BHR Hip Resurfacing with Dr. James Pritchett

I am submitting this journal for those who are contemplating hip resurfacing with Dr. James Pritchett at Swedish Orthopedic Institute in Seattle, WA. I am a 43 yr old male who has been very active all my life. Up until one year ago I was running 5k road races competitively and playing basketball at least three times a week. I have always enjoyed tennis and biking as well. In the summer of 2007 I started to notice left hip soreness/stiffness would occur after these activities and eventually found that I could not participate in such things without increasingly more acute pain. For a year I had walked with a limp. About 10 months ago I went to see a Sports medicine doctor in Seattle to see what was going on. He took X-rays and upon viewing them, he informed me that I had severe osteoarthritis in my hip and that I was headed for a total hip replacement. My initial response was "You've got to be kidding me!" He referred me to Dr. James Bruckner, an orthopedic surgeon who specializes in hips and knees for younger individuals. Dr. Bruckner is a hard guy to see. He is well known and his schedule is always full. I was able to get an appointment with him about 2 ½ months later. During the appointment, I provided a recent MRI of my left hip and he had a new X-ray taken. His analysis was similar to the sports med guy. He even saw some bone on bone evidence. His recommendation was for a total hip with metal on metal components. He provided me with examples of individuals who had gone through the procedure and returned to active and healthy lifestyles. He did say that running on a total hip was not recommended, but biking, skiing (not moguls), doubles tennis, swimming, etc. would be fine. Wow! What an eye opener! I was not ready to give up all of my favorite activities yet. I did have to recognize that the situation was what it was though. I focused on trying to keep my thought open to what was best for me. Around this time, I heard about surfacehippy.info and read through the entire website. I then began the process of trying to find the right doctor for me. I considered all of the options: going overseas, traveling to Wisconsin or New York, or finding a doctor close to home that had excellent results and experience. The search led me to Dr. James Pritchett at Orthopedic International in Seattle, WA. He reviewed my X-rays and MRI which were still fairly recent. He indicated that I was an excellent candidate for HR. Dr. Pritchett has been a hip specialist for a very long time and has performed over 600 resurfacings. I felt that his experience, age, curriculum vitae, and willingness to answer all of my concerns both patiently and thoroughly were enough to put my hip in his hands. The following is my 2 day experience at the Swedish Orthopedic Institute:

Sep 09, 2008 ( Surgery Day)

I arrived at Swedish Orthopedic Institute, Seattle, WA at 10am for check-in. The staff was ready for me and check-in went smoothly. I met with a nurse to verify all pertinent information (left hip, any meds, various required documents, etc) was completed and accurately reflected in my file. This took maybe 20 minutes. My wife and I then did a crossword while waiting for the anesthesiologist to show up. We had over an hour because the check-in and pre-op interview did not take long. My surgery was scheduled for 1200 noon. At about 1135am Dr Pritchett showed up to mark the proper hip and answer any last minute questions. He is a very easy person to speak with. Be sure to ask any questions that you may have because he probably will not volunteer information. It's just his nature. If you do have questions or concerns though, he will patiently and thoroughly answer them. We spent maybe 5 minutes together. Soon after he left, the anesthesiologist showed up to discuss what type of anesthesia I would take. His advice was for a spinal block along with a heavy sedative so that I would sleep through the procedure. Up to this point I had expected to get general anesthesia to knock me out cold, but his suggestion for the spinal block was excellent advice. He stated that the transition of waking up from the anesthesia was smoother with a spinal than with general. He could control the pain meds in a more gradual manner and there would be less discomfort. If one gets general anesthesia, it must wear off quite a bit before the pain meds can be increased to a certain level. There would be a certain amount of time where I would feel higher levels of discomfort and would just have to deal with it. With the spinal, there would be no time limit and I would be able to remain relatively pain free continuously. This turned out to be my experience.

At about 1155am I was wheeled into the OR wide awake. Other than a couple of minutes chatting with the nurse and the anesthesiologist, I do not remember anything else until waking up in the recovery room around 2:30pm. I felt better immediately. From the waist down I was still numb, but I could wiggle my toes. Right away I could tell that I was healing and it was good. I had not eaten since the night before, so the nurse gave me some ice chips first to test my tolerance for ingesting. No problems, so on to a big glass of water.

After about 45-50 minutes in the recovery room, I was wheeled to my private room on the 4th floor. My wife was already there with a big smile to greet me. She was amazed at how wide awake and good I looked. She had expected me to be more worn out and groggy looking. The nurse helped set me up in the bed. From there, we just hung out for a while. Around 4:30pm I ordered an omelete with mushrooms, onions, and cheddar, some wheat toast, and a strong Americano. This was a heavier than recommended meal, but I was starving and had no problems holding it all down.

The PT (Randy) came in around 6pm and we did some thigh tightening exercises, some gluteus tightening exercises, and then decided to try and get up and walk around with the walker. I was able to do it all. Any discomfort was from the surgery, not the hip joint. I even took a few steps with my hands off the walker just to see if I could. Amazing I tell you! I realize that being smart, and allowing the body to heal naturally is the way to go. I didn't push it to the limit; I just wanted to try out my new parts. The PT said I was well on my way and after helping me get back into the bed, he took off. I looked forward to continuing the healing process.

The rest of the night was spent writing this journal, watching a little TV, and chatting with my wife. Swedish Orthopedic Institute is a new and well prepared facility exclusively for orthopedic patients. The In-patient rooms have an extra sleeping platform for a family member or friend that is the patient's helper. I was very happy that my wife was with me. Throughout the night, I was visited just about every hour by a nurse. He or she would take my vital signs or deliver meds, or any other designated task. They have one's entire stay at the Institute mapped out. Unfortunately, it makes for a long night with very little quality sleep. I knew that I was in good hands though so I just relaxed as best I could and went with the flow.

Around 7am I was visited by Dr Pritchett and he wanted to see that I could move my foot back and forth. I could and he was satisfied. I then asked him how everything went and if the prosthetic was a good fit. He assured me that the procedure went well.

Since I had not slept much I tried dozing, but was awakened around 815am by the new shift nurse (Ali). More scheduled meds and vital sign checking. The nurse from the previous shift had removed my catheter and I had not peed for a while. Ali wanted me to do this into a plastic bed pan bottle. I must say that it was very difficult to do because each time the urine came through where the catheter had been it felt like pouring acid on an open wound. Success occurred with much effort. This was not a pleasurable experience.

Physical Therapy was scheduled for 9am. It involved getting oneself out of bed and then standing/walking with the help of a walker. After about 2-3 minutes on my feet, I began to feel light headed. The PT (Bob) had me sit down on the bed and I finished the session by doing numerous exercises in bed that test ROM and general movement. Ankle pumping, Isometric quad sets, Hip abduction, heel slides, etc. This part of the PT went very well. The pain I felt was from the wound and traumatized muscles, not the joint surfaces. Getting light headed during the walking portion was an issue though. Bob said it was not uncommon so soon after surgery.

Later in the day, at 2:15pm an OT (Gina) came to help me learn to put on pants and socks with a reacher tool and a sock aide device. These tools are simple but effective. The inventors are geniuses. She also taught me the proper way to sit on the toilet and we did some walking. I again started to get a little dizzy, so we sat down on the bed. This time was not as nearly dramatic as the first light headed episode with the previous PT. We discussed what we had practiced and she left.

At 430pm, another PT (Peggy) came in to go through the whole range of exercises. She was concerned about my previous light headedness and wanted to take it slow. Interestingly, I felt great and proceeded to walk around the entire corridor w/walker (roughly 500 feet) with no problems at all. I think the light headedness was a result of all the pain meds and residual effect of the spinal anesthesia they gave me. Lack of sleep may have contributed also. Whatever the case, I did great on this last PT session and could tell that I would continue to progress.

The rest of the evening was great because I slept from 6-9 pm. At 9pm I ordered some food. I had a healthy appetite and no problems with upset stomach or anything. I stayed awake for the nurse to take vitals around 11pm, and then slept deeply until 430am (another nurse visit with a pain pill and vitals). Slept again until 630am. I felt very good when I awoke. Any pain I was feeling was only from moving around with the muscles that had been disturbed during surgery; no pain from the hip joint at all.

Dr Pritchett visited me at 7:30am. I asked a few questions and he answered them all thoroughly. The main question was "May I go home today?" Absolutely. The road to recovery continued.

Around 8am I started to feel a slow increase of pain at the surgery site. I had told the nurse at 7am that I wanted to skip the pain med she offered and unfortunately I could tell I should have just taken it. I was given a couple of pills and within 15-20 minutes the pain subsided.

At 8:15 am the next PT (Scott) came in and we did the bed exercises followed by learning how to use crutches. Getting out of bed was now easier for me and the crutches worked great. Everyone from Dr. Pritchett to the nurses said to do weight bearing stuff as tolerated. I must say that the new joint did not hurt to do full weight bearing. The main issue was muscular pain and instability associated with the ligaments and muscles. I was able to walk all the way around the corridors and go up and down stairs with little difficulty. The PT still wanted me to keep the crutches touching the floor while walking, but full weight bearing while standing was not a problem. It was a beautiful thing.

At 10:15am the OT (Gina) was back to teach me how to get on and off the raised toilet seat, get in and out of the shower, and get in and out of the car. The institute has mockups/simulators in a special room so that you can practice these things. The hardest part was getting in and out of the car. Walking with crutches to and from my hospital room and the mockup room (about 300 feet) was easy.

The entire time I was in the institute post surgery all of the PTs, OTs and nurses continually emphasized the BIG 3 NO NOs. (1) Do Not bend forward to 90 degrees torso to operated leg. (2) Do Not allow your operated leg to rotate inward. (3) Do not cross your legs. These instructions are to be followed at all costs. While practicing/learning all of the new skills, one must constantly be aware of the BIG 3. Concentrating on all of one's movements and taking it slow is the key to success. Always obey the BIG 3 until Dr. Pritchett gives the green light otherwise.

Since I was going home in a couple of hours, the nurse (Linda) was coordinating with the pharmacy for take home meds; the medical supply dept for raised toilet seat, reacher, and sock-aide; and showing my wife how to clean and redress the wound. I took a shower (which felt great), ate some lunch, had the wound redressed, and we were on our way home. One of the staff nurses (Abdul) wheeled me out to the car. From check-in to check-out exactly 51 hours had elapsed. Less than 48 hours from surgery.

6 Month Update

It has been 6 months since undergoing hip resurfacing with Dr. Pritchett in Seattle. Overall, my experience has been outstanding. The most important issue is to follow the post-op steps outlined by your doctor (i.e., initial movement limitations and PT). I have worked very hard to get all of my strength and flexibility back. Flexibility has been the most challenging, since it had become somewhat limited in the year or two prior to surgery. I can run, jump, and bike virtually pain free. I continue to see improvement with each passing month. Prior to HR, I would be quite sore in the hip joint with associated limping and sleep deprivation. I'm sure many of you can relate. Now there is a complete lack of discomfort in the joint area. It truly is as though I have been given a new hip (which I have).

To anyone who is contemplating HR, do your homework and choose the right surgeon. Read everything about the procedure, talk to others, ask your surgeon questions, hit the PT, don't be shy. It is your hip and your life. You can have it back.

Dr Pritchett told me that he believes the new hip will last forever. He is quite realistic, however, that the long term data is not available to support his belief. There may be unforeseen issues to navigate as time passes. This procedure is still new and needs time to mature before it enjoys the confidence of total hip replacement within the medical community.

I can only speak from my experience. Clearly, it was the right course for me.

Dave Hodges