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How a PAO is done – in layman’s terms March 1, 2010

Posted by hiphoperation in The op.
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A doctor and fellow PAO patient recently described how a PAO is done:

The cutting is done in part with mallets and chisels (exactly like a carpenters!) and a small electric saw… The leg is moved from straight to bent at hip and knee throughout operation but very little twisting, to ensure freedom of joint movement and to get to the joint. He [the surgeon] puts a big screw called a swhanz screw into the pelvis near acetabulum and once all the bone cuts (or osteotomie) are done uses this to mobilise the acetabular fragment and with use of x-rays gets it into the best position. Then uses 3-4 (4.5 mm wide and 10-14cm long) screws to fix it in place.

He then reattachs the two muscles he cuts to get to the hip join back to the pelvis with fibre wire. Stops all bleeding and closes. It’s obviously a lot more complicated than that and takes about 2-3 hours.

Simple as that!


The video I wished I hadn’t watched! October 15, 2009

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This video, presented by the amazing Andi Peters, is from City Hospital in 2005. Jenny is undergoing a PAO. Just look at the fricking tools they used. No wonder it hurts!

Week two update October 6, 2009

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Two weeks since my operation now. I hope the next few weeks go as quickly. I am pretty much back to work as normal now except I am working from my chair and can’t go to any external meetings. I haven’t gone mad from spending all my time sat in the same chair in my living room – yet. I’ve had at least one visitor every day which is really nice, I am making the most of the attention whilst I can. A friend who had an operation a couple of years ago told me that the novelty will soon wear off and no one will visit. I have been out of the house on three occasions this week. The first time was exhausting and emotional but the second and third were easier. We have brought the wheelchair out with us so that I can sit down if I get too tired or if I am nervous about being knocked over. The embarrassment of going to a pub in a wheelchair is outweighed by the guarantee of getting a seat!

The most frustrating thing is not being able to do simple things yourself such as picking something off the floor, or making lunch, or having a shower, or putting your socks on! I AM fed up with these surgical stockings. I have in my head that I have to wear them for six weeks but I’m not 100% sure. I suppose it’s better to be safe than sorry.

Six weeks of these babies

Six weeks of these babies

I have my first appointment with the physiotherapist in two weeks. No information provided about what I will be doing or what I should bring though. My 6-week check up with the surgeon is also confirmed now for 6 November. I must behave until then.

Scar status: Same as before but the glue is starting to peel off now. My lovely sister has bought me some Bio Oil which I will use as soon as I can.
Pain levels: No more sharp pains every time I sneeze, cough, laugh etc but it is still aching like mad. Seems to have got worse in the last 2 days.
Medication: Paracetamol and diclofenac still. The latter will run out tomorrow so I will have to find something else.

Crutch ability: Few trips out but still not confident. Sore hands.
High point of the week: Going to the pub (albeit in a wheelchair).
Low point of the week: Taking so long to go out and collect a pizza that it was cold when we got home. I cried.
Lesson learned: Recovery is not linear – thank you Maggie for reminding me.
Main achievement: Going out three times and not falling over.
Gains: Weight if I’m not careful. I am sitting on my arse a lot. And there are still lots of treats around.
Losses: Any chance of skiving off work.

Operation day (Tuesday) September 25, 2009

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I had hoped to keep a regular diary whilst in hospital but I think I underestimated how tired, spaced-out and sick I would feel. So here’s a catch up on the last three days.

I arrived at UCLH at 7am on Tuesday but it wasn’t my turn for the butcher’s block until 12.30pm. Apart from the boredom of waiting, the worst thing was not being able to eat or drink anything.

I was very brave up until the final moment and started to panic as they began pumping me with anaesthetic. Silly, as this really was the point at which there is no going back. I’m not really sure what I was scared of, probably just knowing that things are going to be a bit of a nightmare for the next few months.

I woke up 4-5 hours later feeling quite spaced out and with various tubes sticking out of me. After about an hour in recovery, I was taken up to my ward which I have been sharing with three VERY nice ladies who have all been looking out for me and for each other. We are on an orthopaedic ward so everyone has had dodgy hips or knees and is wizzing around (or attempting to) on zimmer frames or crutches. It is nice to see others reaching different stages in their recovery – something to look forward to.

I can’t tell you yet what they did to me but I have a nice big, black scar. It is glued together so there’s no bandage or anything to cover it up. This is good as I don’t have anything to remove but also gross as I can see how horrible it looks. The surgeon came over and said that it had all gone well. I forgot to ask how many screws they have put in.

Previous experiences in traction September 20, 2009

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Thank you mum for digging out these photos! Here I am, back in mid-1981, stung up at 45 degrees by my ankles and seeming to enjoy myself very much. There will be no traction or plaster this time but I expect I will still be less brave and cheerful than my younger self.

Introduction September 13, 2009

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I was born with congenital dislocation of my right hip and thanks to some surgery between the ages of one and four I have lived a normal life without any major problems. My right leg is definitely less flexible but this has only been a problem when attempting to do things like yoga.

Almost two years ago, I started to get pain in my hip after walking for long periods. This coincided with a move back to London so I put the pain down to marching around on concrete and being generally unfit. The pain got more regular and progressively worse so in summer 2008 I finally went to my doctor to ask for advice.

I was refered to University College Hospital and had a couple of x-rays and MRI scans. My x-ray (below) showed damage to the hip socket and that the ball of the hip was not in the ideal position.

Note - the ball was to show how big a hip replacement might need to be

I don't have a ball up my bum. It is supposed to show how big a hip replacement might need to be.

From this you can see that the ball is not sat in the socket properly

From this you can see that most of the ball is outside of the socket.

The various scans also found that my hip socket was quite shallow and that the top of the femor is also an irregular shape. So all in all, a pretty dodgy hip. And to make it worse, the surgeon told me that it is common for hip problems to resurface as you approach 30!

In May 2009 I had a hip arthroscopy to investigate the source of the pain in my right hip further. The surgeon found damage to the hip socket as a result of the ball and socket not fitting together properly. To prevent further damage, it was recommended that I should have a periacetabular osteotomy (PAO) to fit the two parts together. He told me that this wouldn’t enable me to cross my legs properly but had a very good chance of getting rid of the pain. He also told me that the surgery should delay a hip replacement – I will have to have one (or more) but not for a while hopefully…

So I am now booked in for my PAO on Tuesday 22 September. I have created this blog as a way for me to put down my thoughts and hopefully manage my nerves and frustration. I don’t expect anyone to read it but there might be others going in for similar operations in the future who will find it useful.