I’ve been making great progress in this first week. Since my last update I’m now able to move around the house without crutches and the two incisions are healing well. My range of movement is still very limited so I have to use a crutch if going out of the house, but it’s constantly getting better… and far more quickly than I expected pre op.
However, today I’ve been reminded why my consultant says a full recovery can take 3 months. I’m getting a very dull and downright painful ache deep in my groin, which has put me a step back from how I was feeling yesterday. As I’d been making what seemed like excellent progress I started to believe that my recovery would be speedy, but this is the most pain and discomfort I’ve had since the op and a lesson that the small cuts on the outside don’t accurately reflect what’s happened on the inside.
An eventful year is almost over. Happy New Year everyone :-)
30 December 2009
27 December 2009
4 days post op (+ operation report)
Things have been going really well since the op and I’m starting to wonder what all the fuss was about! I’ve not had any real pain to speak of. Things have certainly been sore, particularly at the anterior portal, and my ROM is incredibly limited, but it’s not as bad as I was expecting.
For the first few days I needed help to wash my lower legs and feet, and I couldn’t put my underwear, jeans or socks on, but as of today I can do all of those things. Around the house I’m down to one crutch but still need two if I venture outside. I daren’t attempt to lead up any stairs on my operated side but I hope it won’t be long before I can.
Here’s the surgeon’s operation report:
Operation Sheet - Arthroscopy of the Hip (Right)
Preparation
This was a primary procedure. Major symptoms were of posterior hip pain.
He was positioned supine on the table. The traction device used was the standard Smith & Nephew hip distractor. The portals used were lateral and antero-lateral. A cocktail of two antibiotics given as prophylaxis. The joint was “inflated” and maintained at pressure using an arthroscopic pump Arthrocare system set at 60 mm/Hg. Very tight hip with difficult access – but no chondral damage caused by instruments on entry. The arthroscopic tools used were: the Arthrocare RF “wand” and an arthroscopic burr.
Findings
The arthroscopic inspection revealed normal synovium, a normal ligamentum and no loose bodies. The abnormal findings included severe labral damage with anterolateral acetabular overhang impingement in the hip flexion. The acetabular cartilage appeared normal apart from very small posterior articular cartilage damage – grade 2 for 10 x 10 mm, there was no medial wall osteophyte and the ligament Teres was normal. The acetabular labrum had sustained what appeared to be a traumatic tear, there was no sign of degeneration. The labral tear was 10 – 15 mm in size located superiorly and antero-superior. There was minor antero-lateral chondral carpet damage adjacent to this tear.
Procedure
The femur was not treated in any way. The acetabulum treatment included debridement of the area of degeneration. The labrum was debrided back to stable articular cartilage and the anterior acetabular rim was burred back to reduce anterior impingement. The hip was moved into 90 flexion with 10 IR and no impingement was noted.
Closure
Estimated blood loss was minimal. Prior to closure haemostasis was not specifically addressed. The surgery took between 1 ½ and 2 hours. The portals were closed with an interrupted 3-0 nylon suture. Removal at 10 days by the GP practice. The procedure was performed under image guidance. Photographs were taken of the joint intra-op. For pain management the joint was injected with 20ml 0.5% marcaine into joint.
Post-operative instructions
For antibiotic prophylaxis Flucloxacillin 1 gm given intravenously at induction but need not be given again post operatively. In addition Gentamicin 120 mg given intravenously at induction but need not be given again post operatively.
Rehabilitation
Post surgery no immobilisation was required. His rehabilitation can commence as soon as he is comfortable. Discharge today or tomorrow, once mobile and safe. He will be reviewed in 6 weeks in the outpatient clinic. He will be mobilised as FWB (full weight bearing) as tolerated.
For the first few days I needed help to wash my lower legs and feet, and I couldn’t put my underwear, jeans or socks on, but as of today I can do all of those things. Around the house I’m down to one crutch but still need two if I venture outside. I daren’t attempt to lead up any stairs on my operated side but I hope it won’t be long before I can.
Here’s the surgeon’s operation report:
Operation Sheet - Arthroscopy of the Hip (Right)
Preparation
This was a primary procedure. Major symptoms were of posterior hip pain.
He was positioned supine on the table. The traction device used was the standard Smith & Nephew hip distractor. The portals used were lateral and antero-lateral. A cocktail of two antibiotics given as prophylaxis. The joint was “inflated” and maintained at pressure using an arthroscopic pump Arthrocare system set at 60 mm/Hg. Very tight hip with difficult access – but no chondral damage caused by instruments on entry. The arthroscopic tools used were: the Arthrocare RF “wand” and an arthroscopic burr.
Findings
The arthroscopic inspection revealed normal synovium, a normal ligamentum and no loose bodies. The abnormal findings included severe labral damage with anterolateral acetabular overhang impingement in the hip flexion. The acetabular cartilage appeared normal apart from very small posterior articular cartilage damage – grade 2 for 10 x 10 mm, there was no medial wall osteophyte and the ligament Teres was normal. The acetabular labrum had sustained what appeared to be a traumatic tear, there was no sign of degeneration. The labral tear was 10 – 15 mm in size located superiorly and antero-superior. There was minor antero-lateral chondral carpet damage adjacent to this tear.
Procedure
The femur was not treated in any way. The acetabulum treatment included debridement of the area of degeneration. The labrum was debrided back to stable articular cartilage and the anterior acetabular rim was burred back to reduce anterior impingement. The hip was moved into 90 flexion with 10 IR and no impingement was noted.
Closure
Estimated blood loss was minimal. Prior to closure haemostasis was not specifically addressed. The surgery took between 1 ½ and 2 hours. The portals were closed with an interrupted 3-0 nylon suture. Removal at 10 days by the GP practice. The procedure was performed under image guidance. Photographs were taken of the joint intra-op. For pain management the joint was injected with 20ml 0.5% marcaine into joint.
Post-operative instructions
For antibiotic prophylaxis Flucloxacillin 1 gm given intravenously at induction but need not be given again post operatively. In addition Gentamicin 120 mg given intravenously at induction but need not be given again post operatively.
Rehabilitation
Post surgery no immobilisation was required. His rehabilitation can commence as soon as he is comfortable. Discharge today or tomorrow, once mobile and safe. He will be reviewed in 6 weeks in the outpatient clinic. He will be mobilised as FWB (full weight bearing) as tolerated.
24 December 2009
1 day post op
It’s been just over a day since the op so I thought I’d give an update. It’s going to be a long one!
I arrived at the hospital at 1130 and was taken to my room, where I went through the usual pre-op checks and questions. The physiotherapist came to deliver a pair of crutches and talked me through some post-op exercises. A nurse left a Flowtron DVT prophylaxis machine and leg sleeves at the end of my bed, but I wasn’t asked to put them on yet. I showered with some pre-surgery antibacterial soap and waited nervously for the anaesthetist in a fetching hospital gown.
He arrived at 1230, asked a few questions and talked me through what would happen. He said that he wouldn’t use an epidural (unless I really wanted it) and would just use morphine, as two thirds of patients (of this type of operation) wake up comfortably in recovery this way. My surgeon then visited, talked me through a few things, asked me to sign a couple of forms and marked my leg with a big arrow and the word 'scope'.
Shortly before 2pm I was wheeled off to a little room just outside theatre and had a small cannula put in my left hand (I didn’t feel a thing). I was first given a clear fluid, which I vaguely remember was to prevent sickness, followed by something else that made me tingle all over. The third and final syringe contained a white fluid. As it was administered, I was asked how I was feeling, to which I replied something like ‘I can taste the anaesthetic and...’ I then woke up in recovery some 2 hours later!
I came to without any notable pain, but with a horrendously itchy nose! A kind lady beside my bed said I’d been scratching and rubbing it for ages, although I thought I’d just woken up. I looked around the room and saw a lady in another bed. Her whole body was shaking and I asked the lady with me if she was ok. I can’t remember her reply. My surgeon came to speak with me, showed me some images of the inside of my hip and told me what had happened on the operating table, but I quickly forgot what he told me… much to my frustration!
Back in my room my parents were waiting. I was still quite groggy from the GA and did my best to talk coherently, but I wasn’t fully with it and kept losing my train of thought. Along with my itchy nose, my legs and feet were also itchy, so my devoted mother provided a welcome leg-scratching service. Maybe it was a reaction to the GA? It also made me feel quite sick, which didn’t ease off until the evening.
After a couple of hours in my room I started to feel more human. My surgeon visited and talked me through what had happened: Posteriorly, which is where I have pain and catching, he found no problems. It was as it should be. Damn... Not the news I wanted. However, and very surprisingly, on the anterior side he found ‘severe’ labral damage. My operation sheet says:
“The abnormal findings included severe labral damage with anterolateral acetabular overhang impinging in the hip flexion” and “The acetabulum labrum has sustained what appeared to be a traumatic tear… The labral tear was 10 – 15mm in size located superiorly and antero-superior.” (I’ll add the full report another time when I feel like typing it out!)
I had 5mm of bone removed from the anterior acetabulum rim and the labrum was debrided back to stable articular cartilage. I have about 5 nylon stitches, which will need to be removed in 10 days.
My surgeon said it’s unlikely that the anterior labral damage is the problem I (only) get posteriorly, but he can’t say for sure. Only time will tell. It certainly wasn’t the initial outcome I was expecting though.
So how do I feel now? Not too bad! I came home late this morning (exactly 24 hours in hospital) and have been in and out of bed, pottering around the house chatting with family. My hip is sore but the pain meds are keeping me comfortable. It’s particularly sore around the anterior portal and even slight stretching of that hip flexor makes me wince, but it’s not that bad. Anticipation of the surgery and post-op pain was far worse than the reality.
That’s all for now. I’ll post again in a few days (after Santa has been) with an update on progress and a transcript of the surgeon’s operation report :-)
I arrived at the hospital at 1130 and was taken to my room, where I went through the usual pre-op checks and questions. The physiotherapist came to deliver a pair of crutches and talked me through some post-op exercises. A nurse left a Flowtron DVT prophylaxis machine and leg sleeves at the end of my bed, but I wasn’t asked to put them on yet. I showered with some pre-surgery antibacterial soap and waited nervously for the anaesthetist in a fetching hospital gown.
He arrived at 1230, asked a few questions and talked me through what would happen. He said that he wouldn’t use an epidural (unless I really wanted it) and would just use morphine, as two thirds of patients (of this type of operation) wake up comfortably in recovery this way. My surgeon then visited, talked me through a few things, asked me to sign a couple of forms and marked my leg with a big arrow and the word 'scope'.
Shortly before 2pm I was wheeled off to a little room just outside theatre and had a small cannula put in my left hand (I didn’t feel a thing). I was first given a clear fluid, which I vaguely remember was to prevent sickness, followed by something else that made me tingle all over. The third and final syringe contained a white fluid. As it was administered, I was asked how I was feeling, to which I replied something like ‘I can taste the anaesthetic and...’ I then woke up in recovery some 2 hours later!
I came to without any notable pain, but with a horrendously itchy nose! A kind lady beside my bed said I’d been scratching and rubbing it for ages, although I thought I’d just woken up. I looked around the room and saw a lady in another bed. Her whole body was shaking and I asked the lady with me if she was ok. I can’t remember her reply. My surgeon came to speak with me, showed me some images of the inside of my hip and told me what had happened on the operating table, but I quickly forgot what he told me… much to my frustration!
Back in my room my parents were waiting. I was still quite groggy from the GA and did my best to talk coherently, but I wasn’t fully with it and kept losing my train of thought. Along with my itchy nose, my legs and feet were also itchy, so my devoted mother provided a welcome leg-scratching service. Maybe it was a reaction to the GA? It also made me feel quite sick, which didn’t ease off until the evening.
After a couple of hours in my room I started to feel more human. My surgeon visited and talked me through what had happened: Posteriorly, which is where I have pain and catching, he found no problems. It was as it should be. Damn... Not the news I wanted. However, and very surprisingly, on the anterior side he found ‘severe’ labral damage. My operation sheet says:
“The abnormal findings included severe labral damage with anterolateral acetabular overhang impinging in the hip flexion” and “The acetabulum labrum has sustained what appeared to be a traumatic tear… The labral tear was 10 – 15mm in size located superiorly and antero-superior.” (I’ll add the full report another time when I feel like typing it out!)
I had 5mm of bone removed from the anterior acetabulum rim and the labrum was debrided back to stable articular cartilage. I have about 5 nylon stitches, which will need to be removed in 10 days.
My surgeon said it’s unlikely that the anterior labral damage is the problem I (only) get posteriorly, but he can’t say for sure. Only time will tell. It certainly wasn’t the initial outcome I was expecting though.
So how do I feel now? Not too bad! I came home late this morning (exactly 24 hours in hospital) and have been in and out of bed, pottering around the house chatting with family. My hip is sore but the pain meds are keeping me comfortable. It’s particularly sore around the anterior portal and even slight stretching of that hip flexor makes me wince, but it’s not that bad. Anticipation of the surgery and post-op pain was far worse than the reality.
That’s all for now. I’ll post again in a few days (after Santa has been) with an update on progress and a transcript of the surgeon’s operation report :-)
23 December 2009
Surgery day
Today’s the day! I need to be at the hospital in Cornwall at 1130 and hopefully the op won’t be too long after that. I’m quite nervous, which is to be expected.
Thanks to those of you who’ve sent messages of support. I’ll post an update in the next day or two with all the gory details.
Merry Christmas!
Thanks to those of you who’ve sent messages of support. I’ll post an update in the next day or two with all the gory details.
Merry Christmas!
18 December 2009
5 days to go
The operation is just 5 days away and I’m feeling pretty good about it. The open procedure seemed like such a big op for what are relatively minor symptoms, so arthroscopy is much more appealing alternative! Let’s hope they find that suspected labral tear that has eluded me for so long.
I’m not looking forward to the after effects of the GA. The last times I had it (following two sinus operations about 8 years ago) I suffered from mild post-operative depression. It didn’t last all that long, maybe 2 weeks or so, but it made me quite down and teary, and wasn’t particularly nice. I’ll be out of hospital on Christmas Eve and moving back to the family nest for while, so I’m hoping festivities and family will keep me chipper.
Good news (for me anyway) is that my butt is on the mend. After a deep sports massage, increased stretching and walking more often, the pain and discomfort has started to fade and it’s slowly returning to normal. This episode lasted for about a month and really was dreadful… I’m just glad it’s eased off so that I won’t have the problem while recovering from surgery next week.
I’m not looking forward to the after effects of the GA. The last times I had it (following two sinus operations about 8 years ago) I suffered from mild post-operative depression. It didn’t last all that long, maybe 2 weeks or so, but it made me quite down and teary, and wasn’t particularly nice. I’ll be out of hospital on Christmas Eve and moving back to the family nest for while, so I’m hoping festivities and family will keep me chipper.
Good news (for me anyway) is that my butt is on the mend. After a deep sports massage, increased stretching and walking more often, the pain and discomfort has started to fade and it’s slowly returning to normal. This episode lasted for about a month and really was dreadful… I’m just glad it’s eased off so that I won’t have the problem while recovering from surgery next week.
8 December 2009
Can I have a new bum please?
The paperwork came through from the hospital at the weekend confirming dates and times. I’ve got to be there at 11.30am on the 23rd December. I’m allowed to have a very light meal before 8am and then nothing until after the operation. What, no pre-op bacon and eggs?!
I had my blood samples taken at thehospital last week to save me driving down again before the op. I also had more MRSA swabs rubbed around my armpits and thrust up my nostrils. Bleah.
I’m asking Santa for a new bottom this year. The nerve problem has been driving me crazy, delivering constant aching and pain. Although my hips can hurt and catch, this problem is far worse as there’s no let-up. In an attempt to get some relief, I had a deep massage yesterday in my bum, legs and back. It’s was quite painful at the time but gradually became more comfortable. I felt great afterwards, but unfortunately it only lasted a short while. Back at my desk it soon flared up again.
I’m walking more than before, trying to keep everything moving. I also bought a rubber ring (not for water frolicking, sadly), which I’m going to sit on to take pressure off my glute and piriformis muscles. Maybe that'll help. I'll be forced to rest in a couple of weeks anyway - I'm hoping that'll help too.
I’m counting down the days now… It’s 15 days to go until the operation. 17 until Santa brings me my new bum.
I had my blood samples taken at thehospital last week to save me driving down again before the op. I also had more MRSA swabs rubbed around my armpits and thrust up my nostrils. Bleah.
I’m asking Santa for a new bottom this year. The nerve problem has been driving me crazy, delivering constant aching and pain. Although my hips can hurt and catch, this problem is far worse as there’s no let-up. In an attempt to get some relief, I had a deep massage yesterday in my bum, legs and back. It’s was quite painful at the time but gradually became more comfortable. I felt great afterwards, but unfortunately it only lasted a short while. Back at my desk it soon flared up again.
I’m walking more than before, trying to keep everything moving. I also bought a rubber ring (not for water frolicking, sadly), which I’m going to sit on to take pressure off my glute and piriformis muscles. Maybe that'll help. I'll be forced to rest in a couple of weeks anyway - I'm hoping that'll help too.
I’m counting down the days now… It’s 15 days to go until the operation. 17 until Santa brings me my new bum.
3 December 2009
A change of plan!
The appointment yesterday went very well. I was able to chat with my surgeon for quite some time and had the opportunity to ask all of my questions. After further consideration, he has decided to do the procedure via arthroscopy. Although he’s confident the pain is a result of a labral tear, open surgery is big operation without firm evidence, so he’ll investigate arthroscopically first.
Although the tear, if one is found, will be sorted out with this method, arthroscopy makes it harder to address the underlying cause – hence why the open procedure is preferred. If indeed the underlying problem cannot be rectified, open surgery may be required at a later date. I’m hoping that won’t be required, but if it did, at least I’d know it was to address a problem seen through the arthroscope.
I’m reaaaally happy with this decision. I’ll be out of hospital in a day or so and fully recovered in 3 months. It’s still quite a procedure and will involve partial hip dislocation, but it’s significantly less invasive than the open procedure.
Hip Arthroscopy Information
Oh, and this morning I got a call to say the procedure will now take place a week later on the 23rd December. My surgeon is already performing an arthroscopy on the 16th and he doesn’t do two arthroscopic surgeries one the same day.
Although the tear, if one is found, will be sorted out with this method, arthroscopy makes it harder to address the underlying cause – hence why the open procedure is preferred. If indeed the underlying problem cannot be rectified, open surgery may be required at a later date. I’m hoping that won’t be required, but if it did, at least I’d know it was to address a problem seen through the arthroscope.
I’m reaaaally happy with this decision. I’ll be out of hospital in a day or so and fully recovered in 3 months. It’s still quite a procedure and will involve partial hip dislocation, but it’s significantly less invasive than the open procedure.
Hip Arthroscopy Information
Oh, and this morning I got a call to say the procedure will now take place a week later on the 23rd December. My surgeon is already performing an arthroscopy on the 16th and he doesn’t do two arthroscopic surgeries one the same day.
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