3 weeks post op and the follow up appointment

Right hip scope: The 4 images shown are from my arthroscopy and they show areas on the acetabulum that are hyperemic (increased blood accumulation to specific area due to an inflammatory response) and also some labral degeneration. There is some yellowing of the cartilage and some of it looks like crab meat. This area Dr. Z debrided away. The first image also shows the swelling and softening of the cartilage. This is chondromalacia and currently I am at grade one, which is the first stage of cartilage breakdown. On images 2 and 3 you can see on the femoral head a lesion of cartilage that is also breaking down. Both these spots on the femoral head and socket are in the lateral space of the joint (outer edge). This is what Z thinks is probably causing my joint space narrowing which will be seen in the following xray images. Image 4 is the thermal ablation of the cartilage to "seal" it back down and clean it up on the socket side. The inside still looks pretty decent actually, but the start of arthritis is there.

Xray progression:

The first xray image is pre-op to any of my open surgeries with Z. The 2nd image is the LPAO and right hip post SDD and screw removal. The 3rd image is the right hip PAO in the "captain morgan" stance. Notice the joint space in the lateral (outside edge) portion. The 4th image is the RPAO and left hip post PAO screw removal. Again, look at the joint space on the right lateral edge compared to the left. The left is ideal joint space, great cartilage and coverage. The right hip joint space is too narrow, meaning a couple of things. The cartilage is thinning (which he said he did not expect going by the MRI arthrogram or previous xrays. He said even the scope findings he would not have expected the outcome he got. He feels the scope findings are really not that significant, but that once he started putting the joint back together is when he realized that the hip is not ideal and may not last.

Post op appt:

My post op follow up appointment went well yesterday, technically speaking. I was taken back for xrays, which would be used for my 6 month LPAO check and the RPAO "2 week" check. The LPAO looks perfect. The bones are healing, right on track, and the fragment is exactly where it needs to be. The screws are out and it looks great!
My right hip is a bit of a different story. On image, Dr. Z is not as optimistic about the right side. He said the fragment is stable and it gives the proper coverage I need but the hip will need to be watched very closely and carefully. The joint space troubles him and it was easy to see when he was talking with me yesterday. He began with pointing out the area of concern to me and said he just didn't expect it to turn out that way. He also then explained that while the scope confirmed degenerative labral tears, the area was cleaned up and even without the scope, he feels the hip would have healed itself once the PAO was done. However, he patched things up and now we know I have chondromalacia (softening of the cartilage) in the hip socket and damage to the femoral head. This knowledge doesn't help or hinder the outcome of the PAO, but it does give him an idea of what could be causing the joint space narrowing.
From my perspective this was the most cautious I have seen him with me. He would not tell me one way or another what the outcome would be, even when I point blank asked him. He said we just need to watch it, give it time. But then he said that there are things we can do to delay a hip replacement and when I asked him what he meant by that, he said that short of cortisone injections he would suggest doing a proximal femoral osteotomy to reposition the head of the femur in the socket better to take the pressure off the area of the joint where the positioning isn't ideal right now. We did not go into this in detail, it's way too soon to be thinking about that right now. But basically, the vibe was now "it's not a matter of if, but a matter of when".

He had me show him my ROM in both hips by lying down on the exam table then and was happy with the left. The active ROM on the left is no where near what it used to be but is definately within good measures. The right hip actively stopped well before 70 degrees and then he asked me to use my hands to get the rest of the ROM and I was able to get it probably to about 95-100 degrees which he was satisfied with. The incisions are all healing very well and there are no issues there. Then we talked a little more about the outcome of the surgery. At one point, it came out that the hip could last 2 months or 20 years, it's just too hard to say. Overall, he doesn't want to upset me because it could be likely that I'll never have anymore issues once I'm healed up. Time truly is the only deciding factor here. I also gave him a list of questions and he answered them accordingly:

-Right hip very painful when I go down steps and use the right leg to step down. If I rotate leg inward, there is no pain, why? It's too soon to really tell what could be causing that right now. It could be inflammation from the surgery, but it might be other things too. Let's just watch that for now.

-Right lateral hip pain, bursitis? Bruising? This is probably bursitis, just keep icing it.

-When will I be able to drive? As soon as you feel like you have good control of your leg muscles and you're off all narcotics.

-Knee problems, popping and pain underneath the knee cap? We'll have to address this once you're healed from your hips. (I asked what he meant, but he said we'd talk about it when it's time. I think he means muscle strengthening/PT).

-Right SI joint still hurts more than usual, is this going to settle down? Yes, the surgical inflammation is probably causing the SI joint irritability.

-Can you suggest a better NSAID for me other than ibuprofen or naproxen? I don't really feel that any other anti-inflammatory is superior to the ones mentioned. The only difference in my opinion is the side effects and you don't want those side effects. It's probably best to just stick with motrin or aleve and in small quantities because of your right hip, so I don't want you taking very much of it right now.

-Please look at my left hand. I've had pain in it since the IV was taken out from surgery (swelling in the hand, bruising, hardened vein that feels like a tendon now, and hard, painful, little blue lumps in the knuckles and below the wrist). Looks like thrombophlebitis. Use a warm, moist compress and I'd usually advise ibuprofen but with you I don't really want you taking a lot of it. It can take a while to heal, up to a year.

So, aside from some joking around and "catching up" conversation, that was the extent of my post op visit. I could tell he wanted to give me better news and say that it went as well as the left hip did, but it just wasn't something he could do at this point. He wants me to come back to see him again "in about a month or so". It doesn't sound like he's really rushing to get me back on my feet and just take our time with this recovery. The full restrictions are still in effect and I'm definately still under keen observation so I don't go doing housework. In fact, he point blank asked Todd, "So is she being a good patient this time?" : )  I jokingly mentioned that I would like to extend this being waited on hands and feet period and he laughed and said, "Don't bring him next time and we'll work it all out!". I set up my next appointment to see him July 25th. Fingers crossed that visit is a much more inspiring one! On the way home at some point in the car, I noticed my hip to knee swelling and I even had it elevated. The knee especially looked puffy and it was warm to touch. Once I got home, I continued to elevate it and ice it and this morning it does look better but still feels "full".

At 3 weeks I again do not have much to add to my list of "can do's" or accomplishments. I did send the CPM back last Wednesday and have slept pretty well without it. I have noticed a slight stiffening and "fullness" in the hip without the CPM but it's not as bad as the left side was. I'm still in enough pain that I'm needing my vicodin daily. However, I mostly take it upon wakening and at bedtime only. This is better than last week when I was still taking a 3rd vicodin in the middle of the day. Sometimes I need it because there is actual joint pain and other times it's for the stiffness of the joint. I'm also noticing more and more clicking in the hip, front and back, as the days go on. It feels like tendons or ligaments shifting. I'm able to sleep on my left side now, with one pillow between my legs and a couple pillows behind my back for support. While I fall asleep like this, I end up waking up on my back, so it's not totally comfortable for me just yet. But it's getting there!
While this hip feels better in mobility (crutching around the house, etc) and passive ROM (achieved weeks before the left hip) it is not feeling as well comfort wise. It's taking longer to feel "good" and doesn't feel the immediate gratification that I felt with the left PAO. I do realize that the left hip may have been extraordinary in healing in that way, and it is too soon to tell how anything really is right now, as I'm only 3 weeks post op. I am trying not to compare the 2 hips too much seeing as the mechanical outcome of the joints are very different, therefore they will have very different stages of healing. No two recoveries are the same. I just need to keep remembering that.
So what is all boils down to is that my right hip will deteriorate at a much faster rate than my left hip. My left hip probably won't need a THR until I'm old, if ever, but the right hip at this point is anybody's guess.