Hip Arthroscopy for labrum tear on femoral head

[LMS]

Hi everyone, newbie here and WOW what a great site for info. Wished I'd found it a year ago! As it's true: you are left on your own to find out what's possibly wrong & how to go about finding the right help.

I just had a hip arthroscopy done on my left hip 2 weeks ago. I'm seeing my surgeon for the post op appointment this Friday, where I'll be able to weight bare & lose the crutches.

I have many questions for him (though some I read the answers to on here... like the one about intimacy: 2 months? This was the look on my husband's face => ) and thought I'd ask on here too to see what other people's experiences were.

I had a labral tear on the femoral head caused by a cyst in the acetabulum. My questions to him will be:

- Why did he only do a debridment on the tear & not address the cyst as well like we had discussed?

- Can any weight be carried (groceries, heavy objects...)? If yes how heavy & how soon?

- What movements/positions are to be avoided?

- What are the chances of re-damaging the labrum because the cyst is still present?

- In general, how long is recovery and time in physio therapy?

- If I have concerns regarding my hip (pain or otherwise): who do I contact?

- Will there be any more follow up visits? (Since I signed an agreement to be part of a study)

- Can I have a copy of the diagnosis & what was done?

I'd appreciate any feedback & if there should be other questions I should ask.

Thanks
Lynne

[slimsmith]

Hi Lynne,

Welcome to the site. In my experience unless you know the right questions to ask, you don't get very far in this situation, so you've come to a great place for information gathering. My main advice would be to make sure you get a proper rehab program with a physio via your surgeon if at all possible. I had to have physio for 9 months prior to surgery and am now at 2 months post-op (with physio). Take a look at Surfchick's recent thread on this and the 'Warwick' link for reference. In my view this stuff really need to be under supervision as every case is different, but it gives you an idea what you should be expecting, and a fall back if no rehab help is available. Good luck.

Slimsmith.

[soccermom]

lynne

like slimsmith said, get yourself a good rehab program. by good, i mean quality not quantity. the rehab out of this surgery is long and slow with ups and downs. like no other ortho rehab i have had. i find myself pushing the limit sometimes and then i pay the price and have to stop for a week or so until my hip calms back down.

good luck

soccermom

[LMS]

Thanks for the responses!
I'm confident that'll I'll be in good hands regarding the physio aspect of it. It was my physio therapist who bothered to help me regarding my hip & put me in touch with a sports therapy clinic where they were able to assess me in order to get in touch with a surgeon. They raved him & from doing some research on the net, I found out that I was probably going to be in great hands.

I just feel discouraged that where I am now could've been altered had there been more available information out there, and doctors & therapists who have the interest to look into matters further. I'm 39 now and have been complaining of hip problems & back pain since I was 14yrs old. First doctor said: "Growing pains, leave it alone & you'll be fine in a couple of years."

Second doctor put me in touch with a physio therapist and a neurosurgeon, as well as ordered a battery of tests & ct scans. I guess it was still too early in the game to see into the future or the experts only give a "need to know" info, and problems will be addressed only when they arise.

Then 4 years ago, still doing physio (going every 5 yrs for a new assessement & still asking about my "catching" & sore hip but with no one addressing it), that's when the debilitating flare ups began. Finally in spring 2006 I'd had enough and with a sigh, my doctor (this is doctor #4 by now) checked my hips, said it was probably bursitis, ordered an x-ray & physio.

The x-ray was described as: good candidate for osteoarthritis because of minimal narrowing between the the femoral head & acetabulum. Cyst (5mm I think) in the superior lip of the acetabulum.

My doctor's response: Just continue your physio, stop doing any activities or movements that will aggravate a flare up & let's monitor it. I couldn't believe it! My flare ups were debilitating, the pain was a 20 on a scale of 1 to 10! Spasms, shocks,no ability to weight bare. I was screaming in pain when it was at it's worst.

My new physotherapist was wonderful (he was also a client of mine) and he suggested arthroscopy & got the ball rolling for me. By the time I finally met the surgeon, he said I was too late & not a good candidate because arthritis was already present but he ordered the MRI arthrogram (do I have that right?). It was after this test that he said that if I wanted to, he would do the surgery to remove the torn labrum and possibly address the cyst. He could not garantee the outcome though. He gave me the worst case, possible case (no change) & the best case scenarios.
He put me on Celebrex (which worked wonders thank goodness!), I continued with the physio for a few more months until I couldn't afford it anymore. I also switched doctors to one that was more pro-active.
Fast forward to today, over a year later, and finally had the surgery.

So I'll either be going to the sports therapy clinic for physio (where I first met my surgeon) or the physio therapist who started the ball rolling. I guess it all depends on what equipment will be needed.

I gather then that therapy will be at least 3X a week & quite intensive? He did say it would be at least 3 weeks.

Sorry for the biography there, but I wrote it just in case others went or are going through the same thing.

PS yes I has a look at the post op physio link, it's great! Thanks.

[LMS]

Well I had my brief post-op appointment today and it did not end how I imagined it. I don't understand why he bothered to give me barely 10min of his time. I guess unless one is a patient that was brought forth from a traumatic experience, you're just another tick mark on the clip board.

I managed to get some questions answered between him & the physio therapist:

- Why did he only do a debridment on the tear & not address the cyst as well like we had discussed?
Dr. B: because it wasn't that significant and far enough in the socket (acetabulum) to warrant it based on the x-ray.

- Can any weight be carried (groceries, heavy objects...)? If yes how heavy & how soon?
PT: Take it easy & wait until you're off the crutches.

- What movements/positions are to be avoided?
PT: No restrictions, do what's comfortable, gauge yourself.

- What are the chances of re-damaging the labrum because the cyst is still present?
Dr. B: There's arthritis present, any complication means hip resurfacing or total hip replacement.

- In general, how long is recovery and time in physio therapy?
PT: Up to a year. Physio will only be once every two weeks, time undetermined starting in 10 days from now.

- If I have concerns regarding my hip (pain or otherwise): who do I contact?
Dr. B: Dr. B

- Will there be any more follow up visits? (Since I signed an agreement to be part of a study)
Dr. B & PT: In 2 - 3 months

- Can I have a copy of the diagnosis & what was done?
His receptionist gave me a copy of the surgery report only.

Funny (and not in a ha-ha way) that both his attending & the therapist checked the range of motion & strength while I was lying down, and then asked: "So how do you feel? Any pain? Are you better or worse than before the surgery?" I told them it wasn't fair to ask this last question in the hopes of me replying that I was so much better because I had nothing to compare with yet because before the surgery, the pain was controlled with the Celebrex & avoiding any positions or movements that would cause a flare up; and now for the past three weeks I had been doing nothing and staying off the hip completely.

All three still said to wean off the crutches asap & weight bare fully. Then they all left not bothering to see if I could weight bare at all.

I tried to and my hip felt numb, then the whole length of the leg on the inside went numb & my foot was all prickly. I made it to the front of the hospital & while I was waiting for my husband to come with the vehicle, I felt my first twinge in the hip where the damage part of the cartilage is. By the time we got back to our office 2hrs later, I barely set foot in the display room that the familiar searing pain shot like a knife where the damaged cartilage is. Thank goodness I had crutches or I would've ended up on the floor.

I tried again to put a bit of weight on the hip but the pain was too great, it just took my breath away & the tears started again. Took 1 Tylenol 3 (codeine) + 1 extra strength Tylenol & went to lie down. Now 4 hrs later, the numbness is still there, the overall pain has gone but I can't put any weight what-so-ever on the hip.

The PT also told me to massage the puncture site to prevent internal tissue scaring.

Any comforting words out there? Thanks

[Zaynah]

hi...

I also had arthroscopy (3hour surgery) 12days ago. A piece of bone with the cartilage broke off in my acetabulum and it was impinging in the joint. The doctors removed this piece but left the hole in my acetabulum as it is to see if it will heal spontaneously. Being a physiotherapist myself, i'm not very convinced by this, as cartilage doesn't have bloodsupply, so i have an idea that i'll be having open arthrotomy surgery in the next year or so to fix the 1cm hole in my hip socket!

My doctor said tolerated full weight bearing day 1 post operative without crutches! I nearly died the first step i took!! Ouch using the muscles they pierced through with their equipment and in the joint. The hip needs weightbearing asap because the bone looses density quickly (that leads to osteopenia and then osteoporosis and easy fractures) and the cartilage needs that compression for healing. So weight bearing is sore and uncomfortable at first... The numbness is from the nerves.... they were stretched out with surgery using the traction table and you've been off that leg for a while. My advice is that since you've been off that leg for a while, now for the first 4 days use 2 crutches to support you and try slight weight bearing, then progress to one crutch on the opposite arm to the operated leg, try more weight bearing as tolerated for a few more days. You can't jump from no weight bearing to full weight bearing on an operated hip without problems!!! Take it easy, listen to your body... I used 1 crutch at home for the first 7 days with tolerated weight bearing, and now i walk without anything, without a limp and i climb stairs with both legs, normally!!!

I've been my own physio, which helps alot and saves money. But.... theres always a but. Twice already i've gotten up from sitting and had a catching sting in my groin, and i thougt OMG. But it's less in intensity and goes away immediately and doesn't cause me to limp. I'm seeing my doctor tomorrow to get my stitches removed. I have a ton of questions for him aswell!!!!

Physiotherapy shouldn't be expensive. Many physio's use machines as therapy, that pushes up the cost!!! I believe in hands! If you don't want an 'Ultrasound', then you are allowed to tell him/her that. Massage and joint mobilisation techniques using their hands work just as good! Those machines just increase bloodsupply and help with healing. There's other ways of achieving this and you can tell them!!

Good luck, an remember.... go at your own pace, baby steps!

[LMS]

Baby steps... that's what I thought. I'm putting just enough weight shy of when it hurts. So maybe 1/4? It's not much weight. The inside & top of the thigh (just below the crease) goes numb & my foot tingles.
I don't know why he's using this approach, no one is questioning it. So I'm assuming that it's part of the study he's doing.

Last night I tried doing some leg lifts (lying supine) and it hurt! I managed 5 lifting up to 10inches off the bed.

Are the side lifts suposed to be done lying on the good side? (As opposed to lying on my back or standing up)

The hospital physio therapist assured me that I would be covered by our province's health insurance in this case because I was referred by the surgeon & being sent to another hospital for the physio. So that's a big relief.

Thanks

[LMS]

I've been thinking more about this different approach (taking 3 weeks non weight bearing) and I remember him saying at the begining (over a year ago) that he was going to do it that way. And really, I understand. Since the surgery, I couldn't put my own slippers on or do anything by myself. And now three weeks later, I can do more. Doesn't make sense to stress the area when it's been traumatized.

Anyhow, today I received a phone call from the physio therapy department and I start this Thursday.

[LMS]

Went for my first day of physio. We spent a whole hour discussing the history on my hip, back, what was done, by whom & why. So 25yrs up to how I came to be referred to them. The process from diagnosis to surgery. They examined & measured my legs, analyzed how I stood, measured different degrees of how much I can bend this way & that, as well as the strength. I had to fill out a questionaire as well. Actually, it was similar only to the last physio I went to & he was the one that put me in touch with the surgeon.

Either times have changed, or it really depends on who you happen to have the luck of crossing paths with.

Then we only had 5 min left to tell me which exercises they wanted me to do. (Only 3 for now) I wasn't too sore when they were poking, proding & twisting but boy oh boy was I tender & sore once I was walking back to my truck! (with my trusty crutches of course)

Ends up I'll be going twice a week for 4 to 6 weeks.

A good bit of advice was: if it's the weak tissues that are aching, keep doing it (but ease up). If it's the repaired site that hurts, stop! But go in moderation & apply ice to the sore area 3X/day. I would probably preffer a nice hot relaxing bath but I can't get into one even if I wanted!

[LMS]

Holy cow am I ever one sore sloth today! And all I did yesterday was sit in the vehicle for a couple of hours of driving (was getting my chauffeur aka OH to help me with a few things) drive myself in & out of the city for the physio assessment & did the three excercises last night. (Even though I did less reps than what was recommended)

The muscles around the hip joint spasmed most of the night and this morning I feel like I had a major workout!