Since I started this blog to be informative to other people thinking about and researching PAO, I wanted to write about how I got here. In an earlier post, I described how my pain initially started as a sharp ache after long periods of walking in December. At the time, I figured I'd strained something and it would just get better on its own.
In March, my mother and husband finally persuaded me to see somebody so I did some research and found an interesting orthopedic specialist who was also an ultra-marathon runner. I figured that anybody who did something that like in his spare time had to be pretty zen. I was half expecting him to tell me that I was just getting old and I should take Advil and quit my complaining. He did an exam and took a single x-ray. The exam consisted of him moving my leg around and asking "does this hurt?" "how about this?". Most of it didn't hurt, but when it did hurt, it hurt a LOT. It was a sharp, catching pain right inside the hip socket followed by a dull burning ache in the same spot.
So when he put the x-ray up on the light board, he said "hm, I'm not surprised that your right hip is bothering you. You've got a really shallow socket on that side". That was the first hint that this was structural and not something minor. He told me he wanted me to have an MRI to see the condition of the cartilage. At first I argued with him about the unnecessary cost and time. I wanted to make sure that the MRI would actually mean something and wasn't just going to lead to more tests and no results. He assured me that it would tell him a great deal and that he could make treatment decisions from it about whether it was cartilage or something that could be fixed with therapy. So off I went to be shoved into a metal tube.
The MRI wasn't too bad and the CD of images I got was pretty interesting. It's always an odd feeling to see your insides. To realize that there is all this stuff underneath the fleshy exterior that we think of as "self". After waiting another week, I got to see him and review the results. My husband and I had already done some research and I was suspecting that I had a cartilage tear by comparing my images with those I found on the internet (how did we ever live without the internet??). And the doctor agreed. I had a tear in the labral cartilage that covers the femur head. And nothing I could do was going to fix that and it wouldn't heal on its own. So I knew I was facing surgery, but hoped I could get in and out and on my way pretty quickly. This orthopedic doctor didn't specialize in hips (who knew that even the specialists specialize?) so he referred me to another doctor who did a lot of this sort of arthroscopic surgery.
Another $35 co-pay later, and I'm sitting in an exam room wearing a pair of disposable shorts and silently chastising myself for not shaving my legs the night before. This doctor wanted to do another series of x-rays and again I found myself questioning the additional expense. But he assured me that he needed to see the hip "structurally" in a way that doesn't show up on the MRI. So down the hall I went to get more x-rays, including one of my leg in a "frog" position with my foot on a block and the knee rotated outward, which hurt like hell.
Back to the exam room and he comes in and spends about 5 minutes taking measurements of my hip on the x-ray. This was done with a pretty cool computer program that allowed him to click and drag little arrows all over the screen. Then he turns and delivers what was, to me, pretty devastating news. He tells me that he thinks the cartilage is torn because I have hip dysplasia. The way my hip is structured is unstable, so eventually the cartilage just gave way. He could go in fix it, he says, but it wouldn't address the underlying structural problem. Now I'm realizing that I'm out of the frying pan and into the fire. What I thought back in December as some sort of ligament strain is now just getting worse and worse every time some new doctor takes a look at images of my hip.
He wants to send me to yet another specializing specialist who does "surgery to address hip dysplasia". More waiting, more wondering. And I've just been told that my hip is malformed. At this point all I can think of is that I need a hip replacement. At 44. Short of a cancer diagnosis, this is about the worst thing I can imagine. The scheduling desk then tries to give me an appointment that is 3 weeks away and I lose it. It's amazing what a woman in tears can accomplish. Normally I don't give way to sobbing in public but I'd had all I could take. So they found me an appointment 2 weeks out and explained the doctor wasn't even in the state the following week so that was the best they could do.
During this waiting period, I get back on Google and start researching hip dysplasia. I have to do searches on "adult hip dysplasia" or I get a bunch of results about German Shepherds. And I read, and read, and read. I do searches on "non surgical treatment of hip dysplasia". I do searches on hip replacement and I finally discover a procedure called PAO. It sounds pretty gruesome to be frank. But, it saves my hip and that is of the utmost important to me. I read about the movement limitations of a hip replacement and I learn that they only last about 10-12 years. At the end of my reading, I'm determined to make my case for a PAO despite being over the age of 40.
As it turned out, I didn't have to argue at all. After another exam and more measurements of my hip, the third doctor tells me that yes I have hip dysplasia. The clinical criteria for this condition is a center edge angle measurement. You get this by drawing a straight line up from the center of the femur head and then another line that goes from the same spot to the outside of the hip. Anything less than 25 is considered dysplasic. My left hip is 20 (and so far has not given me a single problem). My right hip is 10. Less than half what it should be. So that's that. Nothing I can do at this point but put up with the pain or get it fixed. In some ways, it's nice that it's that simple. There's no watchful waiting here. The doc tells me that if I don't get it fixed, then I will develop arthritis and need a total hip replacement in "2 years at most".
He tells me that the last time he did a PAO on a person over 40 was over a year ago. So I'm unusual. I asked him why me and he said that my cartilage is still in really good condition (discounting the tear, which he can fix) and I don't yet have arthritis. I'm a normal weight and always have been. And I don't have any other underlying medical conditions. And for that I'm grateful. The thought of having metal parts in my body was pretty appalling to me. However, the doctor did tell me that I'll need a hip replacement eventually. Which could mean anything. As long as it's not today, I'm good. I'll cross that bridge when and if I come to it. In the meantime, I'll get to see x-rays of my hip with three metal screws in it. My 15 year old son will be very impressed with THAT.
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