The HSS Operative Record
Patient Name: Me Date: 17 September 2007
Attending Surgeon: Dr. Kelly
Operating Surgeon: Dr. Kelly
Preliminary Diagnosis: Right hip labral tear with snapping psoas, Synovitis, Combines Cam and Pincer Impingement
Postoperative Diagnosis: Same
Name of Operation: Right hip arthroscopy, Labral tear, debridement, synovectomy, partial psoas and acetabular rim decompression with labral re-fixation and a cam decompression.
Anesthesia: spinal
Estimated blood loss: less than 20cc
Inoperative fluids: one liter of ringer's lactate
Drains: none
Indications: The patient is a 37 year-old female with progressive right hip pain, right worse than left. The patient had combined Cam and Pincer impingement with snapping psoas and inflammation. The patient had persistent symptoms despite non-operative measures and given these persistent symptoms, the patient was indicated for right-hip arthroscopy and associated procedures.
Procedure:
The patient was correctly identified in the Holding Area and the patient was brought to the Operating Room. The spinal anesthesia was administered. The patient was placed in supine position and approximately 10mm of distraction was achieved from the acetabular joint. The right hip was prepped and draped in the standard surgical fashion.
The lateral portal was established under fluoroscopic guidance using the Seldinger technique. A distal lateral accessory portal and a posterior portal were both established under direct visualization. The arthroscopic examination of the central compartment demonstrated a labral tear anteriorly with a significant synovitis with areas of early delamination of the anterior and superior cartilage consistent with Cam impingment and crushing of the synovium and labrum anterior, superiorly consistent with Pincer impingement. There was also extensive tension on the psoas anteriorly consistent with psoas impingement.
The cartilage on the femoral head was otherwise in good condition. The ligamentum teres was in good condition. The patient had a (looks like a word was whited out) injury posteriorly. At this point, a wide synovectomy was performed using the Tac-radio frequency probe starting posteriorly and working our way anteriorly. The labrum in the front where it was torn was debrided gently preserving the majority of the labrum. A capsular cut was then made connecting the anterior and anterolateral portals for elevation of the capsular tissue off the acetabular rim lesion.
The acetabular rim lesion was identified and then a 5.5 mm high speed bur was used to recontour the acetabular rim. The fluroscopy confirmed the appropriate resection. At the completion of the acetabular rim decompression, the psoas was partially released over the front of the joint where it appeared to be compressing the labrum anteriorly. The labrum after it was debrided was stabilized through the transition zone cartilage using the radio frequency probe but no suture anchors were required.
All cartilaginous loose debris was evacuated from the central compartment at the completion of the synovectomy. A partial psoas release, acetabular rim decompression and labral debridement. The scope was placed in the peripheral compartment as the traction was released. The hemi hip joint was placed back in the socket. A Cam lesion was identified and then a Cam decompression was performed using fluoroscopic guidance to confirm the appropriate resection.
The dynamic arthroscopy was performed demonstrating the absence of any residual impingement. At the completion of the Cam decompression, no further pathology was identified. The instruments were removed from the joint and the arthroscopic portals were closed with 3-0 nylon sutures and a marcaine cocktail was placed into the joint. The wounds were cleaned, dried. Sterile dressings were applied. The patient was awakened from anesthesia and brought to the Post Anesthesia Care Unit having tolerated the procedures well.
07 October, 2007
One step forward, two steps back
At least that is what it feels like at times. I have slept the last two nights but only because I've taken my "magic" pills. I am trying to get as much sleep as possible to get ready for next week.
My mother and I did a 'test run' to the office on Friday. I was originally going to do it during rush hour, but since I hadn't slept that night and was so sick from the pain killers, it was delayed for a few hours. We ended up leaving about 12.10 pm from the flat. I had to walk one block to the crosstown bus, take that to 6 long blocks to the Park, and then switch to a downtown bus. There was a lot of traffic from road works. We finally reached my stop, got off and walked a block and a half to the office. The whole trip took over an hour. I was pretty wiped out when we got to the office, but at least I made it. I waited there for a bit to see one of my coworkers who was out to lunch, and also thought to ring Dr. Kelly's office to see if they had the surgical report yet. After a couple of calls they finally faxed it to me. I will see if I can post it as the PDF or will have to retype it all. I was also extremely relieved to find out that my bosses will be out on Monday and that M arranged for me to work from home. It felt like a stay of execution - not that work is horrid, just getting there at present is quite a workout.
After we left the office we stopped to get something to eat, I had just a little as I was still queasy from the pain meds, and then we took the bus up Madison. It was not even rush hour but the bus, when it finally did show up, was absolutely packed. No matter when I take this bus line it seems to always be delayed and always be packed like a sardine can. I had to ask a not very happy looking girl to get up so I could sit down. Unfortunately my mother had to stand and I felt so bad, she was getting jostled all about. Some woman decided to step on my right foot with all of her weight for a minute or so, she seriously wouldn't move, put all of her weight on it, till I finally let out with an expletive! My toe throbbed for over an hour. It's like constantly getting beat up, no matter how hard you try.
Yesterday was a bit of a late start, but we didn't have any place to go so it was ok. I had some pictures from my Gran's flat that we needed to hang so we did that. A friend was meant to come by but never heard from her so we went across the street to Starbucks and sat outside for a couple of hours, then I tried to walk around a little bit. I am still wearing my brace as I feel much more secure with it and the doctor told me that I should wear it as long as I feel so. We ended up going to a German restaurant near me, and even though it was early the place was very crowded as it is Oktoberfest. It was pretty good but very expensive. And it also delayed my return to my flat. I normally love my flat but am so tired of it.
Think I will go eat some breaky and do my PT. I have to go shopping later to get lunch supplies for the week also. My mother is going home today and I am stressed about that. She has been a life saver these last few weeks. I wish I had some dosh so I could send her on a well deserved and earned holiday, this year has been rough for her, not even including my surgery. I should start playing the lottery! My friend T is meant to stay with me tonight and for at least part of the week, so I won't be completely alone which is good. I am getting around better in the house but I still feel better if someone is around for the time being. It's all so stressful.
On one other note, this has been a very difficult recovery, not just the hip itself, but all of my other body issues (hands, shoulders, etc). I would like to thank those people who spent time with me. Even a brief visit was such a welcome break from the monotony of this slow recovery - so just wanted to say thank you.
My mother and I did a 'test run' to the office on Friday. I was originally going to do it during rush hour, but since I hadn't slept that night and was so sick from the pain killers, it was delayed for a few hours. We ended up leaving about 12.10 pm from the flat. I had to walk one block to the crosstown bus, take that to 6 long blocks to the Park, and then switch to a downtown bus. There was a lot of traffic from road works. We finally reached my stop, got off and walked a block and a half to the office. The whole trip took over an hour. I was pretty wiped out when we got to the office, but at least I made it. I waited there for a bit to see one of my coworkers who was out to lunch, and also thought to ring Dr. Kelly's office to see if they had the surgical report yet. After a couple of calls they finally faxed it to me. I will see if I can post it as the PDF or will have to retype it all. I was also extremely relieved to find out that my bosses will be out on Monday and that M arranged for me to work from home. It felt like a stay of execution - not that work is horrid, just getting there at present is quite a workout.
After we left the office we stopped to get something to eat, I had just a little as I was still queasy from the pain meds, and then we took the bus up Madison. It was not even rush hour but the bus, when it finally did show up, was absolutely packed. No matter when I take this bus line it seems to always be delayed and always be packed like a sardine can. I had to ask a not very happy looking girl to get up so I could sit down. Unfortunately my mother had to stand and I felt so bad, she was getting jostled all about. Some woman decided to step on my right foot with all of her weight for a minute or so, she seriously wouldn't move, put all of her weight on it, till I finally let out with an expletive! My toe throbbed for over an hour. It's like constantly getting beat up, no matter how hard you try.
Yesterday was a bit of a late start, but we didn't have any place to go so it was ok. I had some pictures from my Gran's flat that we needed to hang so we did that. A friend was meant to come by but never heard from her so we went across the street to Starbucks and sat outside for a couple of hours, then I tried to walk around a little bit. I am still wearing my brace as I feel much more secure with it and the doctor told me that I should wear it as long as I feel so. We ended up going to a German restaurant near me, and even though it was early the place was very crowded as it is Oktoberfest. It was pretty good but very expensive. And it also delayed my return to my flat. I normally love my flat but am so tired of it.
Think I will go eat some breaky and do my PT. I have to go shopping later to get lunch supplies for the week also. My mother is going home today and I am stressed about that. She has been a life saver these last few weeks. I wish I had some dosh so I could send her on a well deserved and earned holiday, this year has been rough for her, not even including my surgery. I should start playing the lottery! My friend T is meant to stay with me tonight and for at least part of the week, so I won't be completely alone which is good. I am getting around better in the house but I still feel better if someone is around for the time being. It's all so stressful.
On one other note, this has been a very difficult recovery, not just the hip itself, but all of my other body issues (hands, shoulders, etc). I would like to thank those people who spent time with me. Even a brief visit was such a welcome break from the monotony of this slow recovery - so just wanted to say thank you.
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