Tuesday, December 27, 2011

26 days post-op

I feel the need to apologize to my readers who have come to expect detailed accounts of my recoveries and experiences. I guess with 3 kids aged 7,6 and almost 3, I just don't have the time. Keep in mind that at my first surgery I had 2 kids aged 1 and 2, yes, they are busy ages as well but there was no homework, after school classes, projects etc. 
At 26 days things are going a lot slower than I had hoped. I am still on 2 crutches, desperately  trying to get down to 1. I am using my brace when outside the house and trying to wean off of meds. I am still on Lyrica 2x/day for nerve pain. It is a lot better and I am trying to go to 1. I had to stop Mobic because I went into a horrible Crohns flare up. I occasionally take 1/2 Percocet at night to hep me sleep. I have a lot of pain in 2 out of 3 of my incisions, I'm not really sure why. They look good, have closed up but have a hard, marble like piece of scar tissue under the surface. I have been to PT a few times but am in miami now for 10 days so won't be going until I get home. 
PT until now has included quad sets, glut sets, bridges, prone quad/abs/glute sets, hand heel rocks, bike, gentle shoulder theraband exercises with 25/75 weight bearing. At my last session we added stool rotations but at my own discretion I have stopped them. ROM is not my goal at this point and I don't want to push it. I am concerned that I already have regained too much ER so I don't need  more. 
I am extremely annoyed bc I still have posterior hip pain and pain with sitting and quite frankly it is a pain in the ass. I haven't addressed it w my OS as I just want to give it more time and there isn't anything he can do abt it. If I stay in bed I feel pretty good but when I do any amount of activity I get pain, mostly in the area of the incisions and occasionally it will move medially to the groin. I am using Lidoderm patches in that area, idk if they help or not though. 
I am flying home alone with the 3 kids so I need to be much better in 8 days! Keeping my fingers crossed!

Wednesday, December 14, 2011

Op Report #5

Op report

Preliminary diagnosis:
1. Right hip instability with labral deficiency 
2. Capsular tear
3. Ligamentum teres tear
4. Loose body

Post operative diagnosis:
1. Right hip instability with labral deficiency 
2. Capsular tear
3. Ligamentum teres tear
4. Loose body

Name of operation:
1. Right hip arthroscopy
2. Labral repair:augmentation using semitendinosus
3. Synovectomy
4. Removal of loose bodies
5. Debridement of ligamentum teres tear
6. Capsular shift procedure 

The patient suffered from persistent right hip pain and instability secondary to ligamentum teres rupture, iliofemotal ligament and capsular tear, loose fragmentation and labral deficiency. She failed non operative measures. She had clinical, radiographic, and diagnostic studies consistent with this pathology. Given her persistent pain and lack of improvement with non operative measures, she was indicated for a right hip arthroscopy and associated procedures. 

After the patient was correctly identifies in the holding area, she was brought to the operating room. Spinal epidural anesthesia was administered  She was placed in a supine position on the traction table and approximately 10mm of distraction were achieved across the femeroacetabular joint. The right hip was then prepped and draped in a standard surgical fashion. The lateral portal was established under fluoroscopic guidance using the seldinger technique. Then, a mid anterior and a distal anterolateral accessory portal were established. The distal anterolateral  accessory portal was established as a separate incision for removal of loose fragments and also for the placement of the labral augmentation. 

Initial evaluation of the central compartment demonstrated the cartilage surfaces to be in good condition. There was scarring and deficiency of the labrum between 12:00and 3:00. There was capsular attenuation anteriorly. There was a ligamentum teres tear with chondral and osseous loose fragmentation and subtle ligamentum teres tear. At this point the ligamentum teres Debridement was performed with removal of loose fragments, the largest measured approximately 5mm and this required an anterolateral accessory portal for removal. The scar tissue and adhesions were then removed from the area of labral deficiency and the edges of the acetabular rim were clearly demarcated. A good bed of bleeding bone was prepared between 12:00 and 3:00. 

A semitendinosus allograft tendon was prepared on the back table and was inserted into the defect using multiple 1.4mm PEEK anchors. A total of 7 anchors were used to secure the graft in position and then side to side suturing of the labrum was performed to the native labrum anterior-inferiorly and posterior -superiorly.  The labrum was then contoured to a normal anterior-inferior and normal posterior-superior labrum. 

At the completion of the labral augmentation and the labral repair, removal of loose bodies, synovectomy and removal of scar tissue, all debris was evacuated from the central compartment. 

The scope was then placed in the peripheral compartment, after the release of the traction, using the mid anterior portal.  A capsular shift procedure was performed removing the distal aspect of the iliofemoral ligament to the proximal fragment using four #2 Orthocord sutures. Once this was completed and no further pathology was identified, the instruments were removed from the hip joint and it was drained of fluid and the arthroscopy portals were closed with 3-0 nylon sutures. A Marcaine cocktail was placed in the joint. The wounds were cleaned, dried and sterile dressings were applied. 

The patient was awakened from anesthesia and was brought to the PACU having tolerated the procedure without complications. 

Post op Appointment x 5

I saw my OS yesterday, he is extremely happy with the way I am looking. I actually think he was pleasantly surprised to see me looking so much better than last week. He showed me the pics from my surgery (op report to follow). He is also really happy that my joint and cartilage look so good, despite having been in there 4 times already. He created me a new labrum with a semitendinosis allograft. At this point the most important thing is to protect the graft. I have to avoid extreme flexion and external rotation. At this time he wants me on crutches another 2 weeks and wearing my brace another 2 weeks.
He is also on board with me taking care of my shoulder in a few weeks. He thinks it makes sense to just get it all taken care of at once. So I will have the shoulder surgery on January 9th.
Things are coming along slowly. But I think that slow And steady is the way to go with this surgery.

Thursday, December 8, 2011

Having a Meltdown

Today has really been a challenging day for me. I woke up with all my nerve pain all over again. I know it's only been a week since surgery, and I don't know what I really expected, and I know in the past I have always gone through a rough patch. On top of this I can't get my mind off of the upcoming shoulder surgery. I had a long talk abt it with another hip friend last night, what she said was extremely helpful. She said no one else is going to understand. No one else gets it. You have to ignore the stupid comments and get over it. It's good advice for any of us in these situations. And of course, the worst possible comment is "you must like having surgery"
I texted my PT early today bc I am freaking out about the nerve pain coming back. His suggestion was avoid ankle pumps, avoid prone knee bend and go back on Lyrica. I am really not a fan of Lyrica and was thrilled when my OS told me I could come off of it. I guess I have to suck it up and stick with it bc my pain was great while I was on it

Wednesday, December 7, 2011

PT day 1

So today was my first day of PT. Let me backtrack a little and tell you how my week has gone. Since I got home from the hospital, I have been incredibly dizzy and lightheaded all the time. I spent the majority of my day in bed with ice and my CPM. I was having a lot of nerve pain and having a lot of trouble getting into a comfortable position. On Sunday my OS and I emailed a little abt what to do. He wanted me on some sort of blood thinner to prevent blood clots since I was so immobile. He also wanted me on Lyrica for the nerve pain.
My husband didn't like the way I looked on Sunday so he called my brother in law who is a doctor to come over. He said the Percocet was dropping my heart rate too much which is why I was so dizzy.
I got off of the Percocet by Tuesday but it seems Lyrica also makes me dizzy.
PT went ok. My ROM is good and my strength too. My OS came by to see how I was doing since it has not really been smooth sailing for me. I told him the nerve pain is a lot better and I asked if I could stop Lyrica. He said yes so I asked for Lidoderm patches for the small areas of nerve pain.
My PT put me on a short crank bike but I developed groin pain after a few minutes. I did quad sets and glute sets and then iced.
I also had the opportunity to visit another hip friend in the hospital who had an FO yesterday.
I am now having groin and butt pain. I guess I overdid it today. I ended up taking half of a Percocet and hopefully I will wake up pain free tomorrow.

Monday, December 5, 2011

What My Day Consists Of

Apparently nerve pain is worse than surgical pain, and I have a lot of it. My OS prescribed Lyrica and Mobic in hopes that it will go away. In the meantime, I gave a lot of trouble getting into a comfortable position. CPM is now my best friend!

Sunday, December 4, 2011

Surgery#5........ Done!

My surgery went well. My OS found exactly what he expected, a torn ligamentum teres, small labrum and very stretched out capsule. He debrided the ligament, augmented my labrum with an allograft and re-tightened the capsule.
The surgery was long and with prolonged traction time. The total time in the OR was about 4 hours and total traction time was 2 hours. My OS never keeps ppl in traction longer thx 1 hour. He needed the extra time to place the allograft down perfectly. He didn't think it would cause major issues given the instability that I have, there wasn't very much resistance when i was in traction.
I had a lot of trouble in the PACU between pain control and being dizzy so I spent the night in the hospital.
The traction is causing my leg to feel tingly and heavy and hard to move/walk. This is my 5th scope and I have never really used the hip brace but I am finding it to be extremely helpful in supporting my leg. I am also getting my money's worth w the cpm, I stay in it all day, even if it's off. I find the position comfortable. My OS doesn't want me in that position all day bc he's nervous I'll develop a contracture. If the leg issues r not better by Monday he will put me on Lyrica.
I think I covered the basics.
From what I recall, the report from my OS was that the looked great despite everything that it has been through. He also wants me to be extremely careful and mentioned something crazy about being on crutches for 4 weeks. I see my PT on Wed for my first visit so we'll see what he thinks.

Thursday, December 1, 2011

Surgery is still going on

for all you interested folks, susie is still in surgery. she's going on almost 3 hours now. here's a little pic of her walking into the or.

speak to you all later

- the most supportive husband susie has ;)