Sunday, June 2, 2013

A Visit to the Hip Surgeon

On Wednesday I went to visit my hip surgeon after Friday's MRI. It ended up being a long day. Traffic was horrible and it took two hours to get to the appointment. Without traffic it is under an hour. I was 30 minutes late, but so was everyone else shuffling in. The surgeon was real busy and it took 2 more hours before he saw me. He decided I should get another cortisone injection in my hip, so I waited another 2 hours until I could do that. Nothing was coming up as good news.

The surgeon saw an abnormality on my labrum, but couldn't tell if it was from the surgery or a new tear. He also mentioned my shallow hip socket and I think he said, "mild dysplasia". I didn't like the sound of a cortisone injection, but he says I can have 2-3 per year. It helped last time, so I thought it might help again.

While I waited for the injection, I went to pick up my MRI disk and the radiologist's report. I learned that this is free, easy to do, and gives me new information. Some things stood out to me.

BONES AND JOINTS: Osseous alignment and bone marrow signal is otherwise unremarkable. There is subtle articular cartilage thinning and irregularity suspected.
ACETABULAR LABRUM: There is prominent degenerative signal within the labrum anterosuperiorly and throughout the anterior labrum. In addition, there is linear contrast undercutting the labrum anteriorly, consistent with tear. The labrum is quite irregular  in appearance anteromedially, consistent with degenerative tearing. There is also mild heterogeneous signal within the  labrum posteriorly, consistent with degeneration.
MUSCLES AND TENDONS: There is minimal gluteus medius tendinopathy near its insertion on the greater trochanter, with overlying soft  tissue edema. There is minimal contrast anterior to the hip joint within the fascial layers consistent with the arthrographic procedure. The visualized muscles and tendons are otherwise unremarkable.
OTHER COMMENT: The examination was not tailored for evaluation of the pelvic viscera, the visualized structures are grossly unremarkable.
My hip x-ray from last month
For the first time in my life, I like being called grossly unremarkable! The rest of it sounds worrisome.

That said, this time the cortisone shot had no positive result for me. The last shot, I had facial flushing for a day. This time it lasted two days, so I am not tolerating it well. My joint felt a little juicier, but the muscles around it still hurt, in fact the inside the hip pinching doesn't really stop any more at all. I feel a pulling, tension, pinching feeling that feels like a little injection most of the time. I tried a 4 mile run the day after the shot and like every time I have tried that in the past month, my hip started getting tight 2 miles into the run. I have ridden my kickbike and strangely enough that doesn't hurt like running. In fact, I have a decent range of motion kicking on that left side. However, I notice it is hard to dial in a correct balance when bearing weight on that side. The back of the glutes seem too tight. 

I am not sure if any exercise is even good for me now. I don't want to further damage my labrum or joint.

Monday, I go  to see a new physiatrist. I hope he has some knowledge and gets interested in my case. I am curious if this is a tendon-muscular thing or something to do with the hip. 

In talking briefly with other hip patients and "doctors" online, there are a few options if things don't improve.

My surgeon said they could go in arthroscopically again and see what can be done. Number one, I am sending my files to other prominent hip surgeons to get their take. I want to see if I have FAI (an impingement) that could be damaging the labrum. I would need a surgeon that fixes those, if so. I saw a mention on a message board this morning from a doctor who says that sometimes a second surgery is necessary to get rid of scar tissue between the hip capsule and the labrum. I have never heard of this, but I remember that sprinter Tyson Gay, who had his surgery the same time as me in 2011 was still struggling until he had a second surgery last Spring that quickly fixed things so he could qualify for the Olympic Games. I wonder if this is the same thing. The doctor did say that, "The good news is the recovery from the second surgery is 1000 times easier than your original surgery. It is more like a knee scope than a big labral repair." He also said that scar tissue cannot be seen on the MRI.

Another hip doctor answered a few questions I had on another board, and some people saw  what they think could be a cam impingement on my femur as well as what could be dysplasia (my surgeon has mentioned my shallow hip socket a few times and a think he said "mild dysplasia" when talking to me Wednesday). They do a surgery for that called PAO to correct it. It doesn't look fun as they cut apart your hip. He said, I might be too old and that I should be looking for a hip replacement instead. Oh, happy thoughts! I do realize that these guys are only offering advice with limited knowledge and I don't know them from Adam except they are respected on the message boards.

My only thoughts are that the better I get aligned, the more my hip hurts. Things have been lining up pretty well from head to toe with some of the therapy I have been getting, but I wonder if that puts stress on my hip joint in the wrong way. That might be why my body thought up all my compensations through the years. 

I really need to go for a run, but I can't!


Joe D said...


To a well-informed amateur on hip issues, that MRI does not sound so good. I think sending out your files is a really good move. I would def send to Dr Kelly in NYC.

I had an epidural shot this week that has (so far) been quite good on my hip pain. really hoping the latest issues were back related. Funny you mention the facial flushing; I have a bunch of other cortisone shots before but for whatever reason this one really effected me. My legs, chest, everything have been "hot" for 3 days.

I hope you get some answers, man. I am pulling for you!

Joe D

Jim Hansen said...

I already contacted Dr. Philipon's office and have sent most of what he wanted. It will be interesting to hear what he says. The new chiropractor's office I have been going to, looked briefly at some of the reports and said, "No more running!" They were concerned with mild dysplasia in that hip and softening of the bone. My surgeon hasn't said anything about not running and he knows that is what I do. I hope they were just being alarmists. It is too much to think about at this time.

Yeah, the hot flashes really were weird and uncomfortable like everything was buzzing.

Good to hear that the epidural is helping.

Thanks for pulling! Hopefully we will both be fixed soon.