Impending Hip Surgery

Thank you all for your patience while I took a break. I was burned out and having a rough time with my mental health. Unfortunately, infertility is still a major part of our lives, but that has needed to be put on hold for a few months because I need to have surgery on my right hip.

On August 13th, just one week from now, I will be having surgery on my hip. The surgeon we met with originally had been practicing in Denver, but then she moved up to Vail (which is two to two and a half hours from Denver). She is an amazing surgeon and was willing to work with all of the complications of my life and health conditions. We live in one of Denver’s suburbs, but we will be driving up to Vail for my surgery. Since it’s such a long drive, and surgery check-in is usually very early in the morning, we will be spending the night up there before the surgery.

What’s Wrong?

My right hip has been in significant levels of pain for over two years now. It would hurt off and on, then I slipped in the shower and hit it on the soap dish, and the pain became constant. My rheumatologist thought I got bursitis from the fall, and attempted a bursa injection. Unfortunately, the injection only made it more painful. All of my x-rays were normal. Finally, after we were finally able to articulate how awful the pain had become, he ordered an MRI. Suddenly, we had answers. My rheumatologist referred me to a hip specialist (the surgeon that will be doing my surgery), as this was outside of his expertise.

It turns out I have the same problem in both of my hips, but the left hip doesn’t cause me any pain so it’s not worth having surgery at this time. Hopefully, continuing my maintenance physical therapy will help to postpone surgery on my left hip for many years.

Hip Anatomy

First, a quick explanation of hip anatomy so that we’re all on the same page. Your “thigh bone” is called the femur. It’s one of the strongest bones in the human body. Your “hip bones” are a part of your pelvis called the ilium, which is not labeled in the below image, but the part you can feel through the skin is the part of the bone the word “cartilage” is written over in the image. Your hip joint is the area where your femur connects to your pelvis. As you can see in the below image, the hip joint has a lot of tissue to help keep it stable.

The head of the femur is round, and the “ball” part of the “ball and socket” joint that makes up the hip. The ball of the femoral head fits into an alcove on the pelvis called the acetabulum. As you walk and move, the femoral head glides around inside the acetabulum thanks to the synovial fluid and cartilage.

My Anatomy is Not Normal

It turns out I was born with femoral heads that were not round. Some people that need a similar surgery to me were not born with misshapen femoral heads, but instead had injuries or conditions that caused bone deformation over time. Since both of my femoral heads are misshapen, it’s almost certain I was born like this.

Because the femoral heads are not round, they pinch and grind at the tissue in my hip joint, instead of gliding smoothly. Over the course of my 29 years of life, they have torn the labrum (it’s hard to see in the above image, but it’s a thin layer between the cartilage and synovial fluid) away from the cartilage and have started wearing away the cartilage on the acetabulum. This is happening on both sides, but the right is worse.

My right hip MRI, you can see the labral tear. The tear is at about the 11 o’clock position on the circle.

It’s very difficult to see the exact shape of my femoral head in my MRIs, as I don’t have the images that show it best. In the above image, you can see a slight fuzzy edge on the left side of the circle, and I believe that is one of the areas with extra bone.

What’s the Surgery?

I will be having an “FAI Correction with Labral Repair.” FAI stands for femoroacetabular impingement, which is a fancy phrase saying that the bones in the hip joint are pinching the soft tissue.

The surgeon will be using arthroscopic surgery to correct the problems in my hip joint. Arthroscopic surgery is the same thing as laparoscopic surgery, but in a joint instead of the abdomen. The surgeon will use thin tools and insert them through very small incisions in my hip, seeing inside the joint with a camera instead of her eyes. Arthroscopic surgery minimizes infection risk as there is less area for bacteria/viruses to enter and the incisions heal much faster.

They will “distract” my hip, meaning they’ll create space in the joint for their tools (they’re going to pull the femoral head partly out of the acetabulum). Then she will take a suction drill and grind the extra bone off of my femoral head so that it will be perfectly round and smooth. Reshaping the bone is the “FAI Correction” portion of the surgery. She will then use a special “bioinert” plastic anchor to reattach the labrum, which is the “labral repair” portion of the surgery. A bioinert substance means that it does not react to biological substances, so my body won’t try to attack it and I won’t have to worry about allergic reactions.

It is possible she may have to do more if she sees more problems once she gets in there. One possibility, that I read about when doing research, is that if my cartilage has worn down to the bone anywhere, she may need to drill tiny holes in the bone. As the body tries to heal those small holes, it will also regrow the missing cartilage. If it’s not down to the bone, it sounds like the cartilage should repair itself once the labrum is back in place and the cartilage is no longer being pinched.

Recovery

Obviously, this sounds like a pretty major surgery, and it is. The hips are one of the most important joints in the body. All of your body weight is evenly distributed between your two hips when walking or standing (if you weigh 150 pounds, then each hip supports about 75 pounds while you are standing). Your hips are also one of the main shock-absorbing joints in the body. Because my hip hasn’t been working properly, walking causes me significant levels of pain because the shock absorbing power in my hip is gone.

Because the hips are such a major joint, and because we’re doing a lot to my hip, the recovery is a long process. From what I was told at my initial consultation, I will need to use a walker for three months (I cannot use crutches for extended periods of time without dislocating my ribs and damaging my elbows). I will also be in a brace that goes from my waist to my knee, and will prevent me from bending too far, for the three months as well. The entire three months, I will also be non-weight-bearing on my right leg. I’m not sure if I’ll be able to very slowly work up to weight bearing, or if it’s three months of absolutely nothing before I can start working up to it.

Physical therapy will start a week after surgery. I am going to see an insurance-covered physical therapist for my hip surgery rehabilitation. My maintenance physical therapist and I will continue to work on the rest of my body to make sure I’m not damaging other parts of my body while my hip heals. Hopefully, between the maintenance physical therapy and targeted physical therapy, I will recover quickly!

Pain Control

This is the part of the recovery that has me the most nervous. Medication for pain control is complicated for me. My everyday pain levels are high enough, that Tylenol won’t even touch post-op pain. (Honestly, Tylenol barely touches my daily pain and I mostly just use it for headaches.) I cannot take opioids. Every opioid I’ve ever taken has caused atrocious side effects that make my pharmacist nervous, and I’d honestly rather deal with unmedicated post-op pain than experience the horrible side effects I had last time I tried to take an opioid. If I take a miniature dose of Tramadol, I don’t get as sick, but I also get very limited pain relief. Now that I’m on low-dose naltrexone, I don’t think doctors are technically supposed to prescribe me opioids anyway. (This is controversial. Apparently LDN has a very limited half-life in the human body, so technically it shouldn’t interfere with opioid use. But since it blocks opioid receptors, doctors/pharmacists say not to take them both.)

One of my chronic illness friends from Instagram cannot take opioids as she’s allergic to them. For her outpatient pain control, she takes benzodiazapines. I thought that class of medication would be worth a try, but I just discovered that a medication I’m extremely sensitive to is a benzodiazapine, so now I’m very nervous to try them. However, the benzo side effects are much more tolerable than the opioid ones.

Before someone jumps into the comments to suggest marijuana/CBD use, I’m allergic to all of the cannabis plants. Therefore, I cannot use MMJ, CBD oil, or any other form of cannabis. It would make me far sicker than opioids.

I’m hoping that there are other options that an anesthesiologist or my doctor will have for me. Pain control post surgery is incredibly important. The better controlled the pain, the better you heal.

For a few months now, I have been doing acupuncture on a weekly basis. I will be taking the week of my surgery off, but will start back up with weekly acupuncture the week after my surgery. I am hoping it will help control the pain! I have found acupuncture to be extremely helpful for my mental health, and it definitely has had physical benefits. Going into this surgery, I’m cautiously optimistic that it will help with the post-op pain.

The Benepod, ice packs, TENS unit, essential oils, and meditation techniques are also all tools in my pain control toolbox. While I’m grateful to have them, I’m very hopeful that they will not be my only forms of pain control.

Life After Surgery

This is going to be exciting, said with all the sarcasm. Dan is, thankfully, able to take time off for my surgery, and then has the flexibility to work from home if he needs to. We figure that for the first week, I’ll probably need him home all day. Hopefully, I’ll be able to take care of myself well enough that he’s able to go into the office starting the second week.

Dan is also starting graduate school again on the 19th of August, and he’s taking two classes this semester. I will either need to figure out how to come with him to school (he has a two hour gap between his classes that he’s staying on campus during) and still recover, or I will need to be able to be on my own for most of the day. Right now, we’ll have to play it by ear. We may be able to bribe some of our friends to help “babysit” me, but I’d rather be able to keep myself alive without help! (And both my mom and Dan’s mom have offered to come help if we need it.)

This surgery, however, should completely fix the pain in my hip! I am looking forward to being “recovered” (the entire process takes about a year), and no longer experiencing the daily excruciating hip pain. It’s going to be amazing to be able to do things again!

If You Want To Help

Some people have reached out to me and asked how they can help me/us during this time. I did setup a wish list on Amazon, if you would like to contribute in that way: Hip Surgery Wish List. I would love to be able to send you a snail mail thank you card if you purchase something off of my wish list! If you would like one, please either include your full name and mailing address on the “gift message,” send me a message on Instagram, or contact me via my contact page.

Some people have expressed a desire to simply provide some money to contribute to travel or procedure expenses. To contribute financially, you can send money to my PayPal account. If you choose to make a PayPal donation, please put your name and address into the “notes” box and I’ll send you a snail mail thank you card! (Obviously, you may remain anonymous, I would just like to be able to properly thank you for you help.)

For a totally free way to support me, I am very open to all of the good vibes and love that everyone has been sending my way! Feeling all of the love and support from everyone has really helped to reduce the anxiety I have about this procedure.

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