I have created this blog for two reasons. First, to serve as an update to friends and family on how I am progressing through recovery. This way my mom doesn't have to send so many mass e-mail updates. Also to provide a source of information to others with dysplasia who may be facing a Periacetabular Osteotomy, or PAO for short. Reading the blogs of others who have already gone through with the surgery has helped me tremendously with what to expect.
*I apologize for the length of this post. I have decided to recap on how/when my hip problems started.
The Beginning...
I was a competitive gymnast for 9 years so I am no stranger to injuries. Over the years I have built up a tolerance to pain and for the most part was able to ignore it to train and compete. In June 09' I was training to make a "come-back" and compete in college. Unfortunately, I was not in the physical shape needed to be a collegiate athlete. Needless to say I trained anyway as I was determined to get back to competing. I was at practice, doing a fairly simple tumbling pass, when my hip problems were first realized. During the pass I felt a pop in my left hip and had sharp pain in my groin. I knew immediately that this was not something I would be able to push through. I had planned to spend the entire summer training, away from home, but at this moment I was eager to get home and see my Sports Medicine doctor, Dr. Shiple.
My Symptoms (at this point):
-Sharp groin pain with movement and weight bearing
-Sharp pain in butt
-"Clicking/popping" sensation when walking
-Decreased range of motion and flexibility
Of course, my doctor ordered an MRI and x-ray to see what was going on as he suspected a labral tear. For those of you who don't know the labrum, or acetabular labrum as it is formly known, is a ring of cartilage that surrounds the socket of the hip joint (acetabulum). It's main purpose is to increase the depth. When the scans came back, the MRI did in fact show a labral tear but the x-ray images showed something even more interesting. It was hip dysplasia. I had heard of hip dysplasia in babies and dogs but never in teenagers/young adults. I then learned that dysplasia can either be congenital or developmental. In my case it was most likely developmental, where my hips did not develop correctly. This diagnosis would be the beginning of a year filled with scans, doctor appointments, injections, and of course pain. Although, after reading many other blogs about hip dysplasia and surgery, I am very thankful that Dr. Shiple was able to come up with an accurate diagnosis from the very beginning.
He asked me to contact Dr. Philippon in Vail. After trying other therapies and conferring with Dr. Philippon, I was referred to two specialists out of the Children's Hospital of Boston. One surgeon specializes in arthroscopic hip surgery and one performs the PAO surgery to correct dysplasia. We quickly made an appointment to see the scope surgeon and flew out to Boston for the appointment. Meanwhile the pain in my left hip was increasing by the day and I was struggling to coach at my gym, not to mention navigate a college campus. The appointment was very helpful as we got a lot of great information and the options were laid out in front of us. We left the appointment knowing that I would undergo arthroscopic surgery to repair the labrum in my left hip. We would hold off on PAO on the left side to see how I fared having the arthroscopic procedure.
We scheduled surgery for my left hip on March 9th, by which time I was walking like a penguin because I was in pain with both hips. I was unable to bear weight for long periods of time, and coaching became increasingly difficult. I took the Spring semester off from school in order to have the surgery and recover. The surgery for my left hip went very well although there was far more damage than was expected. Not only did my surgeon have to repair the tear in my labrum but I had FAI (femoroacetabular impingement) as well. With that he had to shave a piece of my bone away. We also learned that I have arthritis, something I have not completely come to terms with as I am only 20 years old.
I had very little pain after the surgery on my left hip and was progressing fast in physical therapy! Unfortunately that did not last long as I fell and landed on my left hip. Since then I have been in excruciating pain in both my left and my right. I had another x-ray and MRI done to make sure I didn't tear the labrum again in my left hip and thankfully it doesn't look like I did. However I may have torn the capsule and have psoas impingement. My surgeon modified physical therapy and hopefully my left hip will calm down on its own. Unfortunately my right hip has gotten worse.
For my 2nd post-op appointment we had planned to evaluate the right hip as it had been hurting since my first visit. It turns out that my right hip was far worse than we thought. I have a labral tear and FAI. Not to mention the deterioration of my cartilage. Cartilage is graded by thickness level to determine how deteriorated it is. 800 to 900 is considered good and intact and 100-200 is arthritic. I am currently at the 400 level (pre-arthritis). For someone my age this is far more deteriorated than it should be. He also said that gymnastics sped up the deterioration by many years. At this point my only real option is the periacetabular osteotomy (PAO) to correct my dysplasia and preserve the remaining cartilage for as long as possible. My surgeon contacted other surgeons out of Children's Hospital of Boston to confer.
I heard back from the PAO surgeon's assistant today and scheduled surgery for June 1st. I will be traveling to Boston to prepare and donate a unit of blood. Since the surgery is so invasive they ask that you donate 2 units of blood to be given back after surgery.
A lot of people have asked me what PAO surgery is. So I'll explain the procedure for you-
"Periacetabular" means around the acetabulum. "Osteotomy" means to cut bone. Simply put, the PAO cuts the bone around the acetabulum that joins to the pelvis. Once the acetabulum is detached from the rest of the pelvis, it is adjusted to a position of ideal coverage. PAO thereby reorients the acetabulum by changing its rotational position. The dysplastic roof that incompletely covers the femoral head is brought over the head to give it normal coverage. Once repositioned 3-4 screws are used to hold the hip in place. The surgery typically takes 5 to 6 hours and patients spend anywhere from 3-7 days in the
hospital.
Until June 1st I will be working extremely hard in physical therapy in order to improve the function of my left hip. This is extremely important to the recovery of the PAO surgery. It will go a lot smoother if I am able to weight bear with my left hip.
Hope this is useful information for everyone!
Thanks,
JMurph
