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A Montana Surface Hippy with
excessive calcium growths
I am a researcher at
Montana State University in Bozeman, MT and an avid tennis player. We are
surrounded by mountains and could spend every weekend hiking, horseback riding
and skiing.
My first arthroscopic
crisis occurred about 3 years ago with a calcium spur on the back of my heel
(commonly called “Pump Bump” in honor of the thousands of women who develop this
spur after spending years in high-heeled shoes). The spur was painful but the
biggest problem was that it encased my Achilles tendon and could put me on my
knees in the middle of a point (Fortunately, I had an awesome partner capable of
covering the vast majority of the court). The surgery to remove the bone spur
(Dr. Diebert) was very successful and I was back on the tennis court in about 8
months.
A couple of months later, I
started noticing pain in my right hip. My GP diagnosed the problem as bursitis
and recommended PT. PT was humiliating. I had minimal flexibility in my hip.
If I was laying flat on my back, I could not flatten my knee without arching my
back. The PT felt the entire problem was lack of flexibility and recommended a
series of exercises. After a couple of weeks with no results, more exercises.
There was never any consideration that my problems were due to bone and not to a
lack of dedicated stretching on my part.
My hip was starting to
affect my work. I work with developing a high omega-3 oil crop suitable for
production in Montana (Camelina sativa). One of the strong selling
points of omega-3 is that they reduce inflammation subsequently minimizing
arthritic symptoms. If I had to sit or stand still for 10 minutes, my hip would
be very painful and I would walk like a pirate. Not good PR for an
anti-inflammatory product. I finally made an appointment with an orthopedic
physician (Dr. O’Brian). He took films and diagnosed the problem as a pincer
impingement (i.e. I have more bone spurs on the ball and hip of the socket that
limit range of motion. Pincer impingement (spurs in the hip socket) and cam
impingement (spurs on the hip ball) have only recently been described as the
cause of hip pain in younger patients ranging from 20-50 years old.
Functionally, impingements are a form of Osteoarthritis. Unfortunately, his
recommendation was to let the disease progress until it was bad enough to do a
total hip replacement. He did give me a shot of cortisone which provided 17
days of pain-free tennis!
Once again, I went back to
PT with the goal of strengthening the hip. Again, I was completely frustrated.
My right hip ached continuously and my left hip was carrying the load. Two
events drove me to an Orthopedic surgeon. First, I was trying to wade across a
small stream. My balance was horrendous. My right hip was becoming more or
more useless. This lack of balance also affected my tennis game. I could get
to the ball, but I was not square when I hit the ball.
In September 2007, I went
and saw Dr. Daniel Gannon, an orthopedic surgeon specializing in hips. He took
new films of my hips and spent quite a while contemplating what to do. He could
see the bone spurs but also felt that the spacing and cartilage in my hip were
in fairly good shape. He felt that I could be a candidate for arthroscopic hip
surgery to remove the calcium deposits. I was thrilled, the surgery he
described was day surgery and entailed two small incisions and an overnight stay
in Seattle. The next day, I had a MRI and the films were sent to the surgeon in
Seattle. He evaluated the films in consultation with Dr. Gannon. Dr. Gannon
called and few weeks later. Unfortunately, the arthritis in my hip was
progressed beyond the point that the arthroscopic surgery would be effective.
At this point, the best option was a hip resurfacing.
I was disappointed that my
hip could not be fixed using the minimally invasive surgery. However, I was
very fortunate to be working with an innovative surgeon aware of emerging
techniques in treatment of hip degeneration. A year ago, I would have been a
candidate for the arthroscopic day surgery. The equipment necessary for
arthroscopic hip surgery is currently only available in a few of the larger
medical centers in the US. It will be several years before it is available in
Bozeman, MT (population 80,000). It likely that my left hip will be a
candidate for the arthroscopic surgery sometime in the next couple of years.
Dr. Gannon is a busy man.
He is one of the first surgeons in the US to use the anterior approach to total
hip replacement. In this approach, the incision is only about 4 inches long.
There are no post-surgery precautions. The recovery is very rapid.
Resultantly, his schedule is quite full. My resurfacing was scheduled for
Jan.18.
In the 8 weeks prior to
surgery, I worked out on an elliptical stepper for 30 minutes and did as much
work strengthening my quads and glutes as possible.
Finally, surgery arrived.
Prior to surgery, I had a radiation treatment on my hip. Recent research has
demonstrated that small doses of radiation just prior to or just after surgery
can prevent re-growth of bone spurs. The radiation was completely painless
without any side effects. It did take awhile to remove the drawings from my hip
and groin and I know have three very small tattoos.
The last I remember from
pre-op was the anesthesiologist telling me she was
giving a mild sedative to take the edge off…. Lights out. The surgery was done
with a spinal as Dr. Gannon feels the muscles are more relaxed and easier to
manipulate.
I woke up as
I was being moved from recovery to my hospital room. I apparently dropped right
back out as I don’t remember eating dinner or any of the evening. The nurse
woke me up several times during the night. I took my first painkillers (oxycodon)
about 3 AM. My hip has not hurt since the surgery. However, the 10-inch gash
is uncomfortable.
Day 1. The
physical therapists started exercises and walking about 9:30 AM. My first walk
was with a walker and it was pitiful. I went about 10 feet. Then I took a
nap. Later in the day, I walked about 80 feet. Then I took a nap. I took
oxycodon and Tylenol throughout the day.
Dr. Gannon
stopped by. We decided that I would most likely need to remain in the hospital
through Monday (3 nights). He said that there was a lot of spurs in both the
joint and the ball.
Day 2. The
difference between Saturday (post-op day 1) and Sunday was phenomenal. In the
morning I walked several hundred feet and took a shower. By the afternoon, I
was walking on crutches, could climb up and down stairs and was cruising the
hospital. I convinced the hospital to spring me that afternoon. It took my
husband over 3 hours to plow the driveway to our house so I actually did not get
out until evening. The hospital insisted that if he couldn’t get me home, then
I couldn’t leave.
Big MISTAKE.
My husband and I still sleep in a water bed and I knew that it would be sometime
before I could get in or out. I figured that the couch would be adequate for the
interim. WRONG. Couches are cramped and tend to be very low. It was a
miserable night.
Day 3. Set
up twin bed in living room. Whatever you do, make sure you have a comfortable
place to lay once you are home! My husband is a wonderful nursemaid and caters
to my every whim.
Day 4.
Started PT. Great therapist. I won’t be playing tennis for awhile but I am
definitely on the way back. Am walking with a single crutch. Am a bit
unsteady with the cane.
Day 10. My
hip feels great. My muscles are very sore. I think it is because I still do
not move freely in bed and spend too much time in a single position. Tomorrow
the staples come out!
The weather
is horrendous. It is snowing, the wind is blowing, and it is 10 below zero.
Looks like all my walking will be inside. The dog does not seem to agree that
weather and ice are a legitimate excuse to remain inside.
What have I
learned.
1. Dr. Gannon
is phenomenal and Bozeman is lucky to have such a skilled, innovative surgeon.
2. Hip
resurfacing is an effective option for control of hip pain and arthritis. There
are some advantages over a total hip replacement.
3. However,
recovery from an anterior total hip replacement may be easier than recovery from
a hip resurfacing.
4.
Arthroscopic surgery is rapidly emerging for treatment of early hip arthritis.
Hopefully, this technology will readily recommended for younger patients.
5. Ice picks
on crutches and canes are a good thing!
One Year Update - January 30, 2009
Hi all. It has been just over a year since
my surgery and I wanted to send an update.
Last week, I flew to France (I have a great job) for a meeting. When I passed
through security, I set off all of the bells and whistles. IT TOOK TWO PASSES
THROUGH THE METAL DETECTOR BEFORE I EVEN REMEMBERED THAT I HAVE A RESURFACED
HIP! I then had a personal moment with the TSA.
My reality is that I have been absolutely pain-free for over a year and my hip
no longer plays a significant role in my conscience.
I did make some choices last summer. I was an avid tennis player prior to my hip
problems. I could have returned to tennis last summer. However, I decided that
it was more important to focus on fitness and strengthening. I spent a lot of
time working out (elliptycal machine, pool, aerobics), stretching, and walking.
Tennis in 2008 was not nearly as important as tennis will be in the next 40
years.
The worst part of my recovery was not being able to tie my own shoe or put on my
socks. I workout at a university and there were many occasions where I had to
wander around the locker room and ask a 18-year old to tie my shoe. It did take
nearly 9 months post-surgery before I could actually put on my sock with out the
orthopedic device.
I started playing tennis again a couple of months ago. It is great to be back. I
still cannot jump off of tall buildings!!!
My advice. Convince your surgeon to do the re-surfacing as soon as possible. It
is not going to get better, it is going to get worse. The most painful day was
the day before my hip resurface. Every day since then has been pain-free.
Life is too short. Go for it.
Alice
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