MRI results and discussion with my OS

I got my MRI results on Thursday and was not too happy. (I will post the report later). In short, my labrum is degenerated, one of the anchors holding it in is not really holding, I have evidence of micro instability and have cartilage damage that has progressed since my MRI in may. I was freaking out all day Thursday, I couldn't believe the changes in the MRI in just 4 months and that I was unstable again. I sent my OS an urgent email that I NEEDED to speak with him. I knew he was going to the hip meeting the next day but I was so freaked out I didn't know what to do. 

He called me the next night and went over the MRI with me. The labral allograft clearly wasn't working and my ligamentum teres was once again all stretched out. He had discussed my MRI with second opinion OS but wasn't actually able to look at it with him bc of computer issues. He would do that the next day and go over it with other colleagues he trusts. 

He feels terrible and says I am the victim of a learning process that has gone on in the field of hip arthroscopy, he said had I come to him just a few months later I would probably not have gone through all of this. His reasoning for the last scope failing was that possibly the fluid medium during the scope affected the allograft, scopes are done with fluid in the joint to help with visualization. 

What we both agree on is that I will not have another scope to fix this. The only way to do it now is with an open surgical dislocation so he can have full access to the joint, full view, do a very very thorough assessment, a high quality labral reconstruction and a full capsule repair. 

I have been thinking about open surgery for the last few weeks so I was well prepared for this conversation, held it together and was in complete agreement. 

My OS is supposed to call me back after reviewing the new MRI at the conference and I guess we need to discuss details and timing etc. 

As far as timing goes- it couldn't be worse, I just started my own practice and don't know exactly how I will take so much time off. I guess things have always worked out in the past so they should work out this time too. I just want to close this chapter in my life and move on. 

And the Saga Continues.....

As "luck" would have it, my last injection was of no help to me and things seem to have taken a turn for the worse. Standing is painful which is not good given what I do for a living. The pain has just gotten to a point some days that it is now unbearable. I sent my OS an email to let him know and hoping he would let me know he had spoken to the second opinion OS. He responded that he had been emailing back and forth but hadn't yet spoken to him but will soon and will let me know. A few days later he must have changed his mind because he decided that since my pain had gotten so bad after the last injection, we should move up my next MRI to now, and to do it before the IHSA conference this week where all the top hip scope surgeons will be, so that he could review the scan with colleagues as well as second opinion OS.

So today is MRI #10......my valium is packed and I'm ready to go. I don't know what the best and worse case scenarios are for this but I guess all I want are answers. I asked him what specifically he is looking for, he said "integration of the labral allograft"...not sure what he plans on doing if it isn't "integrated"....

Another second opinion

I had a phone consult last night with another OS. He is "sure" that I have a delamination defect of the cartilage of the acetabulum. (I will put in an article abt it). He sounded pretty certain abt it, he said he sees it a lot in ppl with continued pain after hip scopes. I asked him why my current OS wouldn't see this, he said "you have to know to look for it". He also thinks my new labrum is not functioning and not providing a suction seal. He would like to go in and repair the delamination defect by microfracturing under it and anchoring it down and removing the new labrum and re-creating it again (I think). I clearly am not to happy with this, a 5th surgery? Seriously? I asked him if he thought this could wait, he said if I was within a comfortable pain zone yes but if I was in a lot of pain no bc it meant I was doing more damage. Well, let me tell you something, I don't reach out across the country for second opinions if I am not in a lot of pain.
He also suggested I not have surgery with the same OS again, or, if I chose to, to make sure that he spoke with him. I didn't like that surgery was the only option, I don't think he did either, he kept saying how bad he felt for me. To be honest, I don't need anyone to feel bad for me, I always say there are no "feelings" in orthopedics, just go in and fix it!!
I was clearly not about to hop on a plane and let him operate on me based on a phone conversation, and a diagnosis that he can't prove or see but feels strongly about. So I asked him if he'd be willing to speak to my OS and discuss this with him, bc really, no one knows what the inside of my hip looks like other than him, he's seen it 4 times. He said he'd be happy to so hopefully they will speak in the next few weeks. I did warn my OS to expect a phone call from him, and he said he'd lookout for it and let me know once they spoke. So once I know what is going I will report back!

http://hiparthroscopy.net/pdf/publications_lectures/Arthroscopic_Treatment_for_Chondral_Lesions_of_the_Hip_T_G_Sampson.pdf