Hip labrum and FAI surgery: Week and Day of Surgery

My last post about my hip labrum and FAI surgery indicated that my surgery date was going to be 12/15/15. I had my pre-op testing at the hospital on 12/1 which included a complete blood count, EKG and chest X-ray. I received a call the next morning from my surgeon, Dr. Tim Bert‘s, office (Hedley Orthopedic) explaining that my white blood cell  (WBC) count that was too high for surgery on the 15th – I had been battling a sinus infection for a week and had just been put on antibiotics a few days prior to the testing. The surgeon would need me to see my Primary Care Physician as soon as possible to treat as necessary and clear me for surgery. I would also need to be off of antibiotics for a week and have normal WBC 4 days before surgery.

I saw my PCP the following week and my sinus infection wasn’t quite clear, so he ordered another 5 day antibiotic and blood work to be drawn 5 days prior to the new surgery date, 12/22. He explained that  it is extremely important that there is no infection anywhere in the body when having surgery on an area with little blood flow, such as a joint or bone. If any systemic infection gets into those surgery areas, the joint or bone can get infected easily and can rapidly cause the whole body to go septic, which can be fatal. Wow.

Labs came back on 12/21 with a good WBC and I was all cleared for surgery the next day. For a week prior I did everything possible to prepare my body for the best environment possible for healing and recovery. I continued to do PT to strengthen my glute muscles and to make sure my pelvis was in as good of alignment as possible, as after surgery I knew that my body would be compensating for only weight bearing on one side. I drank green juices every day with a variety of vegetables, lemon and ginger to promote healing and flood my tissue with nourishment. I also kept myself hydrated, drinking about 100 oz. of water per day. On the 21st, I knew that I could eat and drink until midnight, but also knew that my digestive system would be impacted by the anesthesia during surgery, so I kept my meals light and avoided red meat. I also drank several packets of Emergen’C loaded with vitamins and minerals, and another green juice with extra ginger.

The day of the surgery they allowed me to take my anti-depressant with a small bit of water, which really helped to keep me calm in the hours prior to leaving for the hospital. I arrived, checked in for my surgery and they took me back right away to get me prepped. While in the pre-op surgery room, I met with my surgeon Dr. Bert who reviewed the surgery, asked me to verbally state what surgery I was having and on what hip, and marked and signed my left hip with a purple sharpie. I also met with the anesthesiologist who reviewed my medical history, my “abnormal/normal-for-me” EKG, and answered all my questions regarding previous concussion and general anesthetic. Dr. Bert chooses to do General Anesthesia (GA) for this type of surgery because of the impact on the sciatic nerve with the position of the leg and hip on the surgery table. The foot of the surgical leg is strapped into a ski boot looking device that tractions the leg away from the hip, which creates more space inside the joint for the camera and tools. If the entire nervous system is shut down during the procedure, there is less risk of sciatic nerve side-effects, and as you can imagine, an impaired sciatic nerve will make recovery and PT rehab more difficult. As I understood it, he also tries to keep the leg traction portion of the surgery under an hour to also reduce the risk of sciatic side effects.

After I was prepped and all my questions were answered by my two physicians, the surgical nurse came in and again asked me to verify what surgery I was having and on what hip, and also asked if I had any further questions. She then wheeled me into the OR, which was FREEZING (I think I commented that it was a meat locker), and helped me move from the pre-op hospital bed onto the surgical table. The anesthesiologist talked with me some more, gave me some Versed to “relax” me, continued talking with me about life, and before I knew it, I was waking up in Post-op recovery. 🙂

All went well with my surgery. It was a little shorter than expected, about 1 hour 45 mins from start to finish. I woke up to find my husband there, and was surprisingly alert – although I can’t remember talking to my surgeon post-op, but my husband insists that he was there and I had a conversation with him. 🙂  They injected my joint with morphine at the end of the surgery to immediately reduce post-surgical pain, which lasted about 4 hours ( the perfect window of time for me to fill my Percocet prescription on the way home and start taking later that night). After I had a few crackers and some water, I was given a set of crutches and shown how to use them, and given my post-op instructions. I used the bathroom via wheelchair and then was rolled out of the hospital and helped into my car, and headed home! I chose to take our sedan versus our SUV because I felt it would be easier to drop down into a car with one leg versus climb up into an SUV – good choice! All in all, from arrival at the hospital for check-in to leaving in the wheelchair, my time was about 5 hours. I was given a prescription for pain, nausea and constipation (from the pain medication), a high-powered NSAID, and sleeping medication. I chose to not have the sleeping medication filled because of the extreme addictive qualities, but all others I needed!

That night I was alert enough to be up moving around on a walker – but only toe-pressure weight on my foot, which means only resting the foot when up and about. I quickly found out that walking and maneuvering on one leg was going to be challenging. All the single leg balances and single leg Roman Dead Lifts (RDL’s) that I practiced in PT and training sessions pre-surgery were coming in handy – it’s as if my PT knew that I was going to need those… 😉 I also quickly realized that I needed the raised toilet seat with handles, crutch pads, and compression hose that I purchased pre-surgery with online research of others who had been through the surgery.
The first overnight was tough on me and my husband, and I quickly realized why they gave me a prescription for Ambien. I couldn’t sleep AT ALL. I’m not sure if it was a side effect of the GA, or the morphine, or the Percocet every 4 hours. Or if it was my body’s adrenaline just processing everything it had been through in the previous 24 hours, but it was rough. My poor husband was so worried about me that he couldn’t sleep, and every 2 hours I was getting up to go to the bathroom, which was a 15 minute procss. It felt like we were back in the “newborn baby” phase all over again!! To sleep, I was instructed to only sleep on my back, and no rotation with my surgical hip to protect the repaired labrum. I’m a side sleeper first, and back sleeper second, so I decided to wedge my hips between two heavy pillows as I knew I would be prone to rolling on to my side – my heavy memory foam pillow was wedged on my surgical side to keep me from rolling on the hip, and a heavy feather pillow was wedged on my right side to keep me from rolling right. When I had to get up to go to the bathroom, I found it easiest to slide down toward the foot of the bed instead of pivoting my pelvis and legs to the side of the bed. My husband helped me down onto my good foot – and reminded me repeatedly not to land on my surgical leg – and guided me with the walker to the bathroom. And this is true love – stayed in the bathroom with me to make sure I could get up and down from the toilet without pain. 🙂 Getting back into bed was a little more challenging – I sat at the edge of the foot of the bed and placed my good foot on his thigh, and pushed against him and used my triceps to slide back into sleeping position. Whew. Then repeated it all every 2 hours.

The day after surgery I received call from the hospital and also my surgeon’s office to see how I was doing and to answer any questions. I also received the Post-Op report per my request, which had a few surprises. My MRI Arthrogram in September had indicated a small labrum tear and possible pincer/CAM FAI combo, however once Dr. Bert got in there, he found the labrum tear to be much larger (anterior from 10-2 o’clock instead of 9-11 o’clock), some degeneration on the posterior labrum, and the pincer/CAM FAI combo. But the biggest surprise was Grade II chondromalacia (bone degeneration) on the femoral head, which was not seen on the MRI despite my physician specifically noting it from review given my medial hip pain. It’s not clear if this was present but not showing in the MRI or if this degeneration happened over the course of 3 months given the larger labrum tear. Regardless, I am VERY happy that I did not wait on surgery! As I understand it, the newest protocol with hip labrum tears and severe chondromalacia is to bypass the repair and go straight to a hip replacement. Had I waited a few months or a year for this surgery there may be been more bone degeneration and I may have needed that surgery instead.

Day of Labrum/FAI post-surgery needed items: rolling walker, crutches with extra crutch pads (Crutcheze), raised toilet seat WITH handles (they make standard and elongated toilet versions), compression socks (several pairs), water bottle with loop or handle, pajama pants or loose yoga pants WITH POCKETS, slippers with sturdy sole and a pair of easy slip-on shoes, 3-4 large ice packs (I used the ThearPearl Back wrap – it wraps all around the front and side of the hip), several boxes of breathable band-aids and a box of waterproof band-aids, a shower seat, and for when you are out and about at appointments – a Temporary Handicap decal for Handicap parking! Also, my favorite chair is my glider/recliner, but any chair that puts your hips at no more than 90 degrees flexion will work. Have several good options, I have to rotate between chairs/walking/laying down frequently to keep my hip moving and decrease pressure on the joint. Sitting on low and/or soft couches does not work. A backpack would also be a good idea once you are more mobile, maybe in week 2. It’s difficult carrying things from chair to chair, especially a laptop!

I have to say that I am extremely happy with the level of care I have received with Dr. Bert, his MA Jennifer,  and his office staff (Hedley Orthopedic). I am also very happy with the level of care I was given at St. Luke’s Medical Center’s surgical Orthopedic unit. I will be posting Week 1 Day-by-Day surgical recovery also. I am choosing to blog about my medical condition and my experience due to the minimal amount of surgical and post-surgical information on labrum surgery available online, and also the minimal amount of information on labrum tears due to childbirth.

Rachel

Important Disclaimer  *****These are my opinions and the information I am posting is my own, and is not that of  Dr. Bert, Hedley Orthopedic or St Luke’s Medical Center. Every patient and patient outcome is individual.  My results may not be the results that others experience.****