teres pain. I explained that I often sit or stand in external rotation, it is the most comfortable. He flipped through the MRI a few times and really didn't see anything of concern. He said he doesn't think it is my psoas, I agreed.
He sat down, sighed and said "so what do you want to do?", so I said "can you just cut it off? I really can't deal with this anymore". He laughed and said "should I amputate above the pelvis? you may look funny like that" so this went on a little.

Then he said it:
"I think I need to go in and have a look"
My heart stopped for a second and I got a little tear eyed I think. I said "You want to do an exploratory scope?" He said he doesn't think we have any other choice/ solution. He thinks that when I got up that day way back in June and had pain, I must have torn through some scar tissue, it then kind of flipped over and got stuck in the joint and now healed down like that.I was quiet for a long time (which is unlike me). I looked REALLY upset, and I think he was nervous that I would break down and lose it, so he said "do you want to try one more injection". Fine, what do I have to lose at this point. So we went over what I had injected in the past and what worked, what didn't. Do I want to inject the psoas? HELL NO, that was the worst one ever! So we agreed that injecting the joint would be a good idea since I had 2 days of relief last time, and since I have a "hole" in the capsule, it will leak out into the psoas anyway, so we are killing 2 birds with one stone. Fine.

So he left the room to dictate his note, I changed and went out to get the Rx from him. I walked around the corner to his receptionist and he followed me a minute later and said that he remembers we had discussed Synvisc a while ago. Anyway, he said at the time get the cortisone first and then we'll see. We ended up with the PRP then. So now he said try the Synvisc, it can be done with the cortisone.

As I drove home through crazy Manhattan, Friday afternoon traffic, I felt defeated. I was really sad, and angry, and anxious and a million other feelings all at once. I hope I can make the right decision on this and return to my prior level of function.