RBHR Jan 18, 2008 Dr. Gannon
A Montana Surface Hippy with excessive calcium growths
I am a researcher at Montana State University in Bozeman, MT and an avid tennis player. We are surrounded by mountains and could spend every weekend hiking, horseback riding and skiing.
My first arthroscopic crisis occurred about 3 years ago with a calcium spur on the back of my heel (commonly called “Pump Bump” in honor of the thousands of women who develop this spur after spending years in high-heeled shoes). The spur was painful but the biggest problem was that it encased my Achilles tendon and could put me on my knees in the middle of a point (Fortunately, I had an awesome partner capable of covering the vast majority of the court). The surgery to remove the bone spur (Dr. Diebert) was very successful and I was back on the tennis court in about 8 months.
A couple of months later, I started noticing pain in my right hip. My GP diagnosed the problem as bursitis and recommended PT. PT was humiliating. I had minimal flexibility in my hip. If I was laying flat on my back, I could not flatten my knee without arching my back. The PT felt the entire problem was lack of flexibility and recommended a series of exercises. After a couple of weeks with no results, more exercises. There was never any consideration that my problems were due to bone and not to a lack of dedicated stretching on my part.
My hip was starting to affect my work. I work with developing a high omega-3 oil crop suitable for production in Montana (Camelina sativa). One of the strong selling points of omega-3 is that they reduce inflammation subsequently minimizing arthritic symptoms. If I had to sit or stand still for 10 minutes, my hip would be very painful and I would walk like a pirate. Not good PR for an anti-inflammatory product. I finally made an appointment with an orthopedic physician (Dr. O’Brian). He took films and diagnosed the problem as a pincer impingement (i.e. I have more bone spurs on the ball and hip of the socket that limit range of motion. Pincer impingement (spurs in the hip socket) and cam impingement (spurs on the hip ball) have only recently been described as the cause of hip pain in younger patients ranging from 20-50 years old. Functionally, impingements are a form of Osteoarthritis. Unfortunately, his recommendation was to let the disease progress until it was bad enough to do a total hip replacement. He did give me a shot of cortisone which provided 17 days of pain-free tennis!
Once again, I went back to PT with the goal of strengthening the hip. Again, I was completely frustrated. My right hip ached continuously and my left hip was carrying the load. Two events drove me to an Orthopedic surgeon. First, I was trying to wade across a small stream. My balance was horrendous. My right hip was becoming more or more useless. This lack of balance also affected my tennis game. I could get to the ball, but I was not square when I hit the ball.
In September 2007, I went and saw Dr. Daniel Gannon, an orthopedic surgeon specializing in hips. He took new films of my hips and spent quite a while contemplating what to do. He could see the bone spurs but also felt that the spacing and cartilage in my hip were in fairly good shape. He felt that I could be a candidate for arthroscopic hip surgery to remove the calcium deposits. I was thrilled, the surgery he described was day surgery and entailed two small incisions and an overnight stay in Seattle. The next day, I had a MRI and the films were sent to the surgeon in Seattle. He evaluated the films in consultation with Dr. Gannon. Dr. Gannon called and few weeks later. Unfortunately, the arthritis in my hip was progressed beyond the point that the arthroscopic surgery would be effective. At this point, the best option was a hip resurfacing.
I was disappointed that my hip could not be fixed using the minimally invasive surgery. However, I was very fortunate to be working with an innovative surgeon aware of emerging techniques in treatment of hip degeneration. A year ago, I would have been a candidate for the arthroscopic day surgery. The equipment necessary for arthroscopic hip surgery is currently only available in a few of the larger medical centers in the US. It will be several years before it is available in Bozeman, MT (population 80,000). It likely that my left hip will be a candidate for the arthroscopic surgery sometime in the next couple of years.
Dr. Gannon is a busy man. He is one of the first surgeons in the US to use the anterior approach to total hip replacement. In this approach, the incision is only about 4 inches long. There are no post-surgery precautions. The recovery is very rapid. Resultantly, his schedule is quite full. My resurfacing was scheduled for Jan.18.
In the 8 weeks prior to surgery, I worked out on an elliptical stepper for 30 minutes and did as much work strengthening my quads and glutes as possible.
Finally, surgery arrived. Prior to surgery, I had a radiation treatment on my hip. Recent research has demonstrated that small doses of radiation just prior to or just after surgery can prevent re-growth of bone spurs. The radiation was completely painless without any side effects. It did take awhile to remove the drawings from my hip and groin and I know have three very small tattoos.
The last I remember from pre-op was the anesthesiologist telling me she was giving a mild sedative to take the edge off…. Lights out. The surgery was done with a spinal as Dr. Gannon feels the muscles are more relaxed and easier to manipulate.
I woke up as I was being moved from recovery to my hospital room. I apparently dropped right back out as I don’t remember eating dinner or any of the evening. The nurse woke me up several times during the night. I took my first painkillers (oxycodon) about 3 AM. My hip has not hurt since the surgery. However, the 10-inch gash is uncomfortable.
Day 1. The physical therapists started exercises and walking about 9:30 AM. My first walk was with a walker and it was pitiful. I went about 10 feet. Then I took a nap. Later in the day, I walked about 80 feet. Then I took a nap. I took oxycodon and Tylenol throughout the day.
Dr. Gannon stopped by. We decided that I would most likely need to remain in the hospital through Monday (3 nights). He said that there was a lot of spurs in both the joint and the ball.
Day 2. The difference between Saturday (post-op day 1) and Sunday was phenomenal. In the morning I walked several hundred feet and took a shower. By the afternoon, I was walking on crutches, could climb up and down stairs and was cruising the hospital. I convinced the hospital to spring me that afternoon. It took my husband over 3 hours to plow the driveway to our house so I actually did not get out until evening. The hospital insisted that if he couldn’t get me home, then I couldn’t leave.
Big MISTAKE. My husband and I still sleep in a water bed and I knew that it would be sometime before I could get in or out. I figured that the couch would be adequate for the interim. WRONG. Couches are cramped and tend to be very low. It was a miserable night.
Day 3. Set up twin bed in living room. Whatever you do, make sure you have a comfortable place to lay once you are home! My husband is a wonderful nursemaid and caters to my every whim.
Day 4. Started PT. Great therapist. I won’t be playing tennis for awhile but I am definitely on the way back. Am walking with a single crutch. Am a bit unsteady with the cane.
Day 10. My hip feels great. My muscles are very sore. I think it is because I still do not move freely in bed and spend too much time in a single position. Tomorrow the staples come out!
The weather is horrendous. It is snowing, the wind is blowing, and it is 10 below zero. Looks like all my walking will be inside. The dog does not seem to agree that weather and ice are a legitimate excuse to remain inside.
What have I learned.
1. Dr. Gannon is phenomenal and Bozeman is lucky to have such a skilled, innovative surgeon.
2. Hip resurfacing is an effective option for control of hip pain and arthritis. There are some advantages over a total hip replacement.
3. However, recovery from an anterior total hip replacement may be easier than recovery from a hip resurfacing.
4. Arthroscopic surgery is rapidly emerging for treatment of early hip arthritis. Hopefully, this technology will readily recommended for younger patients.
5. Ice picks on crutches and canes are a good thing!
One Year Update – January 30, 2009
Hi all. It has been just over a year since
my surgery and I wanted to send an update.