Amy's THR
Hi everyone,
I don't know if you remember me posting, but I was having a few stresses a
couple of weeks ago about my surgery (I posted about worrying about catching a
cold and other general pre-op anxieties). I did have some lovely supportive
personal messages from people, which I didn't have time to reply to, but I would
like to thank everyone who emailed me with kind reassurances.
I thought I would let you all know that my surgery on Feb 28th (Mr O'Hara,
Birmingham UK) did not go to plan.....
I awoke in recovery in a lot of pain (I am normally quite immune to pain and
have never, ever, suffered from pain post-op before) and was very anxious, as a
glance at the clock showed that I had been in surgery for over 3 hours. So I was
anxious right from the second I awoke.
I overheard the recovery nurse talking to my ward nurse as they were about to
transfer me back upstairs, and the ward nurse said, "But I thought she was
having a resurfacing?". And that is how I found out I had got a THR. (It was a
horrible way to find out and I will be submitting a formal complaint, by the
way). I became immediately hysterical, and was violently sobbing, and screaming
at the nurses to take my back upstairs to see my husband. There were delays due
to them having trouble with my wound, and by the time I got back to the ward I
was in floods of tears and inconsolable.
Anyway the point I really wanted to make to this group is that I have been
lurking reading posts for well over a year now. I have read all the arguments
about THRs and there are a certain handful of people in this group who seem to
be "keyboard missionaries" on a mission to save the world from THRs!
I have only ever skim-read these posts, and have taken them with a pinch of salt
in the past. This is because of my own family's experience with THRs. Both my
Uncle and Dad have very successful THRs. My Dad's first one is over 15 years old
and it still serves him very well indeed, and he is very athletic (hill walking,
cycling 50 miles every weekend etc). He had his other hip replaced more recently
and was out of hospital within 3 days, fully weightbearing within 2 weeks and
back on his bike within 4 weeks, as he was with his 1st. His 1st hip is
metal/poly and his 2nd hip is ceramic/metal. My cousin is an outpatient nurse
for an eminent THR surgeon here in the UK and reports similar outcomes with her
patients. So I think the UK experience with THRs is a lot more positive than in
the US.
So, I took most of these posts with a pinch of salt.
However, something must have sunk in, because the racing panicky thoughts that
went through my head in that awful hour in recovery were lifted directly from
things I have read on here.
I felt like all the voices of Surface hippy were shouting at me, "You'll have a
lifetime of restrictions. You'll never be able to do everything you could have
done with a resurfacing. You'll never be able to have a revision if it goes
wrong. Your femur will degenerate and crumble. You won't have full ROM."
It sounds like I am exaggerating, but at the time I was devastated, in agony,
terrified and feeling utter, absolute, despair, and all I could hear in my head
were these voices.
The voices didn't stop for hours, in fact not until I finally fell asleep in the
early hours of the morning. I was taken back to the ward (eventually - they had
problems with bleeding and getting my pain under control) but as we came back to
my room the nurse found my husband in a crumpled heap on the floor. They had not
told him why I had been gone so long and he had worked himself up into a
migraine. His BP was high and they had to stretcher him out and revive him in
another room while I was left out in the corridor wailing and crying. (I can
laugh about this now but it was just horrible as I needed a hug from him.... I
mean really NEEDED one).
My Mum came in to see me while they were tending to my husband and she couldn't
handle the hysterical state I was in and had to leave.
My husband eventually came in and comforted me, but I was inconsolable. They
sent the anaesthetist in to see me, and he explained that Mr O'Hara had had a
real battle in theatre, but had reverted to a THR eventually and was very
pleased with its stability.
Mr O'Hara was busy, so they sent the on-call Doctor in to see me to try and calm
me down. He explained that a THR was still a good outcome, which didn't exactly
reassure me.
I demanded to see Mr O'Hara and he did come up and see me straight from theatre.
He explained that he was really pleased with the outcome and that he couldn't
have done a resurfacing.
It wasn't much consolation, and I had a horrible night.
Mr O'Hara was away at a conference the next day, and there was nothing anybody
else could say or do which would console me. I burst into tears at the slightest
thing and cried myself to sleep the 2nd night too. All the time, the worries
were caused by things I have read on here. Even my Dad coming in to see me and
show off his new THR wasn't enough.
I saw Mr O'Hara on the Saturday and asked him more direct questions. He
explained that I would be able to do all the things I could have done with a
resurfacing (except skiing.... although I know a lady with a THR who goes skiing
so it might be possible after all!). I questioned him deeply, asking about
specific activities I wanted to be able to do and he said I would be able to do
them all with no restriction. I said that I was worried about stress shielding,
but he said that the state my femur was in (apparently only slightly less
crumbly than cake!) meant that this was the best possible outcome for me, as I
would now be able to fully weight-bear and this could only make the femur
stronger, whereas a resurfacing would have been dangerously unstable even if he
had managed to get it on safely. He also explained that he got the cup in place
(with 2 dysplasia screws) absolutely fine - it was the femoral component which
he could not get on satisfactorily. Both parts are made by Adept and are
O'Hara's own design. So I have the same cup I would have got, but with a THR
femoral component.
I couldn't get up the next day as my pain was still not under control. I was
told that they had really done battle with me in theatre, trying to get the
femoral resurfacing component to stabilise before finally giving up on it, so I
had been through a lot more than other patients.
I got up on day 3 I think and since then I have been gradually getting much
better. Although I was initially told a long list of restrictions by one of the
physiotherapists, she later came back and said I would have NO restrictions, as
Mr O'Hara uses a sophisticated muscle-sparing anterior approach and is the only
surgeon in that hospital to do so.
I also found out that Mr O'Hara had a lot of trouble getting the hip INTO the
socket once he had finished, so it is now a very good fit and apparently I would
find it practically impossible to dislocate it. Apparently he had a good "play"
with it on the table to make doubly sure it could not be shifted! (Another
reason I am so battered and bruised!). He really is very pleased with how stable
he made it.
So, folks, I have NO restrictions. No 90 degree rule (I'm sitting here right now
breaking that one!). No weight bearing limitations - he wants me to fully weight
bear ASAP.
However I am finding this tough going - because he managed to equalise my leg
length (HOORAY!), my nerves and muscles are tight and I have some numbness down
the front of my leg. Also this leg has never fully beared weight before, so it
is going to be a long recovery.
I am excited though, and I am just about coming to terms with my THR, although I
am looking forward to starting the counselling I had arranged before my op, as I
think this will really help me to deal with this setback.
I just wanted to say though - I know you all have very good reasons for trying
to dissuade people from getting THRs. I respect this and I wish I could have
been resurfaced myself. BUT this needs to be handled carefully. I honestly
believe that if I had not been a member of this group I would not have been so
hysterical and inconsolable after my procedure. I am not pointing fingers as I
know that even the most vehement of you are only doing it with the best of
intentions.
But please, please, please be careful how you word your posts. I know someone
has warned before that there might be people on here who could wind up with THRs
and could be upset by some things they read on here - well that has now
happened. To me. And I am normally quite a rational person, but I would not wish
the paranoia I experienced for the first 48 hours on my worst enemy.
There are occasional of posts on here which I know my surgeon would dismiss
(sorry to name names, but Ron's recent post trying to ascertain someone's LLD
really worried me for this reason, as an example). I know the beauty of this
board is the right to say what we like and I would hate to see disclaimers start
appearing everywhere. That is not what I want. But I would like people to start
thinking about whether their prose is influenced by their own personal emotions
or experiences and to perhaps consider what effect this might have on other
people, even if those people are the quiet lurkers who don't post very often.
And to be truly honest with themselves about whether they have the medical
knowledge and experience to be able to say what they are saying.
I myself have waited a number of days before writing this, as I was very
emotional and angry before and I didn't want to take it out on you all. I hope
my post has come across as measured and impartial and that it will have a
positive effect and not cause any bun-fights.
Keep up the good work folks, Amy Aged 31. THR.
First Chapter of Amy's Story
Hi everyone,
I hope nobody minds me doing this. I am having my left hip resurfaced
next week and I have started to look at myself a bit more, well,
critically, I suppose, as the day draws closer, to steel myself for
what I am about to go through.
I have been through a lot in the past - 13 operations when I was a
toddler to correct hip dysplasia, then another operation aged 11 to
lengthen my leg, and then a couple of surgeries last year (incl. a
femoral osteotomy) in preparation for my forthcoming resurfacing.
Since the femoral osteotomy I've been severely limited in what I can
do, but that was always to be expected, as it was just the 1st step in
a 2-step process.
However, before then, I'd always considered myself very active and
although I had a bad limp and a 2" leg length difference, I was always
a "tough cookie", someone who didn't let it stop me from doing
anything. I was into swimming competitively, SCUBA diving, cycling,
going out to nighclubs.... everything my friends do.
But I do think I have spent most of my life in denial - if I'm really,
truly honest with myself, I think there were things I *avoided* doing
just so I didn't have to face the fact that I *couldn't* do them.
I also don't consider myself to suffer much from pain, although again
I think it might be because I protect myself from getting in painful
situations.
So I thought I would list all the things I can't do, or struggle to
do, so that when I recover from my surgery soon, I will be able to
look back and see how far I've come! Also, as my case is supposedly a
very difficult one, I thought it would help you all to see the
improvements I will hopefully make as I continue to update you all.
Here is my list!
* I can't walk very far. On my friend's batchelorette weekend I made
an excuse not to go on a hike with the girls in the morning. I
remember walking around the coastal path with my husband 2 years ago
and nearly crying on the way home. I always park my car as close to
the shops as I can.
* I can't do my shoes up very easily - I need somewhere to sit which
is JUST the right height before I can put them on.
* I've always had a goofy way of getting my left sock on.
* I have to physically pick my leg up to get my trousers (pants to the
Americans!) on.
* I couldn't do about 50% of the exercises when I used to go to
yoga/pilates, as my left leg was just too weak to do anything useful
at all.
* I walk with my left foot up on tiptoes (to make up for the leg
length difference), so my foot is now badly distorted and all my
tendons have tightened up.
* I can't ice skate, it hurts too much.
* I can only mount my bicycle from one side, and I can also only fall
off to one side!
* I tried horseriding again when I was 15 and ended up seized up in
agony for 2 days. That was the last time I got back on a horse.
* I can't run. Period.
* I lift my left leg with my hands to get into the car, and over onto
my right leg to get to sit cross legged, and probably in countless
other situations that I take for granted.
* I don't depress the clutch pedal fully in the car when I'm driving.
* I cannot ski. In fact I have tried, but I looked pretty stupid going
round in circles because I never put any weight on my bad leg.
* My breastroke kick in swimming is goofy, and nearly got me
disqualified in compeition.
* I can't walk for about 5 minutes after a long car journey, which is
kind of embarassing when getting out in public.
I think that's all for now! I will keep you updated if you like, as to
how things go after my surgery next week.
I hope this wasn't too boring or self indulgent.
Amy
(age 31, left hip to be resurfaced on Thursday Feb 28th by Mr O'Hara,
Birmingham UK).
Hey Pat, thank you for your email.
My life hasn't been limited really, I like to think of it as having been pretty
full all things considered!
It's only very recently that I've been REALLY restricted, but that's because I
am still on crutches as a result of my osteotomy, so I can't even do half of
what I used to.
Before the osteotomy, my femoral head was barely in the hip socket at all. But
the osteotomy put the hip more properly in the socket, where it should be, which
is why I am now in a bit of pain as there is no cartilage there to cushion those
2 bones from rubbing together. Hopefully that will all change soon!
I'd be honored to have my story up on your site. I am glad to hear about Waqqy -
I remember him posting last year, but I ducked out of Surface Hippy for a while
when I was busy preparing for my wedding, so I didn't follow his story through
to the end to see how he got on.
(By the way, I did manage to walk down the aisle at my wedding, which was quite
an achievement after my osteotomy!).
I can give you lots of photos if you like. I'll try and get some digital
pictures of my x-rays, and I can try and dig out some of my Mum's photos of me
in various spica casts and traction units when I was little. Also my favourite
picture of me walking down the aisle at my wedding last September!
To fill you in on my history, I was diagnosed with bilateral hip dysplasia when
I was about 18 months old, because I couldn't walk properly. They did surgery on
me, but some of the surgery went wrong, and caused further complications, so
while my right hip was fixed perfectly, I ended up having a LOT of problems with
my left hip and it was only after 13 operations that they left me to get on with
my life and start school (aged 5). My Mum had a really hard time of it, and she
doesn't like to talk about it - I dread to think what it was like for her.
At this point, I was pretty much OK (I could walk properly and sit Indian style
etc etc etc) even though my left leg was now 2" shorter. I led a pretty normal
childhood, and was a big horserider and did all sorts of activities as any other
kid would. The only problem was my horrible built up shoe which I stopped
wearing aged 11 as I got self conscious about it.
Aged 11 I had a leg-lengthening, which was done over 6 months using an external
fixator. My current surgeon said it was the worst thing they ever did for me, as
it weakened my femur and sent me all out of whack, and I still had a 2" leg
length difference after all of that, because my femur was so soft that it
developed a curve when I started walking again! (The osteotomy I had last year
was to straighten my femur again and get it back into shape).
I think that it was around the age of 11, after my leg lengthening, that I
pretty much stopped using my left leg. I somehow got around without putting any
weight through it, partly because I had never really done my rehab exercises
properly afterwards, My hip got maybe a little bit worse over the teenage years,
but the only thing I really remember NOT being able to do was horse-ride.
Although I think towards my late teens I might have started to become a little
less adventurous to protect myself, and like I say, I was almost certainly not
weight bearing properly on my left leg. My right leg took over and got really
strong (it is about twice as thick as my left leg) and I learned to compensate.
I had a great time at Uni though, walking a lot, dancing, swimming, SCUBA diving
- my hip wasn't much of a problem really, perhaps because my right leg was so
very strong. The only thing I couldn't do was get out of the water properly
after a dive - with all my kit on, I used to flounder around the shore like a
beached whale and it took 2 or 3 of my male friends to get me up and back to the
car!
Then in my mid-late twenties I started to worry that nobody seemed to be looking
out for me any more and I was no longer under the care of my old paediatric
surgeon. I was left wondering what life had in store for me - was I just
supposed to wait and see if I could still walk in 10 or 20 years? What if I
couldn't carry a baby? I would rather prevent the inevitable problems from
occuring rather than wait until it was too late. And I hated my useless, wasted
left leg.
It took a few years and various routes until I got the answers. One day I found
an article about my childhood paediatric surgeon in my local paper, as he had
retired and become an artist! From this, I managed to get his postal address and
I wrote him a letter explaining my worries. He wrote back and suggested I see Mr
O'Hara, a renowned paediatric surgeon in Birmingham who also enjoyed working on
adults who had had childhood hip problems.
I saw Mr O'Hara for the first time about 4 years ago and he pretty much said "Go
away and come back when you're in too much pain and I'll give you a THR". There
was no mention of resurfacing, presumably because of the state of my hip and
femur. It was a real mess in there!
But 2 years ago I started to get back pain and it confirmed all my worries that
this leg length difference/weak hip would end up causing me long term problems
in other places. So I went back to Mr O'Hara and said "Do
something......anything, to give me a decent hip and my leg length back!".
He put me under general anaesthetic and manipulated my leg, and gave me a
cortisone injection at the same time. I also had a CT scan. I was surprised to
receive a phone call from him the day after, and he said "Good news, I have a
plan for you!". He went on to explain that it was going to be tricky, but he
thought that he could "do something" with my femur which would then put me in a
good position to have a successful hip resurfacing. He said I was one of his
trickier challenges, but he likes a challenge! I trusted him implicity, and
although I had NO idea what a hip resurfacing was, I agreed to whatever he
wanted to do to me, and that's how I got to where I am today!
Oh and since I wrote my original post, I thought of a few more things I can't
do. I can't weight bear on my left leg. I somehow just skip along without really
using it. I can't stand on it, not even for a second. I think it has been like
that since I had my leg lengthening aged 11. Also, I have not been able to sit
Indian style since then. Basically, my leg is just something which dangles
uselessly from my body, it doesn't take any weight, it has very limited range of
movement and i have very little control over it.
Anyway please feel free to use all or some of my words and edit as necessary to
use on your web site. I hope it can be used to inspire other people (trusting
that I get a good outcome after all of this! Otherwise this could backfire!).
Also I want it to go up for selfish reasons, as I know that when I have those
blue days after surgery, I can look back here and remind myself why I had it
done, and how much my life has improved as a result. My ambition is to get back
on a horse, as I am hoping to go back to Uni and become a veterinary surgeon in
2009.
