Pre-op deja vu

Yesterday marked another long and tedious day in the car. It takes a total of 7-ish hours to make the trip to Detroit and back home for an appointment at Oakland Orthopedics. I thought I was going to have to drive alone which would have been really boring, but it turns out my mother-in-law was able to get the day off  work and come with me. I really appreciated the company because southeast Michigan just isn't as pretty as the west side of the state!  Once we got to the office, I checked in for a 3:30 appointment but did not get called back until 4:15 - 4:20 and didn't see Z until probably 5:00 or so. Undeniably he is worth waiting for and really, when you have a 7 hour drive, there isn't anything else you can plan for the day anyway, so there was no point in getting upset with the wait. He always makes your time with him like you are the only patient there, so even though you are waiting, you know you are going to get star treatment when it's your turn.

We treated this like a pre-op appointment only, even though I am due for a 6 month post-op check on the left hip, so no new xrays. He wants to cut down on radiation exposure and just do both hips at the same time when I have my post-op follow up for the right hip. Z asked how my left hip was doing and I told him it is doing awesome! He checked my strength on the left hip by pushing on the leg in various directions with me resisting and I passed. He also had me tighten my quads while feeling the muscles, to see how the left quad was firing and felt I needed to strengthen it a little more. One of my questions for him was regarding my knees and any suggestions he had for the anteversion since my knees (especially left, as has always been the case) are aching, popping and at times feel like they will give out with pivoting. He said short of femoral and tibial osteotomies, I should get orthotics to help re-align my muscles and gait. I told him no more surgeries. He agreed, it is way to much cutting. Once he checked me over, he wanted to go over the PAO surgery, even though I went through it 6 months ago. He said he'd just feel better if he told me everything again. Everything is the same as the left hip basically. About 4 days inpatient, general anethesia and PCA pain pump, foley catheter after asleep, CPM upon awakening, no eating or drinking til passing gas (ice chips only, and in moderation because of how sick I was last time). First day after surgery "chill in bed", 2nd day drains/tubes removed and get up with physical therapy, 3rd day stairs and occupational therapy and possibly go home if feeling well, if not, then 4th day go home. I had a list of questions for him and he answered each one accordingly:

Q: Should we do scope with PAO? (having increased catching/locking, sharp, stabbing pains; very painful intense ache at times, especially night time)
A: We could do a scope but it's probably better we don't. New studies are showing that scopes cause more complications than benefits with open procedures. We can always go back in with a scope later if there are continual issues or stiffening of the joint.
I pointed out that the right hip was different feeling than the left in terms of pain and catching and really felt the scope was something we should do. I told him I do NOT want to come back for another surgery.  He said "Is this your gut instinct you need a scope?" I told him "yes". His answer was "Call me next week after I've had a chance to sleep on it. I hate to go against gut instinct". He also warned me that the femoral nerve could have more chance of being damaged with a scope added to procedure. At this point, I'm willing to take that chance and told him that.

Q: Can the left hip screws be removed during RPAO?
A: Yes, we can add that to the procedure

Q: Will I have the ace wrap around the hip again when I wake up?
A: Yes, I like to use that for post-op swelling. Did you not like it? (I was fine with it)

Q: Will you detach any muscles for this PAO? If not, how will this recovery differ from the LPAO?
A: I will detach the rectus femoris, same recovery as the LPAO.

Q: Will lateral cutaneous femoral nerve be affected more since hip has had prior surgeries? Any increased risk of other complications due to prior surgeries?
A: Lateral femoral nerve may cause numb patch (note comment about the scope as well) Should not be any more complications

Q: How often do you have patients who need PAO and SDD on same hip? What were their outcomes like?
A: I've had quite a few patients who have had to have both procedures, probably about 5%. They have all done well.

Q: Is the right hip classic dysplasia or retroversion/pincer?
A: Your right hip is classic dysplasia but you do have retroversion in the upper region of your acetabulum. I will take care of that during the PAO.

Q: Will this help my S.I. joint pain/locking on the right side?
A: I hope it will help.

Q: Is my femoral anteversion at the hip or the knees? Is there a reason I stand the way I do and do you have any suggestions for me regarding that?
A: The anteversion is in your hips. In order to fix that you would have to do femoral and tibial osteotomies. Try an orthotic to help re-align your legs first, that should help with the muscular imbalance and help with the tendonitis.

Once the questions I brought were answered, I asked him if he knew my time on his surgical schedule. He smiled and told me I'm last of the day because I'm his oldest patient. I groaned and asked why do you do this to me?! He laughed and said it's nothing personal. So I'm guessing that I will be slotted for at least 3:30, if not later, going by last time. At least we don't have to drive down the day before again. It was nice to sleep in my own bed prior to a hospital stay.

So, next week I need to call Z and find out if we will be doing the scope along with the PAO. I pray this is the decision because my pain is different and more aggravating in this hip compared to the left hip. I feel like it's getting ground down inside, which isn't to say it always feels that way, but I want something done about it. And if I'm already under anesthesia and laid open, might as well just do the scope too!