Hip Instability and Plan

I have been in Boston this week visiting my specialists at Children's. There was a lot of anticipation leading up to these appointments as I was expecting bad news regarding my right hip.

Background: I was diagnosed with bilateral hip dysplasia in 2009. I underwent periacetabular osteotomies (PAOs) to provide more anterior coverage to the femoral head. This involved breaking my pelvis in 3 places and repositioning it to provide deeper sockets. In theory, this should have provided greater stability and prevented recurrent labral tears....but it did not.

In 2017, after years of hip surgeries to repair the labrum and address impingement, my right hip subluxated (partially dislocated). Later that year I underwent open reconstructive surgery to stabilize my hip with an allograft tendon (a procedure that had been performed successfully 3 times prior at Children's). They also learned during the procedure that my rectus femoris (largest quad muscle) was detached (likely from the subluxation) which explained why my quad didn't function the year leading up to surgery. Unfortunately, only 2 months into recovery, I managed to tear part of the graft. When I was finally able to start weight bearing again (it took 6+ months for my quad to fire) it became blatantly obvious that my hip was still unstable. However, at that time, my left kneecap was causing major problems with lateral and medial dislocations in and out of the brace, and that became the priority for 2018.

Fast forward to 2019...now that we have addressed my left knee, this week we focused on my worsening hip instability and pain. Due to femoral anteversion, my hip sits approxiamtely 5.5 mm out of the socket in neutral. So my hip is always partially dislocated. As a result, in an attempt to provide more stability, I internally rotate my right foot (most of the time I don't realize I am doing this in the moment). I have been falling everyday, which not only leads to more damage to my hip, but my right shoulder dislocates daily as well (I wake up with my shoulder dislocated every morning too). I am starting to lose function in my hand as it is often numb due to the nerves being aggravated. I having been dealing with constant hip pain way above my baseline, and I am not sleeping due to the pain with very few pain control/management options available. My pain is significant, my quality of life and function are declining, and I am struggling to progress with left knee rehab because I am largely stuck in my wheelchair due to my hip. In order to regain quad function I need to be able to weight bear more consistently, but this exacerbates my pain and often leads to falls (I have to protect my other joints as well).

Because of this, my surgeon feels our only option is to proceed with surgical intervention in the next few months. I was concerned coming into this trip that my surgeon was going to have absolutely no idea what to do as we have basically tried everything, and my hip really should not still be this unstable. However, he believes my best chance at stability is a femoral derotational osteotomy and a replacement of the allograft. It will be a long recovery and I will likely be inpatient for 7-10 days based on my history. This will be my 13th hip surgery. Obviously I am not thrilled to need another hip surgery, but given my pain and lack of function, I would rather try something than have no options at all.

The goal of the femoral osteotomy is to position the femoral head deeper into my socket by breaking the femur, rotating it, and plating it in place. This should improve stability. The allograft will act as a capsule because I no longer have one (also providing stability).

Femoral derotational osteotomy

I will update when I have a date for surgery. Until then I will continue to work on regaining strength and range of motion in my left knee.