“Alright, alright, alright”

I am doing good.

The cortisone took off the edge and does its magic. Quite nice to not have really aching hips and to get a mental breather.

 

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I also went back to the gym but nothing crazy, to not aggravate Majesty hip. 5 minutes the Elliptical/ level 1 and 10 minutes the stationary bike, also level 1 so far. Stretches are back on the menu, light weights, foam rolling and even planks.

Verdict – both times the hip was aching afterwards, but tolerable. I now took eight weeks off because of the flare, which was topped off by the diagnosis of the labral tear. I guess I have to ease back into it and enjoy what I “can” do, more than getting grumpy about what I “can’t” do.

 

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You also know you have been way too long at this, when various people keep pointing out “you are walking! Without crutches.” (Geez. I used to be known for my tennis game. Now I am known for “hips”. What a trade off!)

 

I also don’t know how many times I was asked recently if I am getting a  THR. No, I am not. Final answer.

My hip went through quite a bit already, is not anatomic anymore and a bit beaten up but everything considered, it’s still a good quality, functional hip. And most of all, my own bone.

The hip would have to be in pretty rough shape to qualify for getting a  THR  and mine is far from it.

~~~

Today I met a woman who told me, “I heard arthroscopic surgery on the hip is easy.” Uh huh.

Comments like this  ONLY  can come from people who never had it done. If there is “nothing” to it, I wonder why they knock you out with general anesthesia, why you have to be on crutches for several weeks, why you need  PT  for months and why the heck, the recovery takes a year minimum. Enlighten me please.

 

Sometimes I wish people would just not say anything at all, instead of belittling something that they have no experience with.

To save myself from getting high blood pressure and disappointment, I did not tell most people about the latest developments. People have a short attention span if it doesn’t concern them personally, people don’t care and people are tired of it. (Join the club!)

 

Everything will be okay. I will figure it out.

 

Inspirational best recovery quotes 24 best Wolf Quotes

 

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Cortisone injection

PO  MONTH  16 – not where I thought I would be but I am trying to make the best of it.

A few days ago I had my cortisone shot in my R hip. This would make it officially steroid injection No. 4, spread out over a period of six years “hip fun”.

The techs were very nice but the procedure was still rough. It’s a lot of pressure and burning when the injection goes in there. It’s not like a quick flu shot, it is guided under X-ray and has to be done slowly, to get it in, in the right angle and without hitting an artery, vein and nerves. A skill by itself.

 

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I was told to stay off the joint for two days, so the steroids get the best chance to get absorbed and unfold the maximum relief.

On both days I felt the side effects from the cortisone. It felt like getting the flu – fast heartbeat, tiring very quickly and my face turned red and was hot to touch. Delayed allergic reaction. What else is new? Out of 4x, I got it 4x.

~~~

I continued my research and know now that I again have “FAI” with a labral tear. (= Femoral Acetabular Impingment), just of a different kind and  WAY  more difficult than before.

I found exactly two medical articles about it, almost 20 years old and with this completely outdated; and they both say the same thing. To “avoid impingement down the road, the reduction has to be made perfectly at the time of surgery.” Theoretically true but completely unrealistic and not doable.

No orthopedic surgeon will actually attempt pulling two broken ends of bones “apart” and try to twist the femoral neck back in position before putting the pins in. The chance of causing more damage or ripping some arteries are way too big.

So, as I said, not great medical articles to go by. Maybe I should become a case study for my OS?!

~~~

This week I will try working out again. Starting with 5 minutes. Back to the beginning.

 

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More afterthoughts…

The “after shock” is over and I found my inner peace again. I spent time analyzing my images from “before” the fracture & hip pinning to “after” and see now what my OS meant, when he said he can not address the bone.

 

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I was told subcapital fractures most of the time occur from a fall; are impacted (Explanation:An impacted fracture occurs when the broken ends of the bone are jammed together by the force of the injury”), displaced and in almost all cases, the femoral neck gets slightly rotated because the illios psoas pulls on the lesser trochanter. Check mark on all of those.

 

 

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To put it very simply…I had “interesting” hips to begin with (according to my OS: “those are the weirdest hips I have ever seen”) and now the femoral neck is not just twisted but also shortened. There is literally nothing left for him to shave off. (Enough for the hip to keep banging on the labrum though. Ugh.)

~~~

I really understand it now. I have been at this for a long time; I know my hip anatomy, how the labrum works, how arthroscopic surgery for a labral tear is done etc. – it’s all rather complex.

 

The good news are:

  • I don’t have AVN and don’t need a THR.
  • there is the treatment of cortisone.
  • my bone has healed 100%. No mal- union or non- union.
  • the screws have not shifted.
  • my muscles are symmetric, R vs. L.
  • I have good joint space and no OA.
  • the cartilage damage I have, has not gotten worse since I had my scope, five years ago.
  • the femoral neck looks definitely different now, after the fracture/ surgery BUT it did not end in leg length discrepancy. Some hip fracture patients end up with one leg being shorter than the other and are stuck with a limp. Got lucky there.

 

Looking at the big picture, it’s not optimal but could be worse. Another thing that really made me feel better was, I was told, it was not my fault it happened. I did not do anything wrong. Just crappy luck.

 

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And by the way, the famous “fine line” I have been walking on as a hipster just got thinner.

Now I have to find out what triggers pain, how much is too much and find a lifestyle that does not aggravate the torn labrum, basically “do less” but at the same time I was told to “move, add minutes and do weight bearing exercises” to improve my osteopenia. Fun.

 

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Bittersweet news

I got an earlier appointment with my OS and he was not happy about the new labral tear (….join the club!) and told me very directly – there is nothing he can do. Wham!!!

 

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Labral tears are a subject on their own and I will try to simplify the reason for him telling me this.

My labrum is torn in an angle that makes it difficult for him to attach anchors. Even if he did manage to get the anchors around it, the labrum would end up more narrow and loose function in the hip, ergo – the hip becomes more unstable.

On top of it, the cluster of anchors would look like a “knot”, keep rubbing and speed up the progress of OA much faster.

~~~

To get a labral tear, in most cases it’s caused by an abnormality of the hip, a bone growth that keeps pounding against the labrum and eventually tears it. I had this twice before and the bone was successfully shaven off. It required surgery, followed by a very difficult, lengthy and tedious recovery.

 

If you have the stomach to watch it, here is a very educational video. But don’t say I didn’t warn you. 

 

In a perfect case scenario this would be the solution here too but because of my fracture and hip pinning, the hip no longer has an optimal anatomic shape and my OS can not shave off bone.

Even if he did repair the labral tear; the underlying issue, the bone, would keep doing what it is doing and it is mostly likely to re-tear shortly afterwards.

~~~

He also pointed out that my hip has been through a lot already. First the hip arthroscopic surgery, stress fracture in the acetabulum, followed by the trauma of the fracture and then the actual hip pinning.

I asked if the tear could get bigger and was told, it might and if the pain gets really worse, we have to think of something else.

The best I can do for the moment is get a cortisone shot inside the hip joint, hopefully this will give me pain relief and a mental break for a while. I usually respond well to cortisone but unfortunately those shots always come with cortisone flares for me, which are not fun.

I was let go with an apology from his side. He said he wishes he could do more for me, but “you have always been a difficult patient.” Yes. Thanks.

 

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So how am I dealing with this now? Yesterday was not great, but today is better. I am not loving it, but I understand the situation.

I’ll do one day at a time, hope for the cortisone to kick in and try to find a new level of working out to maintain my fitness level without aggravating my hip too much.

And for the record – hips suck.

 

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Thoughts on my labral tear

I have had now a few days to digest the news of a new labral tear. I did not expect to hear this, I thought it was a stress reaction but…

 

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I bet my OS does not see it coming either. The MRI taken was not with a labral tear in mind.

For labral tears my OS prefers doing a arthogram MRI of the hip, but I had a very smart radiologist looking at my images. He picked it up.

~~~

I have had two labral tears before but the situation was different each time. It was the same surgery, same surgeon and even the same hospital, and yet, the recoveries could not have been more different.

My first hip arthroscopy with bone shaving and labral repair was straight forward. I had the same surgery on my left hip, with the difference of dealing with stress fractures in my acetabulum in the freshly operated hip, as well as in the hip that was still recovering. Now I can add a scoped & broken hip with a labral tear, just to make it a bit more challenging.

 

For some reason I don’t think my OS has another patient with the same scenario. Hm…

It might be a good idea to make a list of questions I have for him. The situation is now completely different from last time since the labrum did not get torn by my original cam or pincer lesion but through the new anatomic, “not so anatomic” shape of the pinned hip. It is a tricky question to answer, how to proceed from here.

I am not exactly thrilled about labral tear no. 3 but…

 

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And just for fun… just when I thought finding information for “young people with hip fracture” is slim – try looking for “labral tear after hip pinning”. Nothing. Zero. Not even medical articles about it. Lame.

 

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OS and MRI

I had my appointment with my OS by now.

Since my last X-rays were taken around the 6 month PO mark and I am now borderline 16 months, it was time for a fresh set of X-rays. Of both hips!

By now I know the drill… “point your toes together”, “give me the frog leg position”…. My  OS  looked at them but said, it is impossible to tell from an X-ray what’s going on, so he ordered an MRI. To rule out  AVN  and to pick up anything else that might be going on.

I asked him what would happen if  it was  AVN. His answer was short and simple – THR and that soon, before the hip collapses. Gosh!

 

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He wanted the  MRI  as soon as possible and I got lucky to get an appointment the same afternoon. While I was waiting and being a nervous wreck about the potential bad diagnosis, I had the pleasure to sit next to some chatterbox.

By the time I got called in, I knew “what, where and for whom she worked, what her husband does and doesn’t do; where her son is stationed, what she sent him for Easter and of course what carrier choice her Grandkids chose for themselves”!

G-o-o-d-n-e-s-s !! Compared to that the noises the  MRI  machine made were calming.

 

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The  MRI  took a good half hour, was not painful but not comfortable either since they had to tape my toes together. That puts the hips in a more optimal position somehow.

~~~

I got my diagnosis the same evening.

The good news first – the bone has fully healed and no  AVN. Bad news – I have a new labral tear! Not the greatest news but compared to having  AVN  and ending up with a  THR, this is gold. And compared to the hip fracture from last year an “upgrade”. (Hipster humor…)

The other, good hip is ok, just stressed out from compensation and overload.

 

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I was told, I didn’t do anything wrong. It happened because the fracture was impacted and had to be pinned in a certain way the day of the accident. Now the hip is not anatomical anymore and to put it bluntly, something is “banging”against my labrum and tore it.

It is a different kind of tear than before, back then it was vertical, now it’s horizontal.

Shows again, listen to your body!! I knew this was more than a regular flare.

~~~

I will see my OS again in six days, to talk it over and discuss the next steps. It’s not ideal but it’s better than  AVN. Never thought I would say “I am happy it’s a labral tear”.

Let’s see what next steps my OS proposes.

 

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