Thursday, January 3, 2013

Hip Op

I started having hip pain in January 2012. I remember feeling a sharp pain in my right hip while I was maneuvering storage containers at my grandmother's house in Nashville (in preparation for our move to Portland). I assumed I had strained a muscle so I took an anti-inflammatory and sat on a heating pad. I was pretty sore for a few days but then it seemed to be getting better.
Was this the cause of my injury?
Fast forward a few months. I joined a gym in Portland and, besides working out regularly (elliptical, treadmill, weights), Greg & I were pretty active walking around town and riding our bikes. I noticed that certain movements hurt my hip more than others but the pain was still tolerable. However the bursitis in my right shoulder (diagnosed in Italy in 2011) had really flared up so I was more focused on dealing with it.
power-generating elliptical machines at Green Microgym Belmont
As the summer progressed and we were volunteering at beer festivals, going on longer bike rides, and out & about often, the pain in my hip became more severe and it was hurting pretty much 24/7. Since we now had health insurance through Greg's employer (we had private insurance previously but had set an extremely high deductible), I was more willing to see a doctor to figure out the cause and, hopefully, get some relief.
I couldn't let the hip pain stop me from riding my bike!
I went to an orthopedist at Oregon Health & Science University in late August. X-rays didn't reveal the source of the pain so my doctor ordered four weeks of physical therapy. Unfortunately, that only made it worse and I had to stop going to the gym plus, no matter what I did (walking, sitting, lying down), everything was painful, sometimes excruciating.
This is the view from the 12th floor of the OHSU South Waterfront complex.
I returned to the orthopedist in October and he immediately ordered an MRI Arthrogram. A week later, the results came in and, when the doctor walked in my exam room, all he said when I asked how he was doing was "I'm a lot better than you are." He handed me a printed copy of the results where I read the words "extensive tear of the anterosuperior labrum...measures up to 3mm" as he said he would try to get me an appointment with the surgeon who specializes in hip repairs that same day.

I met Dr. Andrea Herzka a few hours later. She spent at least 30 minutes discussing the surgical procedure with me and even sketched it out on a piece of blank paper.
Here's what else was revealed by the MRI:
  • I have always been at a higher risk of having hip problems because I have deep sockets (where the femur/upper leg bone fits into the pelvis) and also because the femoral neck (the part of the leg bone that moves around by the hip) is not shaped the way it should be. Mine are almost flat across the top and they should be curved to allow more room for leg movement at the socket. Part of the surgery will include shaving off some of the femoral neck in order to re-contour it. This is called osteoplasty.
  • Where the labrum is torn there is also damage to other cartilage in that area (categorized as focal delamination of the anterosuperior acetabular cartilage). They cannot be sure of the extent of the damage with the MRI and won't know until they get in there with a scope (during surgery). If it is just rough from wear & tear they can smooth it out. This process is called chondroplasty. If the entire cartilage has separated, then they have to do a more extensive procedure to repair & replace it.
  • The torn labrum will be reattached to the hip socket with sutures and/or anchors. This is called labral refixation.
Bottom line: The surgery is outpatient and will take around 2.5-3 hours. It is minimally invasive (arthroscopic) but because of the multiple issues that are being addressed plus the fact that they have to use traction (physically pulling my leg bone away from the hip socket for an extended period of time), there is some risk of damage to the sciatic nerve and other surrounding tissues.
It's going to be a long time before I can crouch down like this again.
I will be on crutches for the first two weeks (six weeks if the cartilage damage is more extensive and a microfracture is necessary to stimulate growth of new "fibrocartilage"). I have to wear a Continuous Passive Motion machine for six hours daily for several weeks. I will start physical therapy immediately: 2x/week for three months then 1x/week for another three months. I also have to do exercises at home. Thus total recovery time is a minimum of six months.
CPM use
Yes, the news is worse than I expected, although it's not like I have to have a hip replacement (yet). And, clearly, my body is starting to catch up to my age and that sucks! But I'm tired of the pain and want to get this over with so I can enjoy the nice weather when it returns to Portland in June.
I want to be able to do this!
The surgery is scheduled for 8:00AM on Tuesday, January 15th, the earliest date available after I got insurance approval (which took several weeks). To help me manage the pain in the interim, I had an ultrasound-guided steroid injection on November 12th. After the initial discomfort from the injection wore off, I was almost completely pain free for about 2 1/2 weeks. It has gradually increased since then but I continue to stay as active as possible, knowing that my life is going to change drastically in a matter of days.
Christmas Eve bike ride
Since the surgery was scheduled in mid-December I have been preparing for the weeks ahead. Greg will be able to work from home while I recover and I hope that I can be independent enough to keep him from having to taking too many days off. He has had plenty of practice washing dishes, doing the laundry, and cleaning in general, but I'm the cook. So I've made a bunch of hearty soups to put in the freezer and I've stocked up on the things that we use the most. We usually don't keep much food in the house as I prefer to buy everything fresh, but our pantry and freezer are overflowing for now!
Do you think we can survive on beer & beef jerky?
And the countdown begins (11 days remaining as of today)...


  1. I so admire your courage miss allie. I can tell you this, that surgery is no fun. But with your determination and positive outlook, you will be just fine. Now is the time to really take good of your body, eat well and get plenty of sleep. Do keep us posted of your progress :)

  2. Given the extent of your injuries, it amazes me how functional you have been, so good on ya, and clearly speaks to your "live life to the fullest" positive attitude - an inspiration to us all!
    I really hope your recovery goes well, and please don't hesitate to call on your friends for help.
    thinking of you and look forward to seeing you before, during or after your surgery.

  3. I have also passed through the horrible experience of the hip pain. When I remember those days, it is also very shocking for me. I was not able to even walk in that moment.
    physical therapy in bergen county

  4. I like to appreciate your courage. You need to some tips for the betterment of your hip pain. You should keep on your exercises plan and also get some massage therapies for the strength of your muscles.
    physical therapy center