Road to Recovery After a Left Hip Arthroscopy

On Wednesday 22^nd October  2014 I underwent a left hip arthroscopy because of the femoroacetabular impingement (FAI, mixed impingement) with labral tears that were diagnosed following months of pain, an MR Arthrogram and a CT scan.

DAY OF THE OPERATION

The operation was a success but the hours following the operation were awful because of the anaesthetic and the morphine. I was awoken from the operation in tears (I was confused and couldn’t formulate a sentence – the nurses thought I was in pain so they gave me more morphine). While patients are usually discharged after 4 hours, I had to wait 8.5 hours because of the nausea (which prevented me from having the mandatory pre-discharge physiotherapy session). The morphine had relaxed my bladder muscles therefore I wasn’t able to pass urine. Any hip pain wasn’t really that apparent – I would occasionally get some instant and sharp pains if twisted or moved into an awkward position but my main focus was trying to ease the nausea. I was sick a few times in the afternoon, which allowed my body to start getting rid of the drugs from my system; I had my physiotherapy session at 6pm and I passed urine at 7.15pm.

My surgeon came to see me mid-afternoon to explain what he had done but I was so high and nauseous I barely remember the conversation. I do remember seeing pictures of the destroyed labrum and the cartilage that had started to peel away.

RECOVERING FROM THE OPERATION

While I breezed through the physiotherapy exercises on the day of the op, the 1^st day post-op was quite tough. I slept beautifully but woke up feeling like a bus had hit me. I couldn’t move well, I was still groggy and incredibly nauseous. My sister helped me to shower – I dropped the soap and just looked helplessly at it as I couldn’t bend down to pick it up or wash my lower body. I needed my crutches for everything, even just to shuffle a few steps, as my leg was too heavy for me to be able to lift unaided.

I managed 1 flight of stairs, with crutches, using the method the physiotherapist had taught me: bad foot down to hell, good foot up to heaven – operated leg first when walking down stairs (so that it remains straight) and non-operated leg first when walking up stairs (so that the operated leg remains straight again).

On the 2^nd day post-op I was moving a lot better and felt as bright as a button when I woke up. I still had to stare at the soap when I dropped it (again) but I could walk (as opposed to shuffle) around my flat most of the day without my crutches. Putting socks and pants on was difficult because I couldn’t bend the leg or my body to reach down properly so I was glad I had someone around to help me to dress and shower.

On the 3^rd day post-op I could walk and do stairs unaided. I didn’t drop the soap but I still needed some help washing and drying my ankles and feet. Overall there was significant improvement in my mobility for every day activities. The physiotherapy exercises were becoming easier so I increased the reps, modified the exercises so that my foot was hovering above the floor and I added some other exercises that I knew would help to strengthen the hip joint without fatiguing the supporting muscles too much. While rest is important I do also think that the body needs to be challenged in order to keep improving – but at no point did I feel any pain from these modifications.

On the 4^th day I was finally able to wash/dry my ankles and feet unaided. I was a little concerned about some hip clicking that I had also experienced pre-surgery (due to the labrum being torn) but my physiotherapist assured me this was common as it was most likely post-op fluids and the inflammatory process happening in the joint and that it could be expected for up to 3 months post-surgery.

MEDICATION

I was still experiencing some nausea after 3 days and after investigating the medication I was taking, I was horrified by the list of side effects for Pregabalin (Lyrica) that I was expected to take for 2 weeks for nerve damage. I came off it after 5 days (with the surgeon’s blessing) as I had no nerve damage (I can’t fire up my left glute properly but I have a sport tens machine to help with that). I am taking Celebrex for 4 weeks to prevent bone forming in the muscles and I didn’t need painkillers for more than a couple of days.

PHYSIOTHERAPY EXERCISES

While the improvements were quite significant initially (for every day activities such as walking, going up/down stairs, bending/squatting down to pick something up), I have seen fewer obvious improvements since then and am now primarily focusing on improving my internal and external rotation. I can squat properly (with a Swiss ball between the wall and my back), I can bridge very well and have increased the intensity by elevating my feet and using a resistance band around my knees but I can’t do bent knee fall outs without pain at the end of the movement because of my lack of rotation. I am swimming to move the hip joint more (only crawl; can’t breaststroke yet) and using the upright cycle. Any other cardio machine will put too much pressure on the hip joint with the repetitive movement.

I had my initial post-surgery physiotherapy session after 9 days and my physiotherapist was pleased with my progress as I can already do exercises from the 4-6 week post-op section of the rehab chart. I put this down to how physically active and mobile I was pre-op and the quality of my nutrition. My focus is to improve my lower body mobility as much as possible so that when I have my left shoulder arthroscopy at the end of November I will still be able to exercise my lower body whilst my upper body recovers in time for my right hip arthroscopy at the end of January 2015.

ADJUSTMENT PERIOD

I have a gym bench at home and some dumbbells so I created a little upper-body circuit of seated exercises (so as to not put any pressure through the hip joint) as I am a little concerned about the effect that this no-exercising is having on my muscle mass. The tens is helping to stimulate the muscles but I’m worried about losing all of the muscle mass that I have built up over the past couple of years. Even just doing a little bit really helps to keep my motivation and positivity up as mental attitude is extremely important when recovering from surgery. It’s easy to become deflated by the lack of progress, putting weight on through inactivity, giving in to the pain – exercise helps to stimulate the blood flow, the mind and get the serotonin pumping through your body.

Not being able to exercise properly has required a mental adjustment as I used my interval training to lose body fat and my metabolic weight training to maintain muscle mass. I am now relying on my nutrition to save as much muscle mass as possible and also not put on too much body fat – my carbs are low (max. 80gr/day), my protein is high (around 220gr per day) and my fats are reasonable (max. 30gr per day). I am keeping my weekly sessions with my personal trainer as it is important to have a focus and he has weighed me every week since we started training together in order to ensure that I am on the right track. While our training over the coming months may be very different to what I’m used to given my physical limitations, there is no reason I shouldn’t be able to stay on top of my fitness and my nutrition with some discipline and a positive mindset.