Here we go, Day 1:
The surgeon found more than either the CT (with 3D MRI-assisted reconstruction) or the MRA showed. Let the record state: I am not surprised at all. A bloody joint (synovitis), two areas of impingement (CAM FAI and AIIS on the femoral head and ilia, respectively), capsular repair, and a labral tear and detachment was served up to me in the post-surgical briefing from the surgeon. He was excited, and frankly, even in my recovery room drug-induced state, I was excited too.
But things were about to get very real over the next few hours. Thank goodness I spent an overnight in the hospital because the facility was a three hour drive. One way. Let’s just say I learned the real importance of “staying ahead of the pain.”
But you may be asking, what in the heck was all that medical speak-gobbledy gook you just spewed out in the first paragraph?
Like I mentioned in the first post, Resurfacing after Hip Labral Surgery, Post 1, hip labral surgery is rarely only about fixing the hip labrum.
So let me break down the medical jargon:
- Synovitis – Synovitis is an inflammatory condition of the synovial lining of the joint capsule. It can happen from overuse, inflammatory disorders of the joint, or in my case, from a shredded interior of the hip joint. My joint was found to be bloody and very mad as a result of the initial traumatic injury three years ago. Read more (see photo at left)
- Impingement – CAM type – CAM impingement happens because of a decreased head-neck offset of the femoral head and neck. This means that the femoral head is essentially not round and doesn’t roll, glide, and spin in the acetabulum (socket) smoothly. This deformity can cause damage to the articular (surface) cartilage of the femoral head, as well as tears of the acetabular labrum. Read my post on Walking Patterns and Hip Impingement (see photo at left)
- Impingement – AIIS type – A relatively new type of impingement, anterior inferior iliac spine or subspinal impingement, was found during surgery. It can also create impingement and/or tears of the acetabular labrum. In my case, my strangely hypertrophied labrum was being impinged from both sides (both inside and outside the joint). Read my post Extra-articular Hip Impingement: A New Discovery in Hip Preservation
- Capsular Repair – Known as capsular plication, this procedure is typically done when someone has an unstable joint. It can be traumatic or chronic, and in my case, it was both. Three pregnancies, coupled with birth trauma on the third delivery, and hip dysplasia, sufficiently wrecked my joint capsule so that a plication was required. Read more
- Labral Tear &/or Detachment – The celebrity darling of hip joint preservation, hip labral tears receive the most buzz in hip preservation/reconstructive surgery. However, repairing a labral tear, as you can see, is only part of the solution. A tear of the hip labrum compromises hip joint stability and can be related to or cause many types of pain: pelvic, back, sacroiliac joint dysfunction, abdominal, groin, buttock, and hip. Read my post on Four “Must Know” Tips for Identifying Hip Labral Injuries.
- For Extra Fun: There was also hip dysplasia (a preexisting a la’ carte condition), of which this surgery could no nothing to correct. But more on that later.
The Personal Perspective
So what was I feeling like on day 1 post-op? Happy, even a bit giddy, to be honest. I was looking forward to being out of daily pain, to getting into the nitty gritty of post-op rehab, and to just plain be able to walk again painfree.
Now first let me say the obvious: As an orthopaedic and integrative PT, I had a serious advantage most folks don’t get. I had built-in and up-to-the-moment knowledge of the science of hip rehab. Heck, I even teach CE about the hip labrum. However, NO amount of medical training and expertise could prepare me for what I was about to get, which was in no small terms, the experiential SMACKDOWN of my life.
In other words, NO amount of medical training and expertise trumps personal experience. That is important enough to say again this way:
If you are a “hippie” patient: Your experience matters. Your story matters. Your health care provider has an obligation to listen carefully to what you have to say about how your hip feels.
If you are a “hippie” health care provider: Tapping a patient’s own body wisdom is incredibly valuable in helping them heal. In fact, their recovery depends on it.
So back to that SMACKDOWN:
First, immediately post-op, I was torn down by the amount of psoas spasm I was having. That cramping, “spasming”-type pain was worse than pain from the surgery itself. The psoas would just seize up and, if you know anything about anatomy, when the psoas tightens, it clamps down on the anterior joint and…you guessed it, the hip labrum gets caught in the fringe.
The psoas spasms were like being caught in some kind of post-surgical purgatory. Now I fully understood why Flexeril was an optional medication on my list. You can imagine how quickly I buzzed the nurse to have it added to my med list BEFORE I left the hospital.
CLINICAL PEARL: Be well hydrated with good electrolyte balance, so dehydration is not a factor in the muscle cramping. Be prepared with strategies, pharmacological if necessary, to deal with muscle spasms. Also, make sure you (or your patient) is warm. Cold made my spasms exponentially worse. Finally, if nausea is an issue in recovery, get a leg up on it. I used the P6 nausea point, even in my recovery room haze (and even schooled the attending nurse on it, who from what I recall, was impressed I could even form a sentence, much less trip into “educator” mode), to prevent MANY episodes of acute nausea bordering on “you-know-what.” Don’t be afraid of asking for anti-nausea meds too, however. Free downloadable .pdf of Acupressure for Nausea
Second, once at home, I was unstable on crutches secondary to orthostatic hypotension; this was due to my ambulatory status and hip precautions, meds, and my already low blood pressure. After 2 near falls, my quick-thinking husband went out and borrowed a walker and a raised toilet seat on post-op day2. Keep in mind that I had excellent presurgical balance!
CLINICAL PEARL: Be prepared to have a walker and raised toilet seat on hand if needed, even if you had excellent presurgical balance.
Last, I didn’t realize that I would need significant stabilization of the hip to avoid external rotation while in bed, and also manage pain. Fortunately, I had plenty of help that could arrange tightly rolled yoga blankets to serve as an anti-rotation pillow.
CLINICAL PEARL: Have an anti-rotation pillow handy for pain management and to stay within your hip precaution boundary(s). Be aware that some surgeons do write scripts for these pillows depending on their protocol.
CLINICAL PEARL: There is NO substitute for a thorough physical examination and patient history intake. Remember when I said the surgeon was excited about the surgical findings? And I was too? This is important because it underscores an important fact: The diagnostic tests MISSED my pathologies. The take-home message is: Don’t decide to have surgery based on MRA or CT scan results. A thorough physical exam by a physio/physical therapist or surgeon who specializes in hip labral injury (not a general PT or general hip or orthopaedic surgeon) is a vital, if not most important, aspect of determining surgical candidacy.
Best of luck in your journey to recovery or success in working with hip labral injury patients!
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Disclaimer: As always, none of my blogs are meant to diagnose or substitute for medical advice. Always consult your surgeon or physio/physical therapist before attempting any exercise on your own. Lastly, the list of pathophysiologies addressed in my surgery are only part of what can be done; and, the list was not comprehensive of everything that was done during my surgery. Nor does the list include medical jargon for the procedures done, such as osteoplasty, etc.