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Old 08-03-2012, 11:17 PM   #1
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Open Hip Surgery Experiences?

Hi folks:
I have a long and weird medical history that starts out with "car/train accident in 1989." That accident resulted in a broken femur, among several other traumatic bone injuries. I was in traction for two weeks for the femur, then had open hip surgery to put an intramedullary nail down the middle of the femur to hold it straight as it healed. In 1991, the nail was removed.
I started having hip pain in that hip in 2007. It was variously diagnosed, over the years, as bursitis, SI joint inflammation, a bulging disk, a slipped disk, a spine issue, and I did a lot of PT. A LOT. Nothing really worked, so in 2010 my GP sent me for a back MRI. Much to everyone's surprise, my back is fine - no slipped disks, no bulging disks, everything totally normal.
So off I went to the orthopedic surgeon, who started treating me for bursitis. PT and cortisone injections. It helped - for a bit. About a week after the injection, the pain would come back. And it hurt - not just my hip, but radiating down my outer thigh. I wa finding it hard to drive, to walk any significant distance, to go to the gym, to do yoga, to play with my kids. My orthopedic doctor thought it might be a good idea to just go in and get the bursa out - he suspected that scar tissue from the previous surgeries might have wedged itself between the IT band and the bursa. I had an arthroscopic bursectomy and scar tissue removal in February of this year.
Immediately afterwards, I felt MUCH better. For about three weeks - and then the pain came back. I did 12 weeks of hard core deep tissue massage with PTs who had very pointy fingers in an effort to break up the scar tissue. Finally, the PTs told me that they were really sorry, but they couldn't help - there was too much scar tissue, it was too strong, and it was pretty much adhering to everything in my leg.
I started pursuing a diagnosis of some kind. I saw a rheumatologist, had ultrasounds, had MRIs, saw a second orthopedic specialist, and the only thing anyone said was "Damn. That's a LOT of scar tissue in there."

Today, my orthopedic surgeon said that he thinks the only way we're going to solve the problem is with an open hip surgery where they go in and physically remove the scar tissue. To prevent adhesions from reforming, he wants to put in some kind of a barrier (I'm not really all that clear on what kind - he says there's several types to chose from) that would prevent the muscles and tendons from adhering to one another. The barrier dissolves over time, the way dissolving stitches do, and they're usually used in abdominal surgeries that have a high risk of adhesions.

At this point, I'm willing to do just about anything. I'm seeing a pain management doctor because the amount of pain this is causing is just crazy. My MRIs show nothing torn, nothing out of place. The ultrasounds show scar tissue, and lots of it, gluing pretty much everything in my hip and thigh together. Any movement I make with that hip yanks on something and hurts.

Has anyone had an open hip surgery? I mentioned that I've had two, but it was 22 years ago and I was hospitalized for multiple bone traumas. The recovery from the open hip surgery was so unremarkable I don't even remember it - it wasn't like I could walk anyway.
Also, has anyone had a large amount of scar tissue stripped out of a joint?

 
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Old 08-08-2012, 12:08 AM   #2
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Re: Open Hip Surgery Experiences?

I had a large amount of scar tissue removed from my hip arthroscopically. I had right hip arthroscopy in October 2006 and February 2009. In June 2011, the surgeon went back to readhere my acetabulum to the bone. He found a lot of scar tissue, and I had immediate improvement here, much like you did.

I tend to get keloid scars on the surface of my skin, which might account for my large amount of scar tissue. On a trip to the dermatologist, I mentioned that I was concerned about keloids from the third surgery. The doctor indicated that cortisone can be injected into the scar tissue to help it to break up. I wonder if such an option might be available for internal scar tissue? This might a better option than another open hip surgery. (I read that you had cortisone injections before, but I am guessing that these injection were into the joint itself, rather than into the scar tissue.) I also wonder whether your scar tissue can be removed arthroscopically?

 
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Old 08-08-2012, 04:02 PM   #3
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Re: Open Hip Surgery Experiences?

Thanks for your reply, Sweet Pea. I don't keloid on the skin. My thought - shared by my doctor - is that my body has undergone so much trauma that it overreacts and produces too much scar tissue. The thought is that by using this film? gel? to separate the muscles and tendons, my body won't be able to glue everything back together. I wish it could be done arthroscopicly, but the doctor (and the second opinion doctor) think that I'm just going to wind up with another surgery down the line if this isn't done aggressively, and they need to open the joint in order to use the anti-adhesion materials.
Unfortunately for me, cortisone after a certain point can actually damage muscles and tendons, and since my scar tissue is over the muscles and tendons, they're not willing to try more cortisone injections in the hip.
I'm glad to hear you had relief from the scar tissue removal. I'm really torn on whether or not to do this - on the one hand, I can't live in this level of pain. On the other hand, we haven't been able to prove that the scar tissue is what's causing the pain. It's kind of a diagnosis of exclusion, as none of the imaging studies have shown any labrum tears or FAI. I almost wish they had, because then I'd know exactly what I needed to do. As it is, it's sort of educated guesswork.

 
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Old 08-09-2012, 09:45 PM   #4
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Re: Open Hip Surgery Experiences?

Sometimes getting a firm diagnosis is a relief. With my last surgery, I had a bunch of mild changes indicated in the MRI report, but when the surgeon went in to the joint, he found a huge amount of delaminated cartilage. If you have any symptoms of the joint buckling, I would recommend going back to the surgeon and/or the radiologist and asking them to check your films for delamination. It is rarely caught on the first read of the film, but once a radiologist knows that it is present, they can locate indications of it on the film. Not much of a help to find the problem after an invasive surgery!

My second and third surgeries were with Thomas Sampson in San Francisco. I don't know whether he will do case reviews without a physical exam, but if you have the ability to make an appointment with him, I cannot recommend him strongly enough. Sorry that it sounds like a less invasive option won't help with potential scar tissue.

 
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hips, scar removal, scar tissue



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