I’m now 29 years old and feeling fine about it. Here’s the report from the UKA doctor from my medical meeting in Coventry, lots of it is over my head, so will probably be over yours too because I am an honourary doctor you know. Basically, I need to have a CT scan before they can decide what type of replacement to do – the joys of being knocked out again…
Stephen was asked to walk, displaying fixed flexion deformities of both hips and knees, spasticity of his hip flexors and adductors, antalgia, stabilization of gait through compression of knees against eachother, pain in his left groin and fatigue on walking just a few yards.
There followed an in-depth discussion between all participants including
i. Stephen’s goals – increased quality of life, ambulation, pain-free, 2012 Olympic club throwing gold, World Championships 2011 – would need to be training April 2010.
ii. Conservative management – analgaesia, injections, physiotherapy, failed arthroscopy (agreed by 90% that as all conservative management had been exhausted and likelihood of continued deterioration given rapid deterioration over last 12 months, surgery was now appropriate).
iii. Further investigations –
a. CT under GA, to assess acetabulum, degree of anteversion – agreed necessary
b. EMG/ Gait analysis, neurological opinion , to assess neurological component of presentation – agreed probably not necessary. Discussed that although cerebral palsy was a non-progressive neurological disease, Stephen had probably escaped more severe disability by his strength and conditioning training. Now that he is unable to train, then effects of disability more noticeable.
iv. Surgical options
a. Timing – pre or post London Olympics
b. Resurfacing – would require large head to neck ratio to reduce dislocation rate (50% would go for this),
c. Total hip replacement (50% would go for this)
d. Deepening of acetabular socket to reduce dislocation rate – most agreed necessary
e. Requirement for osteotomy (subtrochanteric or trochanteric) – most agreed necessary
f. Requirement for soft tissue balancing e.g. adductor release, lengthening iliopsoas tendon (possibility of this needed bilaterally if pursued to balance) – minority would do this
g. Arthrodesis at 90 degrees (0% would go for this, therefore discounted)
h. Surgical approach – discounted posterior approach due to risk of gluteal muscle weakness post-surgery, anterior or anterolateral approaches favoured
b. Unpredictable return of function, despite pain relief (e.g. walking ability)
a. UKA/EIS would be able to provide best practice physiotherapy, strength and conditioning rehabilitation, therefore chances of successful operative result would be increased
b. Motivation – agreed that Stephen’s motivation would increase chances of a successful outcome
Professor Griffin decided to speak to Graeme Wilkes to organize CT scan left hip under general anaesthesia and then to e-mail all consultant hip surgeons at the meeting with the images to begin a “round robin” discussion as to the most appropriate surgical procedure to undertake