I don’t usually post on my blog twice in a week, but decided I wanted to write a post specifically for the PAO group on Facebook. This group has been a wealth of information for me the last few years and I notice a topic that comes up frequently and thought I would write about my own experience with it—mild/borderline hip dysplasia with impingement and torn labrum, how it presented/is presenting and considerations to think of when trying to decide what surgery is best for it: scope vs PAO. I realize everyone’s bodies are different and that symptoms and severity vary between all of us with dysplasia, but there are often communalities (even in those of us that don’t present as a “typical” hip dysplasia patient), so I am simply sharing my experience hoping to help someone who is in the same shoes I was last year.
On my left hip I had a scope April 2013 then a PAO on it in May 2013. Once my surgeon was in with the scope and saw the hypertrophic labrum and where the wearing of my cartilage was taking place, he said that my hip presented more dysplastically (it had a CE angle of 22 with some acetabular retroversion and 27 degrees of femoral anteversion) then it did like an impingement. Being almost 16 months post op on that hip it’s not perfect, but it is way better than it was and I have absolutely no regrets with the decision for the PAO on that hip.
When it was time last fall to decide on the future of my right hip (CE angle 24 with same version measurements as the left) my surgeon really thought I could get away with just a scope because the dysplasia was so mild. My symptoms on the right were somewhat different then the left, so we really thought the impingement was the main problem. I was scoped on that hip October 2013. It had a bit more damage to the cartilage than the left did, and although the labrum was bigger than a normal hip, it wasn’t as large as the left had been. Where the cartilage damage was had been more typical of that of a person with FAI, so my surgeon after the scope again told me he did not think I needed the PAO, and that being it was such a big surgery with a lot more risk he didn’t want to perform it on me unless absolutely necessary. He did say that my recovery would probably take a longer time than most being that I am very hypermobile (likely have EDS, but haven’t pursued the official diagnosis).
From early on I was miserable, I knew I had a lot of things against me (EDS, weakness-I was on crutches for that hip for 5 weeks leading up to surgery because of the pain-, age-I was 34 at the time, and of course having very mild dysplasia still). Everything I did in PT flared me after the first 3-4 weeks; I could not progress past very basic isometric hip exercises without flaring bad. The bike even flared me and I did very little of it in my recovery. My ROM was of course wonderful and within the normal range within weeks (thanks to lovely EDS) but I could not gain strength or get rid of the terrible pain in the back of the hip joint and all the muscles around my right hip and even the whole pelvis at times. My PT kept pushing me through more difficult exercises talking about how I was “behind” in my recovery. I started to hate PT because of how awful it would make me feel for days at a time. At 4 months I saw my surgeon and said I thought the scope failed because I was maybe 10% better than pre-surgery. He said to wait more time, and we couldn’t call failure until closer to 9 months. We agreed my PT was doing me more harm than good (and this is the 3rd hip PT I had—a different one after each surgery since they were not good and always made me worse) and I quit PT. I had been getting ART at the time for pain relief from all the flares PT caused, and his personal trainer who worked there said he would work with me for free doing the FMS training and going very very slowly. As the weeks went by I still had pain everyday all day, but was able to gain some muscle and core strength, so the pain decreased bit to a tolerable level on many days, I had minimal flares, and instead of muscle pain all over I was developing more and more pain deep in the back of the butt/hip socket area. At month 7 I started traveling 2 hours away to see my surgeon’s best PT guy who had tons of experience working specifically with my surgeon’s post op patients. I started seeing him every 3 weeks. He had me start back at very simple isometric glute type exercises. I had a hip injection around this time also, and although the muscle pain did not go away (muscle pain in psoas, low back, hip rotators, glutes and IT band) that deep aching and sometimes burning pain in the back of the hip/butt went away for a few hours. My PT started saying that was more a sign of joint dysfunction then just “chronic” muscle issues. I kept up with the simple PT exercises and my pain decreased more, I was actually doing things like going to the park with my kids and pushing them on swings, staying on my feet for up to 30 minutes with only minor pain. My PT didn’t want me to progress with exercises until I could do all 5 every day and get through my whole day with little to no pain for at least a week. I started to get excited that maybe it really was a muscle issue from my PT pushing me too hard too soon over the winter time. That feeling that I was getting better lasted less than a week before I went backwards. This summer has been filled with ok/tolerable pain days for a day or so, followed by a bunch of really bad days, followed by mid-level pain days. When I saw my surgeon July 31st and we talked and he moved my hip around and saw that my crazy ROM I still have and all the pain I still have and finally said that it didn’t appear the scope worked. According to his PT my strength in ALL of my hip muscles improved greatly, but the pain level only improved minimally. That too apparently is a sign of dysfunction. As I was talking to my surgeon that day thinking I was a bit better he asked me what percentage of my pre-hip life I was living, and I honestly told him maybe 30%. That pretty much summed up the decision to have a PAO on the right hip too.
Anyways, on the PAO group we always want to know symptoms so I am going to write my symptoms pre and post scope hoping maybe it helps someone in their decision making process when faced with the option of scope vs PAO with mild dysplasia. Pre-scope on the right I had pain deep in the butt, some groin pain although not terrible unless I was pivoting on my right hip then I got this sharp, deep catching pain in the groin (this was from the torn labrum). Muscles all around my right hip were constantly going into spasm, as well as my back muscles, and even at times all of the way up the neck. Sitting hurt, standing hurt, walking hurt. Laying down I still had pain but it was much better than any other position. Post scope as I am at almost 11 months out on this right hip, I still have the deep butt pain and it will burn in there if I do too much (which I’m chalking up to inflammation because it usually happens later in the day and I know it’s not nerve pain because I’ve had a ton of that due to my EDS and lumbar instability and pelvic instability) and the muscles around my right hip and low back fatigue and develop trigger points everyday very quickly. I wouldn’t say they are in spasm (unless I go crazy and try to do too much causing a spasm) but they get very tight quickly and hurt/ache/burn a lot of the time. I also can feel the femoral head is not situated up inside of the socket the way it’s supposed to be. It feels like it is lateral and sitting too far back. It’s hard to imagine I suppose, but after my LPAO within a couple months I could feel my hip was in a good position inside of the socket. On this hip I have never felt that, and as time has gone by this past year I’ve felt it settle even more to the side and back. Day by day my symptoms are becoming more and more reminiscent of the how my left hip was before the PAO. My whole body responds to the tightness around my right hip, my sacrum twists, lumbar spine gets pulled on, sometimes I have nerve pain, and my right foot collapses into pronation. I can use my muscles to pull it back up in the socket and hold it in place, but immediately the muscles feel overworked and spasm if I try to hold that position to walk or weight bear. If I walk more than 5-10 minutes I also develop that deep joint pain in the butt and it hurts to weight bear. I also feel much better when laying on my right side, which seems to help push and support the hip in the socket. When I lay on my left side it feels like the femoral head shifts around and the muscles respond badly in that situation. Well, I hope if you read this it can help you with your surgical decisions. It would have been great to go right to a PAO and skip this past year of misery, but I’m not dwelling on it, I just hope to help someone else in the same situation. My surgeon did say that he really believes that if I did not have hypermobility I would have done ok with the scope, but having lax ligaments and borderline measurements is like a double whammy and set me up for failure. Live and learn then move on:) Thanks for reading!