Hip Preservation Surgery

What is hip preservation surgery?  It is surgery that preserves the joint. Not a joint replacement, rather repair of the issues within the joint. In my case, this involved shaving bone to correct bony impingement, repairing the labrum, etc. It is fascinating to me what all can be fixed via only a couple of small portals. My repairs included anchoring the labrum back in place, shaving excess bone from femoral acetabular impingement (FAI), decompressing the anterior inferior iliac spine (AIIS) for subspine impingement, cleaning up a torn ligament, tightening the capsule, etc. Hip arthroscopy is technically a minimally invasive, outpatient procedure. But, it is still a major surgery.

I was both overprepared and underprepared for this surgery.  Having had prior surgeries, I knew the basics of what to expect in some ways, but this was beyond anything I'd had before. I had never been on crutches or used a walker before, etc. These were a huge learning experience. But, overall, I was pleasantly surprised with how much easier it was than I expected! Preparation and rehabilitation each deserve their own separate post.

Some things that have surprised me a bit with any surgery, but especially orthopedic surgery, is no mention whatsoever of how to support healing with nutrition, relaxation, etc. I am never certain if the reason nutrition is not mentioned with me is because it is typically not addressed, or if it is because most of my physicians and other providers know my background is in nutrition. Regardless, I notice it does not get brought up. The approach I take with myself is to make sure I am supporting my body for recovery the final weeks/month before surgery and the initial few months after surgery. This means no weight loss, greater emphasis than usual on protein, strict avoidance of sugar. There are other approaches I take as well. I recently found this link which has great information regarding pre- and post-op nutrition. Most of these are things I have done. Plus, I do some additional strategies as well. I had started moderately high dose vitamin C prior to a surgery a couple of years ago when fighting a respiratory infection, trying to support my immune system in order to be well in time of surgery. Then, knowing that vitamin C is an essential co-factor for collagen synthesis and that collagen is needed for wound healing, stayed on the vitamin C after surgery to help support healing. Further, without any evidence, chose to remain on vitamin C knowing I had a torn hip labrum. I had no expectations of the labrum healing, but figured the vitamin C would not hurt. Then, went into hip surgery--so just kept on taking vitamin C. Interestingly, when I was diagnosed with Ehlers-Danlos syndrome (genetic connective tissue disorder due to defects in collagen), high dose vitamin C was one of the recommendations! Thus, I have gradually increased dose some over time.

Preparing for surgery. This topic deserves its own post, so this will be a brief overview, not comprehensive. Preparation included "prehabilitation" in physical therapy. This helped me go into surgery as strong as possible, which in turn, aided with rehabilitation post-op. With hip arthroscopy, the goals of "prehab" included hip and glute strengthening, core strengthening, also upper body strengthening in preparation for being on crutches. I made sure I had work and school tasks caught up and to good stopping places prior to surgery. I made meals in advance to make things easier after surgery. I made sure regular prescriptions were current, refilled. I arranged to have a family member able to drive me to/from surgery, stay with me the first days after surgery. Friends pitched in to help with rides until I could drive.

Although I said, and still say, recovery was much easier than anticipated, it was certainly not easy. I like to be up and doing things. My body needs to keep moving. Patience is not one of my virtues....just something I have been given numerous opportunities to practice. I strongly dislike restrictions and limitations. However, I understand their purpose and am capable of dutifully following them.

I mentioned in my post regarding hip impingement, and diagnostic process that I was eventually sent out of state for another opinion, and this second surgeon is who recommended surgery. Thus, I traveled for surgery. However, he and his office made it as easy as possible for my family and me. I had an early morning surgery time, so my sister and I drove there the evening before, stayed overnight in a hotel, checked into the surgery center bright and early the next morning. I was discharged same day back to the hotel. My surgeon did request I stay in town overnight, start physical therapy the next morning there before traveling home, but fine to travel after PT.

Surgery. Part of the pre-op process included a very brief tutorial session with crutches since I'd never used them before. I was also given the recommendation not to try using crutches on the stairs once home--rather, sit down and scoot up the stairs. I saw my surgeon before surgery--was able to ask final questions. My burning, final question was how soon I could be in the pool after surgery. (I use being in water as part of total pain management, and past surgeries had disrupted things and made recovery even rockier. So, this was important to me from global management perspective.) Initial response was ~3 weeks, as that gave time to make sure incisions were closed once sutures were removed. Since I wanted to be able to be in water as soon as possible, had experience with being in early, ways to protect incisions, injection sites, etc., I asked if possible to be in sooner if I used Tegaderm or other waterproof bandages. This was conceded to be acceptable. Yay! (But, I also think this is why I was warned against pushing limits later by my surgeon. That question showed my true colors of being a definite limit pusher--something my local physical therapist was already very aware of.)

The surgery itself is the easy part--I slept through it. It helped having a surgeon who is excellent at what he does, who inspired confidence and trust.  I trust him fully.  I was curious about the surgery, but simply from wanting to know what was being done, not because I questioned the surgeon in any way.

I was discharged before noon! Wow! Rested at the hotel, had to problem-solve an effective system for icing. We watched a movie, but I did not remember much. A friend stopped by to visit. I know I woke in the night, but do not recall any major sleep challenges--unlike pre-op. Challenges post-op included I could not move surgical side leg, was completely non-weight bearing. It was hard to get situated in bed, it was hard to get out of bed. I needed help with getting the surgical leg situated. Surprises: I was fully independent in the bathroom! Yay for not needing help! However, I needed help getting out of bed in order to get to the bathroom.

The day after surgery, I was not hungry, but knew I needed to eat. I kept it light but protein dense. I had my first post-op physical therapy appointment. Physical therapy went well and was incredibly helpful! I was given tips for crutches--how to walk correctly with partial weight bearing, stairs tips, etc. I was told it was fine to use my good leg to support and move my surgical side leg. I was given exercises, examples of things to do to help fill in any gaps in surgeon's rehab protocol. I was told how to do quad rocking, allowed to see how low I could get--fully into child's pose! Wow! And, no pain at all! PT let us put my ice packs in the freezer during my appointment, then supplied us with fresh ice for the trip! My discharge info had said to stop every hour on the return trip to get up and "walk" around with the crutches. However, PT told my sister if I was asleep, to just keep driving and let me sleep. We did so. But, this meant I woke after we had just passed a good stopping point, with my hip and leg stiff and sore. I was pretty swollen and uncomfortable by the time we got home.

After surgery, I had a big, bulky bandage, so was not sure where exactly incisions were, how many there were, etc. Bandage made it difficult to ice as well. My discharge info had said I could remove the bulky bandage 24 hours post-op, which was about the time of the PT appt. PT said it did not matter if I left it on or took it off before physical therapy. I opted to leave it on as I figured it was more protection over incisions since I was going to be traveling.  I am also glad I waited as bandage removal was sort of a messy process. One incision had seeped quite a bit. Residual adhesive issues that required scrubbing with rubbing alcohol, rubbing with coconut oil, etc.

Once the bandage came off, I discovered two small incisions, one of which had seeped quite a lot. It was recommended to cover the incision/sutures with bandaids to protect them from catching on clothing. My body dislikes adhesives, so I was reacting to my "safe" bandaids that I had previously tolerated. I was even reacting to the sutures themselves by the time they were removed around two weeks post-op by my local primary care physician.

I was allowed to take a shower 2-3 days post-op. I so badly wanted a shower, but was so exhausted on the first day I was cleared, that it ended up not happening. When I did finally get a shower, it was an exhausting process and required a nap afterward. In fact, everything attempted required a nap afterward. Physical therapy appointments were exhausting...and meant napping once home. I think I slept most of the first week. My existence was sleep, PT rehab home exercises, eat, rest/sleep, repeat. Once I was finally more awake late in the first week, I also discovered I was always hungry no matter how much I ate. I knew recovery from surgery required extra energy, but had not thought about how much more work crutches were as well.

I was prescribed NSAID for first weeks after surgery, non-optional as prevention against heterotopic ossification (abnormal bone growth). I was also prescribed antibiotics as a precaution, narcotic painkiller as needed, anti-nausea medication as needed, stool softener as needed. The NSAID and antibiotic were taken as prescribed. The others were all as needed, and never needed at maximal dose. In fact, I am not certain if any of them were truly needed. Out of precaution after rough recoveries from prior surgeries, I started out on narcotic, but quickly realized I had no actual pain. I was uncomfortable at times, but not pain. This was a pleasant surprise! I had such severe pain pre-op, and had been expecting even worse pain post-op, but that simply was not the case. I am notoriously unpredictable in my reactions to medications, so I was relieved that each of the medications my surgeon prescribed for after surgery, were ones we already knew I tolerated and worked well for me. Thus, no risk of reactions during post-op recovery.

These are a select few resources that I found very helpful pre-op, when learning about surgery itself. My physical therapist and surgeon also received their share of my questions. I am one of those patients who likes to know what to expect as much as possible. However, I also realize that some things are not knowable and I can be alright with that. My physical therapist gave me an idea of what post-op rehab would look like. My surgeon warned me I'd probably rehab slowly. However, I did not know actual restrictions, orders, specific protocol until after surgery. Everything worked out fine.

For reference.
Nutrition info (yes, same link as above because I think it that important!)
Pre- and post-op nutrition (Midwest Orthopedic Specialty Hospital)

Description of surgery (Bart Eastwood, DO).
Part 1 (Overview)
Part 2 (Periprocedure)
Part 3 (Technique)
Part 4 (Medication)

Video of surgery (Viewer discretion warning as this is surgical video, not scope view only. I am not remotely squeamish and I am incredibly curious. I had no issues watching, rather found it fascinating! However, I am aware others may have issues watching.)
Hip arthroscopy video (JW Thomas Byrd, MD)

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