Wednesday, August 28, 2013

What they actually did to my hip

I went in for my post-operation 4 week check today.  Turns out, they did a lot more work on me than I had thought.  Not only did they stitch my labrum back down to the pelvis, they also had to 'microfracture' the socket of the joint where some cartilage had pulled away from the hip.  Here's the full text.  My favorite is that I now know that there is such a thing as "bone wax".

1. Femoral acetabular impingement, right hip.
2. Suspected labral tear, right hip.
3. Suspected chondral lesion, right hip.
1. Femoral acetabular impingement, right hip.
2. Chondral labral lesion, right hip.
3. Large chondral delamination acetabulum, right hip.
1. Femoral acetabular arthroplasty, right hip.
2. Repair of torn labrum, right hip.
3. Removal of chondral lesion, right hip.
4. Microfracture, right acetabulum.
DETAILS OF THE PROCEDURE: Following meeting the patient in the preoperative holding area and identification of the extremity to be operated on, the patient was brought to the operating room. Anesthesia was induced. The patient was positioned supine on the operating table. All bony prominences were padded. The right lower extremity was prepped and draped in the usual sterile fashion.
Utilizing a small anterior incision and modified Smith-Petersen approach, the hip capsule was exposed. An I-shaped capsulotomy was performed. The labrum was examined. There was evidence of tear from 10-12 o'clock position. labrum appeared to have ossification also. The slight ossification was removed. The labrum was reflected free of the acetabular rim. The acetabulum was exposed. There was a large chondral lesion at the 11 o'clock position, which was unfortunately full-thickness. The chondral lesion was removed. Microfracture of this region was performed. The hip was irrigated extensively. This was followed by repair of the labrum to the acetabular rim. 
At this point, attention was turned to the femoral neck. There was a large bump at the femoral head and neck junction, which was removed. Once adequate osteoplasty had been performed, the hip could be flexed 110 degrees and internally rotated 30 degrees. Bone wax was applied over the area of osteoplasty, followed by irrigation of the hip-and closure of the capsule and overlying tissues. A sterile dressing was placed over the incision.
The patient was then transferred to the postanesthesia recovery unit. The patient tolerated the procedure well and there were no intraoperative complications. Dr. Parvizi performed the entire procedure. Three Arthrex Biotech anchor sutures were utilized for repair.
For the near term, it means that I can continue letting pain be my ever-vigilant guide.  I've been cleared to do anything that doesn't involve high impact, like running or tackle football.  Fortunately, I've got a bike that needs some riding.   The pain should generally subside over the coming weeks and months, and I should see an increase in range of motion and strength after 6 weeks when the bone is fully healed.  The doctor said that 6 months is when the labrum should have reattached fully and any replacement tissue from the microfracture should be in place.  This means  I should be essentially back to 100% by February and in time to actually race bikes next year.  Cool.
Long term, this also means that I'm at a higher likelihood of needing a hip replacement down the road, but probably not untill well later in life.  Dr. Parvisi thought that some time between the age of 65 and 80, I'd likely need a new joint.  Not so cool.  Also, I'll need to keep an eye on my other hip for similar pain so that we can catch it early on.  If we had gotten this one figured out earlier, it wouldn't have required removal of that chunk of cartilage, which would be better long term.  Now that I know what I'm looking for in terms of pain, I can hopefully catch that one in the early stages and save a lot of pain and annoyance.

For now though, I think I'll focus on a nice easy bike ride this weekend.

Tuesday, August 13, 2013

Let Pain Be Your Guide

I am pleased to report that I'm limber enough these days to ride back and forth to work.  My leg still isn't really working all that well, but certainly well enough to make the 1.5 mile trek in to the Municipal Services Building from home.  The doctor said, "Let pain be your guide as to what you can do."

Turns out my pain management strategy involves bikes, surprise surprise.

Since I'm not supposed to be bending my right leg past 90 degrees while riding, some modifications were in order-- I added a stem extender which moved the handlebars up about 4 inches, and then added a 80mm stem which I turned around backwards.  

Position so upright that it would make a Pashley Roadster blush.

Tuesday, August 06, 2013


So, surgery went well I think. It's 7 days later and I am hobbling around pretty well without a crutch, though I still take one while walking to the subway and for longer trips.  I took last Tuesday through Friday off of work, expending some of my 42 remaining sick days.  An easy decision to make.  I had initially intended to go in to work on Friday, and probably could have managed it except for one critical oversight: poop.

I learned a valuable lesson in medicine this past week.  Opiates jam your shit up, very literally.  Since getting a drink of water was a pain, and going to the bathroom a bigger one, I didn't drink enough liquids on Wednesday or Thursday.  Also, I was enjoying the prescription of Vicodin that I was on, and the liberal instructions allowed me as many as 8 of those babies within 24 hours.  Well, as it turns out, that was dumb.  Friday morning I found that I had to take a poop but couldn't.  Not just a little constipated, but seriously impacted.  I've always had a pretty speedy digestive system, and this worked to my disadvantage this past week.  I spent the better part of the day on the toilet heaving and screaming and the like.  Look up "impacted stool remedy" and you'll get an idea of how things went.  I tried everything that they suggest on the websites and eventually succeeded to a degree, but gave myself a painful hernia in the process. Nice. The whole time I was sitting on the toilet I was paranoid that I was going to a) explode and b) wreck my surgery.  The one strict doctor's order was not to raise my leg to 90 degrees or greater if I could possibly help it.  I defy anyone to squeeze out a frozen cliff bar of poo with your legs at an obtuse angle.  Can't be done.

As for the surgery, I was in at 5 in the morning for pre-operation prep, was drugged up around 7 and was out of the operating room around 7:50 when I woke up to some paralyzed legs and a cozy hospital gown with heater built in.

It took about 6 more hours for the spinal anesthetic to wear off and for me to be able to move my toes again. Once that happened I was encouraged to see if I could move, pee and be on my way.  I still can't believe that i was able to walk out of the hospital some 9 hours after surgery.  Granted, I had crutches, and wan't particularly comfy at that point, but given that I'd just had hip surgery, doing pretty good.

What appeared in the MRI last month to be a torn labrum, actually ended up being a knob of cartilage on the ball of my hip and a matching cyst on the labrum.  Whenever I would bring my leg up to a seated angle, the knob of cartilage would bump into the labrum and throw my hip out of alignment.  This is certainly consistent with what I felt; it seemed as if I had a small gummy bear jammed in my hip joint whenever it moved.  Dr. Parvisi excised the nubbin and the cyst and put me back together.  I am supposed to let 'pain be my guide' and can start riding my bike as soon as tomorrow, if all goes well.  I'm going to make a test ride later this evening and we'll see how it goes.  Whee!