Anteverted

For my skating friends who talk about "open" and "closed" hips - this diagram gives a nice visual for the anatomy behind the terminology. (My hippie friends already know about angles of version.) I have severe anteversion (see "B" in the diagram). Those of you who are "open hipped" are more like "C" in the diagram. Dance and skating are both much easier for "A" and particularly "C" people. Many coaches who have normal or open hips don't understand how challenging it is for closed-hip people to do even simple things like Mohawks, although twizzles, hydroblades and loops may be easier.

There is a limit to how much external hip rotation you can get if your anatomy is similar to "B" - but there are ways to maximize what you have. "Turnout" includes external hip rotation as well as rotation from the knee and ankle/foot. Once you reach the end of your external hip rotation, no amount of stretching is going to change the alignment of your bones.

Pre-PAO, I was able to get a lot of hip rotation because my hips weren't in their sockets, so they turned more easily. However, this caused bad things to happen, including lack of stability, arthritis, and labral tears. My body learned to turn out below the knee to get things to happen, but my on-ice movement and alignment never looked correct to me when I watched myself on video or saw myself in photos. It all makes sense now.

HO Status Report

I spent two weeks vacationing in Spain, and walked everywhere - up to 10 miles daily, over cobbled streets - and my hips held up just fine. But there is a lot of residual weakness all over the place.  At my 3-month visit to Dr. Santore he signed me up for physical therapy. More on that later.

I've skated twice, and it's the typical cautious return that happens every time I'm injured or cut upon. After dinking around a couple of times I decided to wait until everything is stronger. My PT, Ashley, worked with me after I sprained my ankle and already knows a lot about my body alignment issues.

I'm convinced that even during my PAO rehabs, I cheated on a lot of my exercises, and therefore everything that was weak then never got strong and I just learned how to compensate differently.  While this means the body is a wondrous machine, it really doesn't help me skate better.  This time I vow to do the exercises right, even if it means I can't walk the next day.

And that's about where I am -- in a lot of pain. I'm working the hip flexors, the glutes, the quads, the glutes, the hamstrings, the glutes, the adductors, the abductors, and of course, the glutes. Ashley showed me the CORRECT way to do clam shells which proves once and for all that I never did them right in the past.

GLUTES GLUTES GLUTES! It's all about the glutes.  I'm a skater, for Pete's sake, and I've never had strong butt muscles. So of course my body is all wonky and misaligned and crying out for help.

I guess at age 52 it's time to fix this once and for all.

HO Update

I've had one reader (yes you LS, how ya doing?) ask me to do a followup and I've ignored that request until now as life has just been SO. DARN. BUSY.  But I have a small break and thought it would be good for my hippies and skatepeeps to know what's going on.

It seems I can never do anything in moderation and Dr. Santore described the amount of bone he removed from my left leg as "massive." He seemed astounded that there was even more than what showed up on the x-rays and I was grateful that he removed that too.  So, he basically detached the rectus femoris muscle at the tendon insertion point (for the second time, as this was done during my PAO) and then, I believe the medical term is "chopped and hacked" until all of the bone was outta there.  That bone was blocking my internal rotation as well as flexion (ability to bend at the hip).  He then removed the other bone that was growing on the outside part of my lower pelvis that was blocking external rotation - which we didn't even know about until he was in there and saw it.

I had noticed that the outside of my hip looked "bulgy" after my PAO but never realized that bulge was caused by HO.  So I am more than thrilled that it's out.  I can sit in a V for the first time; I can reach forward and touch my toes.  I can put on shoes that buckle on the outside.  I can put on socks like a normal person.

I had a lot of nerve pain during the first month or so, which has mostly resolved.  I do have a large numb patch on my upper and mid thigh (even more than after my PAO).  Dr. Santore couldn't see the nerves because of all the scar tissue and bone and so he's pretty sure the chopping and hacking impacted the nerves.  Now that the sharp pain has resolved, the numbness doesn't bother me and may eventually resolve as well.

I also had a pretty severe reaction to the adhesives used on me.  We're not sure which one it was yet, but not only did the skin around my incision blister, I broke out in hives all over my body and that took 3 weeks to resolve. The culprit may be Tegaderm or the glue used on the incision. We will do some patch tests to figure this out.

I took one Tylenol 3 the day after my operation and a couple of Tylenol the next day. Other than that I haven't taken any medications except the strong NSAID I take daily to keep the bone from growing back.  I have to take that for 2 months.

There is a lot of residual weakness in the hip flexors. I'm not yet allowed to work on strengthening because Dr. Santore wants everything to heal.  As previously stated, he did a lot of chopping and hacking.  I still have to use my hands to lift my leg into the car, for example.  But this is no different than after my PAOs and I think with some work that strength will come back, at least partially.  I won't try to skate until more healing has occurred - I'm thinking in April.  Meanwhile I have been walking and stretching and I can do 3 miles walking in my neighborhood on hard pavement with no pain.

Dr. Santore is a god by the way - in the same god-like way that Dr. Mayo is a god. They are my heros.  And Dr. Santore is one of the nicest people around.  I just can't say enough good things about him.  I've been so lucky to have such great medical care for such a difficult and rare condition.

That's my update -- I go back to see Dr. Santore in early March, so watch this space for more updates.

H.O. and Hardware Removal

***Please excuse any typos - I'm still under the influence of anesthesia!

Today's follow-up surgery was so different rom my prior hip surgeries.  After experiencing the mother of all hip surgeries twice, I figured this one would be significantly easier and it was.

Unlike the PAOs, where Perry and I stayed in a hotel in Tacoma 3 hours from our house and had to be at the hospital at 5:30 AM, today's surgery was at noon.  I slept in my own bed last night and we took our time going to the hospital around 9:00 AM after a full night's sleep.

This surgery was outpatient - once I was stable in the recovery room I was allowed to go home.  I'm sitting on my recliner at home right now. My pain is well controlled.

I was not very nervous for this one, which is unusual for me. I did know that this would be a much simpler surgery but I'm always nervous around doctors and hospitals.

Dr. Santore was able to successfully remove all of the H.O ("a massive amount," as he told me) and put my rectus femoris tendon and muscle back together.  He also moved some bone that wasn't showing on the x-ray, outside of the rectus femoris, which was preventing external rotation. I am beyond excited that I now have better internal rotation as well as unexpectedly-better external rotation.

He re-used my original scar which is great.  He was also going to remove as many screws as he could easily reach, but when he tried to remove the first one it broke off so they are staying. Dr. Mayo countersinks screws, and it has been five years,  so we knew this could be an issue.  The screws don't really bother me other than a little sensitivity with cold weather but it's always good to NOT have metal in your body if you have the choice.  Oh well!

At least now I have 12 and a half screws instead of 13!

I'm tired from the anesthetic so signing off now.

Act Two

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.

Five Year Hippiversary

Well.

It seems I only update this blog now on my hippiversary. That's good news -- because my hips are no longer a big deal. In other good news, not much has changed since my last report a year or so ago, or the report before that.

I have been walking as much as I can, and I can easily do 3 - 4 miles at a good pace. I'm not race walking and I'm certainly not jogging, but I am able to do more than I could in the past because I've worked at it. I still may get sore if I walk a long way on hard surfaces, but it's not the kind of soreness I experienced before my PAOs. I still don't think walking is the best exercise for me or for many post-PAO patients. However, I enjoy it and now that I've moved to San Diego where it's sunny one of the joys of my existence is walking on the beach and around my neighborhood. So, I've worked to build up those walking muscles. It can be done.

Due to an ankle injury, I haven't been able to skate since October. I thought my hips would be the end of my skating and I see the irony in knowing that I was able to come back from the PAOs -- not to my prior skating level, admittedly -- but I was able to work on international dances again. It took a sprained ankle, not a broken pelvis, to end my skating career. Beware the sprained ankle, readers! If your hips are unstable you may be more likely to roll your ankle. A high ankle sprain is not something to take lightly, and can lead to further problems such as Sinus Tarsi Syndrome (which I now have) if not allowed to properly heal. Anything called a "syndrome" is generally bad news when it comes to your anatomy. Consider yourself warned.

I still lurk on several PAO and hip dysplasia forums, and refer people to my blog when they ask. I know based on traffic reports that a lot of people from all over the world still read this blog. I'm always happy to answer questions from fellow hippies. If this chronicle has been helpful to you then it has served its purpose.

Peace out!  Terri

Almost Hippiversary

Hello Hip Readers!

As my 4th hippiversary approaches, I am happy to report that I am doing extremely well.  My right PAO will be 4 years old soon, and my left is just 4 months behind that.  Most days I don't even notice my hips.  I've been skating at the International level again and while I sometimes get sore the next day, I'm pretty amazed at what I still can do, even with a fruit basket on my head.

Holiday Ice Show, 2012

 

I've moved from Portland to San Diego.  Long walks on the beach have helped build my walking ability although I'm still not going to be running any marathons.  Flexibility is still an issue, but that's old news.  I'm loving my new location and job hunting.  Ho hum.  Not much to report after 4 years, hippies - that's the way we want it!  Just for some excitement, here's a pic of my recent farmer's market haul.  Those of you in Portland will be jealous.

 

And now, back to my regularly-scheduled life.  

Terri