Hip Arthroscopy Where to go now?

[tracycharli]

Hi

I'm new to this site, and not sure if this is the right area for me to post my questions or not.

For 2 years, I had excruciating pain in my groin area/illiac fossa region. I was fobbed off many many times, had my appendix removed, gynae appointments/ gastro/ physio before being referred to othopeadics. I was diagnosed with a pincer impingment with a possible tear of the labrum

At the end of may (2012) I had hip arthroscopy surgery. There were complications during the surgery, as it took nearly 4 hours, instead of the 1 hour I was told it would take. Apparently the inside of my hip was a mess. The tissue was all red, inflammed and bleeding for starters, so they took biopsies because they had no idea what had caused this. During the surgery, they also removed the impingement, had to completely remove a section of the labrum and bone, as well as repairing another part of the labrum. I was told to stay on crutches for 6 weeks and barely weight bare at all. The biopsies came back "fine" and they think it was where the tissues had been nipped within the joint.

I'm now 2 and a half months on, and I really don't feel much better. My hip is still sore if I do anything for too long. Sitting/lying/standing. It's still making very loud popping/snapping noises. when it pops/snaps, sometimes it doesn't hurt too bad, but other times it hurts so bad that I actually see spots in front of my eyes! I still have groin pain, although not as bad, and certain areas of my groin are quite sore to the touch, without prodding! I'm wondering if this is normal?

The physio isn't doing much with me, she won't touch me at all and has never checked my range of movement. I explained to her that my hip is still popping etc and it's painful, but it didn't appear that she was listening, let alone cared. She asked me to do an exercise that she had demonstrated (swinging the leg out to the side) and my hip popped and I nearly fell over. She now doesn't want me to do too much until I see my consultant (for the 1st time since surgery!) and they can explain why it's still cracking. So I'm guessing it's not normal! I'm thinking that they might not have completely removed the pincer impingement and that's why it's still doing it. Could this be right?

Has the arthroscopy not worked? If not, what will they try next? Has anyone had a similar experience? Up until 2 years ago, I was a very active person, in the TA and in the gym every day. Now I struggle to walk, let alone exercise and I feel at 29years old, my situation is just not acceptable!

Please, please help me!!!!

 

[bottomshollow]

Welcome to the forum, Tracy. I do not have any answers to your concerns, but I am going to tag Josephine, or forum mother hen and resident medical expert to address your issues. She, like you, is in the UK and it may be morning before she responds.

I am sorry that you are having such a bad time of it. I'm surprised that there has been no scheduled follow up to your surgery. Please take care and keep us posted. We care.

 

[tracycharli]

Thank you, I appreciate that Hollowbottom. Any help I can get will be hugely appreciated. I had to do all my own research on my surgery, as the hospital didn't have any information leaflets/statistics etc to give me. So I feel a bit in the dark about what I should/shouldn't be feeling.

I had an appointment to see the consultant after 4 weeks, but only got to see a physio and was told that the consultant/registrar was too busy to see me as his clinics are all combined with the trauma clinics.

 

[Poppet]

Welcome to BoneSmart Tracy, what a dreadful time you have had, stay with us.. Lots of advice, information and support coming your way..

 

[Josephine]

Oh my dear girl, what dreadful feedback and support you have had. Let's see if we can rectify it some for you. First you need to read this article so you fully understand the condition of FIA and what you've had done Femoro-acetabular (FIA) or cam impingement then go through this forum and seek out those threads with the Hip Arthroscopy prefix such as you now have. I'm not sure how many of them still post though.

I am also somewhat amazed that your surgeon declared himself as having 'no idea' what caused the condition of your hip. "Red, inflamed and bleeding" tissue is a pretty clear indication of early arthritis and he should have known that. How did you get referred to him? I'll bet he either doesn't do many hip arthroscopies or that if he does, he's what we call an 'enthusiast' meaning he is so focussed on doing the surgery that he enjoys, he sometimes fails to step back and look at the broader picture and recommend the patient seeks alternative treatment such as a hip replacement which I think would be the more appropriate decision in your case.

However, you should know that hip arthroscopies are extremely painful procedures to recover from (the more so for you because he spent such a lot of time messing about!) and recovery also takes a VERY long time, sometimes as long as six months. Obviously you weren't prepared for this which is shameful. I think your PT is very right to not want you doing anything right now as you are in too much pain. Trying to force the issue will only make matters worse and the best thing you can do is to just rest, carry on using your crutches and take pain meds as prescribed and regularly. You might also find some ease by applying an ice pack on your hip but do make sure you wrap it in a pillow case or similar cloth - we don't want you getting freezer burn!

I would certainly recommend you get a second opinion from a hip replacement surgeon though I doubt they would want to see you until at least six months post op to be sure that what they are looking at is genuine hip problems and not post-surgery inflammation and pain.

So you stick with us, my dear. Post lots and let us hear your woes and worries. Vent all you want, there will be someone here to mop up your tears and give you a shoulder to cry on! You've been dealt a poor hand and we will do our very best to see you through. Here's some more Library articles that might help
Pain management and the pain chart
Elevating your leg to control swelling and pain
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

 

[tracycharli]

Thanks Josephine.

I have done a lot of research both pre and post-op. When my consultant suggested arthroscopy, he told me just to look it up on the internet. The trust doesn't have any information leaflets/guides etc. For my pre-assessment, I had to explain to the male nurse what was being done. So I was pretty much on my own. I've read quite a few of the posts on arthroscopy now. I know that recovery is like "how long is a piece of string" and I've only been seeing the physio every 3 weeks so the rest is down to me. Some days I can get my exercises done with little trouble, but other days, there's no chance. I feel like I'm barely functioning on the basics in life, like going up to the toilet and cooking my meals.

So, red, inflammed and bleeding tissues within the hip is an indicator of OA? When they sent the biopsies to the path lab, would they not have checked for that? The registrar told me after the surgery that there was no evidence of arthritis what-so-ever. Now I'm very confused. I have to say that months ago, I told the consultant that I was getting these pin head bruises in my groin, that would appear from no where. He said i must have been lifting something, but I certainly was not carrying anything on that side! Could it be the tissues bleeding that caused this?

I don't think that the hospital does many hip arthroscopies, and the only surgeon who does HA is the one I'm under. Now I'm wondering if he really knows that much about them. He did say that if the arthroscopy didn't work "I'll have to hold my hands up and say I don't know." which doesn't really instill any confidence what-so-ever. I'm supposed to be seeing him on thursday, if he can make time to see me, and I'm really not looking forward to it. I get so disheartened when I get fobbed off, and I suspect that's exactly what he'll do.

The cracking/pain seems to get worse when i'm in bed and rolling over always wakes me up. Turning my leg inward is ok, but turning it out over almost always makes it crack or catch. I had to explain to the physio that I do know the difference between tight muscles stretching, therefore a muscular pull, and the bone catching and deep pain. I'm so frustrated.

I was told by the physio after 6 weeks to not use the crutches anymore, so I haven't. But sometimes I struggle and start limping quite quickly, say after about 1/4 mille or less. I've tried ice packs, but to little avail and find heat packs slightly better. I elevate it whenever I can. I'm due to go back to work in 2 weeks, and as an HCA i'm not sure how I'm going to cope.

So the next step if the HA hasn't worked is THR? That's a scary prospect, but if that's what needs done to get me out of pain, then so be it. I've already wasted 2 years of my life with this and I really don't want to lose any more. I'm usually such a positive person, but this whole situation has got me so far down, I just want to hibernate until it's all over.

If I'm not happy with what my consultant says on Thursday, how do I go about getting a second opinion? Especially if there isn't another HA surgeon in the hospital?

 

[Josephine]

I see you live in Gateshead - so you went to the QE, is that right? Poor you! I don't blame you for being concerned. As you can see, I live just down the road and I've worked at the QE. Never again though (which should say enough)

And you are correct. They not only do few FIAs but few THRs as well. What was his name (pm it to me) You should get yourself referred either to a hip surgeon at the Freeman or at Sunderland Royal where I can recommend Mr Nanu. At Newcastle you can find the following hip surgeons but I don't know any detail about them: Mr Craig Gerrand, Mr James Holland, Professor Andrew William McCaskie, Mr Nigel T Brewster

I have no idea about the laboratory checks - do you know what the report said? And no, the bleeding in the hip would probably have been minuscule and certainly not sufficient to show on the surface of your body!

You might think a hip replacement at 29 is scary but we've had younger. Take a look at this lassie - she was a mere 24! Dancing after THR: 4 months pics THR

And at 6 months!

Also take a look at these Stories of amazing hip recoveries

 

[Josephine]

Almost forgot, if you are in pain, use crutches. Most FIA's on here used them for upwards of 3-4 months and needed to. It's a painful procedure and the recovery is protracted. There is no piece of string there, it's loooooong! Use you crutches when you feel the need. Let your hip be the arbiter, not a physio who clearly knows nowt about this surgery.

 

[tracycharli]

Precisely. the QE does not have a very good reputation at all, and I have first hand experience of it. How the trust has just got a foundation status is beyond me!!!! I've PM'd you his name. not sure if you know him/his reputation or not.

I'm not sure about the lab report. I only found out they came back "clear" through the physio!!!!! I'll ask on thursday.

Wow them pictures are amazing!!!! I thought that by now, I'd be able to go back to the gym etc, but nope. I'll do whatever it takes to get me out of this pain. I just want it sorted.

Any ideas what kind of questions I should ask on Thursday? Should I ask for a repeat CT scan maybe?

 

[Josephine]

It's not generally considered proper for patients to tell surgeons what investigations to carry out! He might ask you when you got your medical degree! I suggest you just wait and see what he has to say. However, there are some questions in this thread you might like to ask him Choosing a surgeon and a prosthesis.

 

[tracycharli]

True, true So I probably shouldn't tell him he's done a naff job then! lol

I just meant that so far, I've just agreed to whatever he's suggested, and I feel like that hasn't got me anywhere! We'll see what he says. BUT prepare for the rant on Thursday

Thanks for your help!!!!

 

[Josephine]

I meant when you see the new surgeon. I'd cut myself adrift from the QE ASAP.

You should instigate your rights under the Patient's Charter
NHS Constitution
Your rights to choice in the NHS
Choosing a hospital

In there it says
"If you need to go to hospital to see a specialist, you have the right to choose which hospital you're referred to by your GP. This legal right, which was introduced in April 2009, lets you choose from any hospital offering a suitable treatment that meets NHS standards and costs. If you're not happy with your chosen hospital after seeing a specialist, tell your GP. They can make you an appointment at another hospital."

 

[AlexBarton]

Just thought I'd pop on in here, as I'd not visited in a long time.

I'm sorry to hear it's been bad for you, fortunatley, I had a good surgery and good support team around me and am doing well.

What I will say, is what I've found on the internet, and what I've seen, is that most surgeons tend to be a little optimistic with their recoveries. I'm not expecting to feel normal until around 9-12 months after surgery (I had mine at the start of May).

If you end up wanting a second opinon, I live down near Liverpool, and the surgeon I had there is excellent, and has an excellent history regarding hip arthroscopies. It depends whether you want to make the trip or not, but obviously for now, go back and see your current surgeon and see what he says!

 

[tracycharli]

Thanks Alex. I read your previous threads yesterday. I hope you're back is ok

There are 2 centres for excellence in my area, so will try them first, but thanks. If I'd had the option in the first place, that's where I would have headed.

I have to see what he says on Thursday, but either way, I'm going to ask him to refer me to Newcastle.

I think the recovery periods shown are very optimistic!!!! If I hadn't have had a manual job, they expected me to be back at work within 3 weeks! Fat chance lol

I'll let you all know what happens on Thursday, but I'm not hopeful of being "heard"

 

[tracycharli]

Just back from hospital appointment and thought I'd better post while evrything is still fresh in my mind

I had to fill in the usual 6 pages of questions regarding my pain and activities that I can/cannot do.

As per the last time, I saw the clinic physio (not my usual physio) and I explained to him that I have been getting lots of discomfort and pain, and it's worse when i'm in bed, so I'm not sleeping, that my hip is still making dreadful snapping sounds when I make certain movements. He got me on the bed and tested my range of movement, which was very painful in some positions (i did tell him that too). He said he's not concerned at all. So I asked why the pain is nearly as bad as before the surgery and why it's still snapping? He said it's to be expected and that obviously the bone is catching where they had removed some of the rim of my hip and where the impingement was. He said he'd go and speak to the consultant, but he'd probably not want to see me. So I said I'd like to see him, since i haven't since the day of surgery.

The consultant came in and told me he's not concerned, that these things take a long time to heal themselves, and that in his opinion, if the pain isn't WORSE than before the surgery, it's worked. He said that most people experience more pain after the surgery than what they experienced before, and as for the fact that I'm still taking oramorph (liquid morhine) it's to be expected. I asked him to give me a ball park time of when things should feel "normal" again, and he said about a year!!!! He said if things were still painful after a year then they'd probably investigate why. I asked about the biopsies he'd taken of the red, inflammed and bloody tissue, so he sent the physio off to check the result. I asked what the lab were checking for and he said that they were checking for inflammatory conditions, namely, reumatoid arthritis. He said he only took the biopsies because the state of the tissue he was seeing didn't correlate with what he expected to see in the joint. The physio came back and said that the lab report said "no eveidence of reumatoid conditions, there was evidence of inflammation and that the tissues have been haemorraging but not actively bleeding at that time."

So basically I've been told that the surgery was a glowing success, that the biopsies were clear, and that unless I've still got problems next May, they're not going to do anything. Oh, and that I should keep up with the exercises. An appointment has been made in another 3 months (22nd November), but I suspect I won't be seeing the consultant again.

Does anyone agree/disagree with what I've been told? Any advice for me?

 

[Poppet]

Hi Tracy, I am sure Jo will pop by and provide a comment...

Just wanted to send you a hug

http://images.clipartof.com/small/2...n-Of-Yellow-Smiley-Face-Emoticons-Hugging.jpg

 

[tracycharli]

Just giving this a bump to see if anyone can help!

 

[Poppet]

I will tag Jo for you Tracy as you have specific questions

Josephine;

 

[Josephine]

Cheerfully encouraging kind of chap, isn't he? I can only repeat my previous advice that you get a second opinion at the Freeman. However, in my very first post to you did I not also say that this surgery can take upwards of six months to recover from?

 

[Poppet]

Hi Tracey,

Our very expert resident Orthopaedic nurse has spoken.