Putting Out

Yesterday, I was speaking with a patient who recently underwent a total hip replacement after years of groin pain. I have treated her for quite a while so we have become close. She was asking me about my hip, and how I am coping.....She asked if I was depressed. I am not, surprisingly. I think so many people with pain are, and I understand why, but luckily, I am not one of them.

The topic of sex got brought up (remember, besides for orthopaedic issues, I am also a pelvic floor therapist). I told her that sex is one of the hardest things for me, it oftentimes hurts, and when the act itself doesn't hurt, I pay for it the next day.

She thought about it for a second and said to me: "Honey, you better put out for him because you don't want him to get it from somewhere else"

Duly noted!

Desperate Times Call For Desperate Measures....Or At Least I Thought So

I haven't really mentioned it here before but Z has given me a run for my money. As cute and adorable as he is, he is constantly sick and having "issues" that worry me. His latest has been scary sounding wheezing. About 3 months ago, I took him to a pulmonologist, we will call him douche bag. Db basically said that Z was fine and I was an idiot/ crazy mother who thinks that sniffling is wheezing. I checked DB out with some friends and it turns out that he is pretty much the top pediatric pulmonologist around, but there was no way I could ever deal with him. After discussing with my pediatrician, she agreed that he indeed had acted like a db and that I needed a new pulmonologist ASAP since she was convinced Z would need constant care from one.

Fast forward to about 1 month ago, I see the new pulmonologist, NP. He took one listen to Z and confirmed that he has asthma and some other crazy breathing stuff going on that I won't get into. He thinks he may need to do a bonchoscopy..... this does not make me happy. He told me to try some meds first and come back in 2 weeks.

This is where the desperate times/ desperate measures comes into play. I took Z to a chiropractor after being convinced by a co-worker (non-PT) and a family friend.
The chiropractor assures me that he can "fix" Z. Fast forward 2 weeks, Z has been on his meds and seeing the chiro and is doing great.

Today the chiro suggested I should see him too. I laughed. My issues are soooo ridiculous and so complicated, you don't want me, trust me!! So I left and walked back home, during which I was in a ton of pain. I decided that at that moment in time I was willing to try anything....so I called him and he told me to come in.

He started off by taking an x-ray of my lumbar spine/ pelvis. He was shocked at what he saw. My iliac crests were not even, trochanters were not even and my spine curving in some funky way. I am not quite sure what he had expected but he said that he would expect the spine to curve the other way given the leg length discrepencies. He suggested putting a small lift into the shoe on the non painful side. He did some manips and I was in a lot of pain. The rest of the day the groin pain was pretty bad.

So now I can add chiropractic to my list of "what makes my pain worse", which now includes: walking uphill, pushing my stroller, PT, sex, repetitive crouching to the floor (like when cleaning up toys) and other random activities. I am puting all my money on the PRP injecion!!

Injection # 6...Scheduled...Finally

To show that I am not an impatient bitch, here is a timeline of events....


Jun 6- all hell broke loose in my hip
Jun 17- appt with BK
Jun 26- MRI
July 2- spoke to BK re MRI and getting cortisone injection
July 21- Cortisone injection
July 29- spoke to BK re PRP injection
so when would you guess it is scheduled.......

no...keep going........

a little longer........


Sept 2- PRP injection scheduled

so yes, I am slightly annoyed and growing impatient. I haven't posted about the annoyance in getting this one scheduled but the mere act of writing about it annoys me. But here it goes. I spoke to BK on a Wed. He said "let's try to get it done this week", to which I simply replied "ok", I wasn't about to start explaining to him how miserable it is to schedule something with his office (I will save this for my next appointment, which will be Sept 25th). I was also supposed to wait for his office to call me with the appointment time.

6 days later, I, of course, had heard nothing, so I called them. They were trying to figure out which hospital should do the injection (HSS or NYP). I let the rest of the week go by, still nothing. I called them back on Monday (this is now 1 1/2 weeks later)....still trying to schedule (it was decided that yes, it could be at NYP with the good radiologist). Radiologist was not in the office that day so nothing could be done. I finally got a call the next day, could I do the following Monday at 10:30? No. I see patients then. Of course, during the past week and a half, no one bothered to ask me what my availability was, mind you, I am pretty flexible, I only see patients 3 mornings/ week, but this never occurred to anyone.

Fast forward to yesterday, 2 weeks + 1 day since it was decided that I would get the PRP. I called his office to see what the problem was now. To which I got this response: "Oh, didn't X call you?" NO...."Can you do Sept 2 at 10:30?" FINE. Clearly I was not about to start having them find me an earlier time, I will take what I can get with them and just deal with it....complain about it, but just deal with it!!!!

You must think I’m crazy!!! (my little secret)

No, this isn’t Susie writing today. I’m her 25 yr old brother who had surgery on Feb 23, 2009 to repair a partially torn labrum of the right hip. I do follow this blog, not religiously like some, and yes, on occasion I’ll comment either as myself, or anonymously like my brother in law and write obnoxious comments. ie don’t hesitate to amputate. But I digress, I’d like to let all of you a little secret, and I don’t say this because Susie is a PT but because it’s true. PT with my therapist, Ira saved my life. My life is dominated by sports, ice hockey, tennis, soccer and the most recent to be added to my list is the triathlon. (oh yeah, skydiving too). I get moody and slightly depressed if I’m not active or in this case, hyper-active. (no I don’t have ADD) Immediately after surgery Susie pushed me to my limit, which on days 1-3 post-op was extremely limited, but this little lesson would help me along the way. PT 2x a week, swimming for an hour every day and stretching with thera-bands among other things. I won’t get to technical with my stretches and regimen b/c that’s not my thing. I’m an analyst by trade. But here’s a little timeline…
8 days out one crutch, 15 days no crutches, 3.5 weeks a mile on the treadmill, 6 weeks 15 minutes running on the treadmill, 10 weeks back on the tennis court, 12 weeks 20 miles on the road bike in an hour Now I won’t say I’m 100% because I do feel pain every now and then, but nothing to indicate a tear. Just general tightness which is easily alleviated by a few stretches but 90-95% sounds about right. I’m 5 ½ months out, I’m back on the ice, playing soccer, riding my bike, playing tennis 2-3x a week and just got back from the state tennis tournament. (4 matches in 3 days in 95 degree heat and 90% humidity). A little hip pain won’t stop me! I just try my best to stretch and stay loose everyday. If you think my life sounds hectic and my days are consumed by sports, you’re right. Did I mention I have a girlfriend too? Oh yeah I like to go out drinking when I get home after playing. So figure I get home at 10, shower, go out and wake up at 7:30 everyday and do it all again. What do you think, can you handle it? Oh wait, I forgot to mention, I’m eyeing a triathlon late Sept early October. You must think I’m crazy!!!!!

Still Waiting

It has been 6 days since I spoke with Dr. Kelly regarding the "new plan". I have not been able to schedule the injection yet. I finally got around to calling his office today, there seems to be a conflict regarding the vendor of the machine for the PRP and which hospital uses which (big fat mess). There may be a possibility that the radiologist who has been doing my injections will not be able to do this one because his hospital uses the "other" vendor. As usual, red tape and silly delays.

In the meantime, I am truly miserable. I am in so much pain a lot of the time, and having ass pain again. Feeling like I am back to square one is taking an emotional toll on me and I am just worn out. I don't even know if I agree that my pain is being caused by the joint capsule having a problem. My pain is the same as it was pre-op, I have pain with flexion and internal rotation and I have lost most of my active internal rotation on that side. I am really concerned. I am sure, positive actually, that all of the impingement was removed during my last surgery. I don't think I would have had such a great year and a half, and pregnancy and delivery, but what is going on now? He did mention that it is possible for the bone to grow back, but that just seems insane to me.

And if it did, then what? why would removing it again guarantee me that it wouldn't happen again?? And why does my ass hurt?

The New Plan

I spoke with Dr K earlier tonight regarding my injection and funky reaction. Of course he has never seen this happen before, the only possible thing he can attribute this to is some high signal in the capsule on the MRI. Given no other signs, and given the reaction to the injection, he does not think that Synvisc is the way to go at this time. He would rather I try a Platelet Rich Plasma (PRP) injection into the capsule and then see him 4 weeks later.

I am ok with this. Actually, I am so desperate to be pain free I would have agreed to pretty much anything at this point! Now the question is how long until his office can make this happen!!!

What A Waste

I am back to status quo, meaning, the way things were immediately before the injection. What does this mean?? My awful medial and posterior pain are gone, thank goodness. But the painfree days I had immediately post-injection are gone too, I am back to having old fashioned groin pain :-(

Now I most certainly have no idea what is going on and I am getting pretty upset about it. If I had "tweaked" my hip and caused some localized inflammation, the cortisone would have taken care of it. The fact that I had those 2 perfect days clearly shows that the pain is from the hip joint, but now the question is why??

I have a call in Dr. K, he will hopefully get back to me within a reasonable amount of time, or before I do something drastic, like amputate!!!

Despite Everything, I Still Have Something To Smile About

Not So Much Happiness

In all of my worse case scenarios, this was not even a possibility....Let me begin by saying that my injection was Tuesday, Wed and Thurs were amazing, I felt like I was dancing on clouds with rays of sunshine jutting out and birds chirping in my ear. Then came Friday. I woke up with some pain, as the morning went on, I kept feeling this horrendous pain a little more medially than where I normally do. I got home around 1PM and suddenly I could barely put weight on my leg. Of course I called J in a panic, who asked if I was going to be ok because he had to run into a meeting! That subsided but I have been left with really bad medial hip pain and posterior hip pain. All I can say is WTF??????????? I have no idea what is going on, what could have possibly happened, and why I am in so much pain? And why does my ass hurt all of a sudden?

Cortisone = Happiness

Yes! I am once again in a happy place in hipville!! I feel sooooo much better! I don't want to jinx anything but this seems to have done the trick. My plan is to give BK a call on Monday and let him know I am doing well, and re-visit the issue of more injections. It seems silly bc I feel so good now, but lets be honest here, cortisone is much like a bandaid, who knows what the real deal is here! I am just nervous that the cortisone will wear off and basically leave me f--ked all over again! Who would have ever imagined that things would get so complicated!

Injection # 5...over

A huge sigh of relief! My injection into the joint was about 5 1/2 hours ago. I have to say that the radiologist who does all of my injections is truly first class. He is so gentle and thorough. 2 hours ago I was completely pain free, it was such a wonderful feeling. Now the marcaine is beginning to wear off, I hope I am not in for a hellish night.

The injection went very smoothly. First he moved my hip around into deep flexion, then flexion with IR, then flexion with ER. I had to rate each position using a pain scale. Pre-injection I rated 5, 10 and 0 respectively.

He then marked the areas he did not want to inject and the area he did want to, injected a local to numb the skin, again, so gently. Then the big needle. It wasn't bad at all. Yes, I felt it, but it was a piece of cake. He then injected some contrast material and took an xray to see where the contrast went. It all kind of pooled around the femoral neck. He pulled up my old films and explained that he didn't like what he saw because last time, the contrast material moved more medially and did not pool like that. He decided to reposition the needle. Ugh. But again, it was not bad at all, and this time, the contrast spread as it was supposed to.

He injected everything in, gave it time to settle, and retested my hip ROM. This time, my pain was 0, 0 and 0.

So now what??

Hopefully, the pain will just go away, and never come back, and this was just a blip on the radar of successful hip arthroscopies!!!

Soccer

I have been quietly dealing with this flare up of hip pain but it is getting to the point where I am starting to lose it (again). What I have noticed is that soccer is making me soooo much worse. We are not talking about running through long fields, blocking balls with your head, diving into the ground soccer. What it is is playing with L and Jk, who are 5 and 3 1/2 respectively, just lightly kicking around a ball and stopping it with my foot. That is it. This seemingly innocent game is causing a hellish scene in my joint. By hellish I mean that given the opportunity, I may cut off my leg.

Interestingly, I wouldn't even rate the pain as that intense, it is the quality of pain that is getting to me. It is searing, aching, deep deep in the joint. Sound familiar? A little too close for comfort if you ask me.

Day 8

It is scheduled! Phew! Not until July 21st, but i'll take it, it is not worth the aggravation of having to have them call and see what is available, and call me back, So July 21st it is.

As I was about to write this, I got a call from HSS MRI department, calling me to confirm my MRI this Sunday.....huh? I already had my MRI. They said that someone from Dr. Kelly's office called to make me an appointment for an MRI of my right knee. Huh??? I told her to call Dr. Kelly's office since there seems to be a lot of confusion there. Maybe it was for the Laura they were looking for when they called me. So, Laura, if you read my blog, you have an MRI scheduled this Sunday at 3:30 @ HSS! Good Luck!

Day 7

You guessed it, nothing scheduled yet, not even a call back yesterday from his office. I have never heard of such complete and utter bullshit.

6 Days Later

It has been 6 days since BK and I spoke about getting a cortisone injection. It is not yet scheduled, I know, you are completely blown away. I called his office on Monday to schedule, they did not yet have the prescription, but I was assured that as soon as they had it they would call me! I called again yesterday, they were about to get the prescription and call me back...good thing I didn't wait all day by the phone. Actually, I shouldn't say that, they did call, except not for me. I got a call from his office asking for Laura, so I explained that I was not Laura but was indeed waiting for a call back from them, so again, I was assured that they would call me back "very soon". And here I am, waiting and waiting!!!

At least I am not waiting in a state of panic and anxiety, like I have been in the past, when the injection was the deciding factor between surgery and no surgery. This time, it won't change much other than (hopefully :-) my pain level!

I have added a "Follower" button to my blog, I am not 100% certain what it is, but a fellow hip blogger (Sarah) just sent me a link to hers and I see other blogger friends using it, so I figured it is the "thing" to do!!!

So What To Do Now????

So I spoke with Dr. K tonight regarding the MRI and the results. The good news is that there is no sign of an acute injury (subluxation, etc). There is some fluid in the psoas, and scarring on the capsule, both of which may be causing me trouble. He has never seen someone who presents the way I do (of course not, I am very special, he agreed) So...he thinks I should get an ultrasound guided psoas injection.

My last psoas injection was miserable, it took about 45 minutes, and following it, I lost all active hip flexion for a few days. I don't want to do that. He understands and is ok with that. He thinks I should then go ahead and get the joint injected, since the psoas and capsule will benefit from it as well. I don't know if this seems like a final solution, I just am not sure and I don't know what to do. I asked about getting Synvisc injected into the joint, he said he generally doesn't inject Synvisc into people "like me", meaning with no arthritis. I pointed out the cartilage thinning in the joint, he didn't think it was all that impressive. He said that if I go with Synvisc, they first do a cortisone injection about a week before, then 3-5 Synvisc injections after. Or, I could go with super duper non-FDA approved Synvisc that is given only one time. Or...I could go with a platelet rich plasma injection, of which the results are not yet conclusive.

So...... a lot of options, not a lot of evidence...nothing of great significance (shocker) on the MRI. So, I have decided to go ahead with a cortisone injection into the joint, I can then decide if I want to stop with that or continue on with the synvisc. I hope that this will be the solution for me because I am getting pretty fed up with hip pain!

My MRI Report Ordeal

As some of you know, I can be quite obsessive compulsive when it comes to test results. Mri #4 being no different! I was told that it would take 2 business days for the report to be done and delivered to Dr. K. My MRI was Fri at 7am. I called Tuesday, no report. I called again on Tues, no report. I called Wed, no report. So I called the radiology department directly (did I mention I have a touch of OCD), they confirmed that the report was indeed done, and had been sent to my doctor. Hmmmm, sigh! So I called his office yet again (they must love me) and informed them that the report was ready. I was told that they would send someone to go pick it up. I left my fax number and everything. No report. Today I was running out of patience, so I called his office again, no report. I told them it was done, and asked why they didn't have it, they told me that if they didn't have it by mon or tues (today is thurs) that they would send someone to go get it. I got off the phone feeling annoyed and exacerbated, called radiology again and explained my dilema. They offered to fax it to him (they can't fax it to me directly) on the spot, given my annoyance! 30 minutes later I called his office and they had it in the fax machine, now I hold a copy in my hot little hands!!!

Right Hip MRI #4 (edited)
There is mild trochnateric bursal thickening bilaterally. The anterior labrum is somewhat small probably related to debridement. the anterosuperior labrum is deficient, similar to the prior study, with the posterior labrum being intact. There is defect in the anterior capsule superiorly in the region of the surgery extending 2.5cm in transverse dimension.

Cartilage over the femoral head is thinned anterosuperiorly. Focally, there is no full thickness loss. the superior cartilage is high signal. The acetabular cartilage has thinning anterolaterally, slightly more prominent on the prior study as well as anterosuperiorly where there is a focal area of near full thickness loss which has increased from the prior study over 4mm. there is no prominent effusion. No reactive signal in the underlying bone is evident.

The patient has undergone anterior bumpectomy with remodeling of the anterior femoral neck. focal adjacent scar is evident.

There is iliopsoas tendon thickening and high signal representing tendinosis bilaterally.

Prior abdominal surgery has been performed

There is a transitional lumbosacral junction. Disc signal is mildly lost at what appears to be L4-5 where there is a small to moderate central disc protrusion. The sacroiliac joints show mild high signal and osteophytes. Minimal free fluid is the cul de sac. Hamstring origins are intact.
The muscles appear fairly symmetric.

The previously demonstrated left sided edema, presumably from arthroscopy of the left hip has dissipated.
There are 14 degrees of femoral anteversion.

Impression:
Interval bumpectomy since the prior study with postoperative scar and anterosuperior capsular defect.
There is persistently deficient anterosuperior labrum. Since the prior study, there has been a slight increase in the focal acetabular cartilage anterosuperiorly, without advanced arthrosis.

MRI #4...Over!

All my nervousness and planning was for nothing! I "passed" with flying colors, I don't even think my heart rate went up once during the scan. I followed my own rule about keeping my eyes closed the whole time, let the cool "breeze" from the machine's fan keep me feeling like I was not in an enclosed space, and actually enjoyed the time away from work, kids and my blackberry! I did bring a cd with my own music but it stopped working after the first song, I'm not sure why, the technician wasn't too savvy with the stereo system, but despite this, I was still cool as a cucumber! I did inform her that I was nervous, which at first didn't thrill her. But I explained that it was my 4th scan (5th if you count the knee one last year) and I have always gotten through them. She wanted to know what I did, so I explained that deep breathing helps and that the technician tells me how long each particular series will take. She seemed ok with that and spoke to me in between scans. It even got annoying because I almost fell asleep!!!

Now, the waiting game begins for the results! I will be at a continuing ed course all day Sun, Mon and Tues, so this should keep me occupied! I will post once I know!

Too Cute

and an update....

My pain has not gone away but it is a little better. Saturday I did absolutely nothing...I didn't even leave the house, and I felt fine. Yesterday I did a little more and the pain was there, but it is clearly related my activity level. I played some Hopscotch Twister with L and of course the pain came back. I have managed to change my MRI appointment to this Friday (one week earlier than originally scheduled) so we will see....

And the Good News is.....

Today was my appointment with Dr. Kelly. I had my first ever post-op x-rays done. They showed that my joint space is great on both sides, no arthritis and no narrowing of the joint space! Hurray!!!

One view of the x-ray showed a 'shadow'...he wasn't too clear on what it as, but another view did not have it. Shadow on x-ray=MRI :-(

He thinks there is a possibility that my hip may have subluxed and spontaneously reduced the night when all this started. This may have resulted in a cartilage injury. Possible cartilage injury= MRI :-(

The good news is that he really doesn't think I could have damaged any labral tissue, since it has all been debrided! The good/bad news is that oftentimes the labrum sort of regenerates and you get a nice layer of fibrocartilage there, not quite as good as the articular cartilage labrum, but better than nothing. the bad news is that this may have been injured. Again, possible regenerated labrum injury= MRI :-(

So, as you may have imagined, I have to have an MRI. This will be my 4th, yes, 4th hip MRI in 2 years!

He wanted me to get it tomorrow or the next day, I have soooooo much going on this week between ballet recitals, Pre-K graduations, end of the year parties, parents visiting....this was not a possibility. Luckily (for me), the hospital is booked solid for MRI's for a week and a half, the next available appointment was next Friday @6:00pm. This doesn''t work. Monday and Tuesday I have full day continuing education courses, so Wed, July 1st is the first day I can go. Deep down, I think I am hoping the pain will go away and I can cancel it. I am also looking to score some tranquilizers before I do it LOL!!!! I will have to read back on my surviving MRI tips if I go through with this!

Here is a clip from L's recital. She is the one in pink in the middl.

Making Headway???

This whole thing has me extremely upset and anxious (which is why I can't sleep at 10:30 when normally would be passed out). I "broke down" today and called Dr. Kelly's office. I am just so confused as well about this.

We spoke this evening, I explained what I did (or lack of "did"). He thinks its possible that my hip may have 'slipped', so I should get an x-ray. Its also possible that my extremely tight psoas (yes, it's very tight and snaps) may have been put into a lot of tension when I was sitting indian style and could have irritated the joint. There could be synovitis. Also, by addressing the FAI surgically, the cartilage can soften making it more susceptible to injury.

So the plan is to see him (he was sooo nice and accommodating) and get an x-ray. I am juggling my schedule in my head trying to figure out the best way to do this. Friday is looking good. Hopefully, the x-ray will be ok, and my joint didn't shift or move or slide (not sure what the solution is to that), then an MRI (shoot me). I asked him if he thought an MRI would show anything at this point, he said it would show an acute injury or inflammation or synovitis. Then, maybe an injection. I'm not taking any anti-inflammatories bc of my other issues (Crohn's disease), and haven't taken anything for pain, but was reminded tonight that Tylenol works great for me.

J thinks I am overreacting and had the audacity to tell me I have a low tolerance for pain. Need I remind him I just had a baby without any drugs at all, as well as the lack of drugs I ever took pre-op. Yes, I am freaked out, but after all I went through, I REALLY can't go through it again.

Speaking of J, he is down 100+ lbs

This Really Can't Be Hapenning To Me

I am still in pain. It has been 3 days and no relief. Yes, I am completely freaking out. This is not supposed to happen.I am supposed to live "happily ever after".

I feel a lot of the achiness and soreness in the groin that I have had in the past, but luckily, the sharp (impingement) pain is not there. Synovitis? Psoas tendonitis? labral re-re-tear? I have no idea, but I am scared.

What am I going to do? I'm not sure yet. should I call BK? I am not in the mood to deal with office shit and waiting days (weeks?) for a return phone call. I also will not have an MRI at this point. I think it would show nothing, regardless of whether something is there or not given the vast amount of work I have had done already. Maybe it is early onset arthritis, I should get an x-ray, especially since I have never had one done post-op. what I really, really want is a cortisone injection (not sure into what though) to get the magical pain relief it has provided me in the past!

I will keep you posted!

Anyone have any Ideas????

It has been 1 1/2 years since my last hip scope and as you can see, things have been great! Last night, I was sitting indian style on my bed, feeding Z, I went to get up and had an awful stabbing pain in the right hip (revision side). I ended up going to sleep in the middle of the movie that J and I were watching, not because the pain was unbearable, it is more of an annoyance. It is starting creep up in intensity as I sit and write this, and when I try to cross my legs it hurts. I have no idea what is going on, no energy to really think too much about it, less energy to apply my own professional opinion to it (Z is not sleeping through the night yet, but he is soooo cute, 20 lbs of solid cuteness), but need this to go away. Anyone care to give their opinion?

J's Update

I think a while back I mentioned that J was complaining of hip pain. It has been bothering him again, and pretty bad, so he finally has allowed me to make him an appointment to see Dr. K. I can't help but laugh (really hard), but really, its not so funny! I think he may have bilateral FAI and torn labrums. I hope he can get an appointment soon because I don't know how much more complaining I can take!!!

Another "Jeff" Update

My brother is now about 2 1/2 months post-op. He is running, swimming and playing doubles tennis. This is after hip arthroscopy for cam and pincer FAI and a torn labrum (debridement). To add "insult to injury" (bc hey, I was soooo not even close to being this active at 2 1/2 months out) he went skydiving this past Sunday and had no trouble whatsoever! I think he is in the clear to call his surgery a success!!!

On another positive note, J is now 6 months post-op from his surgery and down 96 lbs!!! Here we are celebrating his 29th b-day! Looks like Z is more interested in the cake than anything else!

A Gross and Rainy Day

For those of you who live in the Northeast, I need not tell you about the dreary weather we have been having. It is cold and wet and just gross. Occasionally, when this happens, my hip will flare up. Not so much the actual joint, but minor problems I have had along the road to recovery seem to rear their ugly head on days like this.

The biggest problem is my residual nerve damage. If you remember way way back, after hipscope #3, I had a large patch of numbness on the front of my thigh. This slowly went away but was painful at times. On days like today, I have a lot of pain and soreness along the front of my thigh. It is also tender to the touch. I assume there was some sort of trauma to my lateral femoral cutaneous nerve and it is not fully healed. Will it ever be? Who knows.

I also had a bit of adductor tendonitis today, which I assume is also weather related. So this morning I was not a happy camper in hipville. Things have since calmed down and I am back to status quo, but it makes me wonder if this is something I will have to live with forever.....

Some Pics

I know I have been MIA for a while again, but all things hip continue to be good! I promise an update on my brother this week (ok, I promise to try). Here are just some pics of what has been keeping me busy, plus, I was just away for a week and a half in Miami!

This was actually my carriage as a baby. all 3 kids have used it for the first few months when they sleep in my room!

L at the Clinique counter

Life is Good!!!

Yes, I give my 3 month old cereal to get him to sleep through the night!

ICD-9 and CPT codes used for Hip Arthroscopy

Many people have been asking me what kind of magic I used to get my surgery paid for...well....none really. I think the OS office has a lot of experience dealing with it and billing correctly. My OS was also in network, which took a lot of headache away from this.
Below are the codes used for all 3 surgeries. Maybe one day in the distant future, if I find myself with some time on my hands, I will look up the up and add the name as well. For now, this is the best I can do...
And a link to an older post of what exactly was paid for each surgery

3/5/2007
CPT
29862
27120
29863

ICD9
719.45
738.6
718.85
715.15


7/2/07
CPT
29862
29863
27120
27179

ICD9
719.45
738.6
732.2

11/12/07
CPT
29862
29863
27179

ICD9
719.45
732.2

Another interesting article

I came across this article this week, and if I remember how, I will add it to my "article" file.

Acetabular Labral Tears

Paul E. Beaulé, Michelle O'Neill and Kawan Rakhra

J Bone Joint Surg Am. 2009;91:701-710. doi:10.2106/JBJS.H.00802

A few key points:


Current Concepts Review
Acetabular Labral Tears
By Paul E. Beaul´e, MD, FRCSC, Michelle O’Neill, MD, FRCSC, and Kawan Rakhra, MD, FRCPC
-Acetabular labral tears rarely occur in the absence of a structural osseous abnormality.
-Labral tears are frequently associated with lesions of acetabular cartilage such as delamination.
-Hip arthroscopy is the preferred operative approach in the treatment of labral injuries in the absence of substantial structural osseous abnormalities.

"Despite the recent advancements in imaging as well as
operative techniques, patients are often misdiagnosed. In one
report, it was documented that patients visited, on the average,
3.3 health-care providers before being correctly diagnosed with
a labral tear and waited an average of twenty-one months for
the diagnosis18. More importantly, 33% (twenty-two) of sixtysix
patients received an alternate diagnosis prior to being diagnosed
with a labral tear. In addition, the lack of a complete
understanding of the function of the acetabular labrum as well
as its anatomy has made treatment recommendations difficult
to establish"

"Lage et al.7 described four categories of labral tears based
on etiology.
1. Traumatic, based on a clear history of hip injury and
the subsequent onset of symptoms. More recently, a traction
injury of the labrum by the iliopsoas tendon has been reported
in some cases40, with the intra-articular portion of the iliopsoas
tendon noted to be attached to the labrum in those cases.
2. Congenital, based on the presence of acetabular dysplasia,
defined as a center-edge angle of <25>1041-43.
3. Degenerative, based on radiographic evidence of arthritic
changes, such as joint space narrowing or osteophytes,
or the identification of severe chondral damage at the time of
operative intervention.
4. Idiopathic, based on the absence of any other findings."


"However, three recent studies in which the presence of
osseous abnormalities was retrospectively examined in patients
with a labral tear demonstrated that the majority (49% of
seventy-eight, 79% of ninety-nine, and 87% of thirty-one17,44,45)
had an osseous dysmorphism consistent with femoroacetabular
impingement. It would thus be more appropriate to rename
the so-called idiopathic group femoroacetabular impingement.
Ganz et al. described two mechanisms of femoroacetabular impingement
15: pincer type secondary to acetabular overcoverage
and cam type secondary to a lack of femoral head-neck offset
(Fig. 2). In pincer-type impingement, repeated contact between
the femoral neck and the prominent anterior aspect of the acetabular
rim leads to initial damage of the labrum36,46 and often a
contre-coup lesion leading to premature wear of the posterior
articular surface. In cam-type impingement, abnormal jamming
of the head-neck junction causes an outside-in intrasubstance
avulsion of the labrum from the adjoining acetabular cartilage
15,36"


Diagnosis of Labral Tears
Clinical Evaluation

"In the majority of patients, the chief symptom is anterior groin
pain made worse by long periods of standing, sitting, or walking.
The pain can also be referred to the gluteal area or the
trochanteric region. The onset of pain is usually insidious4, with
the patient often unable to recall a specific traumatic event9. In
one study, only 9% (six) of sixty-six patients with a labral tear
had a major traumatic episode as a causative factor18. The pain
is often sharp in nature and aggravated by activity such as
walking and pivoting on the affected side. The presence of
mechanical symptoms such as clicking and catching is highly
variable and not necessarily indicative of intra-articular hip
pathology9."


"On physical examination, the most reliable sign of labral
pathology is pain reproduced with flexion beyond 90 combined
with internal rotation and adduction4. This is referred to as the
impingement sign"

OMG I haven't posted in a long time

Wow, it's been a while! Zach is 7 weeks old today and keeping me busy! Luckily I have great help!
(I have no idea why that is underlined but I can't seem to change it)

I wanted to post last week but never found the time! My brother had his hip arthroscopy last Monday. This has been a problem for him since last April. He had very similar symptoms as me, except that he is extremely athletic and I, well, am a mother of 3 with a job! His surgery went well, and he had a torn labrum, synovitis, cam and pincer FAI. Sound familiar? Weird that we both have (had) cam and pincer.

He stayed with me for 5 days after his surgery and then flew home. My mom was here too. Just so you have an idea of how well he did post-op (or how poorly I did), every time someone called my mom to ask how he was, I always heard her say "He is doing great, so much better than Susie ever did!"





Ok, so I don't do that well immediately post-op, I have a "thing" with drugs, we just don't get along! But long term, I did kick ass, if I do say so myself!!!





So, at 7 weeks post partum with a rather large baby, my hip joint is still great. I did start having some adductor and flexor tendonitis a few weeks ago. I am not sure why. I have in the past developed SI joint issues a few weeks/ months postpartum and I wonder if it is related. The pain is the worst when I "wear" Zach. Yes, I am a "baby wearer", currently in a Storchenwiege wrap.

Yep, Zach is inside the blue fabric, sleeping soundly, at 1 month old, at Disney World!

So all in all, I can say that pregnancy and delivery have not had a negative effect on my hips. I am confident that the tendonitis will resolve (I forgot to mention it is only on the right (revision) side). Exhaustion is kicking now.....

Welcome to the World Baby Zach

The Birth Story

With my due date quickly approaching and night after night of false labor (16 hours one night), I was losing my patience. I was uncomfortable, swollen, out of breath and in pain a lot of the time. I took an unofficial poll of my friends on facebook to see how they suggested I get this baby out. Castor oil and sex were the top picks, sex had not worked up until then. So J went out to buy castor oil. I was nervous about taking it, it hadn't worked for some people, others threw up from it, but I needed to do something. I had also asked my doula abt it and she didn't seem to recommend it unless you are facing an induction with pitocin.

So once the kids were in bed, J mixed 4 tbsp of castor oil with a small amount of ice cream. It wasn't as bad as I expected and I would recommend the ice cream method to anyone thinking of trying it. 2 1/2 hours later I threw up. I was disappointed that it hadn't worked and was not willing to try it again. About an hour later I realized that I had not thrown it all up and what was in me began to work. After several trips to the bathroom, it had done its job.

I went to bed around 11. At midnight I was having some contractions but was able to sleep and kept remembering all the false labor I had been having. At 2:30 I got up to go to the bathroom and began having awful back labor with the contractions 4-6 minutes apart and lasting about a minute. This all started very suddenly with J insisting the contractions were very close together. I called my doula who suggested we meet at the hospital rather than at my house. The contractions kept coming, now abt 3-4 minutes apart.
We just grabbed my bag and left, I decided I would be better off on the floor in the back of the car on my hands on knees with my body pillow. As I got into the car my water broke. J raced to the hospital and actually had a cop pull in behind us at the hospital but I guess we were excused! The contractions kept coming quickly.

On the way to labor delivery I had 3 contractions. Once we got into the room, they kept coming. I went into the bathroom to change into a gown when I had another contraction and felt the head coming down. The nurse wanted to check the heart rate but I was in too much pain to lie on my back in the bed. I got onto my hands and knees and she tried to find the heart rate, she said it was too low and I should change positions. Turns out she was picking up my heart rate bc the baby was so far down.
He then decided he was ready to be born and was "caught" by the nurse. My doctor didn't make it in time! It was the best birth I have ever had, which have included a c-section after a failed version, a vbac with epidural and pitocin and some tearing. It has been 30 hrs since he was born, I feel great, am sooooo ready to go home.

The big question that belongs on this blog......how are the hips? Remember, my first ever groin pain came right after my last delivery, with the epidural, feet in stirrups, hips being forcibly flexed. This was so fast there was none of that and I feel absolutely no hip pain today at all.

I will continue to monitor in the coming weeks but I am pretty sure that I was able to have successful hip arthroscopy followed by a pregnancy only 5 months later. So yes, it can be done. On a side note, if you are able to I highly recommend getting a doula for birth, it was such a great experience, even though I only used her for a short amount of time.

Its a Boy

Born Jan 12 at 4:30am, 8lbs 7oz.
Name and birth story to follow.

Weight loss Miracle

I thought I had posted this already but it seems that in the midst of a few winter storms and 2 preschoolers in the house, I actually did not.
J is now 5 1/2 weeks out from lap band surgery. The way lap band works is that for the first year you return to the surgeon monthly for adjustments to your band, to tighten it so that you feel some restriction. J's first scheduled adjustment was this past Fri. When he arrived, he saw the PA who could not believe how much weight he had already lost (just about 50 lbs). She said the average is 2 lbs per week, he is at around 5 lbs per week (since the surgery). She was so impressed that she called in the 2 surgeons who were in the office that day to see him, who were also blown away by his progress. They said they haven't seen this kind of result in a long time, if ever. They want their research team to contact him about it! He is soooo happy, as well as relieved that he avoided an adjustment that day!

He is still complaining of hip pain though. I am not sure if he should continue to wait a bit and lose more weight before addressing it, or get, at the minimum, an x-ray now. Actually, I am not sure how much whining I can take at the moment, so my patience may dictate how long he waits!!!

In the baby world, I have been having mild contractions/ cramping for a day and a half. It is nothing serious, more of an annoyance. I was at my OB yesterday who thinks it may be because the head is super low, but she would ideally not like this baby born for another 2 weeks. My bigger concern is that she is going on vacation on Saturday for a week, so if this baby is coming soon, it needs to come before Sat., or wait another week!!!

HSS non-hip Visit Follow-Up

This past Thursday I took Jk back to his OS for a follow-up on his elbow. At first, the doctor went over the old x-ray and said he was still not sure what exactly was going on with his elbow but we should go get a second x-ray, if it didn't show bone healing, he would need an MRI. So we went down the hall, got the x-ray and came back. Thank goodness it showed that it was a fracture (as opposed to an infection or (no I am not joking) a tumor) and he is fine. It is healing nicely and the bone is filling in. He can also stop PT now! Hurray! My guilt is slowly starting to lift and I am becoming slightly less neurotic about him getting hurt!

What Goes Around Comes Around

You are not going to believe this......J, who is down over 40 lbs was lying on the couch last night and out of the blue says to me "you know, my hip hurts". WHAT.
So, by now, he obviously (one would hope) knows that "hip pain" is groin pain, and not pain on the outside of your hip, butt or thigh. But I reply "Where does it hurt", and he takes his index finger and points to that spot, you know the spot, right in the groin. THE spot. I couldn't help but laugh. Really, it is funny. "And", he added, "It hurt when I was walking to the train and it clicks". More laughter from me.

He was still lying on the couch. I told him to bring his knee up to his chest, I think he saw stars! When I had him turn the knee a little more to his opposite shoulder, he saw even more stars. I can already see where this is going and I am not prepared to handle it right now!!!!

Pain(s) in the A$$

34 weeks of pregnancy seem like an eternity, I am wondering at what point I can safely begin hoping to go into labor. Maybe 2 more weeks? I have an ultrasound scheduled for next week, to confirm that the baby is still in proper position and hopefully get an estimate on size. Maybe if it is really big I can will it out quicker!!!

I have been having a ton of ITB pain every night. It begins high, and will start with piriformis pain/spasm and travel down to my TFL and down the entire length of my ITB. It is horrific. It happens every night now when I "slow down". Walking helps the most but, hey, I need to sit down at some point. Interestingly, it is only on the right side (revision side). I also have been experiencing bolts of nerve pain at times, mostly on the right, that occur sometimes when the baby moves. This is why I have decided that it is a big baby! My first was 7 lbs, second was 8lbs 4 oz. If this one is going to also be a whole pound and 4 ounces bigger, we are looking at a 9 lbs 8 oz baby. I hope the trend does not follow!

What I am sort of hoping for is that my pelvis is beginning to separate and the muscles that attatch to it are trying to stabilize it, thereby going into spasm and causing me excruciating pain! I also have bouts of adductor pain but not as often.

J, who is down 42 lbs since surgery, has become an expert at ITB massage (it took him a while to figure out who to go with the fibers as opposed to across the fibers), but sadly, it does not help that much.

Jk has been in PT 2x/week for 2 weeks for his little elbow! He loves going and his ROM has improved. We are concerned about some possible swelling and bruising as well as lack of supination. He will be back at the doctor in a week so maybe they will take a repeat x-ray.

My brother has failed in PT! He still has pain and decided he needs surgery. He finally scheduled it this week and was given a surgery date of Feb 23rd. I know, 2 1/2 months away, crazy. But he is fine with it and doesn't wish to push for something sooner, so I won't either!

Another day spent at HSS...but not for me!

Being the mother of 2 sort of crazy kids, I count my blessings that we have never had a serious injury or required stitches, though we have been close on more than one occasion. About a month ago, my nanny mentioned that she thought Jk hurt his arm in the tub. When I asked him, he said he had a booboo but L had done it. He seemed to be alright, playing, climbing, jumping, throwing himself off of the couch etc. IT really only seemed to bother him if you touched his elbow and if you got him dressed too quickly. So I have been careful getting him dressed and sort of been keeping an eye on it.

Last week my nanny got mad at me and said the arm is not better and I have to take him to the doctor. So I did. First, I made an appointment with someone who I thought was a great pediatric OS and have even had friends use, but he did not take our insurance. I made the appointment anyway (the consultation fee was $350) but J freaked out and demanded I find someone in network. His rational was that we don't even know if anything is wrong, figure it out first and if there is really a problem, we can explore other doctors. Fine. So I found someone.

We went on Thursday. He found that Jk couldn't really extend his elbow all the way and said it was either fractured or he had a subluxed radius (nursemaids elbow). So off to x-ray we went. What was nice was that it was a whole pediatric floor, so the x-ray tech dealt only with kids, the nurses dealt only with kids, and there was even a nice lady handing out snacks for all the kids. It made me feel better about having switched to this OS.

Jk was so good during the xrays, he sat nicely and put his hand where it needed to go, and he was rewarded with tons of stickers! He couldn't have been happier. As soon as we got back to the doctor's office (right down the hall) he came in to look at the x-rays, and lo and behold, a fracture.

Shit. What kind of mother am I, my kid has a broken arm and I had no idea. He said it was too late to cast it, but he is pretty sure the olecranon (proximal end of the ulna) is fractured, as is evidenced by new bone growing and some soft tissue swelling, and Jk needs PT. The mechanism of injury must have been him landing on or hitting his elbow on something. Obviously this is most likely. If he is not better in a few weeks he will need an MRI, which becomes a huge ordeal because he needs to be put to sleep.

I wasn't quite sure what to do about the PT thing. He needs the kind of PT I do, and that we do in my office (orthopaedic) but we don't generally treat kids that little. I have a lot of friends who are pediatric PTs but they treat mostly developmental delays and torticollis, and they don't take private cases. We have one pediatric PT in my office but I was not even sure what she treated. So I frantically called her and she assured me that she would love to treat Jk and she has done this a lot, and that it is a very common injury.

So he has his first PT session on Tuesday. I also have an OB appointment that day, and he has a special enrichment program at school for Thanksgiving. I see the next few weeks looking something like that, running around from PT appointments, to OB appointments, to swim lessons, to OS appointments!

Never a dull moment here!

1 Year Revision Anniversary

It has now been one year since my last (and final) surgery. How the time has flown. What a great feeling it is to know that my surgeries have been successful and I have no limitations from them in my life.

The joint feels perfect! I will have a post-op x-ray at some point after the baby is born to check for signs of arthritis or anything else, but I suspect nothing will turn up. I do occasionally battle some muscular issues, which I mention on this blog when they come about. Like currently, my ITB is not too happy, but again, who knows how much of it has to do with my actual hip joint and how much has to do with being 7 months pregnant. Since I got pregnant so soon after surgery, many of these questions will remain unanswered. The only question I can answer is that 3 hipscopes have not really affected this pregnancy. I do have significantly more swelling in my feet than I have had in my previous 2 pregnancies, but a) it is unclear whether it is directly related to the hipscopes and b) in the grand scheme of things, it is merely an inconvenience.

In other parts of my life, J's surgery went extremely well last Monday. He is already down 32 lbs since beginning the 2 week pre-op diet, and having been "banded" for 6 days. My brother has been in PT for about 5 weeks with no change in his pain level. He does report feeling stronger though. He has decided that he probably wants surgery. My only request to him was that he PLEASE call Dr. Kelly and discuss this ASAP because I would really appreciate it if he had the surgery before the baby is born. He has yet to call.

Jk will turn 3 this month, marking the 2 year anniversary of when my hips "fell apart", a lot has happened in 2 years!

Many of you have been sending me questions by posting them on older posts. I will usually read your questions and then forget to write back! If you would like a response, your best bet is to email me directly suzq613@aol.com

J's Surgery

A few weeks ago I tried to start a second blog about J's upcoming lapband surgery but realized that I barely have time to maintain this blog and answer all of your posts and questions, so nixed the idea. But things have been kind of stressful and crazy around here in anticipation.

See, in order to have lapband surgery, there are many hoops to jump through (much more than I could have ever imagined, and so many more than for a hipscope!) He finally attended a seminar given by the surgeon, obtained 6 months of medically supervised weight loss, saw a psychologist, saw a nutritionist, had a physical, saw the NP at the surgeons office and finally met with the surgeon. This over a course of 17 months. (I remember going to the seminar with him on crutches).

Part of the drama has been dealing with a semi-incompetent surgical coordinator at the surgeons office (who definitely hates me). At the time that we scheduled the surgery, she thought we would have a problem since J's 6 months of documented weight loss did not have an entry for the month of March, rather one at the end of Feb ad one at the beginning of April. Imagine waiting that long, and going through all of that to be told that this tiny little glitch would bring this entire, delicate house of cards crashing to the ground.

Being that I have assumed the role of "project manager" with his surgery, I quickly (and quite hysterically) called the insurance company to straighten it out. I was told that this indeed may pose a problem, but they would do their best to get this approved. The next day I received a phone call telling me that the surgery would be approved! YAY!!

When we left the surgeons office, we were given a packet with instructions (that the coordinator hastily went over with us) but were rather unclear and quite confusing. J had to have his medical doctor fill out some paperwork approving him for surgery which he was to take to the pre-admission testing. Pre-admission testing would fax it to his medical doctor who should fax it to the surgeons office. Retarded? I think so!

This past Tuesday I received a call from the woman in charge of collecting the aforementioned paperwork, looking for approval from J's medical doctor for the surgery. I informed her that it was on page 22 of the fax that had been sent to them (I am not kidding about being "project manager"). Everything seemed like it was all set to go.

Friday morning (the final business day before his Monday morning surgery), the surgical coordinator called me and told me she was missing the medical clearance form fro J's medical doctor. Shit. I told her to look for that page 22 letter again. She informed me that this was not good because it was dated prior to the pre-op testing.

I hit panic mode, and yelling mode. How the fuck did they not realize until THE DAY BEFORE THE SURGERY that they were missing this quite important piece of information. J was having trouble getting through to the doctors office, I was yelling at the surgical coordinator in between patients. It was quite a sight. She needed the paper by 3PM. At 2:25 she did not have it, J was frantically leaving messages. At 2:28 the surgical coordinator called me and said that they would just go with the original letter they had. At 2:33 the fax went through.

So now we are 19 hours away from surgery. Unlike me, J is not frantically cleaning closets or getting a mani-pedi! I will keep you updated!

This is HOT!!!

Clearly what you have in mind is NOT what is on my mind right now! If you could see the box that these stockings came out of, you would see that it reads: "Recommended for: tired and aching legs, swollen and minor fatigue, minor heaviness".

I was at wits end today, my ankles no longer exist. They have been replaced by what used to be "cankles" but today became fat feet oozing out of shoes, to put it gently. I was no longer able to stand on my feet, much less walk and function, so I broke down. I had a quick break at work and literally raced to the nearest surgical supply store in search of these. Sexy, right! Mine are black!

I found the store, ready to buy my super cool, black lacy stockings (with moderate compression), and imagine my surprise to find that it is "manned" by 3 old men. Imagine walking in Victoria's Secret to find THE outfit, and have men helping you.

Well, maybe that is an exaggeration, but eww. Plus, there was no one else in the store, so all 3 were "helping" me.

Once we all determined what I needed, I happily left with my new piece of wardrobe, ready to attack all orthopaedic ailments that would walk through the front door of my office. I grabbed the bag, ran tot he bathroom to put them on, and to my horror, there was a brown pair in the bag. Shit.

So another 2 hours of tortuous leg pain got me through the rest of the day so I could make another run for the store. This time, there was only one old man working there, who politely informed me that they were "final sale, and no returns". As usual, the patheticness of my situation made him feel sorry for me and he quietly swiped the brown pair for a black pair. I also ended up purchasing a knee high pair to wear at home, when no one is looking!

I am not sure why I am having this much swelling, but it is pretty bad. (Bad enough for me to buy compression stockings!). I have an OB appointment tomorrow, I am hoping that this is a problem limited to my feet and legs, and will resolve in the near future. There is always the little voice in my head asking if there is a lymph issue from my surgeries, but since it was not a problem when I was not pregnant, I am confident that it will clear up after this pregnancy!

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!!!

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!

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
http://www.orthosupersite.com/view.asp?rid=32004
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.
Procedures
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.
Reference:
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......

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!