On a whim, I decided to see the best PAO guy here in my new home of San Diego just to be sure everything was still hunky dory after five years. Dr. Santore is just as legendary in the PAO community as Dr. Mayo, and deserves that reputation. As a result of my consultation, I will be having HO removal surgery on December 18th, making for a HO HO HO merrrrrrry Christmas.
For those not in the know, HO stands for heterotropic ossification. That's basically bone growing where it shouldn't be. This occurred not long after my LPAO and I've known about it and dealt with it for a long time. In my case, the tendon connecting my rectus femoris muscle (AKA one of the quadriceps muscles) to the hip area has ossified, or turned to bone. The amount of bone on the x-ray looks like, on a scale of "not much" to "OMG that's a whole lot o' bone in your hip," more on the OMG side. It is a couple of inches long and looks like a claw on the x-ray, right at the front crease of my hip where it bends. Which makes bending difficult. I've had to sit down to put on my shoes and socks on the left side since my PAO, and pants are also difficult. Bending forward to tie skates is difficult. Doing anything that requires my hip to bend more than 90 degrees is impossible as the HO bone just blocks the movement.
I wanted Dr. Santore to tell me if removing it would give me better ROM and he thinks it will. To prevent re-growth, he will treat me with a strong NSAID after surgery (some docs use radiation but I'm glad he does not as that comes with its own complications). I'm a little nervous about this since I have to GIVE BLOOD (I have the veins from hell) during the preop and Dr. Santore said it was possible that I'd lose strength while gaining ROM. Possible, but unlikely.
This is an outpatient procedure and compared to my PAOs should be a piece of cake. I'll be on crutches as needed, more for comfort than anything, but can bear weight right away. I don't think I'll need the heavy-duty narcotic pain killers this time. And, if all goes well, I'll be hitting the gym for rehab around the first of the year.
Other than that, Dr. Santore said that my hips were holding up well. The joint space and cartilage are good. PAOs are performing as designed. All good.
He did say that nowadays they don't put the hip so deeply in the socket in the back (we're talking the crease of my butt if you're trying to picture this). Evidently PAOs have changed a lot in 5 years. Hearing this, I realize this is why my ROM is so limited when I try to do good extension to the back as I skate. I just can't. My hip joint prevents it. I have been stretching and trying hard to get that extension to be better for FIVE YEARS without realizing that my hip socket's new location is limiting the ability to get to where I used to be. I always thought I was just inflexible because my soft tissues had been disturbed by the surgery, which is probably also true, but not causing this particular problem.
This is a bit disheartening. In fact, I was really upset by it at first. It means I will never, ever have that beautiful and graceful extension I used to have when I skate. My free legs will always be twisted to the side, no matter what I do. If I'd had my PAOs later, I might not have had to give that up. Sigh. I know I should be grateful for what medical science has done for me but damn it, I wish Dr. Mayo had explained to me how limiting that was going to be -- perhaps he and I could have worked out a deal. Give me a little more ROM, and I promise not to abuse my new joints. Something like that. Because obviously they do PAOs that way NOW. OK, I'm rambling on. It's done.
I will keep y'all updated on the HO HO HO since I know this is a common occurrence and many hippies will want the full story. For now, over and out.