One Hip Blog

My last post of 2010

2010-12-23T14:19:00.003Z

Compared with the rest of this year, I’ve been exercise a lot lately in preparation for my holiday next week. Things are feeling really good. A little weak but generally very good. The pain in my butt has also gone, which is a huuuge relief.

The big test starts just after Christmas when I'll be putting my hip through its paces in Austria. I'm nervous about skiing again and I'll no doubt be far more cautious than usual, but I'm so happy to be doing it again. Oh, and today is exactly 1 year since the operation... What a different a year makes!

Off topic, here's a nice festive snowy picture taken from my house this week:

More in 2011! Merry Christmas and happy New Year.

Woo hoo! (oh heck)

2010-11-09T18:38:00.001Z

I love skiing/snowboarding but, for obvious reasons, haven’t done it for a couple of years. This time last year I thought I’d never be able to do it again… Well, I’m booked up for my first ski trip post-op and in 7 weeks I’ll be putting my hip to the test in a full-on way.

I’m hugely excited about hitting the snow again and spending New Year abroad, but I’m filled with trepidation about how my hip will feel and whether I’ll hurt it. My muscles still feel very weak so I’m working to increase strength and stamina, but I really can’t predict how it’ll hold up after long days on the mountain. Eeek!

What’s more, that horrid pain the butt I mentioned a year ago has returned. Totally unrelated to my hips it seems, but possibly due to being sat down for too long and maybe directly attributable to a month of long hours and full weekends sat at my desk. I really don’t know how to get rid of it either, so I’m stretching this and exercising that in the hope it’ll disappear again. Humph.

Overdue update - 10 months post op

2010-10-31T09:58:00.005Z

Following on from my last post two months ago, after a week or so of pain and discomfort I emailed my surgeon for advice. 3 days later I was back in hospital getting checked out, scanned and prodded, and my hip joint was perfect, much to my relief. My surgeon suspected I had a new tear on/around scar tissue… scar tissue on the (iliofemoral?) ligament that surrounds the joint, which he made a hole in creating the anterior portal. Anyway, after week or two of good rest, things started to get better and now it’s a distant memory. Lots of jumping around playing badminton was probably too much too soon, so I’m back to taking things nice and slowly. It’s better all the time though and feeling pretty darn good.

Someone posted a comment on this blog a few days ago wanting to know if anyone has had this operation, if it was successful and whether having it was a good decision? My responses to these questions:

Was it successful? The original problem - the deep posterior catching and pain – has gone. Was the op a good decision? This time last year my hip controlled my life and now it’s not a big concern. Sure, it’s not perfect, but it’s infinitely better than was pre-op. I’m even returning to skiing this winter (woo hoo) and I thought that would never happen. Will it ever be perfect again? I don’t know, but I don’t mind.

Good decision? Yes. Successful? Successful enough :-)

Problems

2010-08-20T10:25:00.001+01:00

It had all been going so well! I recently started going to the gym to get my fitness back in order and had started running on the treadmill. Only for a 5-10 minutes, but it felt ok. I then decided to try badminton with a friend in the hope that one day I’d be able to return to playing tennis, but I regret playing and now wonder whether I’ve done some significant damage.

Post op the inside of my joint hurt a little but it was never anything worth noting. However, lunging about on the badminton court has given me quite moderate pain in the joint on the anterior side (not where my original problem was, but where the surgeon did stuff). I’ve had a fairly constant dull ache for nearly 5 days now with little zips of sharp pain. It hurts to sit, as I think it puts pressure on the part of my joint I’ve hurt, and it hurts when my leg is at extension when walking.

Jumping around was a huge amount of impact on my joint, so I’m hoping it’s just sore and tender after not having done anything like it for a couple of years (although, the left hip hasn’t done anything either and that feels fine). If I’m honest, and knowing my own body, it feels like something more notable is wrong and that it’s not something that will just get better :-(

Hopefully my next post will disprove these suspicions. Until then...

Update: 5+ months post op

2010-06-04T13:10:00.002+01:00

I thought it was about time I wrote an update as it’s been nearly 3 months since my last post! Where does the time go?

Progress has been good over last few months and life is returning to normal. The biggest change is that I’m able to walk wherever I like without having to worry about my hip. I go to work on foot most days and can walk around the town for a couple of hours without having to be anxious about pain or catching. That said, it’s not perfect; I still have a very slight limp – especially when walking uphill – and I get some minor discomfort after walking for an hour or more. My sporting activities are still limited and I also have a little tightness around the anterior portal site at extension, but I’m hopeful that all of these things will gradually improve over time.

Generally speaking, I’m still conscious of my hip and how it feels with every step; partly because it feels different to my non-operated side but mostly because this 2-year episode has been so mentally consuming. It’ll take some time for me to be psychologically confident that my hip is fixed, even if physically I’m well on the way.

Progress is definitely logarithmic with any improvements taking longer now than they did in the first couple of months, but I guess that’s to be expected. To put things in perspective though, 6 months ago I could hardly walk anywhere without mild to major pain, causing considerable disruption to so many aspects of my life. I now walk around, cycle with my friends and even do a bit of salsa dancing! It’s a dramatic contrast and I can’t grumble at all. I might even return to snowboarding this winter!

I’ll post again in 2-3 months, by which time my hip will be so good I’ll probably be the world break-dancing champion or something. Ok, maybe not :-)

As one chapter in my life draws to an end, another begins: I’ve just had teeth removed (3 days ago) ready for mouthful of Radiance braces, as I’m entering the world of adult orthodontics... maybe I should start another blog?!

Have a great summer everyone,

Paul

Physio

2010-03-04T13:18:00.001Z

I’ve been having weekly physio sessions for a number of weeks now and have come to the conclusion that my physiotherapist is the best thing since sliced bread.

Firstly we addressed the pain over the greater trochanter. A few exercises and stretches pretty much sorted that out in a week or two. We then focused on my walking, how it had changed and how to fix it. We’re now stretching and strengthening with a few ultrasound treatments thrown in for good measure.

I’ve been out on a few cycle rides. Fairly gentle stuff to start with and not huge distances but it’s a start. I’ve also walked to and from work (1km each way) on three consecutive days this week… maybe a fourth tomorrow. That may not sound like much, but I’ve not been able to walk so well for quite some time so for me it’s a pretty big deal.

I’m feeling great at the moment :-)

1.5 months post op

2010-02-09T11:27:00.000Z

It’s nearing 7 weeks since I had the op and things are more complicated than before. My actual hip is doing great. I don’t have any hip pain so that side of things is progressing well. However, my range of movement is more limited than I thought and I’ve developed some really bad habits… habits that are proving difficult to change.

I mentioned in earlier posts that I started getting a problem in my leg… a sharp pain just under the skin around the greater trochanter, after what felt like a rub or snap in the side of my leg. I mentioned this to my surgeon on the 29th Jan but he wasn’t concerned about it. He said that if the inflammation doesn’t settle, a shot of cortisone should calm things down. I went to the physio department afterwards (they weren’t expecting me) and was given some stretches (one for the IT band, which helped a lot), but that’s pretty much all the physio I’ve been given since the operation. Surely that can’t be enough?

Taking matters into my own hands, I decided to make an appointment to see a physio locally. I had my first appointment early last week, with the painful problem around the GT the main area of focus (stretching, strengthening and ultrasound). Since then, I’ve not had the sharp pain back so it’s definitely going in the right direction, but I’m tight, have restricted movement, and this problem has caused other issues.

I’ve started to walk differently. I’m now walking in a way that stops my leg from hurting, kinda kicking it out to the side slightly to stop any rub over the GT. I now can’t not do it! Walking normally is almost impossible. It’s ironic really, as the reason I started to get that problem was because I walked differently to prevent my hip from hurting post surgery. So we’re trying to fix my walking and gait problems. I’ve been given new exercises and things to focus on, which I’m finding really difficult. My right leg just doesn’t work like it should. My glutes are useless too.

On the plus side, I’m able to cycle a little. I’ve been using the exercise bike often and managed to get out for a short ride by the river on Saturday afternoon. Twas lovely.

1 month post op

2010-01-24T12:58:00.000Z

It’s been just over a month and things are starting to return to normal. I’m now able to walk here and there, albeit not that far, with an ever-improving range of movement. Extension is still pretty limited but it’s good enough that I don’t have to limp. I’ve been using the exercise bike for 10-15 minutes a day (low resistance) just to get the blood flowing and to keep my muscles working, which feels great.

The two incision wounds have healed and all that remains are quite minor pinky scars, which will soon be almost invisible anyway (having hairy legs has its benefits). The scar tissue beneath the skin is a little lumpy, particularly at the anterior portal, but it’s only noticeable when you apply pressure so it’s no big deal.

I still can’t be sure, but I’m feeling more and more confident that the original problem still exists. Particular sensations prior to surgery, like a feeling I get when turning in bed, have semi returned. Also, I went into the attic yesterday (yes, I’m well enough to climb a ladder… kinda) and I thought I felt the old problem. Things still aren’t 100% right after the traction stretching though, which is why I’m not certain about whether or not the old issue is still there. As I said in my last post, and as I have to keep reminding myself, it's too early to know for sure.

Last weekend the new post-surgery issue in my leg returned for a second time. In a way, I’m glad it did as it’s given me valuable information. Since this has happened a second time, I’m confident that the feeling is the same as what I get in/around my hip, just in a different place. If we’re able to find out what the leg problem is, I have hope that they’ll find the hip problem. There are a few possibilities to investigate with physio (ITBS and Snapping Hip Syndrome, for example) at my next appointment.

I’m really looking forward to talking things over with my surgeon and chatting with physiotherapists who know a lot about these things (I’m pretty sure the last lot didn’t). My appointment is on Friday (29th Jan) at the Duchy Hospital and I’ll post an update shortly afterwards.

Get well soon, Louise.

3 weeks post op - Has it been successful?

2010-01-13T18:33:00.001Z

My surgeon advised that I may feel the same/similar symptoms for 2-3 months post op, so it’s really too early for me to say for sure, but there are a few things leading me to think that the surgery didn’t fix the problem…

The surgeon found no damage posteriorly. This is where my pain is.
I’m pretty sure I can still feel the problem.
I’ve started to get a new issue in my leg (probably from the stretching during surgery) that feels just like the problem in/around my hip. Coincidence?

The anterior labral damage could be referred (unlikely, according to my surgeon, but you never know) and my leg could be something unrelated, so it’s too early to confirm whether I’ve been fixed or not. I’m not going to dwell on it until I know for sure.

Generally speaking, my recovery has been going really well. My ROM has improved so much since the last post and my walking is starting to look and feel more normal again, but I’ve still got a looong way to go before I have normal flexion and extension. I can just about sit cross-legged and can lie on the operated side for a short while, although it’s not yet comfortable enough to do either for any length of time.

The hospital called yesterday to ask how I was feeling and if there were any issues or complications. I like that they did that. I have a follow-up appointment with my surgeon at the end of the month, straight after which I’ll be whisked down to physio. I hope they’ll give me new and different exercises to do. I’m getting a bit bored of the current set!

A few photos

2010-01-05T13:31:00.012Z

My room at Duchy Hospital

An hour or two after surgery

Christmas Day on crutches

Stuck in the mud, Boxing Day

Healing up nicely (1 week post op)

New exercise bike for rehabilitation

1 week post op

2009-12-30T23:59:00.004Z

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 :-)

4 days post op (+ operation report)

2009-12-27T14:10:00.003Z

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.

1 day post op

2009-12-24T23:38:00.006Z

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 :-)

Surgery day

2009-12-23T09:17:00.001Z

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!

5 days to go

2009-12-18T13:56:00.000Z

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.

Can I have a new bum please?

2009-12-08T12:40:00.008Z

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.

A change of plan!

2009-12-03T13:23:00.008Z

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.

Questions for my surgeon

2009-11-30T18:25:00.005Z

On Wednesday I have a consultation with my surgeon to ask a few final questions. It’s been rescheduled for 8.15am, which considering I live 90 miles away means a very early start! I will ask…

My usual hip problem returned at the weekend after a rain-avoiding dash in Sainsbury’s car park. Considering I’ve had the hip block, should I have felt this as I did? Could the cortisone effects have worn off so soon or does this indicate a different problem?
As I can almost touch the point that catches/causes pain on the posterior side of the greater trochanter, is open surgery the right thing to do?
My anterior impingement and anterior atrophied labrum are all well and good (they’re not of course), but given that all pain and discomfort is posterior, is open surgery the right thing for me? Is this going a fix a problem that isn’t the real problem?
Is it possible to inspect the acetabulum rim/labrum area without removal of the greater trochanter (in order to eliminate other possibilities before the osteotomy and dislocation)?
I read in your literature that movements do not usually return to ‘normal’ after open hip surgery. What does this mean for me and what might it stop me doing?
I’ve had moderate to downright painful aching deep in both glutes for over three weeks now. My legs feel like they’re not supporting me and, when it’s at its worst, it’s too painful to sit down. Why might I be getting this? Is it Piriformis Syndrome or maybe a sciatic nerve problem? Is it related to my hips? How do I/we fix it?
I’m concerned that my left hip will give me problems when I’m on crutches post operatively. Would it be a good idea to have a hip block on that side to help?

My latest concerns

2009-11-24T14:47:00.012Z

I’m getting properly worried about the forthcoming operation now. It’s not the procedure that I’m really concerned about (although it is hugely invasive) – It’s more about going through all this when the problem is still kind of unknown.

In a funny kind of way, I really wanted the MRA to show a dirty great labral tear. That would’ve at least identified a true source of pain. Instead, we have a mild cam anterior impingement with no anterior pain. None whatsoever! The sharp pain when stepping in a certain way or walking up a stair is solely posterior. Maybe my minor impingement is not an/the issue?

The hip block injection seems to have eased the problem, I fairly sure of that. However, I can’t be completely sure. I’ve had spells in the past where days and weeks have passed without any catching or snagging, allowing me to lead a completely normal life without any pain. I didn’t have a hip block then, so maybe that’s what I’m experiencing now? It’s unlikely, given the gradual worsening of my hip problem, but it’s a possibility. I’m still trying to flare it up, but the other problem of pain in my glutes has taken a more prominent position of late, forcing me to lead a very sedentary lifestyle.

As the operation is just over 3 weeks away, maybe this is just a bout of pre-op nerves, or maybe I have genuine cause for concern. What is certain is that my consultant is going to get a lot of questions at my appointment next week.

Interesting links:

Surgery for femoroacetabular impingement (NHS Library)
Info-sheet about open FAI surgery (NICE)
Open surgery for hip impingement (CAUTION - Contains surgical images. British Journal of Hospital Medicine, Feb 2009 - Norton/Fern)
Open and arthroscopic surgical comparison (University of York)

The countdown begins

2009-11-20T15:36:00.003Z

This afternoon I heard back from my consultant's secretary. He's reviewed my diary since the hip block and feels we should proceed with the surgery as planned. That means I'll be having the operation in less than 4 weeks time.

I have requested another consultation before the op, just to run over a few questions and to voice my concerns. That's booked for early December.

So, it's happening! My stomach has twisted itself into knots a couple of times this afternoon at the prospect of what lies ahead, but I'm sure it'll be fine. Pre-op nerves!

What’s with my bum lately?!

2009-11-20T11:56:00.003Z

It’s been two full weeks since the hip block and I’m pretty sure it has made a difference. I can’t be totally certain as I don’t always have pain, but the usual snagging/catching is happening less often and is moderately uncomfortable rather than painful.

I’m now trying to arrange things with my consultant to discuss the results and next steps, but am not having much luck. The operation is scheduled for less than four weeks time and I’m yet to know for sure if I’m having it! I hope I get a follow-up appointment soon.

This time a week ago I started to get pain and discomfort from deep in my buttocks. Not from the hips so unrelated to hip block, but deep in both glutes. So sore was my behind that it was too painful to sit down or lay on my back, so the only relief was to lie face down on the floor! Just what I needed.

I did a little research and read about something called Piriformis Syndrome, which seems to hit the nail on the head. I’ve been stretching out my piriformis muscles and it’s getting better, although I’m still unable to sit for long periods of time without a deep pain and burning feeling… a nightmare considering I spend most of my time sat at my desk. Ho hum.

A final note of thanks those who’ve posted comments on this blog to share stories, thoughts and experiences. Keep ‘em coming.

Hip block - is it working?

2009-11-10T18:18:00.001Z

On Friday I had the hip block procedure at the Duchy hospital. Apart from a 4-hour wait in gowns, everything was straightforward.

Firstly I was given a local anaesthetic to numb the area, which was little more than a scratch. Then, as with the arthrogram injection, contrast dye was injected so that the final cortisone injection could be guided with fluoroscopy. It was all painless, with just a tight or full feeling after the contrast and cortisone injections.

On Saturday and Sunday I took it easy. The hip was a little tender after the injection so I chose not to test whether the block had worked. On Monday, I decided to walk to my office, which is about ¾ mile up hill. I intentionally walked briskly taking large strides - things that would often (but not always) flare things up. I didn’t have any discomfort or snagging and managed to walk home too. I’ve also been taking large steps and twisting my torso as I walk. Apart from looking rather foolish, these are usually easy ways to cause irritation but I’ve not had any of the usual symptoms. It all feels a bit odd!

I’ll keep doing things that could cause my hip to flare up. If indeed the hip block has given relief to the problem as it initially seems, I’ll be going into hospital in a little over 5 weeks time for surgery. I have butterflies in my stomach just thinking about it.

October update

2009-10-21T16:16:00.009+01:00

It’s been a month since my last update and I’m in limbo until the hip block. It’s been brought forward and is now on the 6th November, so it won’t be long before I know what’s happening. Unlike the MRI-A contrast injection, this one is classed as a day op/procedure so I have to complete some pre-surgery forms and have an MRSA swab.

About 2 weeks ago I started to get the same symptoms in my left hip, which I couldn’t believe. I felt pretty unlucky to have a problem in one of my hips at 30 years old, so a bilateral complaint was all I needed! The problem in my left hip is identical to the one in my right, with exactly the same triggers and symptoms. Given my limited activity over the last few months, is it likely that I’ve torn the labrum on that side too? I’m not so sure.

I’m now worried that I don’t have a tear on either side and that this is some other issue, but we won’t know until the hip block in a couple of weeks. On the plus side, if one side is successfully diagnosed, at least the other will be too. And at least dodgy hips didn’t stop me rolling down a hill in a giant bouncy ball last weekend! Weeeeeee!

I had the opportunity to have a coffee with a lady called Janet recently. She’s had open hip surgery for FAI, and told me about the op and how she felt in the weeks and months afterwards. Her hip problems make mine feel quite insignificant in comparison, and it was inspiring to hear her speak so positively about the open procedure, the consultant and hospital.

Janet also had a look over my scans (as a medical professional) and could decipher them far better than I could. What was interesting and confusing was that my impingement and atrophic labrum are anterior, yet the pain and discomfort is only posterior. Shouldn’t people with anterior FAI and tears have groin pain? I certainly don’t and have never felt a thing on that side. It has always been, in more ways than one, a pain in the backside.

That’s all for this post. More after the hip block in 2 weeks time. A final word to Janet to wish her well for her next operation later this month :-)

MRI-A consultant diagnosis

2009-09-19T11:17:00.003+01:00

"I have reviewed Paul today together with the MRI scan which was recently done. The MRI arthrogram is very helpful in defining the shape of the femoral head in particular. What this shows is that the femoral head is slightly oval shape, particularly over the anterior part of the femoral head, which means that he has a CAM shape femur. He does have an abnormality on the acetabular side also with a very atrophic labrum in the same vicinity as the CAM shape femur. The problem that we have is that I can’t identify an obvious tear on the labrum. This would usually be the identifiable source of pain on somebody with hip impingement, but this is not present in Paul’s case. The difficulty here is therefore I don’t have anything to directly blame as a pain source and I therefore can’t guarantee that be treating Paul’s hip impingement will also remove his pain problem.

"This is therefore a very difficult decision making process. To try and help in this process I have offered to perform a diagnostic hip block with an intra articular local anaesthetic to see whether this would temporarily relieve Paul’s symptoms. If it does, this would tend to confirm that his symptoms are from the joint itself rather than from any of the tissues surrounding the joint or a referred pain from the back, for example. I think that if the local anaesthetic injection does resolve his symptoms for 6 hours post operatively, it would be worth considering open surgery to reshape the femur and explore the hip in more detail, and repair any other damage which might have been caused.

"I will book Paul for inter articular hip injection on the right side and I will review him thereafter to see what sort of benefit he has had temporarily from that injection."

MRI-A images

2009-09-18T16:55:00.006+01:00

Here are two of my MRI arthrogram images showing the cam impingement:

(click to see larger)

(click to see larger)

Hip impingement diagnosis - but no labral tear?

2009-09-16T17:35:00.001+01:00

Today I met with Mr N (my consultant) to discuss the results of the MRI Arthrogram. I was really hoping that he would be able to clearly see where the pain was coming from, but unfortunately that didn’t happen.

My MRI-A results show an impingement on the femoral head (cam shaped). It was expected that a labral tear would also be seen as this is a known source of pain with FAI, but one couldn’t be seen.

As it is not possible to identify the source of pain, Mr N said that he doesn’t know how to stop it hurting. Exploratory open surgery MAY reveal something that didn’t show up on the MRI-A, but this is not guaranteed. He said I need to think about whether I am willing to go through the operation and recovery with the possibility that I could be the same afterwards. I’m not sure how I feel about that at the moment.

As nothing was apparent on the MRI-A (apart from the impingement), it was suggested that this could, although unlikely, be a tissue or tendon issue outside of the joint, and that the impingement has nothing to do with the pain. To test this, I will be having a local anaesthetic injected into the joint… if the pain or catching stops, Mr N can conclude that the problem is from within the hip and that open surgery is worthwhile (though still with the caveat that he may not be able to fix me).

The MRI-A contrast dye irritated my hip, so this is a good indicator that the pain is coming from within the joint and not from tissue outside. Still, we’re going to do the local anaesthetic test to make sure.

After that I need to decide whether to go ahead and have open surgery. It’s a daunting prospect given that it may not improve things.

MRI Arthrogram – my experience

2009-08-26T13:53:00.009+01:00

I was quite nervous on the day or the appointment (two days ago) as I’d read a lot about MRI arthrograms on the internet. Not thrilled at the prospect of having dye injected into my hip joint, I tried to forget the things I read and focus on the positive, which is getting a diagnosis.

The radiologist talked me through the procedure and asked whether or not I wanted to have local anaesthetic (What?! I thought it was always done with anaesthetic!). He said that local anaesthetic requires a series of injections, each getting deeper, whereas without there would be one injection straight to the joint and it would be over more quickly. He said most people find this tolerable but it’s my choice whether to have it or not.

I’m not usually too bothered about needles, but my stomach churned at the prospect of having one in my hip joint without anaesthetic. However, I trusted the radiologist and decided to go for the quick anaesthetic-free option.

I lay on the bed as the injection fluid was prepared at a table beside me. My heart was thumping. After a few minutes, I was cleaned and then told I would feel a scratch. The needle was pushed in quickly and fully, which made me shout out... more through surprise than pain. It certainly was painful and very uncomfortable, but not excruciating like some people would have you believe. The needle stayed in for a while and was aligned using x-ray. The contrast fluid was injected and the needle removed (I didn’t enjoy the removal much either).

The needle is injected in the front near the groin area, not the side. Here’s a picture of me showing where the injection took place (I’ve covered my man parts so as not to scare readers).

After the injection I was put in a wheelchair and wheeled through the hospital for the MRI scan. As I had the scan (which is completely painless) my hip was good. It felt a little strange and numb but nothing notable. After 30 or so minutes of banging and clunking, the scan was complete and I was allowed to go home.

After the appointment

I walked along the car park and all seemed well, until one movement made my hip hurt a lot, but it was a new sensation and not like the usual catching pain. In the car on the way home I was fine for 95% of time, but would occasionally get bursts of pain and discomfort (I'm glad I didn't drive). By the time we reached our destination about 90 minutes later, movement was pretty uncomfortable and it hurt to walk. Things were fine as long as I didn’t move, so I sat in a chair until some painkillers kicked in.

I wasn’t able to walk normally up stairs that night. I had to use my left (good) leg to lead up each step and a walking stick for balance. I didn’t have any pain during the night and I woke feeling good and agile. It still felt a little strange that day but I could walk around just fine. Today, 2 days on, it’s as though I never had it. All I have to show for it is a tiny red dot.

My experience of the MRI Arthrogram is that it’s nothing to fear. Yes, it hurts and makes you feel uncomfortable, but is it as bad as some people make out? No, not for me anyway. If you’ve had one of these yourself, please post a comment to let others know about your experience.

MRI Arthrogram - booked

2009-08-19T13:01:00.004+01:00

Only four working days after my appointment at the Duchy, I received a call to be booked in for the MRI arthrogram, which is scheduled for this coming Monday.

I’m impressed at how quickly they turned this around. The regular MRI that I had at the NHS hospital in Exeter took about 4-5 weeks from referral to scan, so this was incredibly quick!

I browsed the web for information on MRI-A’s and there are some mixed stories out there. For some it’s all pain and doom while others say it’s not too bad. However you look at it, it doesn’t sound like the most enjoyable of things but it’s something that has to be done.

I’ve been told I shouldn’t drive afterwards. That makes things slightly awkward as the hospital is 90 miles away, so someone has to spare an afternoon to come with me and drive me home. One of my brothers has kindly offered his chauffeur services for the day, which is also good as we get to spend some time together.

I’ll post my own account of the MRI arthrogram next week!

Hip impingement diagnosis (maybe)

2009-08-13T12:46:00.003+01:00

Yesterday I had my appointment with the consultant at the Duchy Hospital in Truro. It was a 90-mile drive from my office in Exeter and I was eager to see if my hip problem would be diagnosed. It was ‘orthopaedic day’ at the hospital and the outpatients’ area was bustling with people (mostly hobbling). After a short anticipative wait, I was called into the consulting room.

Following a chat about my problem and how it came to be, a walk around the room and some prodding, pulling and twisting, my consultant seemed confident that the cause of pain was a torn labrum developed as a result of a hip impingement, as suspected by the hip surgeon I’d previous communicated with. It can’t be confirmed for sure until I’ve had an MRI arthrogram, but this is the preliminary diagnosis.

I was also sent to x-ray as a matter of practice and the results were normal, which was expected. So next step is the MRI arthrogram, which I hope won’t be far too far away.

Remedy

Having read quite a lot about FAI and the two main types of surgery (open and arthroscopic), I already had a pretty good idea of the steps needed to fix the problem. However, I had convinced myself that, given the relative minority of my pain and problems, arthroscopic surgery would be the chosen path.

My consultant said that open surgery would be the preferred option as it’s more likely to have a positive outcome in the long term. I was informed that arthroscopic surgery has its limitations and is therefore preferred in older patients where the likelihood of other problems is lower than with open surgery. However, as a young man in good health without any other hip problems, I would expect to recover well from open surgery.

I was informed that a complete recovery takes about 12 months and that the operation has a 90% success rate.

Is this right for me?

I really didn’t expect that open surgery would be for me. My pain, although bad at times, is sporadic and I’m generally able to walk well. I’m unable to do most activities and sports so my life is certainly restricted, but not to the extent where I’m constantly in pain or unable to lead a fairly normal life. Since the appointment yesterday I keep asking myself, ‘do I really need major surgery and 12 months of recovery?’

The more I read about the procedure, like the trochanteric osteotomy, hip dislocation and osteoplasty, the more I’m beginning to worry. We don’t yet know for sure that this is the problem, so I should probably stop thinking about it so much until I have the MRI arthrogram.

A pain in the butt

2009-08-04T09:48:00.006+01:00

My hip has been pretty good over the last few days. I managed to walk from my house into town (about half a mile) and back twice in that time, without any notable pain, catching or twinging.

It’s quite a contrast from last week. At the weekend I went to see a friend compete in an endurance mountain bike race near Plymouth (once which I’ve competed in previously but now can’t). A slight turn or movement irritated my hip and it caused it to flare up for a few days. This is nothing new but it brought on something else…

More troubling was the pain in my right buttock and thigh. Parts of my right buttock were very tender and sore to the touch deep in the muscle, and my right leg was both numb and painful near my groin for about 6-10 inches down my leg. My whole leg felt like a lump of wood and moving it was unnatural and clunky.

I read on some other blogs that people with hip problems (FAI etc) can get sciatic nerve problems too. Looking at the route the nerve takes, it certainly seems possible that this is what was causing the problem in my glute and thigh.

I’m glad it only lasted for about 4 or 5 days. Here’s hoping it doesn’t become a regular symptom.

It started like this...

2009-07-30T16:24:00.003+01:00

Here’s the story about how I came to have a hip problem...

In April 2008 I went to London with Francesca, a good friend of mine. Her parents were visiting from overseas and we spent the day walking around the city taking in the sights. In the latter part of the day I started getting pain in my right hip – something I have not experienced before (at the time I was 29 years old, slim, fit and active).

Upon reaching St Paul’s Cathedral having walked quite a distance around the city, I noticed a more serious problem had developed, as walking up the cathedral steps was quite painful. By this point I had also developed a limp due to the pain, but never having had anything like this before, I assumed it was a one-off problem and one that would disappear in a day or two. Not so…

Ongoing problem

A couple of months down the line I still had minor hip issues. Nothing as bad as that day in London, but the odd painful spell or twinge was never far away. This gradually worsened throughout the summer to the point where the discomfort/pain meant I had to stop most activities and I was avoiding walking where possible. I also developed a problem walking up stairs where a ‘catching’ sensation would cause a shooting pain in my right hip. This has by far been the worst symptom.

Since then, pain in my hip has been up and down, sometimes very localised and other times affecting my thigh, glute and possibly my sciatic nerve. I tend not to walk too far and avoid walking up hills as much as possible, as this is sure-fire way to irritate it. It can flare up for the slightest reason… a slight turn on foot to change direction, getting in the car, stepping out of the shower, crossing my legs, and so on.

Medical advice and treatment

In the summer of 2008 I visited my GP in Exeter. After twisting my leg around and putting pressure on my joint, he was confident that it wasn’t a degenerative hip problem often found in older people. He assumed it was a gait issue and referred me to the local physiotherapy team, based at Franklin Hospital in Exeter.

The physio team initially concluded that the pain I was experiencing was due to inflammation and bursitis, brought on by a right glute that wasn’t doing its job properly. I was given numerous stretching and strengthening exercises, in the knowledge/hope that the additional muscle strength would alleviate the problem and prevent it from happening in future.

However, after 5 or so months of physio it was clear that we weren’t progressing far. The treatment had helped to improve my walking, but I wonder whether this was fixing tense muscles/weakness that had developed during the summer as a result of not walking or doing much. Ultimately, the hip pain was not improving and the shooting pain on stairs continued, despite considerable muscular improvement.

Scans

In April 2009 I was referred to the Royal Devon & Exeter Hospital for an Ultrasound scan, but it didn’t reveal anything. Later that same month I had a MRI scan at the RD&E, and I was hopeful that this would reveal the problem. A couple of weeks later my doctor called with the disheartening news that the MRI scan didn’t reveal anything untoward.

In frustration at having had the problem for a year without any improvement, I emailed about 20 hip surgeons (details found on a private health website) in the hope that someone would offer some advice about what to do or where to go next. Most went unanswered, but one replied!

Femoro what?

After reading the detailed story about my hip troubles, the surgeon suggested a possible diagnosis: “Femoroacetabular Impingement (FAI) and possibly a labral tear”.

What on earth? I had never heard of these things before! They’ve never once been mentioned by my doctors, consultants or physiotherapists. Although trying not to jump the gun, this has given me hope. Hope that we can find the cause of the problem and hope that we can fix it. I’m not saying I’d like to be diagnosed with this condition – from what I’ve read, the steps to fix it are quite something – but this is a new condition that I didn’t know existed, and researching it has revealed information on a myriad of other hip conditions.

I am now being referred to see a specialist hip surgeon in Cornwall (Cornwall Hip Foundation) through the NHS Choose and Book scheme. My initial appointment is a little under two weeks away and it can’t come soon enough!

So that’s my story thus far. This is quite a meaty blog entry as I had to get the background info down, so well done if you made it this far without nodding off. I’ve found a wealth of info on the internet from other sufferers so I hope any information I give, both above and in future posts, is helpful and informative to you.

More soon…