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Dirk Van Dyke
Bilateral DePuy ASR 02/08, 03/08
This site has been a great resource to me. It really helps to read similar
backgrounds, similar scenarios, and resurfacing results from so many people.
That said, no two cases are exactly the same, so in hopes that it might help
somebody weighing hip osteoarthritis decisions, I'll give my resurfacing story.
I am a 47 year-old male, always very physically active, diagnosed with
osteoarthritis in both hips in mid 2005. I had my right side resurfaced by Dr.
Scott Ball in February 2008 and the left side done 5 weeks later, in March 2008.
Pre-Diagnosis Background. I played ice hockey, as the goalie, since 3rd grade,
continuing through high school and college teams. After college, I kept playing
in men's leagues, and was playing 2 to 3 times a week until the arthritis got too
bad, and I just couldn't play well anymore.
I've also been very active as a road bicyclist, in addition to tennis, skiing,
running, etc.
Arthritis Diagnosis. When the diagnosis came a couple years ago, I couldn't
stand still - literally. While waiting in line to place a lunch order, or at a
stoplight, it hurt to stand. It wasn't an immediate fall-to-the-ground issue -
more of a slow buckle. My GP doc suggested some stretches and ordered X-rays,
which ultimately revealed hip arthritis.
Resurfacing wasn't FDA approved at the time, and my doc gave
the standard line: try to stay as active as you can, put off THR as long as
possible. (To move forward in the story, I had my resurfacing pre-op work done
locally by that same GP doc. When I told him I had resurfacing scheduled, he
knew exactly what I was talking about and said that if he were in my place he
would choose resurfacing in an instant.)
In retrospect, the hips had been bothering me for years. I
had stopped playing tennis a few years earlier because of hip impairment/pain.
For the past few years, I would limp with sore hips for a day after hockey
games. But after or little time (or some ibuprofens if I was in a tournament),
everything would be fine.
In cycling, I also had a few hints that something was wrong.
At the time of diagnosis, and for the previous couple years, I would get an
infrequent muscle pull/irritation at the isochial tuberosity (sp?), where the
hamstring goes into the hip. Sometimes, I could ride through this, other times I
couldn’t.
Post Diagnosis. In hockey, it's interesting that I was able to play at a high
caliber with minor arthritis for many years, but once it reached some threshold,
things went down fast. In March of 05 I was playing on tournament teams. In
July, I got the arthritis diagnosis. By November 05, I hung up the skates and
quit hockey.
In terms of physical activity, I was lucky that I enjoyed
cycling and that cycling is therapeutic ("motion is lotion") and minimally
impaired by hip arthritis. Somewhere in my internet searches, I came across a
cycling-aware doc who mentioned that he had a hip arthritis patient who could
ride better than walk. This provided lots of incentive. In November of 05, after
diagnosis, I was still able to participate in the 110 mile Tour de Tucson (for
the 6th year in a row). The following year, however, the irritation of my
isochial tuberosity became much more frequent, to the point where I really
couldn't train. I missed Tour de Tucson in 2006 but still tried to get out on
ever shorter rides.
After this, I grasped at straws a bit, and saw a sports ortho specialist, who
commented on the "obvious" impingement (FAI, cam femoral), which none of the
previous docs had noticed. This doc specialized in the arthroscopic FAI
deburring procedure, but I was not a candidate because the arthritis had
progressed too far. He referred me to a doc who specialized in minimally
invasive THR, and that Dr. wanted to schedule bilat THR in early 2007, but by
then I had heard about resurfacing and declined the THR surgery.
Here's a cycling tip that allowed me to postpone surgery for another year. At
this time, a friend who is a way more serious cyclist, suggested that I see his
cycling coach. This coach does bike fittings, is a certified coach, and in
partnership with his wife, who is an MD, lectures on biomechanics of cycling.
They looked at my x-rays, evaluated my bicycling posture, fit, pedaling
efficiency, etc. in light of my hip arthritis. He doesn't sell bikes, but told
me that I really needed a differently sized bike to accommodate my arthritic
condition. With changes to my bike posture to minimize my hip angle, changes to
my cranks to minimize step-over distance, and work on my part to smoothen my
pedal stroke (energy misapplied to the pedals is wasted, and that energy returns
up the leg to the hip cavity), I was able to keep riding and delay surgery. I
set a goal of riding Tour de Tucson at least once more (2007 edition) on my
God-given hips. While it seemed like my daily hip-quality-of-life went down at
an increased slope in 07, I was able to get in good bike rides, and at the end
of November, I again finished ETT (in a personal best, that’s the picture
above). In fact, I was able to keep on riding, well, right up until my surgery.
And it turns out that this extra year of putting off surgery allowed me to
discover this site and other resources related to hip resurfacing, which have
been invaluable in guiding my decisions.
Finding a Resurfacing Surgeon. Dr. Ball, who did my resurfacing, was the 2nd doc
I saw. The first doc I saw was one of the leading numbers guys, but I think I
had the bad luck to see him on a bad day. My appointment started a bit late
(always the case), but after 10 min, a nurse came in to remind the doc that a
film crew was waiting in his office for some session. I felt rushed - didn't get
a chance to discuss bilat timing - and a significant part of the session seemed
spent on what seemed like the doc trying to talk me into MOM THR. After that, he
did say that I'm a good candidate for resurfacing and would be glad to schedule
me. I left thinking that I don't care if he's not a good communicator; I know
he's good with the knife.
But I scheduled a 2nd-opinion visit with Dr. Ball. This time,
the office visit had the benefit of me being able to describe how I define
myself - that it's more about going on hikes with my wife and kids, riding our
bikes across Iowa, participating in competitive events, etc. Dr. Ball is a very
personable man and he answered all my questions. It was getting to the point
where I was worried I was taking too much of other patient's time, but Dr. Ball
twice asked whether I had any more questions. Dr. Ball also noticed the FAI and
surmised that this was the cause of my arthritis. (I wonder whether the FAI is
entirely genetic or whether the hip stress from playing goalie for 30-plus
years, including during bone-formative years, was causative. Also whether I
would have been able to live a full life w/ FAI hips had I not played so much
hockey. If any other goalies have this, I’d be interested to know.) Another
great thing about Dr. Ball is the UCSD facility where he works. The hospital
seems more like a hotel than a hospital. Because my wife wanted to stay in the
room with me, they assigned me a room with a big window seat (with cushion) that
was easily big enough for my wife to sleep on. All rooms are private, I think.
1st Surgery (02/08). The first surgery seems textbook perfect. Dr. Ball seemed
genuinely enthused about my surgery. Two days post-op, I was off all pain meds
(although I took one of the shorter-term oxycodone (sp?) for the 6 hr car drive
home from San Diego on the 3rd day post-op. I was on 1 crutch in under a week
and returned to work 7 days post-op. Fatigue during the 2nd and 3rd weeks post
op were my biggest problems. I started basic PT 1 week post op, which included
setting-up my bike on the resistance trainer and getting in easy spins. By 3
weeks post-op, I was riding indoors with some resistance and getting some cardio
work.
2nd Surgery (03/08). Exactly 5 weeks after the first resurfacing, I saw Dr. Ball
again to get the other (left) side done. Both Dr. Ball and the other resurfacing
Dr. I visited for a diagnostic session said that there is less total risk from 2
relatively smaller surgeries (i.e., one side at a time) than 1 big bilateral
surgery: less risk of needing a transfusion, less risk of infection, and not
said, but I imagine, less risk of surgeon fatigue. So I opted for the staged
bilateral resurfacing.
If the first surgery was the stuff of resurfacing miracle
stories, the second one is more of an exercise in patience and humility for
these first few weeks. Dr. Ball said he had a slight concern because the
“finder” cup he puts in before the real one came out a little easier than usual.
The real cup when in solidly, but just to be cautious, I’m on 25% weight-bearing
restriction for 4 weeks. I had no idea 2 crutches would be so debilitating. I
just try to imagine how liberating it must be for somebody who progressed to
crutches from a wheelchair. Another positive is the right hip, which like the
non-prodigal son just does everything asked of it, does it well, and then
watches while the other hip gets all the attention. In addition, I developed an
allergic reaction to the incision glue and got blisters on my incision. And then
the fatigue seems worse too, which I sure is not unexpected with 2 major
surgeries in close proximity. The left hip itself is feeling better and better,
and that’s the main thing.
That's the hip story to date. Hopefully in a few weeks, the little bumps in the
road to recovery will be forgotten. I’ll try to send some further updates. If
any others are planning or thinking about riding Tour de Tucson bike ride in
November 2008, let’s get in touch. That’s my goal for this year.
Of course, if anybody has any questions or would like to talk about similar
issues, feel free to send an email.
Thanks and keep looking up,
-Dirk
Bilateral DePuy ASR 02/08, 03/08; Dr. Ball
4 Month Update It's amazing how time
drags when you are going through some of the rough spots during recovery, and
with the luxury of time passed, how quick it seems.
I just came back from my 4 month followup (4 mo after the second surgery). All
surgical concerns got a good report. It was actually a bit of a letdown in that
there wasn't more hard data. The xrays confirmed that everything is looking
good, but it seems that the xrays are useful in showing if there is a problem,
but they do not show, for example, that bone growth into the acetabular cup is
65% complete or anything like that. Don't get me wrong, it was great to get a
good report, but I was surprised that the larger percentage is subjective "I'm
feeling good; getting better and better; ROM acceptable; etc." The xrays are
more to corroborate that recovery is going well (everything in place; no
apparent problems, etc.).
It was also interesting to realize the difference in perspective between
physical therapist and surgeon. I've been going for therapy for the past couple
months or so, once or twice a week. I'm glad that the therapist's goal is
complete recovery. When comparing my current status against that goal, there is
still a long ways to go. Strength is still missing, and the even bigger
challenge is ROM. I wasn't super big into stretching pre-surgery, but it wasn't
too long ago, only 3 or so years, that I was playing hockey, so I know what my
ROM was before arthritis really hit, and I know that I am still a long, long
ways from where I was a few years ago. The Phys Therapist also thinks that ROM
needs lots of work. But the surgeon gingerly moved the legs around, checking for
specific ROM measures, and was very happy. It really brought
home to me the idea that the surgeon's definition of success is a well placed
prosthetic, and it's up to the patient to decide whether recovery is defined as
walking, working around the house, low-impact activities, or being able to do
things like play hockey or singles tennis or skiing black diamond runs, etc.
etc. So I'm glad that I'm working with a Phys Therapist who defines recovery as
getting back to a pre-op, non-arthritic state. Don't
misunderstand, the surgeon is supportive of returning to a higher level of
physical activity; but it struck me that from a surgical standpoint the
operation is already a success, while I still have a long ways to go in terms of
muscle recovery and ROM before I reach my goals.
And If I don't take it to that next level, the surgery
certainly is already a success. I'm much better than before the operation: I
wanted to be able to go on (fairly strenous) hikes with my family and not be
left behind, to be able to shoot some hoops with my son and not be sore for the
next day after taking a few semi-quick steps for a rebound, to be able to keep
riding bike. I feel like I've already got those things now. I didn't allow
myself to think that I'd play hockey again (even gave away most of my gear), but
the way the recovery is going, now I want to give it a try. So
now it's the gradual plateau stage of recovery. It's funny that a surgery can
make you measure your life by toenail clips. I don't think I'm getting much
better, but every time I clip my toenails, it's easier than the time before.
I do have a few concerns. As mentioned, ROM, ROM, ROM. I know from reading on
message boards that this comes gradually over a year or more, and my surgeon
also stated that people report big gains even up to 2 yrs post op. My left side
(done last) is a bit more of a challenge in this regard, but it is making
progress. I also have a bit of that clunking in the left hip. It's infrequent
and getting more infrequent and more and more at the extremes of ROM. I expect
that it will go away sometime in the first year, as is the case with many who
have this issue. I’m still setting an event goal of riding 111
bicycle ride Tour de Tucson in late November (no time goal, just finishing). If
any hippies are interested, I’d be glad to help coordinate ( I live in Phoenix
area). Keep lookin up,
-Dirk
Bilat ASR, 02/08, 03/08, Dr. Ball.
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