UK Surfer
25-03-2007, 03:55 PM
THERE SHOULD BE TWO ?DECISION POINTS? IN OPTING FOR LABRAM TEAR SURGERY
This will be of most interest to individuals who are initially considering arthroscopy and are hoping to return to their chosen sport.
I suspect that if I had found this site before having my labrum modified 14 weeks ago, I might not have gone ahead at the time I did. It has been a great opportunity to read all the individual experiences on this forum. I have learnt a lot. I hope my observations benefit others. I am a 36 year old surfer.
I will present my case history (sob storey) in another posting as I believe it might dilute some key points I hope will be useful to many.
If you are new to the issues of the labrum and its geometry the following article will be invaluable: http://www.ptjournalonline.org/cgi/content/full/86/1/110
My experience of having an arthroscopy is to be given one decision point. I believe that there are two ?decision points? prior to the labrum being modified. The first is to have the labrum imaged using the arthroscope. The second is whether to have the labrum modified. Both decision points should be offered by the orthopaedic surgeon to the patient. In my case and I suspect most others, this was not the case. The surgeon only decides the course of treatment once the camera of the arthroscope shows the true extent of the labrum damage. Clearly, the patient cannot be asked real-time what they would like to be done to them at this point. However, the percentage chances of success of the surgery are totally dependent on whether a ?cut-and-throw? or ?repair? of labrum is performed. Infact, it is fair to say these are two different operations and should be classified as such ? not simply referred to as arthroscopy. There appears to be no disagreement in all that I have learnt to date that the post operative prognosis of a ?simple? labrum debridement (where a section of the labrum is cut off and removed for good) is very good. This assumes the cause has been dealt with. However the same cannot be said for a labrum repair (where stitches and anchors are used).
My surgeon recommended the arthroscopy procedure to me based on a 5% chance of my symptoms being worse post surgery. These were odds I was willing to accept. My symptoms at 14 weeks post surgery are much worse. The majority of his patient?s have an arthroscopic procedure involving the relatively ?simple? cut-and-throw. I was informed post-operation by his intern, that virtually 100% of these patients see an improvement. So, the patients that have their labrum?s repaired, must virtually all be within the 5 out of a 100 who experience a worsening. Hence, at the point he identifies a labrum that ?needs? repairing during the arthroscopic procedure, the chances of the patients symptoms worsening are far, far, higher that 5%. Given this information the patient could opt by declaration, prior to the operation, to request that they do not wish to have a repair done to the labrum (only a cut-and-throw if appropriate). Hence they could virtually walk out of the operation knowing the specifics of the degeneration their hip.
After all my research and personal experience I question the medical benefit of repairing the labrum through stitches and anchors. This is based on having a good understanding of materials, some limited experience of working on medical products and some understanding of the complexity of the hip joint. If the labrum can heal, then we are onto a winner. From an engineering perspective, without healing, the stitches and anchors will only create stress concentrations, for more tears to propagate. And for healing to be effective, new fibres must grow across the stitched butted join. Possible, but challenging given that there is a limited blood supply to the labrum. My gut feeling is that if a repaired/anchored tear in a labrum can heal it will need considerably more than 3 months to withstand the phenomenal loads it withstands.
The approach where the surgeon gives the patient one decision point, rather than two, means the patient is less in control of their treatment and hence is not in the best position to accept responsibility for their treatment. Hard to say now, but suspect I would have rather carried on with the minimal pain prior to the operation, with a good understanding of the joints? degeneration, than be where I am now.
I welcome any comments/challenges to what I have said. I will also be posting ?my story? shortly.
As a final thought, there is a fundamental difference in what I have learnt from this forum and the medical professionals that I saw during the course of my treatment, the former is an experiencial perspective, whereas the later is an academic/hands-on experimentation. This scares me.
Good luck in your path. I feel for you.
Benn
This will be of most interest to individuals who are initially considering arthroscopy and are hoping to return to their chosen sport.
I suspect that if I had found this site before having my labrum modified 14 weeks ago, I might not have gone ahead at the time I did. It has been a great opportunity to read all the individual experiences on this forum. I have learnt a lot. I hope my observations benefit others. I am a 36 year old surfer.
I will present my case history (sob storey) in another posting as I believe it might dilute some key points I hope will be useful to many.
If you are new to the issues of the labrum and its geometry the following article will be invaluable: http://www.ptjournalonline.org/cgi/content/full/86/1/110
My experience of having an arthroscopy is to be given one decision point. I believe that there are two ?decision points? prior to the labrum being modified. The first is to have the labrum imaged using the arthroscope. The second is whether to have the labrum modified. Both decision points should be offered by the orthopaedic surgeon to the patient. In my case and I suspect most others, this was not the case. The surgeon only decides the course of treatment once the camera of the arthroscope shows the true extent of the labrum damage. Clearly, the patient cannot be asked real-time what they would like to be done to them at this point. However, the percentage chances of success of the surgery are totally dependent on whether a ?cut-and-throw? or ?repair? of labrum is performed. Infact, it is fair to say these are two different operations and should be classified as such ? not simply referred to as arthroscopy. There appears to be no disagreement in all that I have learnt to date that the post operative prognosis of a ?simple? labrum debridement (where a section of the labrum is cut off and removed for good) is very good. This assumes the cause has been dealt with. However the same cannot be said for a labrum repair (where stitches and anchors are used).
My surgeon recommended the arthroscopy procedure to me based on a 5% chance of my symptoms being worse post surgery. These were odds I was willing to accept. My symptoms at 14 weeks post surgery are much worse. The majority of his patient?s have an arthroscopic procedure involving the relatively ?simple? cut-and-throw. I was informed post-operation by his intern, that virtually 100% of these patients see an improvement. So, the patients that have their labrum?s repaired, must virtually all be within the 5 out of a 100 who experience a worsening. Hence, at the point he identifies a labrum that ?needs? repairing during the arthroscopic procedure, the chances of the patients symptoms worsening are far, far, higher that 5%. Given this information the patient could opt by declaration, prior to the operation, to request that they do not wish to have a repair done to the labrum (only a cut-and-throw if appropriate). Hence they could virtually walk out of the operation knowing the specifics of the degeneration their hip.
After all my research and personal experience I question the medical benefit of repairing the labrum through stitches and anchors. This is based on having a good understanding of materials, some limited experience of working on medical products and some understanding of the complexity of the hip joint. If the labrum can heal, then we are onto a winner. From an engineering perspective, without healing, the stitches and anchors will only create stress concentrations, for more tears to propagate. And for healing to be effective, new fibres must grow across the stitched butted join. Possible, but challenging given that there is a limited blood supply to the labrum. My gut feeling is that if a repaired/anchored tear in a labrum can heal it will need considerably more than 3 months to withstand the phenomenal loads it withstands.
The approach where the surgeon gives the patient one decision point, rather than two, means the patient is less in control of their treatment and hence is not in the best position to accept responsibility for their treatment. Hard to say now, but suspect I would have rather carried on with the minimal pain prior to the operation, with a good understanding of the joints? degeneration, than be where I am now.
I welcome any comments/challenges to what I have said. I will also be posting ?my story? shortly.
As a final thought, there is a fundamental difference in what I have learnt from this forum and the medical professionals that I saw during the course of my treatment, the former is an experiencial perspective, whereas the later is an academic/hands-on experimentation. This scares me.
Good luck in your path. I feel for you.
Benn