Day 12 - post op with Dr. Safran

Today was my post op visit with Dr. Safran. After the stitches were removed, the doctor came in and showed me pictured of the surgery. I was shocked at how much damage there was. I had 8mm of exposed bone on one side; however, after he removed part of the overhang (pincer) I only had approx 5mm which he said did not need micro fracture and would be fine for the rest of my life. He said there was only one side of exposed bone with cartilage on the other and he had created enough room in the joint that they would not even rub in the future regardless how I moved my hip with kicks, stretching, etc..

He reattached the labrum and removed a cyst. The doctor said I was on the upper end in terms of healing time and released me from the hip brace, CPM, bunny boot and crutches (when I'm ready). YES!

Afterwards, I went to PT where they stepped up the drills. Many leg lift, clamshell exercises. Afterwards I had a nice Ice and strarted walking around on my own? Crazy, I didn't think I would be doing this well 12 days out - Dr. Safran is the MAN!

Happy Halloween!

Diagnosis / Equip Needed / Recommendations

Preop Diagnosis:

1. left hip combined type femoral actetabular impingement
2. left hip labrel tear

Postop Diagnosis:

1. left hip combined type femoral actetabular impingement
2. labrel tear
3. left hip chonromalacia of the stem
4. synovitus
5. ligamentum teres hypertrophy
6. capsular tightness

Surgical Procedures Performed:

1. left hip athroscopic partial synovectomy
2. left hip arthroscopic debridement of ligament teres
3. left hip arthroscopic labrel repair using 3 anchors
4. left hip arthroscopic cheilectomy
5. left hip arthroscopic acetabuloplasty
6. left hip arthroscopic capsulotomy with partial capsulectomy
7. left hip arthroscopic chondroplasty of the acetabulum
8. fluroscopy with physician inerpretation greater than 1 hr

Equipment:

• crutches 2wks
• hip brace 2wks
• CPM Machine 2wks
• bunny boot (keeps foot inverted allowing hip to heal/ set properly) 2-3 wks while resting

Standing Orders:

• 20lbs flat foot weight bearing / crutches 2weeks
• bunny boot 2-3 weeks
• CPM 0-70 degrees 6-8hrs / day for 2 weeks
• wear brace at all times
• caretaker to rotate leg - mini circles 6x day (1min)
• wear stockings for 2-3 days
• take naproxin 2xdaily for 6wks

My Recommendations:

• strengthen other leg before surgery (hip / knee) as it will take the load while on crutches
• strengthen shoulders / triceps before surgery - will prevent injury from crutches 
• 4 bags of frozen peas (2 on rotation) ice 20 on/off unless no brace, then game ready device
• shim bunny boot with cloths - mine was way too big preventing proper foot alignment 
• have really baggy sweats / shorts to wear over brace (much more comfy)
• have plenty of veggies n fruits - blend them, make salads, etc... since you will be pretty heavily medicated for the first few days, this will help with constipation and toxicity
• drink plenty of water
• prepare you environment for life on crutches
• figure out what side of the bed you will be on - I went on the opposite side (left hip / right side of bed looking up) so that I wouldn't have to climb over the CPM every time I entered or left the bed even-though the Doc recommended otherwise... However, I think either side would work as my leg was strong enough to carry itself within a few days.
• get an exercise bike, selection of resistance bands, swedish ball, smaller compressable balls, foam roller and tennis ball for rolling out muscles / self massage (mp3 player for time on bike)
• be positive
• be nice to your caretaker :)

Day of the Surgery

Off we go to the Stanford Surgical Center in Redwood City. This surgy center is far different than the last one I was at in Menlo Park as this was definitely a hospital setting as I was behind a curtain in pre-op. The nurses were friendly but busy. The rep for the equipment I was going to use came in and walked me through the possible rehab tools I would need depending on the outcome of the surgery. This included, a CPM machine which passively moves your leg through about 70 degrees of flexion as well as a bunny boot which keeps your leg inverted while resting or laying down. Also, there was a game-ready icing device as well as a hip brace to limit mobility allowing the joint to heal properly.

The doctor came in and realized that the pre-op physician didn't have me sign the waiver during my pre-op visit. Therefore, he had to tell me all the risks involved with this surgery :( After approx 3 min of freight I agreed and off we went.

I was placed on a special hip table and sent in to sleepy land...

I awakened to the docs around me saying "everything went well" I remember saying "I'm alive"
Next, I was in recovery where the nurse asked about pain levels and gave me pain killers in my IV. The pain was still there - I think she gave me 3 doses. Furthermore, she gave me a percocet for the road.

The doc came in and told me everything went well and that he would explain it all later when I was off medication. I asked "cruches - two weeks or eight?" He said two - YES!

My surgery was approx 2hrs and started on time at 9:45am. I left the hospital around 3:30pm. l had a hip brace on which is fairly bulky and i was quite immobile. The nurses wheeled me out to the car and off I went. My orders were to place no more than 20lbs on that leg and to wear the brace for 2wks with crutches. First post op visit with Dr. Safran's assistant in 3 days as well as Physical therapy same day.

In the meantime, I have to use the CPM machine 6-8hrs per day and do some light mobility exercises. Medication was 2 vicodin every 4hrs as needed for pain and 2 naproxin per day for 6 weeks.
Pain was minimal throughout the evening and I got good sleep. I needed a lot of help from my wife, mom and the kids :) Everyone chipped in and I was a happy camper!

Preop Diagnosis:

1. left hip combined type femoral actetabular impingement
2. left hip labrel tear

Postop Diagnosis:

1. left hip combined type femoral actetabular impingement
2. labrel tear
3. left hip chonromalacia of the stem
4. synovitus
5. ligamentum teres hypertrophy
6. capsular tightness

Surgical Procedures Performed:

1. left hip athroscopic partial synovectomy
2. left hip arthroscopic debridement of ligament teres
3. left hip arthroscopic labrel repair using 3 anchors
4. left hip arthroscopic cheilectomy
5. left hip arthroscopic acetabuloplasty
6. left hip arthroscopic capsulotomy with partial capsulectomy
7. left hip arthroscopic chondroplasty of the acetabulum
8. fluroscopy with physician inerpretation greater than 1 hr

Equipment:

• crutches
• hip brace
• CPM Machine
• bunny boot (keeps foot inverted allowing hip to heal/ set properly)

Standing Orders:

• 20lbs flat foot weaight bearing / crutches 2weeks
• bunny boot 2-3 weeks
• CPM 0-70 degrees 6-8hrs / day for 2 weeks
• wear brace at all times
• caretaker to rotate leg - mini circles 6x day (1min)

Day 11

Feeling more mobile. I stepped up the PT a bit yesterday and even more today. I rode the bike for 18min, did all my PT work and started delving into more of the long term phase I PT protocol even though my therapist hasn't officially introduced me to the exercises. Slept pretty good last night - no pain, just a bit of tossing n turning (back, front, 1side). I still have to wear this bunny boot to keep my foot angled properly for my hip to heal.

I'm seeing Dr. Safran tomorrow for my post op where he will talk me through the surgery and show me pics. Also, he will let me know when I can get out of this brace and off crutches.  I'm thinking I might be walking by this weekend? It's tuesday...

Day 9

I was pretty uncomfortable last night. not necessarily in pain, just uncomfortable. I might have done too much, as I did my PT exercises and went to my son's soccer game for over an hr where I stood the whole time leaning on my other leg while bracing myself with the crutches. Also, I only got in about 1-2hr of CPM time. I Ice very often, usually at least 15min of every hr, so not doing that yesterday along with the above could have played a part. Also, being off the pain meds. probably had something to do with it as I felt like I had hyper-tension and irritable.

However, after a vicodin (which I'm glad I still had) and CPM / 2 good icings I was fine and got some very deep sleep especially towards the end. I think I slept till 8:30 (sunday - relatively quiet at home). I've been Icing all morning (20 on/off) and am feeling great today!

I'll bust some CPM, maybe get in a bit of PT and head out to my son's baseball game.

-back from my PT work in the dojo. It went  well. I felt extremely good, pain free and in a great mood! 8 min on the bike, all my PT exercises, some additional stuff as always including many seated punches, blocks, etc...

I feel like I can do much more, as my body just starts doing things that it is used to such as fire-hydrants (knee raise to side while on all 4s) but I stop myself and stick to the plan. I'm only really supposed to be activating / firing muscles right now. Soon enough...

I'm back under the ice in the CPM waiting for my breakfast to arrive - thanks wifey :)

Day 8

Cruised to my Sons soccer practice last night - hung about for over an hr. It was nice to drive again as well as crutch the field. Just got back from my training studio (dojo). I rode on the bike just 5 min today as my skin / stitches were a little uncomfortable and I wanted to take it easy today. I say I wanted to take it easy because everything is going so well and that is usually when I end up doing too much and hurting myself.

So I did 5 min, then all my PT work and some upper body stuff on the TRX, core stuff like the plank and flag. Looking forward to game three of the world series - come on Giants!

Intro - My Hips

I am 40 years old and have been actively training in shotokan karate for about 18years as well as jiu jitsu and some judo. Shotokan Karate is very demanding and requires you to articulate your limbs through their full range of motion, often beyond... As I've always tried to kick faster, further and harder while remaining in a low stance my hip joint has developed a condition called FAI where the hip joint binds leading to osteoarthritis and tearing of the labrum.

I have both abnormal Cam and Pincer

My left hip developed severe pain approx 2 years ago. the pain developed the night after a training session where I had tried a stretching technique called P-N-F stretching. Also, I had just gotten back to training after my shoulder surgery which was approx. two months beforehand. In addition, I had always had clicking, popping,catching, etc... in my left hip which is an indicator of hip abnormality.


The pain was acute and near my groin as well as my glute. The sports med doctor told me to stay off it and recommended NSAIDS. After several months, I decided to get an MRI. The sports med docs and Palo Alto Medical didn't see anything wrong with my hips but said if you continue to have pain I should see a hip specialist.  Dr. Marc Safran M.D. of Stanford Sports Medicine  and Dr. Thomas Sampson M.D. were recommended. 

Dr. Safran examined the MRI and said I had Femoroacetabular Impingement (FAI) and that he could fix my hip. For a second opinion, I also saw Dr. Sampson who said the same. Dr. Safran said that if I wanted to be certain that the pain was coming from inside the joint I could get an injection inside the joint that would numb the joint; thus, if the pain goes away after the injection this would confirm the need for surgery.

Approx 1 year after the onset of the hip pain I opted for the injection (which included cortisone). The injection was inconclusive as I didn't have much pain in the joint when I went in and I walked out with a limp? However, in the following weeks and months I had less discomfort and was able to train fairly rigorously. In addition, I had a great training program including heat before every workout as I would soak in my hot tub. Afterwards, I would warm-up with about an hour of physical therapy / functional training type exercises to support my hip imbalance. I modified my karate / jiu jitsu training so that I could listen to my body and do drills / techniques that my body would allow. While I could not participate in traditional dojo class type training structure, I have training partners that would follow my lead. Finally, after each and every workout I would jump in an ice bath which I made out of a horse trough (rubbermaid 100 gallon). The ice bath is great in that it reduces inflammation in the whole body; as a result, I could go about the rest of my day pain-free.

The cortisone shot lasted over 1 year and then I was back in pain again. While the pain was minimal and intermittent it was present and I knew I needed to get this fixed as I could not train the way I wanted and I knew I was just doing more damage than good. I got another shot which did remove the pain, therefore, I knew it was inside the joint. This gave me a green light for the surgery.

I scheduled the surgery with Dr Safran at Stanford Hospital in Redwood City on October 19, 2012.

Casual Bag Training 2 weeks before Surgery

Informal Kata 3 weeks before Surgery

-

Day 7

More of the same
Worked out on mine own. 7 min on stationary bike (no resistance)
Completed all the PT work with some additional ab / core drills like plank, flag. Eventually had to kick myself out of the dojo :)
Off pain meds - feeling good!

Day 6

Feeling great - heading into my private dojo for some PT and whatever else I can do :)
I got through all my PT stuff and incorporated some ab / trunk work, push ups TRX for back, pecs, shoulders.

Later in the day, feeling amazing. I think I'll be walking soon! I am experiencing some light soreness but I am sure thats from the PT work I did today and must be normal. Overall, much more limber and mobile :)

Day 5

Getting around a lot easier. Heading in to PT.
PT - got on the bike...whoa  glute slides, glute squeeze, internal /external abduction. Feeling good!

Day 3 - post op / PT

The post op physician said everything went extremely well. They removed the dressing / bandages and gave me new band-aids. They went over the surgery in detail in a way that I could understand although it would have been nice if they had the pictures of the surgery or at least a diagram of the hip joint.

I will see Dr. Safran in about 9 days in which time, he is supposed to over the pictures of the surgery and possibly release me from the hip brace and crutches.

Physical therapy was pretty basic. I did some quad isometrics, ankle flexors, and core / ab squeezes.
I will see PT in 2 days.

Pain very tolerable - I am amazed at how little pain there is. I am down to 1 vicodin every 6-8 hrs. My shoulder and ankle were both much worse than this :)

Day 2 after Surgery

Soreness went away and was back to minimal pain. I began weening myself off pain meds the day before and hope to be off within a few days. I continued with the CPM and leg circles (someone moves your leg for you in a small circle both ways). I iced diligently as well as kept hydrated. One huge difference with this surgery compared to the last two, was that I am eating a lot of veggies and drinking a veggie / fruit smoothie every day. I use the vitamix to allow fiber intake. My smoothies typically have kale, broccoli, chard, spinach, carrots, apple lime, frozen berrys, mangos and peaches - all organic. This has helped tremendously with constipation from medication.

Post op visit tomorrow and Physical Therpay.

Day 1 After Surgery

In the morning I was okay. I had been trying to abide by all restrictions and spent a lot of time on the CPM. Also, Since I didn't get the game ready icing machine due to the hip brace, I used frozen peas and ice packs throughout the day and night. 20-30 on / off.

Around noon, I went to get up and was extremely soar in my hip. This lasted throughout the day. I slept well that night.

Pre Surgery

I tried to stay positive and not read about the negative experiences on the web. Since the doctor said I might be on crutches for 8 weeks and would at a minimum be on them for 2 weeks, I prepared my environment. This included preparing my staff and business to run itself while I was gone as well as my room and house.

I had to shower with an anti-septic scrub the night before and the morning of the surgery. As with most surgeries I could not eat or drink anything after midnight.