Hip Dysplasia, Femoro-acetabular Impingement, Hypermobile Labrum

All are official medical words to describe why I will be spending the entirety of my summer and the better part of the fall and winter with restricted activity levels. In layman’s terms, my hip joint is supposed to be like the ball and socket on a trailer hitch. Unfortunately, the ball and the socket that make up my right hip never formed correctly. As a result, I made it through 25 years of moderate to intense athletics before a surgeon correctly identified that my femur was flat on one side (it’s supposed to be the ball) and my hip socket was 27% smaller on my right side than on my left. Hurray congenital problems that go unnoticed!

After I endured hip pain for 7 years, my brilliant Dr. White diagnosed the problems I described above. He proposed a two-part plan to fix the huge problems with my hip joint. The first part happened on June 26th, when he went in arthroscopically and, with only three tiny holes, reattached my labrum (essentially a suction cup/cushion/wonder substance, that just happens to look like mozzarella, lining the hip socket) and ground out my femur so that it actually does look like a ball. The difference between my pre and post Xrays is huge and I’m really excited to have 2/3 of the problems with my hip fixed.

Surgery number two involves breaking my pelvis in three places and rotating the outer piece so that the socket fits around the new and improved ball of my femur. Then they screw it back together with 2-5 screws and close the 5 1/2 inch incision. The procedure is called a Ganz Osteotomy and was invented in Switzerland in 1983. There are only 2 surgeons in the country that Dr. White trusts to do the procedure, so I have to go to NYU to have it done. That surgery will leave me in the hospital for around 5 days and on crutches for six weeks. I’m not ecstatic about it, but the other option is spending the next 20 years waiting for my hip to get so arthritic that it needs to be replaced. Unfortunately the average lifespan of a hip replacement is 12 years, and the more you do, the less time they last. After two replacements, it becomes significantly more challenging to replace the hip. Also, my dysplasia would put me at risk for continuing to detach/tear/grind up up my labrum, and after Dr. White spent 4 hours repairing it once I would hate to put him through that again.

It's not exactly the kind of fun I anticipated when moving to CO last fall, but at least I finally found a surgeon who would take the time to actually measure my bones on my Xrays rather than simply slapping them up and saying, "Wow, your bones look pretty good."

Ouch. I have FAI that I'm scheduled to have scoped in August. I put it off last fall so I wouldn't miss any skiing. But all I'm supposed to have done is the arthroscopy. I broke my hip in August 2005 and I've developed a bit of a bone spur on my femural head that exacerbates the cam deformity I already had (like you, it sounds).

Good luck.

i'm in there too with the fai. i have it bilaterally with once side cam and the other a combo. the labrum on the left was already shown to have a big posterior labral tear in 06, and has torn more since. and there is arthritis, too.
i was told to have an arthroscopy for it last summer. but i am seeing dr su in nyc at hosp for special surgery next week for an opinion regarding resurfacing instead. my hip on the one side is prolly too far gone for arth surgery to work. the other one i can deal with.
my activity has been leveled since the initial injury. but unfortunately, im going to get my shoulder fixed up a bit and stronger before i go under the knife for the hip.
if i were living in colorado with a hip issue, i'd be sure to go see dr march phillipon for a consult, and he will refer you to whoever is top dog for what you need.
of give hospital for special surgery in nyc a visit if you need. they are the best ortho center in north america and see the worst hips from all over the world. if you can swing it insurance wise and financially.
best of luck

I know Philippon is the man on hip stuff, but he's not in-network and he's also way backed up all the time (that's what happens when you're the go-to guy for people like ARod). So instead I went to Dr. White at Western Ortho who did his fellowship with Philippon and still communicates with him quite a bit. Philippon doesn't do the Ganz osteotomy so it's to NYU for me. (Dr. Ganz only endorses ~ 12 surgeons in the country to do it.)

Good luck to both of you.

Wow, that's tough.

Are you a purebread lab, by chance? I didn't know humans got hip dysplasia

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Originally Posted by stuckathuntermtn

Are you a purebread lab, by chance? I didn't know humans got hip dysplasia

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1 in a 1000 babies are born with dysplasia apparently. Your chances increase if you are female, first-born, or breach, and I'm two out of the three. It sucks, but I'm glad to have a diagnosis after 7 years.

At least you weren't born a small poorly formed tail.

My right hip and right knee gets worse every week. I struggle to crouch down some days. And this is in summer when I do almost no exercise besides farming, all after 6 months if intense winter activity without so much as a sore toe.

This thread has be worried.

That sucks that you have those issues and sounds like your summer is going to be spent healing, but the prognosis sounds good.
++++ healing vibes from me the Mrs. and our furkid with one replaced hip and dysplasia in the other. Hope it all goes well and we get a chance to share turns again some time.

Do you have copies of the xrays showing the before and after? You should post them up if you do!

Ow L!!! Glad to hear that you're making progress tho, sounds like there is finally light at the end of the tunnel. Mend quick!

i just saw my dr in nyc 2 days ago. no resurfacing for me...the joint space is well preserved, thus not much arthritis.
fai scope here i come. i'm not excited about this at all.
i'm going to try and see dr phillipon in vail if i can work out the peripheral logistics, being and out-of-state patient.
i just read an article that most fai accompanies a form of dysplasia, meaning the extra bone that has grown causes dysplasia of the socket.
it's the recovery that freaks me out. seems like it is long and rough.

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Originally Posted by mysteryzombie

i just saw my dr in nyc 2 days ago. no resurfacing for me...the joint space is well preserved, thus not much arthritis.
fai scope here i come. i'm not excited about this at all.
i'm going to try and see dr phillipon in vail if i can work out the peripheral logistics, being and out-of-state patient.
i just read an article that most fai accompanies a form of dysplasia, meaning the extra bone that has grown causes dysplasia of the socket.
it's the recovery that freaks me out. seems like it is long and rough.

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The FAI scope is not terrible for recovery time. It should only be in the neighborhood of 3 months. Today is three weeks out for me and I've ditched my crutches (after using one, mainly for balance, for the last week) and started strengthening and stationary biking with low resistance. Compared to an ACL, the length of the recovery is way shorter for an FAI scope. If Phillipon is a no-go, I'd seriously consider Dr. White at Western Ortho. Like I said, he trained with Phillipon and really seems to know his stuff.

I think in mine, the dysplasia may have come first. Apparently my aunt had it and spent the first year of her life in special braces. Being female and a breach baby, that also increases the odds that it was congenital.

apparently, when i was a baby, my doc told my parents that i should have worn some kind of leg brace for a while. i think now that it was due to a hip issue i was born with. my dr in nyc (hip guy) says most fai situations are congenital. go figure my mom has a bad hip, too, only on the other side.
the way i look at it is that a certain percentage of people have a hip deformity of sorts, just as about 40% of dogs do. in regards to evolution, we became bipeds not that long ago, so we haven't been quite "perfected" in the hips, as a whole.
there is a similar percentage of athletes that end up with an injury called a sports hernia, which is a very, very elusive diagnosis. about 30-40% of those people with that injury also have fai. i have spoken with the world's best sports hernia surgeons (one of them being mine, from germany), and they agree with the hip-groin connection and congenital connection. the surgeon in germany, who only focuses on groins in surgery, says 30-40% of all sports hernias are congenital.
anyhow- there may also be a connection between fai, sports hernias, labral tears, and connective tissue disorders (not the kind that kills you or anything).
knowing that, i plan to undergo prolotherapy to the hips and knees and any other spots to fine-tune me once i get the hip(s) done.
i am glad to hear the fai recoup isn't that bad. i read horror stories. i'll be diligent in my pt so i can increase my chances of being an irresponsible funhog again!

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Originally Posted by wandering, not lost

I know Philippon is the man on hip stuff, but he's not in-network and he's also way backed up all the time (that's what happens when you're the go-to guy for people like ARod). So instead I went to Dr. White at Western Ortho who did his fellowship with Philippon and still communicates with him quite a bit. Philippon doesn't do the Ganz osteotomy so it's to NYU for me. (Dr. Ganz only endorses ~ 12 surgeons in the country to do it.)

Good luck to both of you.

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Thanks for your post. I have my hip scope scheduled with Dr. White just next week and it is nice to hear a satisfied and confident patient. Any words about what your first few days/ weeks of recovery were like would be appreciated.

Puder Luder

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Originally Posted by PuderLuder

Thanks for your post. I have my hip scope scheduled with Dr. White just next week and it is nice to hear a satisfied and confident patient. Any words about what your first few days/ weeks of recovery were like would be appreciated.

Puder Luder

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Small world, isn't it?

I was and am still very happy with my scope done by Dr. White. I don't remember all that much from the first couple of days other than that I was in less pain than I had anticipated. Riding in the car was definitely painful, so I avoided that. I spent as much time as possible in the CPM, it ran pretty much constantly for the first 48 hours after the surgery, which I definitely think helped reduce my pain a lot.

I would say be very careful of your hip flexor in the early stages of recovery, especially when you start weight-bearing more. I guess the way they do the surgery they have to detach the hip flexor and that increases the chances of it flaring up after the surgery when you start walking. I'm 4 1/2 weeks out now and can walk with almost no limp for distances in the 1/4 mile range. It also feels better than it has in 7 years now (really makes me want to bail on my second surgery). I noticed yesterday while doing my PT that I actually felt like I had some muscles back in my leg, which was awesome.

Good luck and shoot me a pm if you have any more specific questions.

Sounds like things went well on round 2, L! Looking forward to seeing some more "aggressive baking blogging" soon.

sounds like you are recovering well, that is awesome!
i'm heading to vail for my scope this winter.

Hi wandering, not lost,

Well,The title contains the official medical terms to describe why I will be spending the entirety of my summer and the better part of the fall and winter with restricted activity levels. In layman’s terms, my hip joint is supposed to be like the ball and socket on a trailer hitch. Unfortunately, the ball and the socket that make up my right hip never formed correctly. As a result, I made it through 25 years of moderate to intense athletics before a surgeon correctly identified that my femur was flat on one side (it’s supposed to be the ball) and my hip socket was 27% smaller on my right side than on my left. Hurray congenital problems that go unnoticed!

After I endured hip pain for 7 years, my brilliant Dr. White diagnosed the problems I described above. He proposed a two-part plan to fix the huge problems with my hip joint. The first part happened on June 26th, when he went in arthroscopically and, with only three tiny holes, reattached my labrum (essentially a suction cup/cushion/wonder substance, that just happens to look like mozzarella, lining the hip socket) and ground out my femur so that it actually does look like a ball. The difference between my pre and post X-rays is huge and I’m really excited to have 2/3 of the problems with my hip fixed.

Thanks

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Originally Posted by martinpaul12

Hurray congenital problems that go unnoticed!

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Thanks for chiming in MP, how do you feel after 3 months of recovery? Now for the fun part.. what is your doctor planning on doing about your Displasia? I would love to see some x-rays that show your right hip socket smaller than the left.

I recently had a MRI that revealed labral tears to both hips, and large cam lesions on my femurs that are to blame for the tears. It doesn't appear that my cam lesions are damaging the cartilage in my hip socket yet so my Ortho-doc says I can put off arthroscopic surgery for another year or two.

Good luck with round 2 on that right hip!

WNL updating from Squirrelmurphy's computer:

I'm almost two weeks post-op from surgery number 2 and feeling like I might finally be getting better. I spent 6 days in the hospital (the first 2 with epidural in my back and the first 4 with IV, foley, and drain (collecting blood and other fluids out of my pelvis)), had two blood transfusions of my own blood that I donated 2 weeks prior to surgery, and experienced the most severe g-i distress I have ever had. Luckily for me, I don't remember most of the worst parts. Squirrelmurphy does as he was right by my side the whole time.

I'm just about off my pain meds, only had 1 vicodin in the last 24 hours. My surgeon also told me I'm not allowed to be a couch potato so we've been going on lots of little field trips from the house we're staying in.

From what I can tell, my 6ish inch incision is more or less healed. The steri-strips are still on there, but it gets itchy at times, which I think indicates healing is happening.

It wasn't as painful as I thought it would be, other than when I first woke up from general anesthesia before they had worked out my epidural. It also got pretty painful on POD 3 when my abdomen swelled up like a balloon and they took me off pain meds for 12 hours. Right now, the biggest thing that annoys me is that I lost some feeling in my skin down by my knee. Even that is getting better though, I felt a strange burning sensation in my thigh and then the area I couldn't feel got a lot smaller.

Thanks to everyone for following my story!
WNL

p.s.`markointheboat, martinpaul12 just quoted my initial post, and I highly recommend getting your hip issues fixed sooner rather than later. Twice this summer I have walked into a hospital and crutched out, but I think it's better to deal with your problems as they become apparent.

WNL:

Thanks for the update, I'm glad you're getting through it.

Now I am about 8 weeks post op from The Man B-White and doing well, still a ways to go though.

Hang tough,

Puder Luder

New update:

I'm posting under my own name because I am back in Colorado with my own computer! After three weeks back East, we took an early bus down to New York and saw my surgeon. He was absolutely psyched about my progress thus far, said that if all patients from Colorado heal like me, then he wants more. My incision was almost entirely healed and they were thrilled about the amount of bone healing that has already taken place. They also gave me the okay to start PT after 8 more weeks, so 11 weeks post-op rather than the original 12.

I finally got to see my xrays, so I now know that there are 6 stainless steel screws in my hip. There are 3 long ones pointing down (3 inchers, I'd guess), and 1 long one pointing up. There are also 2 short ones (about 1 inch) pointing towards midline. It looks pretty badass, that's for sure.

He approved us to fly back, as long as I promised to get up every 30 minutes and walk the aisles (with my crutches...) to prevent blood clots. We caught a flight back from JFK late that night and I spent the flight sleeping in 30 minute intervals and annoying the crap out of everyone else on the plane as I crutched up and down the slightly too narrow aisles.

In terms of how I feel now, I'm in some pain since I managed to stick my crutch in a gopher hole on my way to the truck at lunch time and I ended up landing on my leg. It also still surprises me how much my whole leg still hurts, or turns purple, or gets cold or blotchy at times. My surgeon said to expect that for a while just because of all the trauma to my pelvis, which is obviously where the blood that supplies the rest of my leg passes through.

I get to skip going back to NYC in 2 1/2 weeks and instead go to see Dr. White in Denver for more xrays and hopefully permission to walk. I go back and forth between being depressed about how long this process has been and being excited about hopefully eliminating hip pain for good. I am also starting to be more hopeful about skiing in February since I get to start PT around 12/9.

I just had my 6 weeks post-op appointment with Dr. White in Denver. He's thrilled with my progress so far. As you can see from the image, they kinda screw the piece of bone with the hip socket into place and wait for bone to fill in the gaps. I have clouding, but not full bone growth in the gaps in my pelvis, so I'm still waiting on the okay to start putting weight on it.

http://www.orthojournalhms.org/volum...gifs/a11-1.gif

I'm anxious to put weight on it, but I'm even more anxious to make sure that my "textbook-perfect" hip heals fully so I don't mess it up. I have a copy of my xrays from today on a cd, but we can't figure out what program we can use to open them. If we figure it out I'll definitely put them up.

keep up the good work in healing!
and keep us posted!

ok, i am wondering how you guys are making out post-op.
i just scheduled my surgery for march 22nd.