Just a "Pinch" of Pain

Hello again, all!

I had my appointment with Dr. S. on Monday. I wanted to take a few days to digest it all and think about how to write this post before I went about my business, so here goes nothing.

Here’s what we discussed in the appointment:

1. “Excess” Bone Growth
2. Psoas pain
3. Deep groin catching/pulling pain
4. Non-union
5. Heterotopic Ossification
6. Left hip pain

Here’s what Dr. S. said about each of these things:

1. The bone growth that I can feel on my iliac crest is completely normal and to be expected. Dr. S doesn’t think it has anything to do with my psoas pain or any of my other soreness since the growth is high and above my attachment point. He asked me if the screws that I can feel are uncomfortable and if I want them out, I said no. They are slightly uncomfortable, but I don’t want him anywhere near me with that scalpel anytime soon.
2. Dr. S. told me that my psoas and some of the surrounding muscles are really tight, but that my hip-flexor and quad strength is actually pretty good. He didn’t seem overly concerned about it, but does want me to try and get those muscles looser and in less pain. We are trying for 6 more weeks of physical therapy (on my own time) to see if that helps the pain I’m having. If it doesn’t, we’ll take it from there. 
3. Dr. S. was a little concerned about the deep groin/catching pain I described in my earlier post. He doesn’t like the idea of having pain that won’t allow me to stand up straight or walk (obviously). He’s hoping that it’s a continuation of the psoas tightness and pain and that it will resolve itself with physical therapy as well. If it doesn’t, he’s thinking some deep tissues could be catching on my screw head (see photo below). If PT doesn’t help, we may have to consider taking my screws out. That would not be ideal, since some of my screws are pretty deep. He’d have to re-open my incision and do a lot of moving around to get to the screws. It’s not as cut and dry (tee-hee) of a procedure that I was thinking it might be. He did mention that he’d really like to avoid putting me through that if he doesn’t have to. We will see at the end of the 6 weeks. 
   
4.  The non-union is a non-issue. He said that it’s not a weight bearing bone and it’s not going to have any impact on me. He also said that while it appears that it’s not closing, it more than likely is still growing bone and will close on its own eventually. 
5.  Dr. Schiller did confirm that I do actually have heterotopic ossification (HO) in the areas that I had suspected by looking at the x-rays. He said that's no big deal and it's mostly in the deep muscles tissues and I'll probably never even know I have it.
6. This is the part where I sigh loudly and with general unrest. As I’ve mentioned in past posts, I’ve been having “start-up” pain in my left hip. This isn’t a new thing, it’s been happening for years. Lately, though, it’s a little more common and a little more startling. I had attributed it to the RPAO and that my left hip has had to work overtime for years. Even before my RPAO, my poor left hip got the brunt of it as I compensated for my right hip pain. So I explained everything to Dr. Schiller. He showed me my x-rays and told me that in terms of coverage, I’ve got pretty good coverage on the left side. He wouldn’t consider LPAO at all. However, he did say that I do have impingement on my left side, and that that is what is more than likely causing all of my left hip pain. He said that if he had to guess, that he’d say my left hip is probably a little degraded due to both the impingement and the overtime work it’s had to put in and that that’s why I’m feeling the pain.

I did a little research on my own so that I could better explain and show you what’s going on (and better understand it for myself). What I’ve got in my left hip is called Femoroacetabular Impingement (FAI). There are a couple different kinds and they are outlined in the website I’ve provided below.

http://orthoinfo.aaos.org/topic.cfm?topic=A00571

I have what’s called Pincer FAI. I’ve attached a couple of my x-rays, one pre-RPAO and one post-RPAO to point out where my FAI is.

Pre-RPAO

Post-RPAO

So, what now? Well, Dr. S. said that there are some surgeons who would have fixed it as soon as they saw it, regardless of if it was really bothering me or not. He doesn’t really operate that way (pardon the pun). He would prefer to leave well enough alone until it starts to bother me to a point of needing fixing. Over time, it will probably continue to wear at my labrum and joint space, and eventually I will need to have it addressed. It would more than likely be a scope surgery like what I had last March on my right hip. Probably not a big deal. We’ll have to take a day at a time and see how it goes. For now, he wants me to do what I’m doing on my right side for PT to my left side as well. That way we can see if PT will be help to me for the FAI.

That’s that, in terms of what I spoke about with Dr. S. I will say that I’m disappointed to hear that I’ll more than likely eventually need another surgery on my other side. Going through degrading pain on the other side now is not something that I’m looking forward to, I can tell you that much. I guess that we’ll just have to see what happens. Maybe it WON’T get worse after all. Time will tell.

I have to keep doing the PT on both sides for 6 weeks. At the end of six weeks I have to call Dr. Schiller’s office and let them know how I’m feeling and make an additional appointment if PT doesn’t seem to help either side.

I’ll post later about what I’m doing on both sides (RPAO-ed and left FAI) for physical therapy exercises.

Thanks for listening, and we’ll talk soon,

D

Growing Pains

This post will be short and sweet. I just wanted to post my latest x-rays to illustrate where my concerns are about excess bone growth. I talked about these in my "Tidbits" post.

Quick reminder of current conditions:
I'm 15 months out of RPAO. I've had RPAO and a right arthroscope to fix torn labrum, to microfracture and to resurface femoral head.

Any thoughts would be much appreciated! I've heard from a few different people and it seems most likely to be something like Heterotopic Ossification (which may, or may not be an issue). Also, regarding the non-union, my surgeon isn't concerned with it at this point. It isn't bothering me on a regular basis. I will be asking him about it again, just to be sure.

I've discussed the bone growth concerns with my surgeon and as a first step he is sending me for an ultrasound to see if there is any cyst formation in the area. I did have cyst growth prior to surgery.

That is all for now, thanks for all emails, comments and well wishes so far. Please feel free to leave your thoughts in the comments below! Any and all input is welcomed.

Thanks guys,
D