Meeting Dr. Zaltz

This is what my knees look like when my feet are pointing straight forward. This is due to my femoral anteversion.


It is June 29th and the day I finally meet with Dr. Zaltz. My mom went with me to Royal Oak (Detroit) since Todd was working. We left with enough time to eat before the appt but I was just too nervous to eat more than two bites of my lunch. We arrived at his office at 12:50 for my 1:00 appt and I think I finally saw Dr. Zaltz at 2:15 or so. Immediate relief when he came into the room and introduced himself. He is so down to earth, friendly, laid back, smart, honest, humble, you name it! I really, really like this guy! He looked at the xrays that his office just did (while I waited to see him), and wanted 2 more xrays after a little conversation and examination. Once that was done, he told my mom and me that my left hip was very shallow and unstable and reduces nicely (apparently one of the xrays shows reduction; some special angle he has patients do) but that he thinks the right hip is not only dysplastic but also has severe femoro-acetabular impingement (FAI). The angles on the left are 0 and 5 (high grade dysplasia), while the angles on the right are 18 and 20 (low grade dysplasia). This has to do with coverage of the socket (anteriorly and laterally) over the ball. Apparently, during the exam he couldn't get my right hip to flex past 90 degrees and I have no forced interal rotation and very little forced external rotation which is why he thinks there is impingement. My head neck offset is very decreased meaning I have cam impingement (or femoral sided impingement). My socket, while shallow, has a high cross-over sign or slight retroversion (indicating a small pincer impingement). The left hip however, has lots of rotation and crazy range of motion which is why it's very unstable. He also mentioned tibial torsion and femoral anteversion bilaterally (thus the knee pain). He is proposing periacetabular osteotomy for my left hip and not really sure what he wants to do with the right hip yet. He mentioned osteoplasty, hopefully by arthroscope, but wasn't sure if he could do it by scope and may have to do open surgical dislocation to fix the problem. I asked about my low back/SI joint pain and he explained that with these types of hip problems, back pain is common, usually due to compensation. I also asked him about pregnancy before surgery and he recommended surgery sooner rather than later to preserve the hip joint so I wouldn't develope arthritis and need a THR. So, no kids til hips are surgically repaired then, okie dokie. I also asked what would happen if I just didn't have the surgeries done and he responded that I could continue to have worsening pain and eventually arthritis, possibly as soon as 5 years from now needing a THR, although not typical. Not exactly what I wanted to hear. So, I elected to go ahead with surgery. He said it was up to me which hip to do first, depending on which gave me more pain, but they both hurt me equally in their own way. He ordered a CT reconstruction scan and MRI with arthrography (dye injected into the hip joint to view the soft tissue structure really well; tears, cartilage damage, cysts, etc) and stated that once those reports came back we could make a decision then on which hip to do first as they would tell us which one was worse internally. I had a 4 page list of questions for him and he answered all my questions patiently and honestly. He never once made me feel rushed or insignificant. I figured that if he was the only surgeon in the state that did this surgery, then he would be a complete jerk, you know? But he's not, he's really quite sweet and has a great sense of humor and a real knack for people. So, my mom and I headed home at about 4:30 that afternoon (yes, he really spent 2 hours with us. Unheard of in my book!) and I read over all the information pamphlets he gave me about 20 times :) Next on my agenda - schedule my MRI/MRA and CT scans.
Scheduling those tests were a pain - not only do I have to drive back to Detroit (3.5 hours away) for each test, I can't even do them back to back or one day then the next so I don't have to make several trips! So now I have one appt scheduled for this month, one for next month, and then finally the follow up with Dr. Z in September to discuss the results and schedule for surgery. That is such a bummer. Oh well, at least that's all out of the way. Dr. Z told me at my appt with him that he's booked through October for surgery right now, so I'm hoping that once I see him in September that he'll have an opening for right after Christmas for me. That is my plan anyway. I have my 6 week follow up appt with Dr. H on Tuesday, so it'll be interesting to see what he has to say in all of this. I will likely ask him for a 2nd (3rd?) opinion about my right hip as I am totally sure about the left. The right one has me confused though. Oh the drama of hips...