Radiologic and Intraoperative Findings in Revision Hip Arthroscopy
Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego, California, February 2007.
Benton E. Heyworth, M.D., Michael K. Shindle, M.D., James E. Voos, M.D., Jonas R. Rudzki, M.D., Bryan T. Kelly, M.D.
Arthroscopy. 2007 Dec;23(12):1295-302.
Purpose: The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy. Methods: We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction “cam” lesions or anterosuperior acetabular “pincer” lesions). Results: The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery. Conclusions: Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery. Level of Evidence: Level IV, prognostic case series.
Revision Hip ArthroscopyMarc J. Philippon, MD*, Mara L. Schenker, Karen K. Briggs, MPH, MBA, David A. Kuppersmith, R. Brian Maxwell and Allston J. Stubbs, MD
Am J Sports Med. 2007 Nov;35(11):1918-21. Epub 2007 Aug 16
Background: Hip arthroscopy has become increasingly popular; however, little is known about revision hip arthroscopy.
Hypothesis: Revision hip arthroscopy is associated with unaddressed femoroacetabular impingement. The purpose of this study was to describe reasons for revision hip arthroscopy.
Study Design: Case series; Level of evidence, 4.
Methods: Between March 2005 and March 2006, 37 revision hip arthroscopies were performed by the senior author. Data were collected through retrospective review of clinical and operative notes.
Results: All patients required revision surgery because of persistent hip pain. There were 25 women and 12 men with an average age of 33 years (range, 16–53 years). The average time from prior surgery to revision was 20.5 months (range, 2.9–84 months). Common findings among patients needing revision were hip pain, decreased range of motion, and functional disability. The average modified Harris Hip Score was 53 (range, 22–99). Thirty-six patients had radiographic evidence of femoroacetabular impingement at the time of revision. Revision procedures included 34 (95%) for femoroacetabular impingement, 32 (87%) for labral lesions, 26 (70%) for a chondral defect, 23 (62%) for lysis of adhesions, and 13 (35%) for previously unaddressed instability. Two patients had total hip arthroplasty after revision, and 3 patients required further revision. Of the remaining 32 patients, early follow-up was obtained on 27 (84%) at an average of 12.7 months postoperatively (range, 6–19 months). Outcomes showed patients regained some of their lost function within the first year.
Conclusion: Patients commonly required revision hip arthroscopy because of persistent impingement.
Showing posts with label failed hip arthroscopy. Show all posts
Showing posts with label failed hip arthroscopy. Show all posts
Thursday, May 1, 2008
Saturday, March 29, 2008
5 Month and 9 Month Hip Updates
I haven't mentioned my hips in a while as other things have taken precedence lately. But here we go:
I am back to normal, or as normal as I will get with scoped hips. I will not use the treadmill, I think it is too hard on them and I really want to keep "these" hips for as long as possible.
I am getting more aches and pains now than I did before the knee thing (BTKT) began, so I totally attribute it to compensation. Previously, I had almost no achiness. Now I occasionally get achiness, right more than left (right was scoped twice), my adductors still get spasmy occasionally, more now than BTKT. I also now have a alot of clunking and clicking in both, I think left more than right. It is painless but loud. I have gotten into he habit of "cracking" my back, so I use various techniques, adopted from what I would use in the clinic. I always say that whatever needs to crack will crack with a manipulation, so at time, I will be focusing on my low back/ SI joint and will get a nice crack in a hip. I still hold onto the theory that it is scar tissue, and I don't worry one drop about it because it is painless, there is no FAI in either hip anymore so I won't tear my labrum again, plus, a good chunk of labrum was debrided so even less likely to tear (bc it is gone), and it is important to stay positive.
My IT bands get tight and tender sometimes, but I think they always were, even before the hip shit started. My "invisible bruise" on the right is still there, believe it or not. It does not interfere with my life anymore and the box of lidocaine patches sits on my desk, untouched. The area does consistently get smaller but the pain level is about the same, just in a smaller area.
I can push my stroller with no hip pain, I spin with no hip pain, I work with no hip pain, what more can I ask for :-)
A big part of healing, and healing well, is staying positive, focusing your energies and returning to life and moving past this messy chapter, and always remembering, things could always be worse!
I am back to normal, or as normal as I will get with scoped hips. I will not use the treadmill, I think it is too hard on them and I really want to keep "these" hips for as long as possible.
I am getting more aches and pains now than I did before the knee thing (BTKT) began, so I totally attribute it to compensation. Previously, I had almost no achiness. Now I occasionally get achiness, right more than left (right was scoped twice), my adductors still get spasmy occasionally, more now than BTKT. I also now have a alot of clunking and clicking in both, I think left more than right. It is painless but loud. I have gotten into he habit of "cracking" my back, so I use various techniques, adopted from what I would use in the clinic. I always say that whatever needs to crack will crack with a manipulation, so at time, I will be focusing on my low back/ SI joint and will get a nice crack in a hip. I still hold onto the theory that it is scar tissue, and I don't worry one drop about it because it is painless, there is no FAI in either hip anymore so I won't tear my labrum again, plus, a good chunk of labrum was debrided so even less likely to tear (bc it is gone), and it is important to stay positive.
My IT bands get tight and tender sometimes, but I think they always were, even before the hip shit started. My "invisible bruise" on the right is still there, believe it or not. It does not interfere with my life anymore and the box of lidocaine patches sits on my desk, untouched. The area does consistently get smaller but the pain level is about the same, just in a smaller area.
I can push my stroller with no hip pain, I spin with no hip pain, I work with no hip pain, what more can I ask for :-)
A big part of healing, and healing well, is staying positive, focusing your energies and returning to life and moving past this messy chapter, and always remembering, things could always be worse!
Monday, March 3, 2008
Ride On!
The weather was beautiful today so I piled the kids into the double stroller and went to the park. For those of you who do not remember, pushing the double stroller was what eventually landed me in Dr Kelly's OR 3 times.
Just to recap, I drive this:
And I push
Just to recap, I drive this:
And I pushand
This is one of the first times since my revision scope that I remember pushing the double stroller all the way to the park, so it felt like an accomplishment, plus, I like having the experience and knowing that I can do it. My right hip felt weak while pushing. Then again, I am pushing 35lbs of stroller and about 70lbs of kids. I also had discomfort in my trouble spot. The area along the front of my thigh along all of the scope sites, where I have supposed nerve damage. It didn't hurt but I could feel that it was an area that was not done healing.
As for my arm, the tingling has diminished.I have decided to see my acupuncturist this week, I will let you know what happens.The good news is that I don't think it is too serious and the tingling has centralized to my elbow. The bad thing is that my elbow hurts now. I think it may be the way I am doing a manipulation at work so I will have to be careful.
In an unrelated story, have you been following Carlos Delgado's story, from the NY Mets? He was flown from Florida to NY to have an MRI at HSS, the findings were that it is not serious, it is just an impingement in his hip.
WTF???? Not serious? How many of you have been sidelined bc of a simple "hip impingement"?
Tuesday, February 12, 2008
3 Months Post-op Hip Arthroscopy Revision
I was on the phone with hipster Amy tonight. We have a 'date' tomorrow at Dr. Kelly's office, for her 2 week follow-up and my 3 month follow-up. The topic of conversation turned to successful surgeries! Finally, someone who can understand my joy and elation, and smiles when no one else knows why. Joining us on our date will be 'L', who loves bones. I promised her she could see my x-rays, she is ecstatic.
Since my life has returned to pre-hip issue status for the most part, my old knee issues have returned. Way back in college and PT school, I had such bad knee pain, I had to ice after each ride. I am approaching this again. I really can't handle another orthopaedic issue right now, or ever! The good thing is the knee pain doesn't make me crazy, or do crazy things! I need to ice and get a grip on this, before it gets out of control.
J has been away on business, he was in Mexico last week. He decided to come home early tonight, conveniently missing bath and bed time for the kids, but early enough to want to know what I had made for dinner. His bright idea of the night came as he was watching a Tivo'd episode of The Biggest Loser. "Why don't you gain a ton of weight so that we can go on the 'couples' version together". For those of you not familiar with The Biggest Loser, it is a reality TV show featuring heavy contestants who battle to lose the most weight in the season. He is obsessed with it, and wants to go on it, but not alone. So, his idea is for me to join him! Fat chance!
Highlights from tomorrow's visit to follow!
Since my life has returned to pre-hip issue status for the most part, my old knee issues have returned. Way back in college and PT school, I had such bad knee pain, I had to ice after each ride. I am approaching this again. I really can't handle another orthopaedic issue right now, or ever! The good thing is the knee pain doesn't make me crazy, or do crazy things! I need to ice and get a grip on this, before it gets out of control.
J has been away on business, he was in Mexico last week. He decided to come home early tonight, conveniently missing bath and bed time for the kids, but early enough to want to know what I had made for dinner. His bright idea of the night came as he was watching a Tivo'd episode of The Biggest Loser. "Why don't you gain a ton of weight so that we can go on the 'couples' version together". For those of you not familiar with The Biggest Loser, it is a reality TV show featuring heavy contestants who battle to lose the most weight in the season. He is obsessed with it, and wants to go on it, but not alone. So, his idea is for me to join him! Fat chance!
Highlights from tomorrow's visit to follow!
Sunday, February 10, 2008
What My Readers Symptoms of FAI or Labral Tear Were
Ok, so this is not a scholarly peer reviwed journal or anything, but I have found it helpful to know what other people have experienced, and I assume you do too, or you wouldn't be reading this. In the past, I have polled my readers to find out what their symptoms of FAI and or labral tear were, here is what they have shared. Feel free to add your own in the comments section, or email them to me and I can edit this post.
Here were my pre-op symptoms: Groin pain, deep deep groin pain, not always excruciating, but so annoying I felt like cutting off my leg, tight hip flexors, pain with sitting, pain with walking uphill, pain with pushing my stroller. I did not have radiating pain down my legs, all the hip pain was anterior medial.
This is what my readers had to say:
-At original onset of pain, I had acute, sharp pain along with a deeper pain in the anterior (non-PT term - front) hip. Once the acute pain subsided, I was left with a persistent but not 100% constant deep ache (only way I can describe it is comprable to early labor pains, or really bad menstrual cramps, or, in other words, not bad enough to put me in bed, but bad enough to ruin my day - but deep in my hip joint) along with the occasional "catching" of my hip. I would be walking and suddenly it would pinch and hurt too much to walk normally. I would usually stretch or range my hip and that would sometimes work. Otherwise I'd just have to wait it out, and later that day, the ache would be particularly bad. Now (3 + years post op) I'm at the achy stage, with occasional catching and occasional pain that is bad enough to keep me from sleeping, ie: can't find comfortable position, even with pillow between legs, must get up and take 600-800 mg Advil and wait. Those have been my symptoms to date. Hope this helps. I am eager to read about other people's symptoms - knowledge is power. (This reader had a scope a few years ago for a labral tear, her symptoms came back, she ended up being diagnosed with FAI and had an open surgery to address it)
-Clicking, catching (especially when changing direction when walking or getting in and out of car), deep aching. Now post op (scope with labral debridement of fibrillated labral tear) and still have aching (especially with sitting for long periods), nerve pain in thigh and butt, episodes of the hip giving way (though less frequent now). Pain is better with rest and worse with increased activity. Am now six months post op. Wish I had just broke it lol
-My symptoms started with groin pain, which seemed both deep and also superficial, and sometimes radiated up to my lower right pelvic/abdominal area. After awhile, I developed pain over my greater trochanter and in my piriformis muscle. Before my first scope I had SI joint discomfort as well, and also IT band tightness and soreness down my thigh to my knee. At first my pain was intermittent, but over time it became constant; it would get better or worse, but there was always a baseline amount of pain. Driving was horrible. Groin pain was always the worst symptom. Yuck!
Here were my pre-op symptoms: Groin pain, deep deep groin pain, not always excruciating, but so annoying I felt like cutting off my leg, tight hip flexors, pain with sitting, pain with walking uphill, pain with pushing my stroller. I did not have radiating pain down my legs, all the hip pain was anterior medial.
This is what my readers had to say:
-At original onset of pain, I had acute, sharp pain along with a deeper pain in the anterior (non-PT term - front) hip. Once the acute pain subsided, I was left with a persistent but not 100% constant deep ache (only way I can describe it is comprable to early labor pains, or really bad menstrual cramps, or, in other words, not bad enough to put me in bed, but bad enough to ruin my day - but deep in my hip joint) along with the occasional "catching" of my hip. I would be walking and suddenly it would pinch and hurt too much to walk normally. I would usually stretch or range my hip and that would sometimes work. Otherwise I'd just have to wait it out, and later that day, the ache would be particularly bad. Now (3 + years post op) I'm at the achy stage, with occasional catching and occasional pain that is bad enough to keep me from sleeping, ie: can't find comfortable position, even with pillow between legs, must get up and take 600-800 mg Advil and wait. Those have been my symptoms to date. Hope this helps. I am eager to read about other people's symptoms - knowledge is power. (This reader had a scope a few years ago for a labral tear, her symptoms came back, she ended up being diagnosed with FAI and had an open surgery to address it)
-Clicking, catching (especially when changing direction when walking or getting in and out of car), deep aching. Now post op (scope with labral debridement of fibrillated labral tear) and still have aching (especially with sitting for long periods), nerve pain in thigh and butt, episodes of the hip giving way (though less frequent now). Pain is better with rest and worse with increased activity. Am now six months post op. Wish I had just broke it lol
-My symptoms started with groin pain, which seemed both deep and also superficial, and sometimes radiated up to my lower right pelvic/abdominal area. After awhile, I developed pain over my greater trochanter and in my piriformis muscle. Before my first scope I had SI joint discomfort as well, and also IT band tightness and soreness down my thigh to my knee. At first my pain was intermittent, but over time it became constant; it would get better or worse, but there was always a baseline amount of pain. Driving was horrible. Groin pain was always the worst symptom. Yuck!
Sunday, February 3, 2008
Turning the Bend
I think tomorrow is 12 weeks post-op, wow, how time flies when you are having fun! I can't believe I have had the privilege of experiencing 3 hip arthroscopies, how did I ever get so lucky!
Thankfully, everything went super this last time! I attended PT a whopping 3 times this week, I guess that takes care of the dropout status, for now anyway. J is traveling this week so I won't be making it in early to have P work on me, so this week I revert to drop-out status once again. The only thing is, I may really need P tomorrow. My SI joint is giving me grief this week. It was giving him grief as well Friday, I asked him to manipulate it, which is a high velocity, low amplitude thrust that if done correctly, will generally result in a "pop". I am generally a great "popper" but it would not go for him. I was so sore all day Friday and Saturday as well. Today it feels better but I am keeping my fingers crossed that it remains like this. SI pain stinks, I develop a deep achiness right along my PSIS. It is definitely not my first bout of SI pain though, at one pint in time, I had taught J how to fix it for me, the only trouble this time is that I am not sure what type of dysfunction I am having so cannot instruct him in correcting it. I find that in the past, I am always developing 'issues' on the weekend, when I have no access to 'help'! SI joint issues are a small price to pay for hip relief, and I will take this any time over groin pain, losing my mind, and another surgery!
Thankfully, everything went super this last time! I attended PT a whopping 3 times this week, I guess that takes care of the dropout status, for now anyway. J is traveling this week so I won't be making it in early to have P work on me, so this week I revert to drop-out status once again. The only thing is, I may really need P tomorrow. My SI joint is giving me grief this week. It was giving him grief as well Friday, I asked him to manipulate it, which is a high velocity, low amplitude thrust that if done correctly, will generally result in a "pop". I am generally a great "popper" but it would not go for him. I was so sore all day Friday and Saturday as well. Today it feels better but I am keeping my fingers crossed that it remains like this. SI pain stinks, I develop a deep achiness right along my PSIS. It is definitely not my first bout of SI pain though, at one pint in time, I had taught J how to fix it for me, the only trouble this time is that I am not sure what type of dysfunction I am having so cannot instruct him in correcting it. I find that in the past, I am always developing 'issues' on the weekend, when I have no access to 'help'! SI joint issues are a small price to pay for hip relief, and I will take this any time over groin pain, losing my mind, and another surgery!
Tuesday, January 22, 2008
As Tight as a.....
I can't think of a simile, but my hip is TIGHT. As I was riding tonight, I got into some standing sprints for the first time, but it felt as if there was a cord wrapping tighter and tighter around around my hip with each revolution, until I couldn't take it anymore. I kept saying to myself, 'it is not your problem, P will deal with it tomorrow...' but hell no, it is my problem now! Especially since Jk is asleep and I have no one to sit on my leg and stretch me!
Interestingly, I had a pretty shitty day on Sunday and Monday. Ironically, those 2 days were really really cold, the kind of days where you don't want to go outside unless absolutely necessary, the days where you drive down a street in Manhattan and there are no people on the sidewalk. Why is the cold bothering me so much???? I was between Tylenol and Darvocet, I was going to start with Tylenol and then take a Darvocet if it didn't help but it must have bc I never went for the stronger stuff!
I am going ice skating again tomorrow with hipster Amy, who has been banned from the ice by Dr. Kelly, but L really wants to learn how to skate! I am more nervous about freezing my ass off than breaking something since we are going to the Wollman Rink in Central Park, the indoor rinks are closed tomorrow or don't have public hours, I already started packing a bag with extra socks and sweaters! You can take the girl out of Miami, but you can't take Miami out the girl (did I ever mention I was from Miami, and have been 'stuck' in NY since college???)
On a positive note, I think I had the best ride tonight since my revision scope! YAY!!!
Just curious....should I still call scope#1 a 'failed hip arthroscopy' or 'part 1 of the job for my right hip'!
Also, I think I have to change my profile since I mention the 'twisting/popping' incident and really, it has nothing to do with anything, other than sending everyone down the wrong path on the ever so fun investigation of 'why does my hip hurt AFTER my arthroscopy?"
(I have to stop exercising at night, I have way too much energy)
Interestingly, I had a pretty shitty day on Sunday and Monday. Ironically, those 2 days were really really cold, the kind of days where you don't want to go outside unless absolutely necessary, the days where you drive down a street in Manhattan and there are no people on the sidewalk. Why is the cold bothering me so much???? I was between Tylenol and Darvocet, I was going to start with Tylenol and then take a Darvocet if it didn't help but it must have bc I never went for the stronger stuff!
I am going ice skating again tomorrow with hipster Amy, who has been banned from the ice by Dr. Kelly, but L really wants to learn how to skate! I am more nervous about freezing my ass off than breaking something since we are going to the Wollman Rink in Central Park, the indoor rinks are closed tomorrow or don't have public hours, I already started packing a bag with extra socks and sweaters! You can take the girl out of Miami, but you can't take Miami out the girl (did I ever mention I was from Miami, and have been 'stuck' in NY since college???)
On a positive note, I think I had the best ride tonight since my revision scope! YAY!!!
Just curious....should I still call scope#1 a 'failed hip arthroscopy' or 'part 1 of the job for my right hip'!
Also, I think I have to change my profile since I mention the 'twisting/popping' incident and really, it has nothing to do with anything, other than sending everyone down the wrong path on the ever so fun investigation of 'why does my hip hurt AFTER my arthroscopy?"
(I have to stop exercising at night, I have way too much energy)
Monday, December 24, 2007
6 Week Update
I can't believe it has been 6 weeks since my revision surgery. I see that there are a lot of new readers, so welcome, I hope you are enjoying this pathetic rendition of what my life has become!!! J/K!! I am actually really happy!
Just to recap- I had a revision hip arthroscopy on November 12, 2007 after my original scope on 3/5/07 failed secondary to residual FAI (femoroacetabular impingement). I originally had a labral tear and cam and pincer FAI, the initial surgery did not address the cam FAI (long story). In the long run, I am very happy my surgeon was not overly aggressive because you can always go back in and take down more bone, but you can never put it back!
So, 3 hip arthroscopies later, I can say that it was all worth it because I am in a much better place.
Just yesterday, we went to the NY Botanical Gardens holiday train show, it was our 3rd year going, I guess it is a tradition now! I have vivid memories of going last year. My hip hurt so much, and this was before I had been 'officially' diagnosed. I was so anxious at the time, as well as frustrated that the simple task of pushing my stroller hurt. Yesterday was a pleasure, for my hip anyway. We waited in line for over 40 minutes just to get in, and then the entire show was done in 'line form'. The kids loved it, and we had a blast. I never once thought about my hip!
I cannot remember if I have joint pain. Clearly, it is not an issue. What is still an issue is the 'invisible bruise' on my thigh.It still bothers me at work, when leaning with that leg against a treatment table. I have learned to fold a towel in between me and the table to help add more cushioning and protection there. The scope sites have been neglected this time so are tender to the touch, they are in the vicinity of the 'invisible bruise', so the entire area is tender to the touch, still.
My numbness is still there, and most recently has began to burn. It is not constant, and has only happened a few times, but is quite irritating. The alternative would be to try a heavy duty med called Lyrica, but the side effects are pretty intense, so I can only imagine what that would do to me, so no thank you! Hopefully it will not get worse than this.
My pain in the ass is better, but my piriformis is still in spasm, not as bad as last week though, phew. I had PT today and had P work on the scars and 'invisible bruise' and stretch my psoas, which is tight (but not so tight it needs to be released!!!)
I am supposed to go back to Spinnning today/ this week as per my own goal but I have a pretty bad sinus headache/ infection so it will have to wait a few days until it clears! Tomorrow is a new day though!!!!!
My left side is almost 6 months out, doing great, with just some pretty noisy popping/ snapping. The noisiness is painfree so I am not in the least bit concerned.
Just to recap- I had a revision hip arthroscopy on November 12, 2007 after my original scope on 3/5/07 failed secondary to residual FAI (femoroacetabular impingement). I originally had a labral tear and cam and pincer FAI, the initial surgery did not address the cam FAI (long story). In the long run, I am very happy my surgeon was not overly aggressive because you can always go back in and take down more bone, but you can never put it back!
So, 3 hip arthroscopies later, I can say that it was all worth it because I am in a much better place.
Just yesterday, we went to the NY Botanical Gardens holiday train show, it was our 3rd year going, I guess it is a tradition now! I have vivid memories of going last year. My hip hurt so much, and this was before I had been 'officially' diagnosed. I was so anxious at the time, as well as frustrated that the simple task of pushing my stroller hurt. Yesterday was a pleasure, for my hip anyway. We waited in line for over 40 minutes just to get in, and then the entire show was done in 'line form'. The kids loved it, and we had a blast. I never once thought about my hip!
I cannot remember if I have joint pain. Clearly, it is not an issue. What is still an issue is the 'invisible bruise' on my thigh.It still bothers me at work, when leaning with that leg against a treatment table. I have learned to fold a towel in between me and the table to help add more cushioning and protection there. The scope sites have been neglected this time so are tender to the touch, they are in the vicinity of the 'invisible bruise', so the entire area is tender to the touch, still.
My numbness is still there, and most recently has began to burn. It is not constant, and has only happened a few times, but is quite irritating. The alternative would be to try a heavy duty med called Lyrica, but the side effects are pretty intense, so I can only imagine what that would do to me, so no thank you! Hopefully it will not get worse than this.
My pain in the ass is better, but my piriformis is still in spasm, not as bad as last week though, phew. I had PT today and had P work on the scars and 'invisible bruise' and stretch my psoas, which is tight (but not so tight it needs to be released!!!)
I am supposed to go back to Spinnning today/ this week as per my own goal but I have a pretty bad sinus headache/ infection so it will have to wait a few days until it clears! Tomorrow is a new day though!!!!!
My left side is almost 6 months out, doing great, with just some pretty noisy popping/ snapping. The noisiness is painfree so I am not in the least bit concerned.
Thursday, December 13, 2007
Another Interesting Article
Radiologic and Intraoperative Findings in Revision Hip Arthroscopy
Original Article
Radiologic and Intraoperative Findings in Revision Hip Arthroscopy
Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego, California, February 2007.
Benton E. Heyworth M.D., a, , Michael K. Shindle M.D.a, James E. Voos M.D.a, Jonas R. Rudzki M.D.a and Bryan T. Kelly M.D.a
aHospital for Special Surgery, New York, New York, U.S.A.
Available online 5 December 2007.
Purpose: The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy. Methods: We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction “cam” lesions or anterosuperior acetabular “pincer” lesions). Results: The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery. Conclusions: Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery. Level of Evidence: Level IV, prognostic case series.
Wednesday, December 12, 2007
1 Month PT Measurements
Hip Flexion: R=4/5 L=5/5
Hip Abd: R=4-/5 L=4/5
Hip ER: R=4/5 L=4+/5
Hip IR: R=4/5 L=4+/5
Hip Ext: R=4/5 L=4/5
Not too shabby!!!! I think this is my all time best ever, even pre-op!! Yay, no impingement, no inhibition, nothing but strength!
Work today was better than Monday, no pain until the end of my day, and even then, it was slight. I think this is a huge improvement! If it wasn't so cold, I would be testing out my limits with the double stroller!
Manually, P worked on extension mobs since I am still pretty tight anteriorly, but it is getting better. Today, me exercises consisted of single leg walking on the treadmill, I stand on the left leg on the side of the treadmill and let the right leg move backwards on the belt to the endrange of my extension. I did walking squats with a red band, isometric hip abduction, Hip IR with a blue band, hip abduction with a blue band, isometric adduction with a small ball, bridges and modified single leg bridges, sidelying abduction with added hamstring curl and IR/ER rotation, clam shells and...........
8 STRAIGHT LEG RAISES
Holy shit!!!!!!!!! At 7 weeks out last time I couldn't do more than 1 1/2 SLR! This is amazing! I think Dr. Kelly added some special magic steroid so that he would never have to hear from me again!!!!! Who cares, this way we will both be happy!
THIRD TIME'S A CHARM!!!!!!!!!!!!!!!!!!!!!!!
Hip Abd: R=4-/5 L=4/5
Hip ER: R=4/5 L=4+/5
Hip IR: R=4/5 L=4+/5
Hip Ext: R=4/5 L=4/5
Not too shabby!!!! I think this is my all time best ever, even pre-op!! Yay, no impingement, no inhibition, nothing but strength!
Work today was better than Monday, no pain until the end of my day, and even then, it was slight. I think this is a huge improvement! If it wasn't so cold, I would be testing out my limits with the double stroller!
Manually, P worked on extension mobs since I am still pretty tight anteriorly, but it is getting better. Today, me exercises consisted of single leg walking on the treadmill, I stand on the left leg on the side of the treadmill and let the right leg move backwards on the belt to the endrange of my extension. I did walking squats with a red band, isometric hip abduction, Hip IR with a blue band, hip abduction with a blue band, isometric adduction with a small ball, bridges and modified single leg bridges, sidelying abduction with added hamstring curl and IR/ER rotation, clam shells and...........
8 STRAIGHT LEG RAISES
Holy shit!!!!!!!!! At 7 weeks out last time I couldn't do more than 1 1/2 SLR! This is amazing! I think Dr. Kelly added some special magic steroid so that he would never have to hear from me again!!!!! Who cares, this way we will both be happy!
THIRD TIME'S A CHARM!!!!!!!!!!!!!!!!!!!!!!!
Monday, December 10, 2007
First Day Back
I WENT TO WORK TODAY!!!!!!!!!!!!!!!!
So...you want to know how it went? I actually had pain. Surprise? Not really, my job is pretty physical and was a killer pre-op. At first I was nervous bc I thought I had joint pain but it turned out to be adductor pain, which is, well, a pain, but manageable!
I was planning on taking Naprosyn when I got home (I know, big Crohn's no no) but ended up not needing it. So once again, I am flying high on life (yes, nothing else).
I skipped PT today since there was no way I was going to survive a day at work after therapy, so I will be going Wednesday only this week! We need to work on my abductor strength. I was demonstrating a step up/ down for a patient and noticed that my leg totally collapsed inward during the step down. I need to do that to head off the knee pain that will surely follow if not taken care of!
I will have P strength test me Wed. and give an update.
For those of you still having trouble, I do not mean to rub it in your faces. I have been there and want you to know that there is a light at the end of the tunnel! And when you get there, I will be there, cheering you on!
So...you want to know how it went? I actually had pain. Surprise? Not really, my job is pretty physical and was a killer pre-op. At first I was nervous bc I thought I had joint pain but it turned out to be adductor pain, which is, well, a pain, but manageable!
I was planning on taking Naprosyn when I got home (I know, big Crohn's no no) but ended up not needing it. So once again, I am flying high on life (yes, nothing else).
I skipped PT today since there was no way I was going to survive a day at work after therapy, so I will be going Wednesday only this week! We need to work on my abductor strength. I was demonstrating a step up/ down for a patient and noticed that my leg totally collapsed inward during the step down. I need to do that to head off the knee pain that will surely follow if not taken care of!
I will have P strength test me Wed. and give an update.
For those of you still having trouble, I do not mean to rub it in your faces. I have been there and want you to know that there is a light at the end of the tunnel! And when you get there, I will be there, cheering you on!
Wednesday, November 28, 2007
My 1 Year Anniversary
Today marks the 1 year anniversary of when my hip saga began. For anyone just beginning their journey, I can assure you that in the hands of the right surgeon, there is a light at the end of the tunnel. I am going to do a flashback to November 28, 2006.
Shit, my hip hurts. It hurts when I drive, and especially when I push the kids in the double stroller. It is a really annoying pain. It feels like something is in my joint. My friend/ PT is coming into work around 3, I will ask her to work on it and hopefully get some relief. She showed up and I told her I was dying of pain, she did a painful release on my iliacus/psoas, I felt better immediately, but in the car on my way home, things got bad again.
I went into work the next day, again, in agony. First I had one therapist stretch my hip flexors and ITB, thinking this may help. Then I had another one check it out. She said there is definitely some kind of impingement. Then I asked P for help. He was really busy so I waited until he was done seeing patients. What makes the day so memorable is that it was Jk's 1st birthday, and I was having a small dinner party, and lacking a few key ingredients. I used P's full schedule to run to the supermarket near my office but didn't find what I was looking for (which I now don't even remember what it was). P did all kinds of releases, ART, mulligan mobs...It felt good...until I was in my car again. Shit. What is this????
I got home, L had ballet and there was no food for my party! I ended up ordering pizza, Jk didn't know the difference! After we had cleaned up and the kids were in bed, I hit the computer. I had a feeling I had a labral tear, and the word impingement reverberated through my head. I think I first looked for a surgeon, before I did anything else, that is me, always thinking ahead! I was trying to remember when I had seen a hipscope, and who did them, and no one was popping into my head. At the time, there was a hipscope patient in my office and she was a wealth of information, but I wasn't willing to see her surgeon (he was in NJ), I knew it had to be someone at HSS. So I looked and searched, and researched labral tears, FAI.....Not just that night, but every night after that for weeks. After a week or 2, I decided this wasn't getting and made an appointment with Dr.Kelly. I was between him and another surgeon. I had emailed a professor of mine about this and he had recommended against the other surgeon for personal reasons. So Dr.Kelly it was. If things didn't go well, then I would pursue other options, it was just a consult, right. Hopefully he would order an MRI and get to the bottom of this. The rest is history....but in a nutshell...
3/5/07 R hip arthroscopy, Pincer impingement, labral tear debridement, synovectomy
7/2/07 L hip arthroscopy, Cam and Pincer impingement, labral tear debridement, synovectomy
11/12/07 R hip revision arthroscopy, Cam impingement, removal of scar tissue, synovectomy, upon examination, found to have beautiful psoas
11/28/07 Riding high on life (bc everything else makes me sick) and enjoying a painfree lifestyle, looking forward to ditching my single crutch very very soon! :-)
Shit, my hip hurts. It hurts when I drive, and especially when I push the kids in the double stroller. It is a really annoying pain. It feels like something is in my joint. My friend/ PT is coming into work around 3, I will ask her to work on it and hopefully get some relief. She showed up and I told her I was dying of pain, she did a painful release on my iliacus/psoas, I felt better immediately, but in the car on my way home, things got bad again.
I went into work the next day, again, in agony. First I had one therapist stretch my hip flexors and ITB, thinking this may help. Then I had another one check it out. She said there is definitely some kind of impingement. Then I asked P for help. He was really busy so I waited until he was done seeing patients. What makes the day so memorable is that it was Jk's 1st birthday, and I was having a small dinner party, and lacking a few key ingredients. I used P's full schedule to run to the supermarket near my office but didn't find what I was looking for (which I now don't even remember what it was). P did all kinds of releases, ART, mulligan mobs...It felt good...until I was in my car again. Shit. What is this????
I got home, L had ballet and there was no food for my party! I ended up ordering pizza, Jk didn't know the difference! After we had cleaned up and the kids were in bed, I hit the computer. I had a feeling I had a labral tear, and the word impingement reverberated through my head. I think I first looked for a surgeon, before I did anything else, that is me, always thinking ahead! I was trying to remember when I had seen a hipscope, and who did them, and no one was popping into my head. At the time, there was a hipscope patient in my office and she was a wealth of information, but I wasn't willing to see her surgeon (he was in NJ), I knew it had to be someone at HSS. So I looked and searched, and researched labral tears, FAI.....Not just that night, but every night after that for weeks. After a week or 2, I decided this wasn't getting and made an appointment with Dr.Kelly. I was between him and another surgeon. I had emailed a professor of mine about this and he had recommended against the other surgeon for personal reasons. So Dr.Kelly it was. If things didn't go well, then I would pursue other options, it was just a consult, right. Hopefully he would order an MRI and get to the bottom of this. The rest is history....but in a nutshell...
3/5/07 R hip arthroscopy, Pincer impingement, labral tear debridement, synovectomy
7/2/07 L hip arthroscopy, Cam and Pincer impingement, labral tear debridement, synovectomy
11/12/07 R hip revision arthroscopy, Cam impingement, removal of scar tissue, synovectomy, upon examination, found to have beautiful psoas
11/28/07 Riding high on life (bc everything else makes me sick) and enjoying a painfree lifestyle, looking forward to ditching my single crutch very very soon! :-)
Friday, November 2, 2007
Article Review
I have been frantically trying to get my hands on an article from this month's AJSM because there is an article titled "Revision Hip Arthroscopy". I finally got it today. It found that the most common reason for a revision is persistent impingement.
Of 37 cases reported, 36 had impingement that was either not previously addressed, or inadequately addressed. 32 had labral lesions, 26 had a chondral defect, 22 had unaddressed FAI, 22 required lysis of adhesions, 13 for unaddressed instability, 12 for repeat treatment of FAI.
Just some food for thought! I feel better that most did have a labral lesion, not that I hope that for anyone...but you know what I mean!!!
Of 37 cases reported, 36 had impingement that was either not previously addressed, or inadequately addressed. 32 had labral lesions, 26 had a chondral defect, 22 had unaddressed FAI, 22 required lysis of adhesions, 13 for unaddressed instability, 12 for repeat treatment of FAI.
Just some food for thought! I feel better that most did have a labral lesion, not that I hope that for anyone...but you know what I mean!!!
Monday, September 24, 2007
Second Opinion (A good place to start if you have just joined me on my adventure)
Here is what I wrote in the letter for my second opinion:
Thank you for taking the time to review my films/ reports. Enclosed you will find radiology reports, operative reports and office notes from Dr. Kelly, as well as my MRI’s, x-rays and CT scan on CD. I would like to consult with you regarding my right hip. Below is a brief history of my problem.
I am a 27 year old physical therapist, mother of 2. I began having right hip pain in November 2006. At the time, physical therapy did not help and I decided to consult with Bryan Kelly at HSS in January 2007. I had positive impingement signs and clicking in the hip, as well as pain with resisted hip flexion. Dr. Kelly ordered an MRI which showed cam impingement and a labral tear. An intra-articular injection of marcaine/ kenalog/ cortisone initially relieved all of my pain. We decided to do an arthroscopy to address these issues, on March 5, 2007. The scope addressed pincer impingement and debrided the labral tear.
I was doing very well after that surgery, with the exception of some residual pain at end range hip flexion, and flexion with adduction and internal rotation. Additionally, my left hip began bothering me during the period of time that I was partial weight bearing, and I had identical symptoms on the left as I had pre-op on the right. We decided on another scope, July 2, 2007. Four days before the surgery on the left, I had a twisting injury on the right side, I was weight bearing on the right and turned to the left, at that time, I heard and felt a pop, and had severe pain. The pain persisted for the entire day and subsided slightly over the next few days.
On July 2, I had the left hip scoped. The scope addressed cam and pincer impingement and debrided the labral tear. The left side is doing well. The right side continued to bother me after the left scope, being on crutches exacerbated that side and all of my pre-op symptoms returned.
Towards the end of July, I contacted Dr. Kelly regarding my symptoms as I was extremely concerned that I had possibly re-torn my labrum. He ordered an MRI, followed by an intra-articular injection which gave me complete pain relief. I have been very concerned about the cam impingement remaining in my right hip. He also ordered a CT scan. At this point, Dr. Kelly has suggested a revision arthroscopy to address the cam bump, and possibly address the psoas, as he feels I injured it when I twisted that hip. I will be having the psoas injected in the coming weeks to determine if it truly is an issue or not.
At this point, I am unsure of how to proceed. I am skeptical of having another arthroscopy since the first one was not able to fully address my impingement. I am writing to you to see if you think my impingement would be better treated via an open procedure, and to see whether you think I should make an appointment to see you in person.
Again, thank you for the taking the time to read this and review my file.
If you have any question, please feel free to contact me at (phone #), or via email (email address)
Sincerely,
Susie
Thank you for taking the time to review my films/ reports. Enclosed you will find radiology reports, operative reports and office notes from Dr. Kelly, as well as my MRI’s, x-rays and CT scan on CD. I would like to consult with you regarding my right hip. Below is a brief history of my problem.
I am a 27 year old physical therapist, mother of 2. I began having right hip pain in November 2006. At the time, physical therapy did not help and I decided to consult with Bryan Kelly at HSS in January 2007. I had positive impingement signs and clicking in the hip, as well as pain with resisted hip flexion. Dr. Kelly ordered an MRI which showed cam impingement and a labral tear. An intra-articular injection of marcaine/ kenalog/ cortisone initially relieved all of my pain. We decided to do an arthroscopy to address these issues, on March 5, 2007. The scope addressed pincer impingement and debrided the labral tear.
I was doing very well after that surgery, with the exception of some residual pain at end range hip flexion, and flexion with adduction and internal rotation. Additionally, my left hip began bothering me during the period of time that I was partial weight bearing, and I had identical symptoms on the left as I had pre-op on the right. We decided on another scope, July 2, 2007. Four days before the surgery on the left, I had a twisting injury on the right side, I was weight bearing on the right and turned to the left, at that time, I heard and felt a pop, and had severe pain. The pain persisted for the entire day and subsided slightly over the next few days.
On July 2, I had the left hip scoped. The scope addressed cam and pincer impingement and debrided the labral tear. The left side is doing well. The right side continued to bother me after the left scope, being on crutches exacerbated that side and all of my pre-op symptoms returned.
Towards the end of July, I contacted Dr. Kelly regarding my symptoms as I was extremely concerned that I had possibly re-torn my labrum. He ordered an MRI, followed by an intra-articular injection which gave me complete pain relief. I have been very concerned about the cam impingement remaining in my right hip. He also ordered a CT scan. At this point, Dr. Kelly has suggested a revision arthroscopy to address the cam bump, and possibly address the psoas, as he feels I injured it when I twisted that hip. I will be having the psoas injected in the coming weeks to determine if it truly is an issue or not.
At this point, I am unsure of how to proceed. I am skeptical of having another arthroscopy since the first one was not able to fully address my impingement. I am writing to you to see if you think my impingement would be better treated via an open procedure, and to see whether you think I should make an appointment to see you in person.
Again, thank you for the taking the time to read this and review my file.
If you have any question, please feel free to contact me at (phone #), or via email (email address)
Sincerely,
Susie
Saturday, September 22, 2007
Venting, Whining and the Ever So Importnat Shoe Choice
Last we spoke, Dr. Kelly had called, I need a revision.... fabulous! (I need to change my blog profile soon). The problem is there is never a good time for surgery, but there is no way I can put this off, my intermittent pain is beginning to give me less and less pain free periods, and the painful times are getting more and more painful.
I have spent the last 24 hours in synagogue for Yom Kippur. Aside for not eating and drinking, we don't wear leather shoes (sexy shoes fall into the leather category). Last night I wore my ballet flats. Huge Mistake. I was in agony, practically tears, they have so little suport but this has never posed a problem for me. Today, I decided to be smarter and wore my Danskos, I cannot say I did not have pain, but it was definitely a huge improvement from last night. I think I will have to begin living in those for the next few weeks/ months.
Emotionally, I don't know how people deal with pain. I guessing I have a high physical tolerance, but it is starting to really get to me. Almost every night is a mini pity party around here! I am just so fed up, and I have only had this new issue for 2 1/2 months. I cant believe it is taking this long to get things done also. What a mess! I will work on changing my profile tonight!! Let me know what you think!
I have spent the last 24 hours in synagogue for Yom Kippur. Aside for not eating and drinking, we don't wear leather shoes (sexy shoes fall into the leather category). Last night I wore my ballet flats. Huge Mistake. I was in agony, practically tears, they have so little suport but this has never posed a problem for me. Today, I decided to be smarter and wore my Danskos, I cannot say I did not have pain, but it was definitely a huge improvement from last night. I think I will have to begin living in those for the next few weeks/ months.
Emotionally, I don't know how people deal with pain. I guessing I have a high physical tolerance, but it is starting to really get to me. Almost every night is a mini pity party around here! I am just so fed up, and I have only had this new issue for 2 1/2 months. I cant believe it is taking this long to get things done also. What a mess! I will work on changing my profile tonight!! Let me know what you think!
Thursday, September 20, 2007
The Plan
He called. This is how it went down.
He said that the CT scan didn't show much of anything on the femur, the alpha angle was 30, anything under 50 is normal. Usually the CT scan will help determine if there is a bump on the femur, which is why I wanted you to have it, but it is inconclusive (I didn't mention that I was the one who actually wanted the scan, but so be it). The MRI did show the bump, but there are also post-op changes, so it is hard to tell what is there and what isn't. I think that based on your twisting/ popping, it is your psoas.
I said- originally, I had thought that we were going into surgery to address the cam, I asked him to look at the scope pics and see if he could see the bump, I don't think I got a straight answer, but I am not sure. He said he looks for the mechanism of injury and it was not consistent with cam impingement.
I started talking now, I also spoke at intervals when he spoke, but I didn't think I needed to give you a dialogue like last time! I had the popping but then went on crutches and after a few days had all the same pre-op pain.
He said- the psoas could have bled and scarred down to the capsule. He looked through my chart a little, so you had about half a day of relief from the injection?? Hmmmm........I think it may be the cam or the psoas, and as much as none of us wants to, I think we may need to go back in again and address it.
I said- What would you do? He said he would definitely take down the cam and do a bursectomy around the psoas. I said I REALLY don't want you releasing my psoas. He said it may be scarred down to the capsule.
I told him I need him to be sure that it either is or isn't the psoas, bc I REALLY don't want him releasing it. He said the only way to be sure is to have it injected, do I mind doing that? No, what's one more injection at this point.
So I then said, Ok, how would you like to proceed at this point...other than disowning me as a patient? He laughed, and said he likes the challenging ones. I didn't get a chance to ask him if he meant the challenging cases or the challenging patients!!!
So, the plan is to get the psoas injected and then see him within a week to determine if that is the issue.
So, it looks like he is definitely recommending a revision, but is not quite sure what needs to be done.
He said that the CT scan didn't show much of anything on the femur, the alpha angle was 30, anything under 50 is normal. Usually the CT scan will help determine if there is a bump on the femur, which is why I wanted you to have it, but it is inconclusive (I didn't mention that I was the one who actually wanted the scan, but so be it). The MRI did show the bump, but there are also post-op changes, so it is hard to tell what is there and what isn't. I think that based on your twisting/ popping, it is your psoas.
I said- originally, I had thought that we were going into surgery to address the cam, I asked him to look at the scope pics and see if he could see the bump, I don't think I got a straight answer, but I am not sure. He said he looks for the mechanism of injury and it was not consistent with cam impingement.
I started talking now, I also spoke at intervals when he spoke, but I didn't think I needed to give you a dialogue like last time! I had the popping but then went on crutches and after a few days had all the same pre-op pain.
He said- the psoas could have bled and scarred down to the capsule. He looked through my chart a little, so you had about half a day of relief from the injection?? Hmmmm........I think it may be the cam or the psoas, and as much as none of us wants to, I think we may need to go back in again and address it.
I said- What would you do? He said he would definitely take down the cam and do a bursectomy around the psoas. I said I REALLY don't want you releasing my psoas. He said it may be scarred down to the capsule.
I told him I need him to be sure that it either is or isn't the psoas, bc I REALLY don't want him releasing it. He said the only way to be sure is to have it injected, do I mind doing that? No, what's one more injection at this point.
So I then said, Ok, how would you like to proceed at this point...other than disowning me as a patient? He laughed, and said he likes the challenging ones. I didn't get a chance to ask him if he meant the challenging cases or the challenging patients!!!
So, the plan is to get the psoas injected and then see him within a week to determine if that is the issue.
So, it looks like he is definitely recommending a revision, but is not quite sure what needs to be done.
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