READ Peter's Complete Blog about his decision to
have hip resurfacing, his surgery and his post-op recovery by clicking here.
Welcome and Background
I'm starting this blog 19 days after enjoying Birmingham hip
resurfacing. My goal is to record my experience with this procedure, including
my decision to go ahead, my concerns and questions, and finally my still-ongoing
journey through the procedure and its aftermath. I imagine that this will be an
intensely boring and uninteresting story for almost anyone, anyone except those
aching souls who find themselves with a sore hip and the dawning realization
that they need to do something about it.
I'm particularly targeting active, athletic middle-aged types who are finding it
a little hard to believe that they might be facing a major operation, and who
are trying to navigate the piles of material on the web, a tangle of dated
material, excerpts from technical medical studies, and mostly, information for
more elderly people who are looking at conventional hip replacement.
It's important to realize that I'm not a medical doctor (I have a Ph.D. in
tectonics and geochemistry that just makes me dangerous, and not an authority on
medicine and orthopedics!). It's likely that other people have done things
better, and it's certain that your hip and your condition will leave you facing
details that could add up to be quite significant. So please, treat this as one
person's story, n = 1.
Back Story
Let's set the stage for this hip story. This will be a
longish post, intended to let you compare yourself to my case to see if anything
jives. If you're more interested in the surgery and the aftermath, you might
want to skip this too-much-information report!
I'm a 51, male, and a college professor. To counteract the sedentary lifestyle,
I try to road bike 4000 miles a year, which between travel and meetings, and the
darker winter months here in eastern Pennsylvania, is about all I can manage if
I include trainer mileage and can throw in some longer summer rides. I love
cycling, and given the state of my knees (and hips), it's the perfect exercise.
I've never raced, but I try to average 15 to 17 mph on the hilly rides around
here, which I'm proud of even if it's a snail's pace for really good riders. All
the riding alows for robust eating and the chance to work out the tensions that
accumulate at work (even professors bear their crosses...). I'm 5'10", and
seasonally fluctuate in weight between about 202 and 212 pounds with a fat
content of about 25% (at least according to a Tanita scale in standard mode). (I
told you this post would be boring!). The other reason I try to keep active is
that for quite some time now my research has involved field work in the Himalaya
and Tibet (see www.ees.lehigh.edu/groups/corners), and even in teaching we lead
field trips, so being fit is important professionally as well as personally.
As I recently learned, I have mild dysplasia in both hips and considerable
osteoarthritis, partly as a result of the dysplasia. The angle of my femoral
neck is also quite shallow. Before my hips became the main focus of my joint
discomfort, I was more worried about my gimpy knees, which are missing some
ligaments due to untreated ultimate frisbee accidents in grad school and in
retrospect, too much jogging and running (leaping down trails in the
Presidential range; humping out heavy packs of rock samples...).
It's hard to know when the hip pain started: probably back about 7-8 years ago I
started noticing stiffness in my groin and thigh after a hard day trekking.
Also, standing or shuffling about, like at art museums or during poster sessions
at professional meetings, really started to hurt to the point where I was
starting to avoid such events. But biking did not cause pain, leading to awkward
explanations about why I could happily ride 50 tough miles, but would start
whimpering if threatened with a visit to MOMA.
About three years ago, a sampling trek in Tibet went wrong: we thought a route
might gradually head up a glacial valley, but instead went straight up a
vegetated cliff. It was a desperate few hours, requiring big lunging steps and
unforgiving foot placement, and by the time we got up and back down, I literally
could not walk due to the sharp hip pain. When I returned to the US I saw my GP,
and she diagnosed osteoarthritis. She put me on two forms of Diclofenac (Voltaran
and Cataflam). It was a miracle: little pain, much improved range of motion, and
I could ride my bike or play 18 holes of golf walking and carrying.
Time passes, and gradually the NSAIDs aren't working as well. Walking a round of
golf is a crap shoot in terms of pain, I'm avoiding museum-type standing, and
meanwhile I am wondering about the long-term wisdom of eating the Diclofenac
twice a day. In late 2006, I noticed at the end of the bike season that at the
end of ride I was feelin very sore, and pulling off of agressive attacks on
rises and hills. When the 2007 season started, the soreness was still there, but
worse.
Then in May 2007 I went to a conference in Hong Kong, and it was nearly a
disaster. Getting off the long flight, I could hardly get through immigration,
and the daily walk to the conference and the standing around were just
crushingly painful. When I arrived back at O'Hare, I honestly thought I would
have to declare a medical incident and ask for a wheelchair to get to passport
control. In the weeks that followed I could only walk with a painful and obvious
limp. When I tried to ride, anything more than 10 miles left me very sore, and I
couldn't push any power through my left side. The pathetic finale on June 18th
was an attempted 15-mile ride where I got caught in a thunderstorm just as my
hip gave out: I bailed, and crept home in a downpour, trying to spin granny gear
long enough to get home.
I revisited my GP, who had me go for X-rays, and after seeing them, said she was
sorry, but really the only thing to do was to see an orthopedic surgeon.
SURGERY
On the day of your operation, you will probably be asked
to get up an unearthly hour, take your antiseptic shower, and report to the
hospital for admission and preparation. This is one time that you do not need to
worry about lack of sleep, I promise you.
I chose to avoid a final decision on anesthesia until meeting with the surgeon
on the morning of the operation. Everyone was 50-50 about using a general versus
a spinal. I decided that I had no interest in seeing the operation, even if my
memory would get wiped. And, as it turned out, if the surgery takes extra time,
like mine did, then a general is the better choice. You'll have to make your own
decision based on your condition and interests and the advice for your doctors.
If you've ever had surgery of an kind, you'll know that one minute your wheeling
along in a cart on the way to the OR, and then suddenly you're groggy and on
your back in a different place. My surgery (on Monday 6 August) took 2.5 hours
because the surgeon needed to work a little harder due to my hip dysplasia.
I had been told that Birmingham patients do PT on the day of their operation.
Well, sort of. It consisted of being moved out of bed to a recliner, maybe 1
meter in distance. I almost passed out on this long journey. Impressively
though, my surgery ended at 10 am, and by 2 pm I was in the recliner, awake. My
family visited and watched while I picked at my dinner (I had ordered the
meatloaf selection as comfort food, but my appetite was beyond comfort,
certainly by that meatloaf!).
When I awoke, I had a urinary catheter, an IV for pain med, antibiotics and
fluids, and a dressing on the incision but no surgical drain. The wound was
closed internally by dissolvable stitches and externally by steristrips
(compared to other Frankensteinian sutures I've had, the closure was gorgeous
and tight; too bad this is not the most photogenic and oft-displayed part of
me!). The catether came out the next morning (no real pain), the dressing got
changed daily (no real pain), and I did PT morning and afternoon starting
Tuesday afternoon (no real pain). Constantly asked about pain on the 1-10 scale
(wtf is a 10 supposed to be: slowly being crushed by a truck??), I never went
beyond about a 4, thanks partly to the opiates, including morphine over the
first two days. Probably the most pain I had were brief sharp tugs in the area
of the incision; these diminished over time as the wound healed and the sutures
adjusted.
By the way, there are various ways a surgeon can access the hip, but if your
view of the hip is of the hands-on-your-hips variety, you may be surprised to
find your incision is on your ass as much as anywhere else!
One thing to be prepared for is an unpleasant norm for post-operative,
opiate-filled life: constipation. They give you some palliative stuff, but
really, in my experience from traveling over the years and using various
"stomach" remedies, once an opiate gets into you, your intestines just go on
extended holiday. What made my life worse was the toilet extender they had
perched around the hospital toilet. I am not a huge guy, but sitting in there
pinned my legs together in such a way that even if something was thinking of
happening, it wasn't actually going to. I had to get home to find relief. If
you're lucky this will not be your experience.
The biggest post-operative issue I had and am still getting over is the trauma
to my quadriceps. If you have the right constitution, find one of the surgical
videos posted on the web and watch the Birmingham operation. You'll see that
fairly early in the procedure, Igor the Assistant gets the word to dislocate the
hip, and this involves a rotation of the leg that ain't natural. Your leg is
twisted in a weird way, the femur is exiting the incision and I assume pressing
up against connective tissue and muscle, and you are unconscious and not in a
position to say 'ouch -- I'm cramping'. That goes on for like two hours. So I
found that while I could bear weight on my hip, and right from the start could
walk on my left leg with a walker or crutches, my quad was shot, and any attempt
to raise it, say in a straight leg raise, let alone climb a stair, was hopeless.
I don't know if this is just something that happened to me, or is common to hip
operations, but I was a bit surprised. I thought that all the pain and trouble
would relate to the incision and the cut tissue there, but that has not been the
case.
I was discharged on Thursday (Day 3) and was able to crutch to our car (a
Prius), comfortably get in, and escape to home.
Day 3 Post Op
We have a two-story house, and it turned out to be no problem
to live on the second floor. I was able to crutch up stairs without problems,
and since the renovated bathroom, the bed, and our best easy chair were up
there, this way I could withdraw and rest. Descending for meals and visits byh
therapist and nurse made for some variety.
I set up a recliner next to my bed, and gathered together some pillows, a big
mug of icewater (you will be thirsty for quite a while), reading material, cell
phone and cordless phone, and my laptop (we have wireless, which is a great
boon). This made for a pretty comfortable base with lots of options.
I grew to hate the phone, because inevitably I would forget to schlep along the
handset, and as I was expecting calls related to nurse visits and such, I could
not ignore the wretched thing. So if you hate cold-calls by solicitors anyway,
wait until you have to wrench yourself out of a chair, hobble to find the phone,
and then enjoy a recorded message form some dufous...
You will probably have arrangements made for a visiting nurse and physical
therapist. It's nice to be able to talk over your condition with someone, and to
start work on mobility and strength. My therapist made the very good point to
not rush things: form, balance, posture, and gait are important. If you were
limping before the operation, it may have been a long time since you've walked
normally, and the goal of the operation is restoration of full activities, not
merely a return to gimphood. I know different people will heal at different
rates, but I wonder if some of the miracle reports about people walking unaided
after a week need to be asterisked: are they walking smoothly, or limping and
gimping around?
A few things to know about:
First, it is very easy to feel lightheaded when you pop up out of a recliner,
especially if you get into the shower and have nice warm humid vapors around.
Make sure you have a place to sit or someone to help you, certainly the first
time or two.
Also, apparently it is common to experience post-operative temperatures in the
evening, and you might find yourself with minor chills, sore skin, lower energy,
or whatever symptoms you show when you run a temperature (we're talking numbers
between 99 to 100 F, not higher values that might indicate an infection and the
need to contact your doctor).
Sleeping sucks. Until you get loose enough to roll over onto your stomach you're
kind of stuck sleeping on your back or non-operative side, and for me that is a
position that turns my brain on, not off. A pillow between the legs is not
required for Birmingham people, but helped me when I tried sleeping on my side.
Even once you can sleep in any position, I found that there was just enough
tightness or discomfort that I would only sleep in blocks of 90 minutes or so,
with lots of twisting and turning, which did not help my wife sleep. For a few
days I reverted to taking a Vicodin at bedtime, but then I saw the recent news
story about ramapant abuse and I decided to stop. If you can at all help it, do
NOT nap during the day.
Finally, I felt-and apparently this is not uncommon-sort of despondent and
depressed for one or two evenings when back at home. I still felt sore, and
incapacitated, and just miserable and sorry for myself and sorry to be causing
such a fuss for everyone. This feeling passed as my energy returned and things
healed up. So if you feel this way, tell people, but don't worry: the feeling is
likely to pass.
Day 11 Post Op
On August 17th, 11 days after surgery, I visited the
surgeon's office and got the great news that a new X-ray showed everything looks
good. The implant looks like a mushroom: can't wait to deal with TSA at
airports. As my left hip was involved, I was given the green light to drive (one
of our cars, the Prius, is an automatic, so the left leg just has to cope with
the parking-brake pedal).
Free to drive, I switched over to outpatient physical therapy, planning to go
about 3 times per week. It's good to get some exercise and beginning to push the
leg with concrete goals like cycling and stair-climbing in mind. By about the
22nd, I was mostly getting around using just one crutch for a little support. On
the 22nd, at PT I actually rode an exercise bike for about 2 miles worth of
spinning.
Here's a timeline of how things progressed for me:
Day 0 - surgery; up in recliner
Day 1 - cathether out, first PT session, walking with some weight-bearing and
two crutches; quadriceps stiff
Day 2 - PT twice, antibiotic IV done; some swelling in leg
Day 3 - discharged to home
Day 4 to 6 - quadriceps sore; swelling in leg; evening fever and some
depression; just occasional Tylenol and one nightime Vicodin for pain. Took
short crutch-assisted walks in neighborhood (maybe 500' total),
Day 7 to 9 - more energy, more flexiblity
Day 11 - visit doctor, ok to drive
Day 13 - maximum likelihood of blood-clot problems is two weeks after surgery;
so far so good
Day 13 to 15 - start outpatient PT; participate in off-campus retreat for new
program I am running
Day 16 - go back to work for a half-day; able to walk down stairs leg-over-leg
Day 17 - full day at work, several meetings
Day 18 - start this blog, discover that I can walk up stairs, ride 20 minutes on
wind trainer (low resistance spin).
Day 19 - basically off all pain meds, including Tylenol. Am just taking 325 mg
of Aspirin twice a day as pain killer. Back on wind trainer again, and am
walking shorter distance around house without any crutches.
READ Peter's Complete Blog about his post op
surgery experience and decision to have a hip resurfacing by clicking here.
