Feelin' hip!

*WARNING: This is kind of a long story...

Wanna know what fun I've been up to the past couple of months?  And what fun I'll be continuing to have?  Well, I'll tell ya...

First, a little background:
You may or may not know--though, you probably do, 'cause I'm a bit of a whiner... : )--that for the past 6 years or so--since I was first pregnant--I've had some hip pain off and on.  With each pregnancy it got worse (remember me waddling at like 3 or 4 months when pregnant with Joshua?) until, about one year after Joshua's birth, I finally asked my doctor about the pain and was told to see an orthopedist.  Well, it just didn't happen.  It has progressively gotten worse.  The past year and a half has been almost daily pain.  The past 6 months or so, I can hardly even cross my legs for longer than 10 minutes, if at all.  Doing the grocery shopping, taking a walk, etc. puts me down for the day.  Anyway, it was to a point that I could no longer ignore it.

So...
About a month and a half ago, I went to see an orthopedist about my hips.  We did x-rays (I had to wear these sexy blue paper/material shorts--they were awesome.) and he manipulated my hips to check their movement.  It was determined that I likely had Bursitis (inflamation of the muscles located on the outside of the hip), and that there was probably something going on in the joint, too.  An MRI Arthogram was ordered, and I did it a week later.  Let me tell you, when I went to have it done, hearing, "Oh...we're doing both?!" was not comforting.  For this test, they numbed my hip, then placed a catheter into the hip joint under flouroscope (live x-ray), through which they injected saline to expand the joint (pretty much partially dislocating my hip), then contrast dye.  I was then taken to MRI for 40 minutes.  Each hip had to be done seperately, so this was done twice.  It was a super fun 3 hours.  NOT!  I could barely walk for the next week!  It was horrible!  The results came the next day: I had partial Labral detatchment and tears in both hips.  The Labrum is a cartilage disc that sits between the Acetabulum (hip socket) and the Femoral Head (the ball part of the hip).  It is, essentially, to the hip what the Meniscus is to the knee.  It would require arthroscopic surgery to tack it back to the bone and sew up the tears.  Unfortunately, my doctor did not do this kind of surgery, so I was referred to another surgeon.  I met with my new surgeon for a pre-surgical consult just after Memorial Day.  He ran new x-rays, with my hips in different positions than my original x-rays had been.  When I met my new doctor for the first time, I actually met with my new "hip preservation team"--my surgeon, a resident fellow, a hip coordinator and a physical therapist.  I got my picture on the wall and everything!  I instantly loved my surgeon--actually, all of them, but he's the one that will be operating on me, so that relationship is important to me.  He did a quick exam and manipulated my hips.  Then he took a seat and we talked about my case. 

The diagnosis:
First of all, the radiologist that read my MRI Arthogram had read it wrong.  There are sometimes crevices in the Labram that do not close during development.  Most people's close and form a complete disc, but many do not.  It is completely normal.  The contrast dye had gone into these crevices and so had been read as detatched.  We did, however, have a bigger problem.  Upon inspection of my new x-rays, my doctor discovered 2 things: 1) {first, picture a hip: the head (ball), then the neck, then the femur...got it?}  The neck of the hip should be curved to allow for full movement of the hip without interference from the Acetabulum.  Mine is almost completely flat, with the exception of what appears to be a small divet where the neck and the socket have been hitting and wearing away that bone.  It exists equally in both hips.  This is relatively new condition (as in it's only been diagnosed about the last 5 years or so) called Femoroacetabular Impingment, or FAI.  My doctor just happens to be one of the leading surgeons for this condition.  2) My hip placement is quite shallow, meaning more of the weight of my body is placed at the top of the Femoral Head instead of being more equally displaced around the whole joint, as it would be if it sat deeper into the socket.  This means I have mild Hip Dysplasia--again, in both hips. 

I am a bit unusual, in that I have both conditions, especially in both hips (dysplasia, especially, is more commonly a 1 hip thing).  The FAI usually occurs because the hip socket is too deep; I, obviously, have the opposite problem.  Because of this, it was determined by my team that my case would be presented at a medical conference on June 11, specifically to one of a handful of Hip Dysplasia surgeons in the country, who just happens to practice at the University of Utah.  I would be having surgery, we just didn't know which one: the FAI Arthroscopy or the PAO Open Hip (dysplasia) surgery.  I had an injection into my hip joint again (ow!) and a 3D CT Scan.  Then we settled in to wait.  It was a nerve-wracking 2 weeks!

* You're doing well!  Wanna go grab a drink really quick, or something?

{You can skip this part, if you want to.}

A little about the surgeries (so you know just what they are deciding for me!):
The FAI Arthroscopy: There are 2-3 small incisions made for their cameras and tools.  The excess bone around the Femoral Neck will be shaved away to make the proper curve.  Any tears or damage to the cartilage or soft tissues would be fixed.  There is a one night hospital stay, then minor weight bearing, with crutches, for 2-4 weeks, depending on the extent of the damage, and a cane an additional week or two.  Physical therapy for about 2 months.  Only one hip can be done at a time, but the second surgery can take place within 6-8 weeks of the first.
The PAO (Periacetabular Osteotomy) Open Hip Surgery: A large incision would be made at the front of the hip.  The socket part of the pelvic bone would be cut out and repositioned where it should be, then pinned and screwed into place.  The excess bone on the Femoral Neck would be shaved away (just like the FAI surgery).  There is a 4-6 night hospital stay, then 5-6 weeks of non-weight bearing, with crutches, followed by another 3-4 weeks of minor weight bearing with crutches, and 2-3 weeks with a cane.  And then there's the 6+ months of physical therapy.  Obviously, this is also a one-hip-at-a-time surgery.  The second would be performed about 1 year after the first.

{Okay, come back.}

The decision:
If I were 18 or 19, I would be having the PAO without question.  As I am a bit older and both problems exist, I am an equally good candidate for both surgeries.  It was decided that we would do the less-invasive FAI surgery first and also use it as an exploratory surgery to see exactly what my hips look like in there and resolve any damage (if I were to develop arthritis because of the damage, I would no longer be able to have the PAO and would have to wait until the damage was extensive enough to require a hip replacement).  As my dysplasia is mild and they can't be sure which problem is causing the pain, they are hoping that this will take care of it.  If it does not, I will have the PAO next summer (and the summer after that).

We feel that we have been so blessed in this, guided to the right surgeons, and that we are doing the right thing.  I am scheduled for my first surgery on Thursday, July 12.  My second will likely take place this October.  I am excited to get some relief and get on with my life!

Okay, I'm done.  If you read all the way to the end, I think you deserve a treat!  Go find yourself some chocolate! : ) 

Thanks for all the love, concern and support!