I’m starting in the middle of my story, but this is what I need to release most. Maybe this will help me sleep. Maybe this can help someone else. So, here it goes.

I went to my third pre-op appointment (yes, three different times I thought I was all set to go for surgery, that is another story) ready for the news: which hip surgery would I need: FAI or PAO + FAI combined. As I drove to the orthopedic hospital, I had my “good leg” (left leg) bent up to my chest, something I always do when I drive to make my hip more comfortable. It’s just automatic. Some people light a cigarette as soon as they get in a car, my bad habit is I bring my knee up to my chest. I know its dangerous if I were hit while driving this way, but I just can’t sit normally in the car… I sat in the parking lot for a second to just relax + try to make my mind go blank before I’d get the news. I scanned my body + realized how I was sitting + just laughed at myself thinking how do you say you have hip dysplasia without saying you have hip dysplasia? You can’t even sit in the car normally.

Does this mean I fully accept that I may hear I’m getting my pelvis sawed apart in a few minutes?

I was in such severe pain that I did fully accept that I would do whatever it takes.

This was a completely overwhelming experience that I kept to myself because I really didn’t want to talk about a super complex surgery with a very complex recovery if I wasn’t even going to have it. And, if I was going to have it, I probably couldn’t think about it because I would probably just need to do it + figure out how to survive it once I woke up. I’m recovering from right hip surgery now, so I’m in a place to let this go by sharing my experience here.

By the way, I’m not a doctor, a surgeon, or a medical professional. I’m just a human sharing her experience. I’m not sharing medical advice.

As a human facing hip surgery, I’ll explain what PAO surgery is but I’ll also include some medical links as well. (Every highlighted link is a different article or video). A PAO surgery is where your pelvis is cut apart and re-set with rods or screws to create a stable hip socket. It’s a difficult and complex surgery to recover from. You can stay in the hospital up to a week recovering, mainly just to get the pain under control so you can go home. Full recovery is typically a year, and that’s for one hip, many people have dysplasia in both hips, and need to go through this surgery + recovery twice to address both sides. If you have severe hip dysplasia, your hip socket can be very unstable causing pain in the hip + back, dislocations, sublxations, a chronic limp, a limb length discrepancy because your hips can be uneven. Most importantly, if you live with untreated hip dysplasia you can develop osteoarthritis in the hip, so you’d need a hip replacement to correct this if you let the symptoms and degeneration go on for too long. I lived a lifetime with these symptoms, so I accepted that this surgery was a real possibility for me. The surgeon showed me on my x-ray how my hip socket was too shallow for my femur, which is hip dysplasia… I’ve been diagnosed with hip dysplasia + hip instability. The hip is a dynamic joint with many angles + many factors to consider when surgery is involved. I also clearly had a hip impingement where the femur and acetabulum don’t fit together properly + grind on each other. Super comfortable. When you have a hip impingement, you also have a labral tear. In my case I clearly needed the FAI surgery, which is arthroscopic, still a significant recovery but this surgery does not cause severe pain. (PAO = severe pain). I was a candidate to consider combo FAI + PAO surgery where one surgeon completes the FAI surgery + another surgeon completes the PAO, while you are under anesthesia for 8 hours, generally. The thing is, PAO surgery is typically done in the teenage years to allow for optimal healing + to allow for a higher quality of life without pain or injury because your hip deformity is corrected, you can live life more fully!

The thing is, my case is complex. Seems like it always is. I have a rare bone disease: Hypophosphatasia. My bones are soft + typically heal slowly + poorly. So, sawing my pelvis apart and resetting it with rods or screws- I would be at a much higher rate of developing a malunion- where the bones don’t fully heal. It’s possible if I had a PAO, I’d go through extreme pain, an intensive recovery + the surgery would fail + then I’d need a hip replacement anyway. Like, my hip bone could die or just stay fractured. Sounds comfortable. Then, I’d finally be able to move on with my life. Oh yeah, then I’d need to address my left side. Plus, I’m at like essentially the max end range for age to go through a PAO surgery, that was also a big factor.

Sound like a lot? It’s been. SO. MUCH.

I had a CT scan of my hips to fully map all the angles of my hips to create a 3D hip map of all my hip angles. This would show the full extent of the abnormal bone angles in my hips. Both the hip impingement + the dysplasia + the angles that would be the outcome to guide the surgeon during surgery to correct the abnormalities. It’s cool that the surgeon uses the 3D map while in surgery to guide where to shave down, etc.

So, bottom line- I went into my pre-op appointment with FAI surgery scheduled two days away or an opening for the PAO + FAI combined surgery at the end of the month. I was going to do one or the other. It was explained that I was a borderline case. Complex yet again. Clear as mud.

The hip map showed that I have more coverage on the back of my hip socket than thought, offering more stability than expected. And, my risks going through a PAO surgery are pretty high… The surgeon said he had a conference call with a comprehensive team that morning about my case. (Insert bawling eyes emoji-they did all of this for me to decide what’s best). My surgeon even included the physical therapist I’ve worked with the past two years as I’ve tried to recover from my chronic injuries. They all agreed my risks are high + that I could have a good outcome with the FAI surgery only.

The initial concern was if I went through the FAI surgery only, my hip may be too unstable + I’d be worse off that I was going into this. Here I am three weeks post FAI surgery. Additionally, I had a capsulorrhaphy for microinstability. The capsulorrhaphy doesn’t allow for all of the correction a PAO + Femoral Retroversion (Like I can’t have anything else more abnormal- but my right femur is also rotated) can provide, but it tightens up the hip capsule to hopefully provide enough correction without the big risks of a PAO or Femoral Retroversion. The intense pain I had deep in my hip prior to my surgery is now gone. My labrum is repaired, my impingement is corrected, the bone spur is removed, the femoral resection corrected the deformity in my femoral head. But, I am still on crutches and in the early stages of recovery, so I don’t truly know if I will continue to struggle with hip instability, my recovery for full return to sport is 12 months, so I’m in it deep and I’ll see how it goes. Hopefully I’ll be good as new + feel the best I’ve ever felt with the best anatomy I’ve ever had. I sure hope I’m on the road to healing.

P.S. I went through all of this, accepted I was going to have surgery in 48 hours + laid back + got a shot in my hip. One thing after the next. I needed the shot so insurance would cover the FAI surgery. (I already had a shot in my hip during a fire alarm with a surgeon I went to for a second opinion but it was the wrong shot, so I had to go through it twice). Honestly, I wasn't even 100% sure the insurance had all the documentation they needed, but I was so exhausted I just hoped it was right because I was able to fully register with the hospital. I truly went into my surgery thinking after all that it’s taken to get to this point I’ll believe this is really going to happen once I’m put under.

P.S.S. Snapping hip is a condition that can present similar to hip dysplasia but the cause + treatment is much more conservative. Bottom line if you have any symptoms similar to what I described here, go to an orthopedic doctor, it might take multiple referrals + months of physical therapy + multiple tests, etc. But, the only way you are going to know what’s going on is to get the correct help. Sometimes you have to be persistent. And, then keep going.