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BellaLove15 04-22-2009 01:36 PM

Femoral Osteotomy, Periacetabular Osteotomy?
 
Hello,

I am scheduled to have a femoral osteotomy and labral repair soon on my right hip. During surgery, my surgeon is going to decide if he wants to do the periacetabular osteotomy, also. Has anyone had these done? What can I expect after the surgery? I'm told I wont be able to go back to work for 8-10 weeks after surgery.

Any information would be great.

I am 22 years old. When I was 16 I broke my right hip. About 6 months ago my hip started fully dislocating very easily. The first time someone fell in to me, and the second time was on the exam surgeon when he was just moving my leg during a routine hip exam. OUCH. It was found I have an "abnormal twisting" of my femurs, and that I have hip dysplasia. All this on top of a hip that hasn't been great since 16 because of the fracture.

1284 04-27-2009 05:43 PM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
I'm sorry to hear about your condition. I, too, was diagnosed with a labral tear and hip dysplasia. I had the periacetabular osteotomy procedure done on my right hip in 2005. I stayed in the hospital for 2 weeks, and started rehab the day after surgery. I used a walker first, followed by crutches, and then a cane. The doctor prescribed some pretty strong painkillers, but I was able to stop using them at about the 3rd week after surgery.

While I was told that I would be off from work for 12 weeks, I went back after 3 weeks and my doctor signed off on it. He actually preferred that I went back because it was critical that I exercised and moved as much as possible. I had a desk job so it wasn't difficult for my employer to make accomodations for light duty.

I know you didn't ask a question specifically pertaining to this, but I feel it's important to share it. The periacetabular osteotomy is a procedure I wish I did not consent to having done. Had I known what I know now, I would have pushed for a hip replacement instead. I was told by my surgeon and my 2nd opinion doc that I was too young, and that the periacetabular osteotomy was my only option at that time; but, who's to say what age is "too young"...some people have long lives while others aren't as long. Had I pursued a hip replacement, I likely wouldn't have needed to spend the past few years desperately searching for doctors who could help me fix what was done to me - the outcome of hip replacements are [U]very [/U]positive. While several orthopedic surgeons (who all perform the PAO surgery) that I've since seen think that my results are excellent ("the bone looks great"), not one can tell me why I'm still in pain on a daily basis. As a side note, prior to surgery, I only had a click in my hip, a labral tear, and sporadic nerve pain. After surgery, I was left with nerve, bone, and muscle pain, and my right hip now double-clicks everytime I take a step. Plus, I continue to require treatment regularly - chiropractic care every other week and physical therapy once a week. I'm sure everyone has done the best that they could to help me; but in the end, it's my quality of life that has been affected.

So, to avoid having any regrets, please spend as much time as possible researching the surgeries you are planning to have. Access as many resources to answer questions and eliminate any doubts. By the time you are signing papers at the hospital admitting office, you should feel comfortable with the procedure, the doctor, and the possible results. If you do not, give yourself more time. Regardless of what anyone tells you, do not feel rushed into it.

cbuto 05-13-2009 09:56 AM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
My daughter was recently diagnosed with hip dysplasia and was given 4 treatment options. Two were quickly ruled out which leaves only two...over the counter prescription drugs and exercise OR PAO. She has already tried the first with prescription drugs and not seen any relief. The PAO option sounds scary. Any additional input would be greatly appreciated.

BellaLove15 05-14-2009 11:47 AM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
I am back from the hospital now, I've been home for 2 days. My surgeon didn't end up doing the periacetabular osteotomy. He did a femoral osteotomy, osteoplasty of my hip socket, and repaired my hip capsule which in his words was "shot to hell".

I can tell you that my osteotomy went well. Surgery took around 6 hours, I awoke and was in pain but this could be controlled with pain meds. I stayed in the hospital 4 nights. Pain at home honestly isn't too bad. Ofcourse I'm living on pain killers right now, but it isn't anything which brings me to tears. Its just going to take time, and it takes some time learning how to get around the house with a walker, and up and down the stairs, ect. I have a bedside commode I have to use since i can't bend down to the toilet (lovely), my bathing consists of sponge baths since I can't get my incision wet (which is about 30 cm long). So ofcourse that stuff is hard and slightly embarassing. But if its going to help me in the long run, I'm glad I did it. And honestly I'm surprised at how well I am doing and how much less the pain is than I thought. I built it up to be horrible.

A home nurse and physical therapy comes out to my house, which is nice. Later I will do water therapy. If you are interested in how I am doing so you can have more information for you daughter's sake later down the road, feel free to e-mail me or have your daughter email me at [COLOR="Blue"]* removed *[/COLOR]. :-) Hope this helps! Its not the same osteotomy but in the same place to cure the same condition.

cbuto 05-15-2009 05:46 AM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
I'm glad to hear you are home and that it went better than you expected. I hope your recovery continues just as smoothly. It looks like your email address was removed from your reply so we'll just keep posting. Thanks and good luck!!

1284 05-15-2009 02:57 PM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
[QUOTE=cbuto;3983284]My daughter was recently diagnosed with hip dysplasia and was given 4 treatment options. Two were quickly ruled out which leaves only two...over the counter prescription drugs and exercise OR PAO. She has already tried the first with prescription drugs and not seen any relief. The PAO option sounds scary. Any additional input would be greatly appreciated.[/QUOTE]
My suggestion would be to get the opinions of doctors who aren't orthopedic surgeons. Seek out the advice of, for example, chiropractors and physical therapists who specialize in hips. My chiropractor has been able to help me tremendously with my right hip (which was operated on), as well as my left. When my left hip is bothering me, he adjusts it and the pain goes away for at least a couple of months. A physical therapist may be able to help strengthen the muscles in your daughter's pelvic area to provide more support to the hip joint. Since I haven't had any stability in my hip since the surgery, strengthening the muscles in that area is the key focus for my treatment right now (and has been for a couple years), in hopes that it will provide some stability to the joint.

Also, because the PAO procedure will involve cutting of muscles, tissues, nerves, etc., talk to doctors who specialize in those areas as well, to see what the outlook would be on the recovery of those particular things. From what I've learned, speaking to orthopedic surgeons will only result in the review of the bone. But, the surgery affects so much more than that. Try to get a full picture of what's involved because injury to one part of the body will undoubtedly affect another part.

As a side note: The success rate of the PAO, based on the people I've come into contact with are not very positive. I, for one, have not seen "success" and am not even close to full recovery yet...and it's been years since I had the procedure done. I used to work with a woman, probably in her late 40's who had better results than me; however, a couple of years ago, she started having nerve pains that ran up her leg and into her butt area. It was so painful. She also had instances where her hip buckled unexpectedly. There was another woman who I worked with whose daughter had the same procedure done about 2 years before me. She was 14 at the time. She, too, has struggled to recover and has sought the help of other doctors and physical therapists. The last I heard, she was unable to bend her neck to look down and could not sit in a car for long periods of time. A therapist that works at my chiropractor's office mentioned to me last year that she worked on an Asian male in his early 30's who had the PAO. He had difficulties as well, to the point where he was scheduled to do another surgical procedure to try and remedy the new problems he was having. Also, an orthopedic surgeon that I visited for a consultation said that he sees a lot of patients who have had the PAO, who shared the same problems as me. A lot of them were uninformed of what the procedure really consisted of; so they too, were searching for answers to find some sort of relief. Last, but not least, this past January, I saw another orthopedic surgeon to find out more about hip replacements, who said that the most frequent repercussion of the PAO is arthritis. This was particularly disturbing to me because I was told that I had to hurry to make a decision before arthritis set in; if it did set it, the doctor wouldn't be able to do the procedure - this came from both the surgeon and my 2nd opinion. There I was, trying to avoid arthritis; and now, here I am, much more likely to get it.

I know how difficult it is to be in constant pain and the feelings of urgency to find solutions to get rid of it, but don't let that lead to quick decisions and the belief that you're down to only 1 option since the prescription drugs aren't working. After I had surgery, and in the process of trying to find help, I realized that there are more options than what I was presented with. There also weren't many articles or resources on PAO in 2004-2005, so I put most of my trust in what the doctors told me. Keep searching, keep asking questions, and tell your daughter not to give up hope.

Good luck and don't hesitate to ask more questions :)

cbuto 05-17-2009 09:48 AM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
Thanks so much for your post 1284. As it was lengthy I know it took some time and I really, really appreciate that. We have been trying to do our homework. At this point in time, I think she has decided to put off the surgery for now anyway. The risks seem too high without any certainty of the outcome. Presently, her hip pain is not 24/7. It is unpredictable which she finds very annoying and frustrating not to mention painful. She just graduated yesterday with her masters in accounting and wanted to start the next phase of her life without this problem/pain, BUT the surgery might actually make things worse. That being said we dropped off an exercise bike to her yesterday and will be picking out a new outdoor bike next weekend. I think she is now committed to trying to strengthen her leg through exercise and therapy first before going through with surgery.
So far we have seen 3 orthopedics who are all surgeons but their opinions have been somewhat varied...
First one said she medicate and wait for a new hip in her 40's. He also mentioned the PAO but said he wouldn't recommend it because sometimes the fix is worse than the problem.
Second one said there should be other options besides medicate and new hip but he couldn't do them at his hospital so he referred us to Mayos.
Third surgeon said PAO.
I have spoken with the 2nd orthopedic after the Mayos visit. Although he said he would consider the surgery for one of his 3 daughters if necessary NOT before all other options i.e. exercise and strengthening have been exhausted because it is a BIG surgery with no guarantees and that she would probably still need a new hip down the road.
So unless the pain becomes unbearable 24/7, I think she has decided to wait on surgery. Hopefully the technology will continue to improve and maybe if we are really lucky her hip will remain status quo.
Thanks so much for sharing your story!!!

1284 05-18-2009 07:20 PM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
Hi cbuto,

That's music to my ears!! I believe your daughter has made a very wise decision to hold off on surgery. Prior to surgery, I, too, did not hurt 24/7; after surgery, I found - and still find - myself to be constantly in pain (except for when I'm sleeping).

I completely understand her desire to start the next chapter in her life pain-free. I'm in the same boat, except I'm holding off on starting a family. In my eyes, she's definitely in a better place than I am (and a lot of others who did go through with the PAO), and I hope she'll be able to see how lucky she is that although she may be in pain at times, she still has moments of relief. It's difficult to find comfort in "being in pain less frequently" when you're uncomfortable, frustrated, and hurting, or even when you have to physically and mentally prepare yourself for the possible onset of pain each day; but, it is something that many people can often times, only hope for.

Please encourage her to look into specific exercises that build the muscles directly surrounding the hip joint. I have tried numerous exercises under the direction of doctors and physical therapists, and the most promising results concerning the stability of the joint are being seen with those that target the particular muscles in that area. Just a thought :)

Congratulations to your daughter, on completing her graduate studies! She must be so, so relieved that her Master's thesis and defense are behind her. Without a doubt, that was one of my most memorable days and events of graduate school. Best wishes to her!!!

cbuto 05-19-2009 04:40 AM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
Good Morning 1284!
Yesterday was a painful day for her; I could hear the frustration in her voice but she still said she was 100% sure "no surgery" at this time. I'm hoping as time goes on and as she commits to exercise she will see some benefit. Are there any specific exercises you found most helpful to you? She has been some by both the chiropractor and orthopedic. I believe they were very similar. Again any suggestions would be helpful! Thank you again for taking the time!

1284 05-20-2009 05:51 PM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
Hi cbuto,

I'm sorry to hear that your daughter had a rough day yesterday. Being in pain does bring out the worst emotions and is often accompanied by physical and mental exhaustion...no doubt about that!

Regarding specific exercises, based on my experiences, my suggestion would be for her to see a chiropractor and a physical therapist. They should have experience and/or specialize in treatment of the hips. Every other week, my chiropractor has to adjust my ilium, as well as my lower back and sacrum. Sometimes, he has to adjust my knee, neck, and jaw. Because the muscles in my hip area are so out-of-whack, those parts are constantly being pulled out of alignment. It doesn't help that my hip ball does not stay positioned properly in the socket...which is what the surgery was supposed to fix. Anyway, I suggest a chiropractor because s/he can maybe realign her body so other body parts are not compensating for the bad hip (preventive), as well as position the ball where it needs to be in the socket. This definitely works for my left hip, which I have not had surgery on.

As for physical therapy, again, my recommendation is to find someone who specializes in hips, who preferably has dealt with hip dysplasia patients. This is very important. She'll likely come across a lot who have dealt with hip replacement patients; however, this is not the same.

Here are several exercises that I have found to be very helpful:
1. Using a rehab rubberband, one end tied to the bottom of the bed post and the other tied around my ankle (side that had surgery): Sitting on the bed, I pull the band inward and hold for 10 seconds. I repeat this 5 times.
2. Tying a belt around my knees, I push out and against the belt for 10 seconds. I repeat this 3 times.
3. I place a small rubber ball between my knees and squeeze it for about 10 seconds. This, I repeat about 3 times as well.
4. I also do a series of stretches that work on my psoas muscles and my hip muscles.
5. Standing on my right foot and my left on a step stool, I tighten the muscles in my hip and hold for 10 seconds. I do this 3 times, which isn't much; but right now, I don't have much strength, so 3 times is a lot for most of the exercises listed.

There are several others that I do, but it's difficult to explain them in writing. Rather than your daughter creating her own exercise routine, I'd recommend that she see a therapist or physician for the sole purpose of ensuring that she's doing them correctly. I didn't realize it until recently, but posture and correct "form" have a huge impact on the results of exercising, especially when there is an injury to the body. With the exercises listed above, there are so many fine details that I didn't include because it would result in a novel. Also, please note that these exercises are helping me post-surgery; I'm sure there are other techniques that are used for people who have not had surgery.

I'm not sure if this was helpful, but feel free to ask more questions if you need to.

cbuto 05-21-2009 06:40 AM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
Thanks again so much! I am picking her up today for a long weekend. I will show her all our conversations. She is still alittle frustrated with ALL doctors in general, but maybe if she sees it in writing from someone other than a doctor or her mom she will be alittle more receptive. I will start the search for a good, qualified physical therapist.
She actually started with a chiropractor before we knew what was wrong. It took them awhile to get to where it was helping. She has lost alot of faith and confidence because of that, but I have suggested the possibility of going back now that we know what the problem is. But you are right, she is mentally exhausted/frustrated right now so I am treading lightly right now. She might have more specific questions for you once she reads all this herself. Thanks again so much! Have a great Memorial Day Weekend!!

electrizze 05-21-2009 07:48 AM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
[QUOTE=cbuto;3990613]Thanks again so much! I am picking her up today for a long weekend. I will show her all our conversations. She is still alittle frustrated with ALL doctors in general, but maybe if she sees it in writing from someone other than a doctor or her mom she will be alittle more receptive. I will start the search for a good, qualified physical therapist.
She actually started with a chiropractor before we knew what was wrong. It took them awhile to get to where it was helping. She has lost alot of faith and confidence because of that, but I have suggested the possibility of going back now that we know what the problem is. But you are right, she is mentally exhausted/frustrated right now so I am treading lightly right now. She might have more specific questions for you once she reads all this herself. Thanks again so much! Have a great Memorial Day Weekend!![/QUOTE]

Hi Cbuto,

I randomly came across this board and your post and wanted to give you some different perspective from 1284.

I was diagnosed with dysplasia as a baby and spent some time in the pavlik harness and the cast. Never experienced any pain in my hip until I was 27. At that point it wasn't so much pain, as it was fatigue and I didn't link the two together. Over a year the fatigue would come on more frequent and started turning to shooting pain in my knee and up/down my thigh. A year ago I went to a wedding and was close to tears after 10 minutes of standing around during cocktail hour. I immediately made an appointment with an OS. He said my options were to either do nothing, wait for the cartilage to deteriorate (which he estimated would be 3-5 years and meanwhile live with the increasing pain) and at that point have a hip replacement or try the PAO route since there was no sign yet of arthritis and possibly never have an artificial hip.

I found a PAO specialist right away and scheduled the surgery. There is no way I wanted to live with the increasing pain and have a replacement in my early 30s.

I had the surgery October 21, 2008. I spent 4 days at the hospital followed by 6 weeks on crutches with no weight bearing on the operated leg. It has been 7 months and I cannot be happier with my decision. I completely forget that I ever had surgery except for the tiny scar on my bikini line. I have zero pain and am back to 100%, maybe even more because I now have more flexibility. I can walk around NYC for hours without even remembering that I have a crappy hip.

Not all PAOs are unsuccessful and the problem with waiting is that the cartilage is wearing out and there is no way of replacing that (YET!).

Anyways, just wanted to give you my 2 cents. Feel free to get in touch if you have more questions. [COLOR="Blue"]* link to commercial website and blog removed by hb-mod, moderator. *[/COLOR]

Good luck!

Marina
[COLOR="Blue"]* email address removed by hb-mod, moderator *[/COLOR]

cbuto 05-22-2009 03:24 AM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
ElectrizzeThanks for your input. It is good to hear a positive outcome since the options are so limited. May I ask who your doctor/surgeon was?

desperateforadv 04-29-2010 06:17 AM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
It was undecided wheter I would have a periacetabular osteotomy or a Chiari Osteotomy very similar, with different requirements..I had major arthroscopic surgery to repair a lot of damage and a labral tear but didn't work. I was leaing toward the Chiari due to severe hip dysplasia on my right, didn't have an accident or injury, born with this and has deteriorated. I also have osteoarthritis and very poor range of motion and strength preventing me to have the "periacetabular". Good Luck in whatever decision you decide. I am still looking for a surgeon in Boston to handle my situation.

Patto88 11-09-2010 02:39 AM

Re: Femoral Osteotomy, Periacetabular Osteotomy?
 
Hi, it os good to read your story. Mine is very similar. I am scheduled for a Petiacetabular osteotomy in 4 months. I had bad hip dysplasia as a child. I jad an opp 2 weeks ago to fix my tears and do a bone Graft as I have bad arthritis. I am just woundering I'f you have been pregnant with aPetiacetabular osteotomy , and how did it go??? That is my main concern.


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