Acetabular Dysplasia, Henry Ford Hospital, Detroit, MI

Acetabular Dysplasia, Henry Ford Hospital, Detroit, MI


This is a great link to the program directed by my surgeon, Dr. Zaltz.  He performs this surgical program at both Henry Ford hospital and Beaumont Royal Oak hospital (where my surgery will take place)  in Detroit.  It explains dysplasia, PAO, and frequently asked questions regarding the operation and symptoms.

Femoral Acetabular Impingement, Henry Ford Hospital, Detroit, MI

Femoral AcetAcetabular Dysplasia, Henry Ford Hospital, Detroit... Acetabular Dysplasia, Henry Ford Hospital, Detroit, MI


This procedure is done at both Henry Ford hospital and Beaumont hospital in Detroit which is headed by my surgeon, Dr. Zaltz. This link has good information on FAI  procedures, and frequently asked questions.

I'm a PT graduate!

Yesterday was a stepping stone day! I was officially discharged from physical therapy as there really is no more that my PT can do for me that I already can't do for myself. She said that technically, I could come back for another 2 weeks if I felt I needed to, but we both agreed that I was to a point that I can continue the exercises at home and gradually build up the weights on my leg reps through the coming weeks. She told me that I could call her or visit her anytime though, if I felt like I was hitting a plateau or just needed a little encouragement. I will miss Liz very much, but we do work in the same hospital and I will be going back to her after the LPAO, so I will get to work with her again. However, she said in order for PT to be a success and help keep me strong for the LPAO, I need to continue my leg/hip exercises every day for the next 6 weeks, and then after that I can take 2 days a week off from the exercises until the LPAO. Also, about 6 weeks before the LPAO, she recommended that I start doing the leg/hip exercises on the left leg (with or without weights) to get it ready for the surgery. So, after 2 months of intense PT, I am done with the outpatient part and it is up to me to continue on my own. I am so happy to have made it to this point and really feel as if PT has made a huge difference in my outcome. I saw leaps and bounds of changes in my strength when I started outpatient PT.
I am still having issues with catching and a painful "something is stuck in the joint" feeling. Just a few days ago, getting into my car this happened pretty severely, and I was trying to maneuver my right hip until it felt like that "stuck" feeling would go away, but it took awhile and when I finally worked out the feeling, there was a very loud crack and bad pain that followed it that lasted for a good 10 minutes afterwards. I was able to walk fine when I got out of the car, thankfully, but something is definately not laying right inside that hip. Whether it's the acetabular cartilage or the femoral cartilage, something still isn't right. It's fortunately not causing any constant, daily pain like it used to, but still. Oh well, in June I'll talk it over with Z and we'll go from there.
I also took my first on-call for work yesterday since I left work on medical leave. I worked my normal shift, went to PT (was d/c'd) then went home and in the middle of dinner, got called in for 2 laparoscopic appendectomies on a 15 year old and a 9 year old. Poor kids! Anyway, worked 5.5 hours and did great! Right hip is holding up beautifully. I have some firm swelling around the incision, it's still sore/tender in the trochanter area. The left hip...well, it's achey, it's throbbing, it's going to get it's dysplastic ass kicked! :) The point is, I'm strong enough to do call now on top of working a normal shift at work too. Good things to report:)

Oh, and I only have 9 weeks until I go to Austria!!!!!

Something to think about....

I am in the middle of my third week back at work and am doing really well. I think that my muscles are more sore than the first week, but I'm doing more and using muscles that haven't been used in 3 months. My co-workers are being awesome and easing me into the call schedule slowly. So this means I won't be at the risk of putting in a 12 or 16 hour day which we have been known to do often when on call. I really am lucky when I think about my work:) I have been able to do all my 8 hour shifts though and only had one really, really bad, painful day out of the 2 and a half weeks I've worked, so that's pretty awesome, I think!

The issue I brought up in my 3 month follow up post about my right hip catching still and having pain was revisited with Dr. Z tonight. I called his nurse on Friday, which was the end of the 2 week ibuprofen trial to see if it would calm down any inflammation, to let her know that it did not help. It hasn't gotten worse, but it hasn't gotten better. Dr. Z called me today to discuss with me how I'm currently feeling and I described my symptoms to him that the catching pain happens almost daily and with turning or side stepping, but that I can't really pin point it.
He feels it could be one of two things.
1) It could be that the femoral head scarring didn't lay down right after the hip scope and the open surgery disturbed it causing it to catch

or

2) There was a soft, unstable piece of cartilage in my hip that he cut away and debrided but he said that to the naked eye it is sometimes hard to see if you are able to get it all and the cartilage could have been more unstable than he was able to see at the time and may have loosened again.

If either is the case, then he said a scope would be an option to go in and suture the loose cartilage or debride the scar tissue.

However, he doesn't want to do anything right now. He feels that it will be approximately 6 months before I would "plateau" from healing and he wants to see how I feel at that point. So I have a 6 month follow up with him at the end of June and that's when we'll revisit how the hip feels. He did offer a cortisone injection into the hip if I wanted it and I can arrange that at anytime if need be. He also said I don't have to worry about damaging the joint anymore because he said the femoral head is smooth and round now whereas before it definately was not. I am pleased as punch that he isn't diving into surgery again on that hip! At least not anytime soon. I just want to know that I'm good to go on activity of my choice and that I'm not going to hurt anything. I want to get strong for my other hip surgery without compromising the right hip.

I'm still not able to sleep on my right side totally yet. I can sleep modified on the right, more like on my stomach but the screw heads are way too tender still. This is also something to think about come June when I see Dr. Z again and see if it would be an option to have them removed when I have my LPAO. If I can't sleep on my side (and it does wake me up or keeps me tossing and turning everynight) then I'm going to go crazy!!!!!

Hi ho, hi ho, off to work I go!

I started work today, first time in 11 weeks. I was a little nervous that I would "forget" my job but I did alright! I was given 2 really easy assignments and then I was basically relearning the charting system as it changed right before I left. Best news is I have reduced joint pain! My surgeon did great work. And I survived :)

2 months post op

These are my xrays from my surgeons office that I was finally able to obtain. The first and second ones are my post op xrays laying down. The third is my pre-op xray. Notice the bone healing in the second post op xray! Pretty cool, huh?

I am almost 2 months post op now (on Tuesday officially). I started PT last Wednesday and will return for 2 more sessions before I go on vacation. I love that I have some more exercises to do now! My PT checked my right quad for strength and we basically both saw that it was very, very weak. I could barely do a straight leg lift. So she modified my strengthening program for the right leg until I see her again on Monday. So far she has me doing 8 exercises, mostly for quad build-up, which I do 10 reps, 3 times a day. I also have some adduction/abduction exercises too and the one where you lay on your side with your knees bent and open up your legs like a clam really gets me!!! It's hard to make my leg do it, sometimes it just doesn't want to fire right away and other times I can do it fine, but it's really sore. I know this is an important one though to help get rid of my limp and I'll be able to walk correctly, so I'm increasing my reps by 1 each time I do a set. I'm really determined to walk without my crutches and my limp within the next 2 weeks! Let's hope I can meet my goal! I can tell I'm getting just a little stronger each day too, so I know the exercises are working. I'm almost to the point where I can get rid of the shower bench and my dressing chair in the closet. I have not used them in the last 3-4 days at all. So, if a week goes by that I don't use them, they're out! It's kind of strange though, as sometimes my leg/hip feels fine and stable and I don't need any assistance with dressing and showering or standing alone on the right leg, but other times it's like I'm back at week 4 where it's just barely strong enough to transfer or pivot on. All in time I guess.
All I care about is that I get it strong enough to not limp and to be able to walk long distances without getting tired or hurting! I've got a couple vacations coming up that I'd definately like to enjoy without thinking about righty:) Lefty is a whole other matter, but I know eventually she'll be taken care of, so I'm going to go with the flow on her!

6 weeks down, 6 to go

Today marks the 6 week point since surgery. I have been having more good days than bad now and I feel like my energy levels are just about as they were pre-surgery. I still get tired more easily than before surgery, but I do feel that I can do a lot more now. Even the muscular pain is getting better. I would say right now the scar itself is the most painful thing. My psoas muscle or tendon (groin region) is really irritated and my glutes and adductors (butt and thigh) are definately angry but I am really pleased with how things are progressing. My joint pain is pretty much non existent at this point, I think I still feel some capsule pain now and then, but not the searing pain of the labrum tear or the startling, painful snapping of the joint with certain movements. I still have some disgusting swelling around the outside of the hip. It's nearly twice the size of the other hip at night and I still occasionally get that full, stiff feeling around the area of the trochanter osteotomy. I'm sure it's all due to activity, as I'm increasingly getting more active as the days go by. The exercise bike is helping my muscle strength. I've been able to stand on my operative leg for 5 seconds before it starts to wobble and weaken. Sometimes it hurts to do that and other times it actually feels normal! Just 3 or 4 days ago I couldn't stand on it alone, only with crutches and even then it felt like more of my weight was going through my arms then my leg. So that's a big improvement! I'm hoping by next week when I go back to see Dr. Z that I'll be able to stand on my right leg for maybe 15-30 seconds before it gives out. I'm also hoping for some formal PT. I'm getting restless with the 3 things I can do at home...

I have officially decided I am going to do the LPAO in November or December now. I went to work to talk to my managers about all my possibilities with work and the next surgery and although they have no problem with me being gone for 6-ish months, it's the HR department that would not look favorably on me being absent from work that long. I decided it's not worth it to gamble my position and will return to work in March with my surgeon's approval. I'm really okay with this. I think I need the time to let my right leg heal properly and get strong for the other surgery as it will really take on quite a bit more work and weight than my left leg did. Plus, it'll give me a chance to just take a breather from all this surgery/recovery process. And I am in no way ready to experience the kind of pain I did when waking up from surgery any time soon. Even though I hope to get a spinal next time, it still scares the hell out of me, especially knowing the PAO is quite a bit worse.
But, I'm ready to get it over with and move on!

On Sunday, my dad and I went to a hockey game and sat on the glass which rocked! The thing that did not rock was all the stairs. They're narrow and there are so many! Especially on crutches. What a workout. My left hip finally had it going up the stairs though and gave out painfully on me at the top. The next morning when I woke up was even worse. I could not put any weight at all on my left hip. It was unbelievably painful and unstable! I don't know how I made it from the bedroom to my recliner, but I somehow did. It was some weird shuffle, scooch, lurching thing with my crutches! My husband tried not to laugh because he knew I was hurting but it did look pretty ridiculous. It settled down after a while, but it's still pretty sore. Luckily, I will see Dr. Z next week and be able to discuss some options with him about an injection into the joint to tide me over til surgery. I'm weary about it, but if it would help, then I'd be willing to do it.

As of right now, I'm concentrating on my trip to Mexico, getting tanned and toned (as much as my work outs will allow) and working on only needing one crutch (hopefully none by the time I go!!!). Then it's on to getting strong for work and planning the next trip; Vienna, Austria!

So, what exactly is a surgical hip dislocation?

I reread all of my blog today (narcissitic and boring, I know!) and I realized there is really nothing in here that explains SDD in detail. I'll do my best now so that anyone who may be needing this surgery knows what to expect, or, if you just have a morbid sense of curiosity, then hey, each to her own:)

Surgical hip dislocation and debridement(SDD) with femoral osteochondroplasty and greater trochanter flip osteotomy is what my procedure was called.
I have femoral acetabular impingement with acetabular dysplasia of my right hip. This surgery addresses the impingement only.

I was given a general anesthesia (just what my surgeon prefers, but I would recommend a spinal! It's what I'll do for my LPAO) and once asleep, a foley catheter was placed. Then I was rolled onto my non-operative side and had blankets stacked between my legs for the operative leg to rest on. The surgeon makes a cut on the lateral thigh (and it's looooong, usually about 10-11 inches) from the top of the buttock to the upper- middle of your thigh. Once that's done, he retracts the muscles and makes his osteotomy cut of the trocanter (with the major muscles still attached to it so that healing is easier and faster) and places it anterior to the hip joint. This is when the surgeon flexes and externally/internally rotates the hip to visualize the impingement. On to the hip capsule. The capsule is accessed by a Z-capsulotomy (cutting open of the joint itself). Then the surgeon uses retractors to pull the femur out of the acetabulum. While he can see inside the socket, he cleans up the damaged areas or tacks the labrum back on with absorbable anchors (my case was debridement, not repair with anchors). The articular cartilage is assessed for any damage and then when satisfactory, he places a wet sponge in the socket. Then the head of the femur is addressed. It is measured with a sizer and extra bone that impinges the joint is removed and the joint is reshaped by a burr and chisel (this is the femoral osteochondroplasty). Once the surgeon is happy with the new shape of the femur he places it back in the socket and does the flexion/external/internal rotation again to make sure there is no more impingement. If all is well, then the surgeon will place a drain close to the hip to collect extra blood and drainage during the hospital stay. He will then begin closure of the hip capsule and pin the trocanter back onto the femur (usually 2 screws). These screws will be permanant unless there is ever a need for an MRI or other surgery. Then the muscle closure/tendon closure begins and the fascia (layer between muscles and skin) is sutured with disolvable stitches. Finally the skin is closed and fortunately for me my surgeon uses glue so it's a nice plastic surgery closure.

Once the dressing was placed I was rolled onto my back, woken from anesthesia and taken to recovery. That's it in a nutshell for the surgery! For pain control, I was given a patient controlled analgesia (PCA) pump that also had a continuos drip in it. This was all the pain meds I needed while on IV meds.

The CPM was started as soon as I was placed in my in-patient room and I had to wear TED compression stockings to prevent blood clots. Also had the sequential compression device (SCD) on my calves which also prevent blood clots.
PT did not begin until the following day and no walker is allowed (apparently my surgeon does not believe in walkers, for PAO's either). So up I went on crutches first thing. The only expectation was to get up and walk to the bathroom and the hallway 4 times that day. Then I just rested and used the CPM. The next day PT showed me how to do stairs, expected me to walk a little farther and showed me my exercises for home. This is also when I was given OT (learned how to dress, shower, sit on toilet, etc, properly). The rest was all up to me after that!

Sweet freedom!

I drove today for the first time since surgery. I was waiting until the roads were clear from most of the snow and ice and today is a beautiful winter day; the sun is shining, the snow is melting and not a cloud in the sky! It felt pretty good to drive. The hip itself did fine, it was the muscles that protested afterwards. I don't know what's going on inside my leg, but it is so sore! The incision won't stop hurting either but it looks fine! Just some questions for the doctor I guess.

On another note, slightly related to the hip saga, the hubby and I were offered a free trip to Vienna, Austria in June with some very good friends...near impossible to pass up! Soooo, this along with the fact that I don't think Z wants to do the LPAO in March pushes me to delay the LPAO until December. I'm not going to make any final decisions until my next follow up.

An addendum:
I got a stationary bike yesterday courtesy of my mom (she's so awesome!) And have been using that along with my 1000 leg reps. Gonna get me some strong, sexy legs!

Holy cow, it's already been a month!

Today is a big day! It's my hubby's birthday and it's been one month since my surgery. I am doing well, besides still being so TIRED. The home exercises I was given continue to get easier and easier and I am still very mentally motivated to be able to have my LPAO in March, but realistically I know it may not happen, as physically I'm not sure I'll be ready. My left hip is starting to become more and more achy and I've noticed that my bursitis on my left hip is becoming a lot more painful. It still hasn't given out on me lately which I am so thankful for, but I have had a few wicked spasms in the left hip/thigh when I've tried to stand up. I've already got myself ready to accept that possibility of delaying my LPAO during my next follow up with Dr. Z.
As for my swelling and my incision, things are still looking ok. The incision is not longer painful at that one spot I mentioned before (I think the triple antibiotic ointment really helped). The swelling is still there, but it hasn't gotten worse, in fact it looks like it may have gotten a little less. Not sure, but the hubby doesn't really think so. I know it goes from feeling like a fluid pocket to firm from time to time, so I really don't know what to make of that. Even though I am a nurse, I am still unsure of my own prognosis/recovery...I think I freak out a little more than I probably should:)
I have "met" a few more hipchicks in the last couple weeks that I am so thankful for getting to know. Hip women yahoo support group and facebook have led me to some wonderful new friendships and I am so glad to be able to use their support and give back support as well. So a shout out to my new hipsters; we are strong, beautiful women!!!!

I have noticed lately that my right quad is really atrophied...uggg. It's gross and I had no idea it would waste away that much for this surgery! I had expected that for the PAO but not really for the SDD. I figured since I was using my leg in the 1000 leg rep exercises that the muscle would still be getting used, but I was wrong. I really hope that PT will be able to sort that out right away!!!! I also hope that I can start PT fairly soon. But I won't be given that go ahead for another month. Arrrrgh. For what was supposed to be a fairly "simple" surgery and recovery it sure does seem to be moving awfully slowly. I am almost getting the feeling that Dr. Z is slowing down my recovery to slow me down from jumping into the LPAO too soon. Not just him telling me "no" but also making it nearly impossible to be able to do it in March due to the physical aspect of it. But who knows? Maybe SDD's are supposed to recover this long? It's hard to say since I don't know of anyone else who really went through one of these surgeries. I just know that for the LPAO I'll be a lot more patient with my recovery (I think) since I've been able to follow up with all the hippies on the support forum about their recovery and what it requires.

I am overall very happy with the outcome of my surgery. That sharp, pulsing pain that was constantly in my groin is gone. The horrible catching pain I had doesn't lock my hip up anymore (hopefully that remains the case forever!) and all I really have left is just a generalized achiness in the hip, but that could just be from the surgery itself. I'm sure I won't really know until all the inflammation and swelling goes away, and I know it could take up to a year before I fully realize how the hip is going to feel for good. For anyone considering this, it's definately worth it. Hopefully the scope option would work vs having the full open surgery like I had, but that was my only option once the imaging scans came back. It worked, so I'm happy! I would liked to have gotten the scope instead of open surgery (scar and more recovery/pain). I completely trust my surgeon though, and am pleased that he is happy overall as well!