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Having read with much interest the reports of others who
were some
way down the track, I thought I would weigh in with an
overview
report of my own first year.
I am a male living in Melbourne Australia, and first
realized that I
had OA around 2000. It became a bit painful doing leg
presses at
the gym (so I stopped), and I started getting pains in my
right
thigh, even going down to the ankle. One doctor thought it
was a
strained tendon, but a few months later it had not healed so
I went
to a sports medicine doctor who sent me for an x-ray and
diagnosed
OA. He discussed treatment (exercise, physiotherapy,
painkillers)
and that it was possible that surgery might be needed down
the
track, with the options being THR, or the newly introduced
resurfacing - of which he knew little (this was 2000).
For the next 5 years I limped along, on physiotherapy, Vioxx,
paracetamol/codiene, and glucosamine/chondroiton. All these
worked
to some extent and I no longer had referred pain. However,
in the
second half of 2005 things went downhill rapidly and I came
to the
point where I couldn't go on - painkillers did not work
properly,
and at night I was waking up with pain every 1-1 1/2 hours,
shuffling around and sleeping another hour on the recliner,
then
moving to the couch etc.
I researched the internet on possibilities and decided that
resurfacing sounded very promising (although I had not come
across
Surface hippies at this stage). My x-rays showed complete
loss of
cartilage in both hips, multiple cysts and so many
osteophytes that
each hip looked as though it was surrounded by a milky
cloud. The
woman who took the x-rays exclaimed "my God, how can you
walk!!".
My sports medicine doctor had no problem in referring me for
resurfacing and commented that he would go that route
himself if he
were in my position. Andrew Shimmin, the surgeon that I went
to, is
very experienced in resurfacing, having done about 500 over
7 years
(up to Dec 2005). At my initial consultation with him on 29
Nov
2005 he went through the advantages of resurfacing
(retaining an
intact femur, much more stable joint, more rapid recovery,
greater
range of activities following recovery, easy conversion to
THR if
the joint failed at some future time), but cautioned that
bone cysts
that could be seen in my X-ray could be deep enough to make
resurfacing problematic - in which case he would need to
decide in
the operating theatre to do a THR. He also cautioned that
whether I
could stand both hips being done in the one operation could
only be
seen in the theatre, and he would do one hip and then decide
whether
I could go on for the second.
I went for it as quickly as I could. Surgery for a bilateral
BHR
was scheduled for 14 December 2005 at The Avenue Hospital in
Melbourne. I went into hospital in the afternoon of 13
December as
I was scheduled for surgery at 10am the next day.
I was in the theatre for about 4 hours, under a general
anesthetic.
Although Andrew Shimmin said later that he had thought it
touch and
go as to whether I could sustain resurfacing (i.e. because of
the poor
condition of the hip surfaces), it turned out fine on both
sides.
Evidently I coped well with the operation and did not need a
transfusion. As my red cell count dropped from 14 to 10
(whatever
the units are) I was put on iron supplements for the next 3
weeks.
I spent the first night in the close monitoring room, before
moving
to the normal room the day after.
It was quite an experience to wake up with tubes going
everywhere.
There was one into my nose to supply a flow of oxygen. A
saline
drip going into the back of my left hand. Two drainage tubes
coming
out of small incisions to the front of the main incision on
each
side, and a catheter coming out of the place that catheters
come out
of.
As I had both hips done it was the second day after the
operation
before the nurses tried to get me out of bed. Two attempts
in the
morning were followed by success in the afternoon. The next
day I
took a couple of steps with a walking frame, and two days
after that
moved to forearm crutches - much better than the frame. The
wounds
healed well with no infection, and over the course of the
first week
I learnt to get in and out of bed myself, have a shower
myself and
commence physiotherapy. While in hospital a physiotherapist
visited
every day and taught me exercises to do on the bed using a
board and
little rolled up socks to put under my heels to enable my
feet to
slide. I'm glad that my upper body strength was sufficient
to fully
raise myself from the bed using the dangling triangle. It
would have
been very difficult if I couldn't do that.......
The staples came out on day 7, and I was allowed to go home
on day
8. I think that the final test (that I passed) was showing
that I
could self inject the Fragmin that I needed to take for 20
days
after going home. While Andrew Shimmin had said 10 days in
hospital,
the hospital itself expected me to be there for 8 days. I
think that
Andrew was being conservative, so I would feel good if
getting out
in 8 days, but not disappointed if it was a bit longer than
that.
Pain? No pain!! The hospital had made clear that all pain
relief up
to self administered morphine was on offer, but I didn't
need that.
Took panadiene forte for a couple of days, then dropped to
straight
panadiene, more as a preventative rather than because I
really
needed it. After I had gone home there was really no need
for
painkillers of any type.
The worst thing about hospital was the food. I did not enjoy
the
experience of taking a bite of a rissole which gave me gas.
Gas
blocked by constipation is no fun! Eventually I was able to
work it
through by using the motorized bed back to raise myself up,
and
lower myself down many times, enabling the gas to work
through the
system.
When I got home I made steady progress each day. I was
careful to do
the sets of exercises that I was given by the
physiotherapist before
I left the hospital, and got a new series of exercises after
a
month. It really was remarkable how, at that stage, I could
tell
the difference between the two legs when doing my exercises.
My
right hip was the first one that went, and so over time I
favored
that side. Though the left deteriorated at the end, there
was still
more residual muscle on that side. I could tell that the
exercises
were reviving muscle on the left, while starting from a
lower base
on the right.
At 3 weeks my wife took our daughter to relatives on the
south coast
overnight, so I took the opportunity to drive into the city
(about
20 minutes). Getting into and out of the car needed care but
was OK,
and driving was no problem at all! My wife was not impressed
when
she found out...
By 4 weeks, I could walk around the house without crutches -
although I did still use them when walking from one end of
the house
to the other. Andrew thought that I should use the forearm
crutches
for a bit longer so I tried persevering for another week or
so, but
it is difficult when you just feel that you do not need
them.
Up to the 4 week mark I still had to sleep on my back, which
created
problems in that I woke every 1-2 hours and had to stretch
my legs
before getting back into bed and having another stint. But
there
was no pain in the joints as there was previously. I started
sleeping through the night, and at about 5 weeks I could lie
on my
side. Such luxury to sleep through the night, wake in the
morning
and just doze off again for a short while, with no pain and
no
pressure to get up!!
Andrew Shimmin and the physiotherapist were very keen for me
to do
hydrotherapy, so I went to the local indoor heated pool and
saw an
exercise therapist for a program which I started at about
the 5-6
week mark. That really did help and I would highly recommend
pool
work.
I went back into the gym at about 8 weeks, and have
continued
throughout the year to go to the gym four times a week for
about 45
minutes followed by another 40 minutes work in the pool.
I returned to work after 7 weeks, and felt no difficulty in
that at
all (I work in a city office job).
Flexibility has been something that I have been working on,
and
there has been gradual improvement. At 8 months I could cut
my own
toenails with difficulty, cutting some skin in the process.
By 10
months the extra bit of bend was there to make cutting my
own
toenails easy.
I felt that for the first 6 months I was engaged in
rehabilitation.
After that it has changed to general fitness and toning
work. I
feel no restrictions now in what I can do.
On 12 December 2006 I had my 12 month checkup with Andrew
Shimmin,
which included x-rays. The implants look absolutely fine,
and there
has been good bone ingrowth into the implants. Carefully
making no
promises, Andrew implied that he could see no reason why the
BHRs
should fail, i.e. he could see no reason for me to ever have a
revision operation. Now that is something that I want to
believe
in!! Of course, things need to be kept in balance. Over the
first
6 months I was so keen to keep up my calcium intake (to
promote bone
ingrowth and maintain my good bone density) that I drank
copious
amounts of full cream milk - with the result that my
cholesterol
went too high. A change to low fat milk was indicated
(sigh).
Was resurfacing the right thing to do? Absolutely!! But if
you
have got this far in this lengthy report I'd just like to
make a
final observation. To me it seems that there are three
critical
stages facing someone who is coming to a decision that
surgery is
needed.
The first stage is deciding what sort of operation to have,
and who
should do it. These are decisions that should not be left to
others. If you are at this point do NOT become swept away by
the
system or surgeons' own choices. If you want resurfacing, go
to a
resurfacing surgeon, do NOT go to a surgeon and ask "what
can you do
for me?" The answer may be "Come in next Wed and I'll do a
lovely
THR".
The second stage is the operation. You have picked the
surgeon, and
now you have to trust in him (any female resurfacing
surgeons out
there?).
The third stage, and where you are back in control, is the
rehabilitation stage. I think that we do not focus enough on
the
importance of this ongoing process. Exercise and diet is
needed
that promotes healthy bone growth and the strengthening of
ALL the
muscles around the hip area. Strengthening of the hip
capsule is
needed, as well as strengthening of all the muscles around
it.
Varied exercise is needed, in all directions, not just
repetitive
exercise in one plane e.g. walking....
So, merry Christmas to all and a Happy New Year. Let us hope
that
the rain comes tonight and put out those bushfires that are
threatening so many settlements in the High Country. Our
thoughts
are with them and the brave firefighters.
Cheers
Ross bilat BHR Shimmin Dec 05
Postscript
On 26 December 2006 the Melbourne "Age" reported on page 1
"This was the Christmas miracle - or at least, the
Australian bush version.
For three weeks, locals and firefighters have sat trapped,
ringed by fire, alone and vulnerable at the top of Mount
Buller. Day after day, the bush burned in the valley below, the
flames making charge after charge up the slopes, fanned by
hot winds.
But then, at Christmas time, it happened. The winds eased,
the prayed-for rains came, and the fire threat abated. On Christmas Day itself, it snowed. A miracle. Lightly at
first, but stronger as the day progressed, coating the
mountain-top in an unseasonable white blanket. As it snowed outside, those on top of the mountain sat down
to Christmas lunch, and relaxed for the first time in more
than three weeks.
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