I am 27 years old, from the Campaspe region of Victoria, Ive spent the majority of my life in this region, with a year or so combined of living in Bendigo and Melbourne in the past, but for the most-part, I'm a rural guy who likes it out in the open space, rather than compacted streets, as fun as they are.
When I was 12 years old, I began experiencing issues with the joints in my knees and wrists, following a bout of Strep Throat, and for a good period of time it was chalked up to growing pains, Polyarthralgia or Post-Streptococcal Arthritis.
Fast forward to 14 years of age, I am in high school and my knees have now ballooned to the size of softballs and are causing considerable pain to the point where they are essentially locked into a straightened position. We sought after extra medical help and after 3 local GP's and mis-diagnosis', we finally had the hoorah moment in my blood testing that could explain the swelling and pain, my Rheumatoid factor was ORDERS of magnitude higher than it should, leading to an initial diagnosis of Juvenile Rheumatoid Arthritis.
This began a string of many visits to the Royal Children's Hospital Rheumatology unit.
In these initial visits it was just scans and tests on tests, and then we got to the golden day where they would be draining my knee and (at the time) right thumb, and injecting with my first cortisone experience.
The procedure wasn't quite traumatizing but it could probably be called my first hallucinogenic experience, and what I thought about while I was under the nitrous was very strange.
Coming out of that procedure was night and day, at 14 years old after months of no school, not being able to bend my knee even a degree, I was able to pout full force on my knee and bend it to a comfortable level.
All while this was happening, I was missing months of school, I believe my total year 8 attendance was down by 5 months, how I passed I don't know.
But the isolation during that time, and the constant pressure on my knees, sitting in bed, quickly became too much to handle, I fell into a deep depression and began seeing a Pediatrician to aid the growing mental state and the Arthritis.
He helped me out with my first attempt at treatment. Amitriptyline, this was intended to be a triple whammy, a sleeping aid, an anti-inflammatory for my arthritis, and an anti-depressant.
I carried on this treatment throughout high school with varying success over the time, and it would remain this way up until leaving high school.
The years after high school I started taking my physical health a bit more seriously for a year or so, dropping myself from 105kg to 75kg over my last year of high school and the following year.
With this increased activity, came increased agitation from arthritis, and over time it started to become unbearable within the knees and ankles. Oddly, my hips were also becoming a huge issue, with femoral dislocations happening frequently, and what felt like a grinder being put to my hip socket.
I got a referral for a Rheumatologist who has been giving me ongoing treatment for my arthritis for since 2020.
With the Rheumatologists investigations, we were able to come to a few conclusions:
The diagnosis of Arthritis is Psoriatic Arthritis, a form of arthritis which is accompanied by Psoriasis, an inflammation of the skin.
My left hip socket had severe damage to the Labrum, as well as Femoral Acetabular Impingement some spurs of excess bone that had developed and were grinding on my pelvis
Both hips had developed Hip Dysplasia, a condition where the acetabulum does not cover the Femoral Head sufficiently, resulting in instability and the constant dislocations.
The Rheumatologist started me on some treatments for the arthritis, and linked me with a lovely Orthopedic Surgeon based out of Melbourne that I owe absolutely everything to.
The initial arthritis treatments were unfortunately ineffective, leading us to the "Nuclear Option" of TNF Blocking medications, an injection that alters the way the body reacts to inflammation, which has been a monumental success for the last 2.5 years of treatment.
Working with the Orthopedic surgeon over the following 3 years was a roller coaster.
Given that COVID had exploded just as I was having all of these diagnoses, it had put a bit of a delay on the options for surgery I had, but since it was considered a critical surgery, we were able to commence in the beginning of 2021, to get me through to that point, I was given a guided cortisone injection directly into the joint. This relief was amazing.
Dr Slattery ran me through the surgeries required and made the results sound like heaven.
The procedures he proposed were:
Begin with an Arthroscopy of the left hip to repair the Labrum and grind away some of the spurs.
After 1 month of healing, we will Perform the left Peri-Acetabular Osteotomy
After 6 months of healing from that, we will perform the right Peri-Acetabular Osteotomy
After 1 year from the second procedure, we will remove the screws from the site of the reconstruction.
Images taken from the Arthroscope mid procedure.
2021 came around and at the beginning of February I underwent the Arthroscopy section of the plan.
When I woke up from this procedure, Dr Slattery had some concerning news.
He let me know that unfortunately he could not complete the arthroscopy due to a sudden bleed out, He advised that I had lost about 1 litre of blood, of that litre, they were able to recover ~600ml.
He explained that he was able to accomplish most of the job, there were just a couple spurs remaining that he could address when the first PAO came along.
My left hip socket mid arthroscopy, femur detached so that the head may be shaped.
As far as recoveries go, this was one of thew easier ones, and I wish had known that at the time because what was to come was no picnic either.
It was just the one night in hospital and then about 2 weeks of crutches after the arthroscopy, as I remember it, it was quite traumatic coming home when the pain relief died off, as you can probably imagine, having bone ground off and cartilage repaired is pretty painful for the first few days.
In the hospital after my first PAO with my leg in the Continuous Passive Motion.
Once April came, we were ready for part 2 of the process, the first of the major procedures.
The Peri-Acetabular Osteotomy is an invasive reconstructive procedure that as the name implies, involves cutting the acetabulum from the hip, re-aligning it so that it covers the Femoral head appropriately, then using 4 Titanium screws to hold the socket in its new position as it heals.
This was a bit of a longer stay in hospital, a week of hospital care which I will be forever grateful for, the pain from this one even with the assistance from pain relief was astronomical.
While I was in the bed for the week, slowly making progress with bathroom visits and incrementally building up to a slow assisted walk with crutches, they had me hooked up to all sorts of machines that all played a totally different role.
IV for hydration and general IV medications.
The Ketamine drip providing a slow release of the drug directly into the site in low doses
A Continuous Passive Motion machine, which would consistently flex the hip and knee at a programmed angle and speed to match the stage of recovery I was at.
Coming home from the first of the major surgeries was nothing short of traumatic.
The pain medication that was administered at the hospital quickly lost effectiveness, and the opioids I was sent home with were not covering the pain I was experiencing. I felt like a vegetable and such a burden for my mum and my sister who both put so much time aside to help for those critical first few weeks where my leg was essentially held on with skin and bolts.
One of the best motivators for this time, and what came as a great comfort was having someone to relate to in this recovery, my Nan.
She herself has been through many hip reconstructions and replacements from falls and arthritis over the years, and being a 23 year old with hip surgery, it quickly became a bit of a circus thing where I didnt want to tell people because they would always make those comparisons to old people.
Thankfully I had my Nan to talk to and seek advice when it came to strengthening and just general motivation to not give up.
There is one aspect of these surgeries that I will look back on with absolute disgust and trauma, that I honestly wouldn't wish on anyone to experience...
Dr Slattery had to position the acetabulum slightly offset from where it would normally meet the pelvis in order to have my leg line up properly and not disturb the alignment of my knees...
Because of this, there was a slight gap at the base where we were expecting the bone to bridge across and form a new connection.
This gap was an issue, due to the fact that it sat directly next to the sciatic nerve, and you can probably see where this is going...
The exercises I was given involved a lot of bending forward, which put tension on the sciatic nerve down my leg, and occasionally, the nerve would get "snagged" on the gapped piece of bone.
It is exactly as painful as it sound, but the initial snag was nothing compared to when it finally came loose and caught up with its slack. The way I like to describe it is like imagine the sciatic nerve is a guitar string, and the bone plucks it like a pick.
This send shock waves through the legs and body and excruciating pain on the site of the injury.
After the first 6 weeks of crutches we were finally given the all clear from Dr Slattery to ween off the crutches and begin proper Physiotherapy to begin strengthening the joint as it makes its new connection.
Around this time I began cycling by my physios recommendation, and my mate for many years joined me as we had a strong history of cycling and walking together in the past.
We built up our rides but quickly got into the larger rides, ranging for 15-20km at a time.
All the way up until September of 2021, we maintained a consistent riding and walking schedule, and I felt better than ever in the joint of my hip.
Although I couldn't achieve quite the flexion that I am currently reaching, at the time, it felt like a night and day improvement.
September 2021 rolled around and it was time to perform the right side PAO.
This time I had some reference for what to expect pain-wise.
Unfortunately it didn't matter, this was a whole new experience unto itself.
The nurses this time around were a blast, and given that I would be in hospital for a total of 8 days this time, in order to avoid a repeat of coming home too early, that was a plus.
It was a lot of fun to be able to go through the process and actually have an understanding and be able to expect what was to come from the hospital stay.
However, this time around my body reacted in a way I couldn't have imagined, I fell into severe spasms in my right leg, all around and among the muscles and bones that had been worked on, this remains the only time I have ever been administered Morphine after begging for any sort of release through a flood of tears.
Returning home from the second PAO unfortunately was similar to the previous PAO return and we were able to prepare a bit more.
Although I received an epidural injection in my lower back for both major surgeries, the pain that came when the hospital pain management wore off was unbearable.
1 year later, despite all of the pain and re-configuring of my hips, we were in a completely different place. I hadn't felt a pain free stride in my hips for years, but now I was walking for kilometers, and riding the bike even further.
Physio is going amazingly and they are really impressed with my progress.
Its now Q4 of 2022, and we ware ready to take the screws out, Dr Slattery had me complete an MRI to confirm we had sufficient fusion between all contact points.
The procedure to pull out the screws goes perfectly with no issues to report.
Dr Slattery even let me keep the bolts as a memento (7 out of the 8, plus one that Dr Slattery gave me as a sample beforehand).
Until...
Within the first week of being home from the pin removal, I had a large red lump over the site, and it was very-very oozy with pus.
I made a visit to the Echuca emergency room, and after just over an hour of waiting they fast tracked me to speak to the Dr in charge.
I had developed a sepsis over the site where Dr Slattery cut down to the screws on my left side.
Given the severity of the situation, I had heard from Dr Slattery the very next day to organize a time to get the infection addressed. He couldn't have been more apologetic and concerned for me which was really nice to hear.
Dr Slattery had me back down in Melbourne within the week to have the wound drained of gunk, and to have me on IV antibiotics required to kill the infection.
Given the state of it, I would require a week long schedule of hour long infusions at 8 hour intervals, which meant being in Melbourne at a hospital for another week.
The infusion in the middle of the night was always the worst one.
Thankfully this was toward the end of 2022 when COVID rules in the city were really starting to calm down, to the point where even hospitals didn't require masks or tests anymore.
So in between my infusions I was able to get out and about and explore the city to the best of my ability, so long as I was back in tie for the nurse to hook me up.
On the very last day of this hospital stay, I came in for my final infusion to a stunned head nurse (whom I hadn't had any interaction with at that stage).
She asked where I had been and I happily explained that I had been for a walk and she was shocked that I had been let out, and that they were still in strict rules, despite every other nurse telling me the contrary.
Thankfully that was my last day and I was able to head home.
5 Surgeries, within 3 years by the age of 24, and Arthritis since I was 14.
Its quite the medical resume to hold and raises some eyebrows when people find out, some just cant fathom the idea of a youngster requiring a hip reconstruction. But hey, here we are.
After a year of a consistent gym routine, I have achieved alot of progress and look forward to future improvement.
Current gym Milestones:
I am able to lift nearly twice my starting weights on the cable pull-downs
33kg > 57kg
I can full stack the hip adduction machine
152.5kg
I have cracked 100kg on the following machines
Calf Raise
Hip Abduction
20kg Rope Tricep Extensions
65kg Glute machine