Whad'dya need ta know about PAO?

Hello, again!,

I went to Massachusetts General Hospital yesterday and met with Dr. Kim for a second opinion on my DDH. In short…he told me that Dr. Schiller’s recommendations were correct. That I absolutely do need PAO, and the sooner I get it, the better.

Dr. K gave me some great information. He explained to me that PAO is one of the rare circumstances that they suggest you go through with the surgery BEFORE you are experiencing any hip pain at all (currently, all of the pain I feel is from the tears in my hip labrum), that is because the philosophy with this type of deformity is that you “go into surgery without pain, come out without pain.” Essentially, if you’re already having joint pain before you have anything done, chances are you’re going to come out of the surgery with pain, the damage has already been done.

I came out of there feeling like this is definitely something that I do HAVE to have done, and that it is the right incision…I mean decision (see what I did there? Gotta keep the mood light).

I thought that this would be a good time to show you exactly what is wrong with my hip, and how they are going to fix it. I’m going to attach my actual medical imaging, and try and compare it to my normal hip so you can see what is going on. I’ll then explain to you, in as much detail as I have, what Dr. S will be doing to fix my hip deformity. 

So, first off, here is a series of imaging of my hip. I’ll try to explain what they are as I show them.

 This is an x-ray of both hips. It shows a mostly normal left hip, and my sad right hip. 

To the left is an image in a 3D CT Scan of my right hip. This view is posterior, or from the back. Here you can see what is the proper coverage of the femoral head.

Now, this is the front of my hip socket. You can see how much coverage I'm lacking on both the top of the femoral head and also in front. I have less than 45-50% coverage.

 This one is just an extra view from the 3D CT Scan, which blew my mind. This is looking from INSIDE my pelvis, out towards the joint. See how I've got pretty good coverage in the back part of the joint, but the front part of the joint is really crappy looking.

The opposite angle from above. Mostly I posted these because I think they are crazy. The imaging that they can do today boggles my mind!

Additionally, I have labral tears in my joint. This is really common in DDH patients. But the MRI is awesome, so I thought I'd post it. This picture is if you're looking from the top looking down, into the hip joint. The circle in the middle is my femoral head.

 How do you fix this? Well, obviously PAO. So, I've inserted some information from a really great website who describes in regular people language...instead of doctor-speak.

 "This surgery involves cutting the pelvis around the hip joint and shifting it into a better position to support the stresses of walking (OR volleyball...okay the website didn't say this...but I did!). After the hip is re-positioned, it is held in place with screws until the bone heals. After the bone heals, the screws can be removed, but this is not usually necessary."

-Hip Preservation Surgery for Adult Hip Dysplasia
http://www.hipdysplasia.org/Content.aspx?id=9252


That makes it sound sooooo easy, doesn't it? They also had these neat looking little diagrams:

So, that is that! It's looking like I will be having the surgery sometime this fall. Probably October/November. In the meantime, Dr. Kim suggested yesterday that I start using crutches when I can to try and get my pain under control. The idea is to reduce usage which will reduce inflammation in my labrum, therefore reducing my pain. He said the best condition to be in when going into the surgery is to go in without any pain. While I'm under for the PAO, they will also be attempting to fix the labral tears. It will depend on what they find when they get in there. 

From here, I'll post as I learn new things and go through the process of getting ready for surgery. 

Thanks for reading! Please feel free to post any questions you have and I'll try to answer them as best that I can. 

 Your gimpy friend,
Danielle