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.

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