Update from Boston- Hip and Knee

I saw my primary surgeon in Boston on July 12th. We discussed my right hip and left knee in this visit. In my "Welcome Back" post I talked about what I thought the plan would be and it did not change all that much.

He presented my case to the hip team Thursday morning. They went over every option for my right hip and my PAO surgeon could not believe my hip is this unstable. Options for the right hip include another PAO for more anterior coverage, a femoral osteotomy to decrease anteversion, and re-doing the graft I had placed in December 2017. Everyone agreed that the graft should only be repaired/replaced if everything else is addressed too as it is likely to fail again if there are other factors contributing to my instability. That would be one massive hip surgery.

I explained that I feel like the kneecap is the worse of the two and that I think that we should focus on the knee and readdress the hip if/when something were to change. We talked about the risks of leaving the hip as is. Risks include dislocation that requires ER reduction (either closed or open), avascular necrosis, worsening pain, and arthritis from wear and tear from instability. 

He agrees that we can focus on knee and discuss the hip if the pain becomes unbearable or there are signs of avascular necrosis. We both believe it is possible that relying on the right hip during recovery for left knee could push it over the edge. 

The plan for the knee will be to replace the MPFL graft (original MPFL reconstruction was in 2010) which is completely ruptured, do a tibial tubercle transfer osteotomy, and provide lateral support as well to protect the kneecap from dislocating medially  His goal is to get the kneecap to sit in the center of my knee (it does not do that at the moment) while stabilizing it from both sides. He said it will require at least 3 surgeons so it will be a full house! The surgery will be in early December. 

While in Boston for the week I was able to spend some time with one of my friends that my surgeon introduced me to 2 years ago! We went mini golfing!

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Hip Hop

I haven't updated recently as there really had been nothing to update on...until now. We decided not to go through with part 2 of the hip surgery this summer. I need to be able to drive to campus in a week. It is my final semester and I didn't want to complicate the situation by having surgery 2 weeks before the semester starts (I wouldn't have been able to drive for at least 4 weeks and I still haven't regained my energy from the last surgery).

We will revisit the surgery this fall. I have a labral tear and FAI in the right hip and the cartilage deterioration has been relatively noticeable on scans. The surgery will likely be in December after my final semester. That would give me time to recover as I won't have the impending spring semester to worry about. 

Post-Op Update: 1 month

Right hip- My incision looks good. I don't have any post-op pain related to this surgery. My hip has snapped a few times but it's hard to tell if that is because of my uneven gait due to my ankle. 

Right ankle- The incision is finally starting to look more normal. I still have quite a bit of soreness and swelling in the ankle. I have been in PT for 3 weeks now and can finally flex my foot/ankle on my own. However, surprisingly ankle is still very stiff. I am able to walk in the boot. 

Right knee- Both incisions look decent. I still have pain over the graft, especially when my knee is bent for any length of time and I extend (straighten) the knee. It is possible that improves over time but the surgery wasn't very extensive (simply removing sutures). I still have overall knee pain and swelling but that was not addressed in surgery because it requires going into the joint.

Left knee- My incision looks good. It was right over the previous incision and healed in a matter of days. The area is a bit sore to touch but otherwise I don't really have post-op pain. However, going down the stairs I still feel the graft pulling (which is why I had the sutures removed). 

In other news, if you are in Massachusetts this weekend, the 1st Annual Hip Hop 5K will be held in Easton. All money raised will benefit the International Hip Dysplasia Institute and Boston Children's Hospital Hip Program. More information can be found at the event's official website.

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