2 Week Post Op FAI/Labral Repair Update

I'm finally back after my left hip arthroscopy to correct my femoroacetabular impingement (FAI) and labral tear. (For pictures and a more thorough explanation of labral hip tears/FAI click here)  I have had some bad days, but in some ways I am doing better than I thought I might be at this point.

My surgery was delayed 2 hours and I was the last case of the night at the outpatient surgery center. When I met with my surgeon pre op I was under the impression that I would have the opportunity to pick from a few different several different nerve blocks pre op to help with post surgical pain. But when the anesthesiologist came in to talk to me he said they only do two types of blocks - femoral nerve block and a lateral femoral cutaneous nerve (LFCN) block in recovery if post op pain is uncontrolled. He warned me that these blocks would not help with "bone" pain - pain coming from inside the hip joint only with surrounding soft tissue pain.

My recovery experience was horrible. I don't remember a lot because apparently my pain was uncontrolled and they had to give me a lot of medication. The anesthesiologist also gave me  a femoral and LFCN block, but I remember feeling a lot of pain like I had never felt before and since the block didn't help much other than to numb my leg making walking/moving difficult, i assume my pain was coming from inside the joint. My nurse was not the nicest. I was extremely hoarse from the intubation tube (this took a good week to get better) and she just sat at the end of my bed and said "huh" over and over. They didn't let my husband see me for a long time and I remember at one point waking up and seeing another patient and their spouse looking at me and the man said, "you're in a lot of pain, aren't you?" Yes, I was. When they finally did let my husband back he told the nurse I was in a lot of pain (I guess I told him I was or he saw it in my face - thankfully I don't remember this experience much) and the nurse said, "well I've already given her enough medicine to knock out a cow!" This nurse obviously wanted to get out of there. I don't blame her. It was 9pm on a Friday night. I never had gone to the bathroom post op so she rushed me into the bathroom and gave me about two minutes. When I hadn't gone yet she said, "well if you haven't gone in 6 hours just call your doctor." I told my husband to ask for her name. Needless  to say I have reported my experience. My level of consciousness and pain level was too poor to be discharged. I should have been admitted to the hospital overnight.

Thankfully we only had a 15 minute drive to my grandmother's house. My husband was able to use her wheelchair to get me into the house and I slept on her couch for the next two nights. The first night I had to urinate about every 1-2 hours as I had such bad urinary retention from the anesthesia I guess. I was itching horribly, and  I would shake like crazy every time I had to get up to go to the bedside commode (it's a good thing I was staying at my grandmother's where I had access to these things!). Benedryl and pain meds helped me get through the night. We also rented a ice system machine called a "Game Ready" (more about this later) that cycled on/off every 30 minutes. My poor husband "slept" in the recliner between my bathroom calls and filling up the Game ready.

We met with the doctor and his nurse the next morning (he came in on Saturday to see his out of town patients). I told them about my experience and that my pain still was not controlled well. They gave me a few new prescriptions, took off my bandage and the surgeon explained what went on during the surgery.

I had an anterior superior labral tear which was repaired with two anchors as well as some posterior labral fraying that was smoothed down.

left anterior labral tear

 

labral tear repaired

The most common cause of a labral tear is femoroacetabular impingement. I had a small CAM deformity on at the head/neck junction of the femur which was shaved down. One of my biggest pre-op concerns was finding out why I had a labral tear since groin/hip pain was only one of my many symptoms. When I asked the surgeon this pre-op he felt like it was likely due to the "way my hips are made" (i.e. FAI). I was concerned, however, after reading this article that the cause might be ligament laxity (since some PTs have felt I have some widespread joint laxity) or due to biomechanical issues and muscle imbalances including lower crossed syndrome (which I have). Lower crossed syndrome often can cause an anterior tilt of the pelvis (which I have) causing increased weight bearing on the anterior labrum and subsequent tearing. When I saw the surgeon the day after my surgery I asked him if he thought my CAM was enough to have caused my labral tears and he said, "no". I want to talk to him more about this at my one month follow up because I am concerned that if the cause of the labral tear is not fixed then there is a greater likelihood of re-tearing. I sure hope this surgery wasn't a waste. Due to my sacroiliac joint dysfunction and pelvic floor pain correcting the lower crossed syndrome has become almost impossible, though my goal with this surgery was to hopefully be able to regain muscle strength in my left glute and leg. Only time will tell if this is possible and if the surgery was beneficial.

 left CAM deformity

CAM deformity shaved

In addition to the labral repair and CAM shaving the surgeon also found that my ligament terres was enlarged. He was able to decompress this with heat and there was also a good bit of inflammation in the pulvinar tissue which lines the acetabulum. The fact that my ligament was so irritated and enlarged concerns me again that the cause of my labral tear might be more biomechanical or that I could have an underlying connective tissue disorder, which is something I have thought for some time now and may be something I investigate further in the future. In order to perform the surgery the joint capsule has to be opened up. Sometimes they leave the capsule "open" after arthroscopic surgery, but thankfully my surgeon closed the joint capsule since I have some ligament laxity .

Enlarged ligament terres

Inflammation of pulvinar tissue of the acetabulum

 The first three or four days of my recovery were pretty rough. We unfortunately chose to travel home on post-op day 2 and my anesthesia was wearing off so the 2.5 hour trip home was difficult. The high doses of narcotics made me extremely emotional/panicky/depressed and they didn't help the pain that much. Ironically once I stopped taking the narcotics and stopped icing I actually felt better. Most people really like the Game Ready icing system, but for me the ice seemed to make my circulation and pain worse (more on this below). A low dose muscle relaxant at night has actually been more beneficial for me and I am taking higher dose anti-inflammatories as prescribed for the first 3 weeks post op. I will be on crutches with 50% weight bearing for at least the first 4 weeks and I cannot flex my leg past 90 degrees or externally rotate my leg at the hip.

At 2 weeks the surgical pain is tolerable unless I am up too long or doing PT exercises.  I drove today for the first time and am able to care for my daughter for very short periods of time. The biggest struggle is that I cannot carry anything with my crutches, bend down, or even reheat food for myself. I had 5 small incisions and got my stitches out on day 10.  Everything seems to be healing nicely except I did develop an allergic reaction it seems to the band aids I was using as I have sensitive skin. I am hoping this goes away soon and then I look forward to hopefully getting in the warm water pool to do some therapy exercises. This is one place where I usually experience less pain. I got a massage on day 10 and tolerated it well, though my therapist was more gentle than normal and stayed away from my left hip. The nerve blocks I had post op took about 7-10 days to resolve. I still have a little big of abnormal sensation on my upper thigh, but nothing I couldn't live with if it doesn't fully resolve. The first three days post op I couldn't move my leg and I felt like I would never walk again, but thankfully my range of motion is improving daily.

My hip at 2 weeks post op with band aid rash

Unfortunately my chronic pelvic, sacral, low back, pain and leg burning has remained the same. I am very thankful I am not any worse though. My biggest concern is that my operative leg has appeared darker in color at times than my right leg. My feet have burned ever since June 2010, but I have noticed that they are more flared up and my left foot sometimes feels like it is asleep/tingling. The doctor's nurse said this could be due to the fact that I am not bearing enough weight or it could be complex regional pain syndrome. Due to my previous "diagnosis" of central sensitization I have been concerned about CRPS for some time. But my pain in my operative leg is not grossly abnormal so I am praying that with time and therapy my leg/feet circulation and burning will get better.

It takes professional athletes 4-6 months to recovery from this surgery and return to their pre-surgery athletic level, so due to my complex and chronic pain I know to expect that long and up to a year (according to my surgeon) to see full healing. Already after only laying around for 2 weeks I notice more muscle atrophy so it is going to take a lot of work to rebuild my strength. Patience is key, as I knew it would be, and I am still very early in my recovery.

Praises:

• I am able to use normal crutches without too much difficulty or increase in any previous chest/underarm pain that I've had in the past!
• My pudendal neuralgia/sacral pain doesn't seem to have been worsened because of the surgery (i.e. I can still sit about the same amount of time).
• My mother did well with her surgery and seems to be healing nicely. Our extended family and church has been a great support to us.
• My GI issues have been much more tolerable! Please pray this continues.

Prayer Requests:

• That my circulation will return to my normal pre-surgery level soon and that the burning in my feet and legs will lessen.
• Pray that my rash goes away soon so I will be able to do aquatherapy
• Patience and peace - that I will trust God is in control and have joy in Him even when the days are difficult
• That I will regain the ability to walk and stand without difficulty (this is especially important since I am unable to sit for long periods of time).
• That some of my chronic pain might eventually resolve with the appropriate therapy and pray that I will be able to get good quality PT as often as possible (I have to travel for this which is difficult for our whole family).
• Continue to pray that God would one day allow my husband to get a job in a bigger city where I could have better access to pain management and therapy treatments.
• Continue to pray for strength for my husband as he cares for us and keeps the home running. He is such a gift from God!

Whew! Sorry for the overdue update. Hope to get back to more regular blogging in the days to come. Thanks for praying and caring.