In November 2011 I had my appointment with Mr Jit Balakumar. Prior to this appointment he had me complete a 12 page hip questionnaire for me to return via email. This questionnaire allowed Mr Balakumar to learn about my family history of hip problems (which was minimal), my physical charasteristics such as height and weight, working status and demands of my job, while also looking at physical and psychological implications from my hip disorder. I found this to be beneficial as he was able to generate a better idea of who I was and my reasoning for getting him to review my hip even prior to meeting me. At my appointment Jit initially completed a physical assessment. He was pleased by my lumbo-pelvic control and stability around the pelvis. Based on the way I moved he was confident that I would be fine without needing any surgery in the near future. It was only when looking at my previous scans that his impression changed. He asked "do you ever limp?" and "does your fiance tell you that you are limping?" It was like he was shocked by the extent of my hip dysplasia on the imaging when compared to my functional biomechanics and movement patterns around the pelvis and hip.
I was referred for a relatively new form of MRI which allowed for better assessment of cartilage quality. The scan is called a dGEMRIC (Delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage). He informed me that this would provide data used to determine if joint preservation surgery would be beneficial or if there is high risk of early failure following PAO surgery due to intrinsic wear within the joint. My dGEMRIC scan showed some early thinning of the cartilage consistent with mechanical damage as a result of my hip dysplasia. It also showed mild trochanteric and iliopsoas bursitis and mild gluteus minimus and medius insertional tendinosis but no tear as of yet. The changes to the gluteal muscles and bursa are expected in ladies above the age of 50 and not commonly seen in a fit active 27year old.
After recieving my results Jit strongly recommended that I go ahead and have the Periacetabular osteotomy. He explained that despite currently having more than adequate control of my pelvis which allows me to be active and complete high level activities such as skiing with minimal consequence, all it would take is for the degenerative changes within my muscles to progress to a small tear and then I would be in a lot of strife! The concern is that it would lead to increased pain and altered biomechanics, eventually resulting in further wear within my hip joint. This would then make the PAO surgery usless as there is no point preserving a degenerative hip and my only option would be a total hip replacement. Plus any further muscular changes would make recovery from the PAO surgery much harder.
So after many years of deliberation I decided that it was time to bite the bullet and book in for my surgery! I chose to book in with Mr Jit Balakumar. This was a hard decision to make as I have a lot of respect for Mr David Young, being one of the Melbourne's top hip surgeons. I have DY to thank for my progress thus far with my hip. Without him I would still be living on constant anti-inflammatory medication and most likely would have had a lot more wear in my joint due to the irregular shaped femoral head. However I found Mr Balakumar a better fit for my needs. He was able to answer my questions relating the the PAO surgery making me feel (for the first time) confident to have this joint preservation surgery. Jit works at the Epworth Hospital and also at The Royal Childrens Hospital. He has completed many periacetabular osteotomy surgeries especially at the childrens hospital. His technique is also slightly different to Mr David Young which will hopefully allow me to commence weight bearing earlier... But I guess time will tell. Only 64 days to go!!
[A great article on this subject is Torin Cunningham, MD; Rebecca Jessel, BA; David Zurakowski, PhD; Michael B Millis,MD; Young-Jo Kim, M.D., Ph.D (2006) Delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) as a Predictor of Early Failure after Bernese Periacetabular Osteotomy for Hip Dysplasia. Journal of Bone and Joint Surgery. Let me know if you have difficulty finding it and I can assist.]
