I am hoping to blog about my recent hip surgery experience on a regular basis. The reason is that there is truly not much information out there for people suffering from what I had, and I happened to stumble across the greatest surgeon in the world (seriously!) for this problem. Otherwise, I might have had my surgery done locally and not had good outcomes. This is a long, detailed post, but I still left out a lot. Please feel free to comment if you have specific questions. Also, if you want the short version: Vail is the place to go for this surgery, the surgery is pretty major, you’ll do a ton of PT, you will have so many restrictions following surgery, so make sure you have tons of help and don’t plan to do anything much outside of home for about three weeks. Taking care of this hip for the first three weeks following surgery is akin to caring for a newborn baby. A baby with colic.
I am a little over one month out from my left hip arthroscopy. To rewind, I was out for a short run on June 1 with my friend, Jo, and her dog, MaeBe. After stopping very briefly, I resumed running and went from curb to road. I did not fall…I just stepped off normally. At that point, I experienced a severe and very, very deep pain in my left hip. It was like nothing I’d ever had before. In retrospect, I had had some very minor tightness in that hip for about a month prior, but it always loosened up with walking/running. Not this time, though. I had no idea what I’d done, but I knew it was very bad. As I was running very low mileage, I couldn’t imagine it was a femoral neck stress fracture, but I was positive it was not muscular. To make a long and frustrating story short: I had an MRI, which turned up normal. I then had an intra articular diagnostic injection, which took away 100% of the pain for 2 hours, indicating the problem was coming from within the joint. I was referred to a hip specialist in Indy, as the one who did the injection thought this was diagnostic for a labral tear. The hip specialist was sure it was a fracture and absolutely not a labral tear, so he ordered ANOTHER MRI, thinking the first one did not pick it up. He felt I was in too much pain and limping too badly for a labral tear. That MRI also came back normal. However, the hip specialist could see a “small anterior labral tear” and ordered PT. I still could hardly walk, folks. He told me that we would consider surgery if 6 months of PT didn’t work, and that it was a simple surgery that only involved cleaning up the labrum.
I happened to be teaching an online PhD course when all this was happening. I mentioned to my students what was going on (I had to miss an in-person meeting when they thought the femur was broken) and, by chance, one of my students said “You need to talk to me. My husband had a labral tear repaired in Indy, but ended up having it revised in CO.” I did talk to her, and then her husband, and found out he had a bad experience in Indy (same surgeon I was seeing) and that the surgery made him worse. He ended up doing a ton of research and found The Steadman Clinic in Vail, CO (www.thesteadmanclinic.com). I talked to him for about an hour, and by the end was convinced this is where I needed to go to see Dr. Philippon, who is the leading surgeon IN THE WORLD in arthroscopic hip surgeries, labral tear repair, and hip impingement repair. He has operated on A Rod (don’t know who that is), Tara Lapinski, the lead ballerina from the NY ballet, a bunch of professional runners, skiiers, etc. This is where pro athletes go for this surgery. You can literally send him your MRI, and he will read it and one of his fellows calls you and tells you if you’ll benefit from surgery or not. I sent off my stuff and got a resounding “YES, you need surgery” about a week later. Note: A normal MRI read by a radiologist, even one certified to read musculoskeletal scans, DOES NOT MEAN YOU DO NOT HAVE A LABRAL TEAR. Mine was missed by two musculoskeletal radiologists, and it ended up being a HUGE tear. If you’re having persistent hip pain, you must have your MRI looked at by a hip specialist/surgeon.Dr. Philippon
However, he has a waiting list. It’s typically 6-9 months, and it happened to be around 6 when I got in the loop, as most people don’t want to have their surgery over the holidays, but I did. I also had to meet my insurance company’s requirements to have PT for 6 months, and also an injection. Everyone at Steadman, as well as my PT, KNEW this stuff was not going to work…but I had to do it anyway. My surgery was scheduled for Nov. 28, and at that point the Steadman team walked me through absolutely everything–how much PT I needed to satisfy the insurance, when I needed the injection, etc. This got a little tricky, as I had to continue to see the Indy-based hip surgeon in order to get the injection. As much as I wanted to “Bye, Felicia” him since I was on Dr. P’s schedule, I couldn’t. I jumped through all the hoops, and my hip never improved (as expected), so surgery was on for 11/28.
Luckily, Dr. Philippon is in my insurance network. However, even if he hadn’t been, I would’ve gone to him anyway. He was published prolifically on this surgery, and he does 15 a week–this is literally all he does. There was some pushing and pulling with my insurance company (they were not satisfied to have the hip surgeons say they saw the labral tear in the progress notes–it had to be in the actual MRI report), but they ended up covering it. The surgery cost $30,000, so I’m glad they did, but I cannot overemphasize that I would’ve spent my savings/gone into debt to go to this particular surgeon had I needed to.
Tim and I flew to Denver two days before surgery, and we drove up to Vail. Vail is at about 10,000 feet. It’s beautiful, but expensive (go for an air BNB instead of a ski lodge), and the air is thin. If you’re having surgery with Dr. P, you will spend about 6-8 hours the day before undergoing testing, meeting with Mark Ryan (Athletic Trainer), Dr. P’s team (PAs and fellows), surgical team’s internal medicine specialist, and all the equipment people (you go home with a lot of equipment). You will also have an MRI. It was a long, exhausting day, and we really did not have time to eat. So, pack snacks for the pre-op day.
During the pre-op day, I learned that, based on this new MRI, my labrum was not just torn–oh, no–it was detached. Basically, more than 1/3 of the anterior portion of the labrum was just hanging there, thus being pinched every time my hip flexed/extended/rotated. This happened because I suffered from significant femoral-acetabular impingement (FAI), both the CAM and pincer types. What this means is that I had two deformities in my hip joint that impinged on my labrum–one was a bump on femoral head, which made it too big, and the other was with the acetabular rim itself–it was too deep and was also impinging. So, I was born with these deformities, which, over the course of time and LOTS of hip flexion from running, eventually popped the labrum right off. That was the severe pain I felt on June 1. So, this was not a running injury. People with FAI are often asymptomatic many years until BOOM, severe hip pain, and those of us with FAI who flex our hips a lot (runners, cyclists, ballerinas, skiiers, ice skaters, tennis players, rowers…) become symptomatic more quickly than people without that flexion. It had nothing to do with my mileage at the time at which I began feeling pain; it was simply the final straw for that hip.
Maybe you’re thinking what I was thinking during my pre-op…so what about the other hip? Well, odds are that it’s deformed also, with the same FAI I have on the left hip. However, besides some limited range of motion, I have no symptoms on that side. There’s a decent chance that that labrum will detach as well, but, until it hurts, there is no use scanning that hip. This is not an easy surgery (I’m about to explain it), so I really, really hope that doesn’t happen to me, but I’m pretty much expecting it. At least I’ll know what it is and where to go next time!
The next morning, I went in for surgery. This was my 10th orthopedic surgery, so I’m used to the pre-op, and I never get nervous. The only difference in this pre-op was that they drew about 200 ml of blood to use for a platelet-rich plasma injection they’d put into my hip before closing to assist with healing (he’s the only surgeon who does this). Also, I got to finally meet Dr. Philippon. For being world-famous and in high demand, he sure is nice, taking his time to describe everything he’s going to do, what else he might have to do, and asking about your goals. He told me my fixed him would not keep me from running. “Your feet might” (I’ve had multiple foot surgeries), “but not this hip.” I met the anesthesiologist, who had me take an oral lyrica (this will be important later), and explained that I’d have an epidural during surgery and would wake up pain free given the epidural. She gave me some Versed. I remember them telling Tim the surgery would be 4-5 hours, then being wheeled into the operating room and turned onto my left side for the epidural. I remember she was struggling to get it, but it didn’t hurt, and that “non-stop” from Hamilton was playing.
The next thing I remember is waking up in 10/10 pain, hearing myself moaning. I was completely confused, thinking maybe I was still in surgery and was waking up before I was supposed to. There was frantic nurse at my bedside, and she was pushing Fentanyl. I was coughing violently. Tim was there, and I told him I wanted to die and that I felt like there was a bear trap on my left hip. I’ve been in a lot of pain a lot of times, and this was only second to child birth. Dr. P came in and I remember him being shocked that I was in so much pain. The nurse said to him, “I don’t think her epidural is working.” No shit! “You are feeling everything I did in there.” Yes. Yes, I was. The nurse continued to push Fentanyl, telling me that she was calling an anesthesiologist to fix my epidural. My right leg (the non-surgical one!) was numb, but the left was not. I suffered for about another hour before an anesthesiologist came and slightly moved the epidural, giving me instant relief. I had to spend the night in the hospital. I coughed and coughed and coughed, and was generally miserable. “I think you have aspirated,” my nurse said. I didn’t think much about it, but I coughed all night long. My epidural had to be shut off at midnight (a bit of a bummer since it didn’t start working til about 9 pm!), and I had to be up at 7 am to be on the bike.
At 7 am, I was up to the bathroom on my crutches and in my hip brace, still coughing, and 20 minutes later was somehow on a stationary bike wearing paper shorts. One of Dr. P’s PA’s met with me, explaining all the procedures I had done on my hip. I actually had three areas of impingement–the femoral head (CAM impingement), the acetabular rim (pincer impingement), and the AIIS (anterior inferior iliac spine) was a third area of impingement that can only be diagnosed during surgery–he flexed my hip and watched that part of the pelvis come down and impinge the labrum. In all, I had 11 procedures done, and my hip was in traction for about 64 minutes. Here’s what I had done: osteoplasty of the femoral head and acetabular rim, as well as decompression of the AIIS (basically, he shaved down these bones to get rid of the deformities, thereby preventing impingement from happening again in the future), labral debridement and anchoring (cleaning up the frayed labrum but preserving the chunk that had popped off, and stitching it back to the hip capsule using three bone anchors), capsular plication (improving stability of the capsule, basically enhancing the suction of the ball into the joint), synovectomy (removal of the inflamed lining of the hip joint), ligamentum teres debridement and thermal repair (the ligament attaching my femur into the hip joint was partially torn, so he fixed that), and PRP injection into the joint (using blood drawn pre-operatively).
So, my hip was a mess. Years and years of walking, running, and sitting on a hip that was constantly impinging on itself left me with not only a labral tear, but an unstable joint, inflamed joint lining, and a torn ligament. I have run thousands and thousands of miles on this hip! I was definitely headed for a hip replacement had I not had this repaired.
Once the surgery was over, the real work began. I had PT twice a day while in Vail, beginning the morning after surgery. I also had exercises to do at my air BNB between PT, and I was cleared to do aquatic therapy within three days of therapy. It is extremely busy–you are recovering from major hip surgery, taking narcotics, but there is not much time for rest. The PTs are incredible. I think it is most important to discuss the very first PT session. You will be sat on the bike in your paper shorts (alongside the other people who had surgery the same day as you), and told to bike 10 minutes forward and backward with ZERO resistance. You must sit straight up, as you aren’t allowed to flex your hip. You will do this 20 minutes of biking twice a day for six weeks.
Next, you walk on your crutches to a PT table where your spouse/care giver/helper will be taught about all your restrictions and how to circumduct your leg. The first three weeks of recovery are INTENSE, and this is due to the extreme movement restrictions and range of motion exercises that must be done to prevent scar tissue. Here are the main restrictions beginning day after surgery: you cannot sit at 90 degrees for 2 weeks (ever try riding in a car, or a plane?!), you must wear your hip brace for 17 days (while ambulating), absolutely no extension of your hip for 17 days, no external rotation of your hip for 21 days, no use of your hip flexors for 14 days, and no lying on your abdomen for six weeks. Basically, this means that your leg has to be in the neutral position at all times, and you aren’t allowed to lift your own leg (someone has to lift it for you)….which leaves you generally helpless is most situations outside of watching Netflix. You will have to have a theraband around your ankles to prevent external rotation any time you are sitting or lying. So, trust me, it’s easier to just stay home for three weeks than to try to maintain all these restrictions in public places. You also must have your leg circumducted at a 45 degree angle four times a day for 10 minutes–40 minutes a day. You cannot do this by yourself. While you’re in Vail, the PT will do it twice a day, and your helper has to do it the other two times per day. Helper must not allow you to go into flexion or external rotation during this. It is stressful! The circumduction keeps up 40 minutes a day for 21 days. You will do so much circumducting, and your helper might complain, but you have to do it. It is the best way to prevent scar tissue. You must also have your leg in a CPM (continuous passive movement) machine for 6-8 hours a day for four weeks. This machine is huge, and it constantly flexes your knee passively. I slept in mine. Of course, you can’t get in and out of it by yourself, so this is another thing for your helper to have to do.
I’m just going to put it out there that this surgery is stressful on a relationship. My husband was by my side the entire surgery and recovery, and supportive of me getting it, but we had legit fights over circumducting (you’re going too slowly! Don’t let my hip rotate!). I became (as you will also become, I predict) obsessively fixated on my restrictions. This is because you are told 5 million times that you have to adhere to them. I had to constantly interrupt my husband or one of my children to come lift my leg into my pants, or to get me out of the car (for real: STAY HOME). It was draining on my family, and particularly my husband. I think this would have been easier to deal with had we known the intensity of my helplessness prior to the surgery. I was adamant that I get all my circumducts in given my history with scar tissue, and that was really hard with him returning to work when we got home. You cannot get your own food, you cannot get yourself out of the CPM machine in the middle of the night if you have to pee, and you cannot put your shoes on. You will need help all day and you cannot be alone at night, either. Let whomever is helping you know this up front.
Anyway, back to Vail. The basic schedule is PT twice a day for as long as you’re there–we were there ten days. I think it would be beneficial to stay longer, but we have kids and my husband has a job, so it just wouldn’t work (unless done in summer and we took kids). You will be doing a lot of PT when you get home, and the PTs at Vail will teach you how the exercises should be done (most can be done at home). Make sure you pay attention to the techniques they show you. Two days after surgery, you get x-rays, and you are shown a pre- and post-op x ray. The difference was shocking–my goodness my hip was so impinged, and now it is wide open! On that second post-op day, I had a major complication. Long story short–I developed severe aspiration pneumonia (I aspirated during surgery, and it had to have been that Lyrica tablet). I was put in the hospital for five days, which means I missed a lot of PT. They came to me, but I was far too sick to do a lot of the exercises. That whole mess is a whole other blog post. Once I was out of the hospital, I started aquatic therapy. Make sure you do this, it makes your hip feel so much better.
The day before you leave, you’ll see Dr. P and his team again, where they will again go over your post-op instructions, your restrictions, and then you head home (don’t worry, you come back in 8 weeks). Except heading home is an ordeal if you’re flying. Make SURE you bring a large, empty duffle bag with you, as you’ll need it to put a bunch of medical equipment in. You also have to check the giant CPM machine in an equally giant box. You’re on crutches, so you need a wheelchair at the airport, and your helper can’t possibly carry everything. Here’s how we handled this: we heavily tipped someone at the rental car place to drop us off at the departure gate rather than ride the shuttle to the gate (that would have been a nightmare), we did curbside bag check, we called the airline ahead to reserve a wheelchair (this is important–there was a line!), and they (Southwest) had a dedicated person who took us all the way through the airport, and we got there really early. Dr. P will give you a letter indicating that it is medically necessary for you to have a bulkhead seat, so make sure to present this to the gate agent as soon as you get there. I have never been so relieved as when the cabin door closed and we took off. I really didn’t know how we were going to manage getting on that airplane.
The first week at home was very difficult. I was still having post-op pain, I was helpless, and the rest of the house had to go back to normal. I was also on a lot of post op medications (they put you on a bunch to reduce scar tissue), and I remember needing to take them, but they were in the other room, I was stuck in the CPM machine, and even if I hadn’t been I would’ve needed someone to lift my leg out for me. I felt really isolated, and very much like a burden. I, nor my family, understood the amount of help I would need following this surgery. After all my other surgeries, while I’ve needed a little help, there has never been a restriction on how I can turn or move my leg, and I could use my hip flexors. You also need help getting to and from your PT clinic, and you do an additional 2-3 hours of PT at home. We jokingly call my hip the newborn baby. It really does require that much time and attention in the first two weeks.
After week three, things get a little easier. They aren’t easy, but you aren’t so helpless. You can finally lift your own leg, and you can begin bearing 50% weight on your crutches (so you still can’t carry anything quite yet). Once I hit week 4, though, is when I finally felt like a new mother whose baby slept through the night for the first time ever. My circumductions went down to twice a day (plus my PT loaned me a baby swing approved by Dr. P to do circumduction…they are about $250 to buy so I wasn’t going to, but since he had one to lend, I use it now instead of my husband to get my circumduction done. It’s called a mamaroo and you use it on the figure 8 setting), and I no longer had to spend 8 hours a day in the CPM machine. I’m also allowed to externally rotated and extend my hip, which means I can sleep in a position other than flat on my back. I’m weaning off crutches (can walk without crutches a little at home, and down to one crutch outside of home). Walking for the first time feels very weird. Make sure your PT helps you when you take your first steps! Over the next few weeks, I have more and more challenging PT exercises being added, and I return to Vail for my follow up on 1/24 (I’ll blog about that also) for my 8 week follow up. At this point, I’ll get a new PT protocol based on my progress, and will hopefully get some dates about when I can swim, cycle, walk, maybe run, etc….though I don’t expect to do any cycling for 6 months and no running for a year.
This is a big surgery, and the recovery is long and, for the first few weeks, very tedious and rough. If you find yourself at Steadman Clinic, know that you’re in good hands, but also that you need to do every part of your post op protocol as prescribed. It is hard to get it all in, and to adhere to the restrictions, but you must be vigilant about it. Advocate for yourself (“Yes, I really do need you to pull up my underwear because I cannot use my own hip flexors”), but also don’t be too hard on yourself–around 10 days after surgery I accidentally rotated my hip externally and was sure I’d ruined the whole surgery. Do the very best you can, but know that you cannot possibly perfectly adhere to everything in the big binder they give you. I am confident that all the stress, work, tears, and having people put my pants on for me will be worth it, and that I’ll live with a pain free hip!
#vail #steadmanclinc #drphilippon #hipfai #hipimpingement #labraltear