Archive for Appointments
Hip Arthroscopy Recovery 2 Weeks
Posted by: | CommentsYayyy, had my post op today and finally got the sutures out. Still not allowed to swim for another week which is a bummer.
Mr R went over all my pictures with me and showed me why he had to do what he did, looks a mess compared to the last time. Can plainly see the CAM lesion, herniation pits and calcification. Thankfully my cartilage is great and I should have a full recovery, however he is unsure of how the labral resection will affect the hip in the long term as there is still debate as to its proper function.
Got the OK to start cycling on a stationary bike with high seat (to minimise flexion) and have made my first physio appointment for next Tuesday. I am allowed to start running when I can do a single leg squat, hopefully by January.
No flexion with abduction for a further four weeks due to the capsulotomy, I can handle that…dunno bout ‘H’ though 
1 = First view of the joint and inflammation.
4 & 5 = Calcified labrum.
6 = Image showing what is left of the anterior labrum and calcification.
7 = Knife cutting labrum from acetabulum to attempt repair.
8 = After anterior labrum removal (fell to bits upon detatchment).
10 = View across femoral neck showing no offset, it should have a dip in it. (Acetabulum on the left)
11 = Herniation pits and chondral damage to femoral head. (Acetabulum on the right)
12-14 = Removal of CAM/Ganz lesion with motorised burr. (Acetabulum on the right)
15 = Finished CAM removal. (Acetabulum on the right)
These are the images from my first scope two years ago. As you can see there has been a lot of degeneration since then.
Operation Report
Mr John Rietveld @ St Georges Hospital, Christchurch, New Zealand.
Left Hip arthroscopy and debridement of labral rim which had some calcification within it, unfortuantely there was no repairable labrum here and resection of significant prominent head/neck junction.
The patient was anaesthetised and the left hip was prepped and draped in the usual manner to give a sterile field. The image intensifier was used and a 2 portal arthroscopy was undertaken. The findings showed that the labrum anterior was pretty much redundant and it was actually really just part of the acetabulum where the ossification within it, there was a small area of calcification in the anterior labrum and the labrum adjacent to this was lifted. I tried to take this down with the knife but unfortunately there was only a couple of millimetres thick and with the calcification it just fell apart, therefore I resected this with the wand. I then inspected the head and found that there was a significant area of chondral damage on the rim, then marked this area where there was a lack of head/neck offset with the wand and then used the burr to resect and recreate a head/neck offset. Following this I ran the hip through a full range of motion both with the image intensifier and direct visualisation and found that it was no longer impinging. I thoroughly washed out the joint, placed some Nylon sutures into the portals followed by dressing.
Post op instructions:
Pain relief as charted, neurovascular obs, see in clinic at 2 weeks for removal of sutures and wound check, patient may mobilise full weight bearing.
After seeing all this do I think I’ve done the right thing?? ABSOLUTELY!!! I (and my surgeon) feel I have made the right decision and because I got rid of the offending anatomy and the rest of my joint is good, I now shouldn’t need an early hip replacement.
I am able to sleep on my operated side for longer periods now and can get up the stairs without the sharp groin pain finally. I can put my shoes on and tie them, though this still remains a little difficult and have managed to shave my legs!
I am off to Auckland tomorrow to visit Mum and her partner for a few days. I will be taking my crutches as I am still needing them for longer walks and if I have any sort of flare up I need to be able to get around. At least if I don’t need them they fit in my suitcase 
Oh, and drove for the first time today!
FEELING GREAT!
Hip Arthroscopy Recovery Day 11
Posted by: | CommentsI think things have plateaued a bit. I can manage around most of the house without crutches. I am still getting a sharp groin pain when pushing off on my op side going up stairs, so using one crutch for those but can manage coming down without. Trialled one crutch for walking a medium distance today (about 200m) and discovered that I am still relying on it quite a bit which makes my shoulder sore. I over-extended at one point which had me seeing stars and unable to flex hip for the walk back (felt like something was stuck in the joint), thankfully this settled by the time I got home, so back to two crutches for walking for now, boo. Good thing is, I have gotten a lot better at using them and it’s not quite so exhausting!
Good hip has been slightly troubled, and if I’ve taken any painkillers in the last couple of days it’s been because the good one is aching. Not that I’ve been out doing anything, I’ve gotten to know the couch very well! It must be all the sitting.
I had ‘the meeting’ with my case manager from ACC. It went well, just had to sign a mountain of paperwork and fill in a musculoskeletal pain questionnaire to keep them happy. (Orebro or OMPQ, for you physios out there). Not very exciting but she did mention that she’d read my op report and was surprised that I was able to get around as well as I am. She is going to post me a copy as I mentioned I hadn’t seen it yet!
I am dying to get the stitches out (3 days and counting) and start some form of rehab. There is a woman’s bike race at the end of February with a flat, short course (37km) available and I’d really like to be able to participate in it. My sights might be set too high but at least it is a goal for now to at least get back on my bike in the new year.
I forgot to send out a HUGE thank-you to Nicky for her amazing box of goodies that arrived for me on the morning of my surgery. What a lovely surprise, full of chocolate, things to do, hand cream, lip gloss, wet wipes, cat toys and treats, my goodness I was totally blown away. I have to say my favourite item has been the laser pointer, if ever I need a laugh and a cat is around, they go berserk! Thank you also to everybody else who has messaged, visited and sent well wishes, every single one of you have brightened my day!
Hipscope No#2 On The Cards
Posted by: | CommentsI saw Mr Rietveld today. He was bang on time and nice to talk to which was a relief. He answered every single one of my questions and I don’t think he thought I was too crazy lol.
He never received the notes from Auckland (surprise, surprise). So started by asking me what my symptoms are and how they started. With the hip pain after competing in the duathlon and the fall off my bike happening fairly close together it is hard knowing what caused the tear in the first place and when asked how long it took for the symptoms to kick in I simply couldn’t remember (it was 3 and a half years ago) other than within a couple of days.
He first looked at the MRI-arthrogram from August and located the now quite obvious labral tear that was not found during hip scope #1. This needs to be repaired.
Then had a look at the CT scan and immediately pointed out my problem on the first scan he looked at. CAM impingement. There is flattening of the head-neck junction anteriorly quite visible on the 3D model and on all of the radial scans. My jaw practically dropped to the floor when he said this without any hesitation as after staring at my images for hours I practically knew this was the problem and he is the first to actually confirm it without a ‘maybe’.
I had a brief physical exam that once again involved that horrible impingement test. It beats me why everyone wants to keep doing this if three people have already said it is positive. I have a positive impingement test on my right side also, but I won’t go there…it’s not causing major problems.
So he gave me three options…you can guess what they are:
1) Do nothing: reduce activity level, avoid squats etc. Not really an option if the pain is there when you’re not doing anything and not really an option if you want to be active.
2) Hip arthroscopy: Minimally invasive surgery, repair tear and cam decompression.
3) Open dislocation surgery: As above but with large incision, hip dislocation and a horribly long and painful recovery.
We came to the conclusion that my best option is to go for the arthroscopic technique. All of my impingement and labrum issues are anterior, there is no need to access the posterior joint and therefor no need for open surgery to avoid all those nasty blood vessels in that area.
The scope surgery will involve:
~ Two incisions.
~ Capsulotomy.
~ Labral tear repair (not debridement as in hip scope #1) – detachment of the labrum from the acetabulum, suturing the tear back together, resecting rim of the acetabulum 1-2mm to expose raw bone and reattaching the labrum with bone anchors.
~ Femoral osteoplasty to remove the prominent area of the femoral neck.
I have been told that recovery varies. Hospital stay is likely to be two nights. I could be on crutches two days, two weeks or longer (from what I’ve read on the forums, two weeks PWB with two crutches and four weeks with one crutch is typical). There is to be no hip flexion above 100 degrees for the first six weeks post op to protect the labral repair. Light swimming is permissible at three weeks post op with no pushing off the wall, physio and non-resistant stationary cycling can be started at six weeks. I will be put on anti-inflammatories to stop bone regrowth and will need four to six weeks off work (this could be interesting).
So it’s the waiting game again now. ACC has to approve surgery before I can book it. This may take 2-4 weeks but I have a lot in my favour (my age, accident-related injury, the fact they’ve covered everything up to now and the fact that this is on-going from the original injury/surgery). Mr Rietveld says it could go either way, but he will do all he can to get surgery approved as he feels it really should be. He also said that if ACC declined, he would do as much as he can to help with an appeal which is fantastic!
The surgical waiting list is 4-6 weeks at the moment so I could be looking at a surgery date in as little as six weeks, fingers crossed.
I am nervous but so relieved that the problem has been recognised. It is hard to believe even yourself now and then when symptoms come and go…one minute you are in agony and the next you feel completely normal…it really does your head in.
Pet Expo
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Boy, what an insane day today! One of my colleagues and I are helping out with the Dunkleys Pet Expo this weekend. We didn’t really know what we’d be doing until we got there.
We ended up working with VCA (Veterinary Companies of Australia) and we sold a tonne of product! From urine and stain remover to shampoo and guaranteed indestructible toys. Altogether a very successful first day and it was great to catch up with some old friends too.
I never gave any thought to how long I’d be standing in one place though…10am-5pm in practically the same spot absolutely wiped me out. I spend 6 hours a day on my feet at work normally, but it is different when you are running around doing things…surgery or going upstairs to tend to the cattery, then back to reception etc. I took some magic white pills with my lunch which helped to get me through the afternoon…tomorrow I think I’ll take some for breakfast too as we’ll be working the same hours.
I’ve been going to the gym a couple of times a week and try to swim once a week too. I have been finding it hard to get motivated lately. I did go for my first bike ride in nearly four months last Sunday and although I felt OK during the ride, just a little unconditioned, I felt awful afterward and was very sore…won’t be doing that again for a while. I’ve been getting the catching sensation in my hip again recently and also pinching in my groin on weight-bearing…the pinching is a new thing so I’m not sure if it is due to increased activity and inflammation, or whether my tear has gotten bigger. It is the same pinching I get with the anterior impingement test (flexion, adduction and internal rotation) and like the other problems comes and goes randomly. Ten days now until I see John Rietveld and I’m anxious to see what he says. I am working next weekend with a full cattery so get a short week and am also going to a fluff-themed party on Saturday night so I think the week will go fast!
Oh, we are now officially house-hunting again! Thanks to extremely generous family members we are fortunate enough to have the opportunity to move out of our crappy, leaky house and start a-fresh. Though we probably won’t be able to get rid of this place we will hopefully be able to repair what is needed and rent it out for a few years.