A lot of the afternoon was paperwork, lots of waiting around, seeing Dr. Mayo's (resident?) James Learned initially, then more waiting around, obtained additional x-rays, then we saw Dr. Mayo with his resident for maybe 45 minutes or so. I am really not sure the amount of time actually, I was in a weird time warp? The day was really overwhelming if I am honest. Overall, I have a top hip surgeon in the US sort of stumped with my case or at some road blocks proceeding with caution. I can't blame him and I highly value his expertise.
In summary, I have acetabular over coverage even after acetabular rim trimming with my previous hip scopes. My Acetabular Center Edge angle measures at 56 degrees on the x-ray from today. I currently do not have updated hip angles on CT after my last surgery. Once I have them from my additional imaging, I will be sure to update this post or add a new one.
My anterior wall is prominent while my posterior wall is deficient. My hip starts feeling pain at 80-85 degrees flexion; he believes this is from the acetabular rim rather than AIIS impingment or from the femur itself. Normally this can be fixed in a hip scope but since two have already failed, Dr. Mayo doesn't think a scope can fix this. He would either need to remove more bone off of the rim or achieve this by reorienting the hip socket with a PAO or some sort of combo open procedure? He was suggesting what he might in way more detail but it is currently way over my head! He described the method as "unchartered". It is a little shocking to have a doctor who has been in the field for 30 years to call my case "unchartered". Yay me??
Next Steps:
1) Receive a cortisone injection into the joint with cortisone and lidocaine then keep a pain diary with a scale of 1-10
2) Prior to the cortisone injection maybe use the fluoroscopy as a diagnostic tool to obtain real time movement of the joint. I don't believe he has made a decision on this step.
3) More imaging via a CT. If the new 3D model on the computer doesn't give more answers then he will actually MAKE a 3D model to monkey with in real life in order to try and recreate my pain. This would help in diagnostics and how he could approach the repair. At that point we will have to decide if surgery outweighs the risks.
I should be scheduling the injection and CT within the next week. We need to see if the injection works and for how long. So I will follow up with Dr. Mayo in about 6-8 weeks. If we proceed with the surgery I am assuming it would then be another couple month wait. Can't I just snap my fingers and this be all over?! I dream of.... being a normal 30 year old!
But don't fret, I will certainly be obtaining multiple opinions before possibly slicing my pelvis in 3 areas and reorienting it. The good news is Dr. Mayo probably would have recommended trying the hip scopes if I had seen him in the beginning of the diagnosis path 3.5 years ago. So my arthroscopes weren't a huge waste of time! And this wasn't caused by any particular surgeon. Just stupid genetics with a wild adventure in mind!
Here is my CT imaging prior to the revision surgery. This is what we can compare it to in the next few weeks.
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