Femoral Acetabular Impingement Repair

 It's been a while, I know. I've been wanting to get caught up on my blog for several months now (okay, like eight) but life has gotten ahold of me and taken me for a ride! So I think I will start with the present and hopefully I will be able to work backwards until I am caught up.

About a year and a half ago, Josh hurt his hip in a soccer tournament (go here to see the post). And, here it is 20 months later and he is recovering from surgery. It's been a very long road for him. He has had physical therapy off and on since December 2011 and has constantly been taking time off from soccer to let it heal.

For the last year or more, he has described the pain as a "pinching" or  "catching" feeling. And on several occasions, he felt a "pop." There were times when he would be on the soccer field in the middle of a game and it would "lock up" on him and he would have to come out of the game.

We have seen doctors at Primary Children's, Granger Medical, Mountain Orthopaedics, Exodus Health Care and more that I can't even remember. He has had x-rays, a CT scan, an MRI and more x-rays. We were told everything from "there's nothing wrong" to "his labrum is torn" and "rest" or "more physical therapy." But, he was frustrated. Nothing was working. Nothing was making it feel any better and he was still missing out on a lot of his favorite things - especially soccer. He hasn't been able to participate in P.E. since he has been in Jr. High. He's been on crutches numerous times.

I could go on, but you get the point. It's been frustrating.

Finally, we found a doctor that knew exactly what to look for and how to fix it. Jer took Josh to see Dr. Aoki at PCMC about 3 weeks ago. They took more x-rays and immediately Dr. Aoki could see that surgery was necessary - and right away. They scheduled a hip repair outpatient surgery that day for August 12.

Dr. Aoki explained to us that Joshua has what is called Femoral Acetabular Impingement (FAI).  "Basically, the ball (femoral head) and socket (acetabulum) rub abnormally creating damage to the hip joint.  The damage can occur to the articular cartilage (smooth white surface of the ball or socket) or the labral cartilage (soft tissue bumper of the socket). FAI is associated with cartilage damage, labral tears, early hip arthritis, hyperlaxity, sports hernias, and low back pain. FAI is common in high level athletes, but also occurs in active individuals." (hipfai.com) 

Finally! An answer! While Jer and I have not been the least bit excited about our fourteen year old son having surgery on his hip, we are thrilled to know what is going on! And so is he. 

Monday was August 12 - surgery day. We arrived at PCMC at 8:30a.m. By the time Josh was checked in and the doctors were ready, it was just before noon when he went back for surgery. It is typically a two hour procedure. Josh was in for almost three hours. Dr. Aoki was very pleased with how well the surgery went. The FAI was a bit more prominent than what the x-rays showed so there was more bone that needed to be shaved down than the doctor had predicted. But, the tears in the labrum were not as extreme so they did not need to be sutchered. Josh will likely have arthritis in his hips when he is older and there is a possibility that the FAI will present itself in the future (in his left hip). But, his right hip is finally fixed. 

We were able to go back to recovery with Josh just before 3:00p.m. He was in good spirits and said his pain level was at a 6. Unfortunately, even though we had warned the doctor that Lortab isn't our drug of choice (I don't do well on Lortab), they started with that to prevent extreme pain as the nerve block wore off. Not long after they gave him the Lortab, he broke out in hives and his pain level went to an 11 (unbearable). His heart rate went way up. His blood pressure was high. He was shaking and had a tight grip on the hospital bed. I've never seen my Joshy in so much misery. It was not fun. When the nurse came in to see what was going on, she suggested giving him benedryl to help with the rash and Fentanyl to help with pain. Then, she gave him a second Lortab. For several hours, Josh would fall asleep and within 4-5 minutes wake up to sharp excruciating pains in his hip. Even with all the narcotics in his system, his pain level was at a 9 or 10.

Around 8:00p.m., Dr. Aoki suggested they give him Percocet and Valium and avoid giving him more Lortab. This combination did the trick. He finally relaxed. And, by 9:00 he was ready to go home. We were all exhausted. I didn't realize how tiring it would be to spend the day at the hospital. I'm sure my emotions were a big contributor. 

 We got Josh home and comfortable on the couch around 9:30p.m. and Jer left to grab the prescriptions before the pharmacy closed and to pick up the girls who had been with my parents all day. Within a few minutes of getting Josh home, Ron Whicker rang the doorbell. Rachel made a pie for Josh and Ron was delivering - it was still warm. Even though Josh was loopy from the drugs and exhausted from the day, he was thrilled with the pie and anxious to eat it.

Each day since the surgery has been very different. He spent day 3 not being able to keep anything down (including pain killers). On day 4, Jer took him to the USA Soccer Tournament in West Jordan to watch his old team play. It was a lot of work for Josh, but there's no better therapy for him. He loves being on the soccer field. He was tired when they got home and he slept the rest of the day. Day 5 was mostly uneventful. He slept a lot. On Friday he was able to take the bandage off the incisions. That felt good. And today is day 6. Jer took him out to the soccer tournament again this morning. Even though it's painful to sit, he was happy to see some of his teammates and feel "normal" for a bit. He has been in quite a bit of pain today as we are cutting back on his meds a little. And, the itch deep inside his hip is about to drive him crazy. But, he took a shower tonight and that was a good start to feeling human again. There are still steri strips on the incisions so he still has to be careful about getting those wet until they come off, but even a 5 minute shower is better than the sponge bath he's had the last few days.

 This little machine is full of ice and pumps freezing cold water into a pad that he can put on his hip. This has been the best form of relief for him. He can't leave it on for long because it can be too cold on his skin, but it is his favorite way to take his mind off the pain.

This picture is a lineup of his medications. It's pretty crazy what they can give a teenager. He is tall - 5'10" and 150 lbs. but, narcotics and valium? He will be on the naproxin for several weeks to prevent any bone from trying to grow back and to keep the inflammation down, but hopefully he will be done with the rest soon. He starts physical therapy in a week and will have a follow up appointment with Dr. Aoki at 4 weeks. He will be on crutches for about 4 weeks, but should be back to running at 3 months. His full recovery will take about 6 months. While that seems like forever to a kid, it's nothing compared to a lifetime of being able to play soccer every day without pain.

That was a rather lengthy first post after my 8 month strike (laziness), but I wanted to get it all down while we are still in the midst of this crazy adventure.

I will definitely have to do some updates on the girls and all the other awesome things that have taken place in the last several months, but for now, that will have to do.