LPAO 8 Dec. 2015

I am currently 16 weeks post-op from my left hip surgery Dec. 8th, 2015. My left hip surgery included an open surgical dislocation entirely through an anterior approach, labral reconstruction with allograft, acetabuloplasty, femoral osteochondroplasty and LPAO. It made for a long day and I was scheduled for about 6 hours. We where concerned with pain management due to the EDS and CRPS. The EDS makes locals and blocks ineffective or wear off much quicker than in the average patient. The docs decided on a lumbar plexus block, spinal block, iliacafascia block with On-Q pump and local anesthetic for the initial first few days post-op. We later learned that the On-Q pump catheter was kinked for the first 2 days in the hip dressing which contributed to the inability to control post-op pain. Dr. Swann even called me the night before surgery to check on me and answer any last minute questions that I had.

The OR was a very busy place between Dr. Swann, the anesthesiologists, nurses, tech reps, etc. It made the process more nerve-wracking then I expected. Originally, the pre-op imaging showed only some labral fraying, but after Dr. Swann was in the joint and the labrum, we where very glad that we planned to have a graft as a back-up because it was completely destroyed. Had we waited much longer for surgery, the left hip would not have been able to be salvaged. Swann was able to reconstruct my labrum, smooth out the femoral head and socket as well as correct my LCEA to 35 degrees. It was a long surgery, but everything was able to be accomplished.

I spent 5 nights in the hospital. Dr. Swann came by every morning to check-in and if he didn't stop in again in the evening he would call or text to check in on me. He placed a woundvac on my incision because of my history, but prior to discharge the wound care nurse decided to change the bandage without consulting with Dr. Swann. Not only was he furious for changing his dressing without notification, but the nurse ended up putting on a dressing that was contraindicated. Dr. Swann advocated for me and made sure the nurse was reprimanded for her behavior. The dressing ended up excoriating my skin leaving it scarred and feeling like my skin had been ripped off. Swann even made a house call that weekend because I was having so many issues with the woundvac and dressing and he didn't want it to wait till the week.

It didn't take too long after the woundvac was removed that my wound re-opened. Not the first time it happened, but I needed up with a different woundvac and a home wound care nurse to help close the incision. I ended up with severe nausea and feeling miserable for the initial weeks post-op. I was so miserable that my protein levels dropped dangerously low. We where unaware that the levels where that low until the wound continued to  re-open and the pain increased. By nearly 4 weeks post-op the wound dehiscence was worsening despite the woundvac, I was miserable with increased pain and felt so sick.

Dr. Swann re-admitted me to the hospital on Jan. 3rd, 2016. I had a hip aspiration done the following day with Interventional Radiology to check for an infection based on my symptoms and history with  infections. After the hip aspiration I went to the OR for Dr. Swann to clean out and re-close my incision. That is when I found out about the low protein levels and had to really increase my daily protein intake or the healing process would continue to be severely compromised. I was 4 weeks post-op and there was no sign of bone growth up to that point. The day after surgery I was sent back down to Interventional Radiology to have a PICC line placed. Although my cultures for infection came back negative, my protein levels where so critically low that I had no immune system and would need strong antibiotics (Vancomycin) to prevent any serious infection as I further recovered. The PICC line and IV antibiotics would be used for at least 4 weeks along with the woundvac to make sure my incision healed and prevent infection or further complications. I spent 4 nights in the hospital before being discharged to go home.

At my 6 week/2 week post-op appointment I was doing a lot better and the x-rays showed some progress in healing with some actual bone growth. I had even lost weight since my LPAO. Those would not be the only road blocks that I would face during recovery. By 10 weeks post-op, although there was a little more bone growth I had developed an inferior pubis ramus fracture. By 12 weeks post-op, the bone growth didn't seem to be progressing as well and what was a stress fracture was quite a visible fracture on x-ray. Dr. Swann prescribed a medication called Forteo that is used to treat osteoporosis, but had been studied and shown good results in healing fractures and non-unions. Unfortunately, insurance denied a prior authorization and 2 appeals by Swann and we are not able to pay the $4,900/mo. for 2 months that I would need the medication. During my 14 week follow-up we did further x-rays that showed minimal healing progress. I would remain on both crutches till 22 weeks post-op, increase my Vitamin D intake and continue to fight insurance for coverage of Forteo. If healing continued with minimal progress, then Dr. Swann would want to further discuss adding additional hardware to stabilize the fractures and promote more healing. Also, because it took 15 weeks for my incision to completely heal, he would not want to re-open a large incision due to my poor healing and would use a guided wire to percutaneously place more hardware to stabilize the fracture sites. To date, I have lost 30lbs since my LPAO. I will also see Dr. Swann again in 2 weeks to check on my bone healing progress. Fingers crossed for significant improvement!!!