Dirk Van Dyke Bilateral DePuy ASR 02/08 03/08 Dr. Ball
7 Year Anniversary – Update
I just celebrated my 7 yr anniversary with resurfaced hips. I was a "staged" bilateral, with the 2 sides done 5 weeks apart, the 2nd one on March 31, 7 yrs ago. I long ago reached the point where I don’t think about my hips when considering any physical undertaking.
With the negative press about resurfacing in general and ASR in specific, I want to give the good report on my 7 yr anniversary. I just reread my hip story from 7 yrs ago that Pat has hosted to remind myself of the early days (http://surfacehippy.info/hipresurfacing/stories/dr-ball/212-dirk-van-dyke-bilateral-hr-dr-ball-2008)
The summary for me is that the surgery has been very successful. It’s almost a cliche to say "it gave me back my lifestyle," but that is the case.
Before surgery: Daily movement was painful. I recall getting irritated doing house chores such as mowing the lawn, just because of the pain.
Now: On the eve of my 7 yr anniversary (for my 1st resurf), I took a 4-day weekend to participate in building a home in MX – kind of a Habit for Humanity lite. I was sore in lots of places, but no problems in hips. Had a great time. In fact, I’ve done this every yr since the resurfacing.
Before surgery: Quit hockey. Hung up the skates approx a yr before surgery, due to pain and diminished level of play.
Now: Playing hockey again. I didn’t start again until a good yr after surgery. I get up to 2-3x per week, until my body starts telling me that’s too much for somebody over 50, and then cut back to once or twice per week. (If you are a goalie, and show up, you can play as frequently as you want.)
Before surgery: I recall going on a hike with family friends, a month or so before surgery, knowing that I’d turn around after 1/4 mile and go back to the trailhead and read a book.
Now: I’ve hiked the Grand Canyon a couple times post surgery. In a couple weeks, I’m taking a short 4-day vacation to hike remote canyons in Utah. It’s great to get this back.
The only thing that’s a bit of a cloud is the ASR. I geeked out on research, and I feel that J&J put profits ahead of patients in withholding or minimizing known problems. If those concerns had come to light, I would have requested a different device. It seems that the ASR design is intolerant of sub-optimal placement. So perhaps my research on selecting a surgeon trumped the device selection. Or maybe I’m just lucky. Knowing what I know from following the legal proceedings, even though my resurfacing is fine so far, my gratitude is mixed with ill feelings towards J&J. It’s kind of like they played ~85% odds russian roulette with me, twice.
But I’m going to enjoy my blessings and get out from under that cloud. Thanks to Pat for hosting the site, and Vicki (wow, time flies, the community certainly misses her) for all she did for resurfacing, and Chuck for his concern and advocacy.
On this forum, I’m kind of in that camp of people who have had a successful surgery and gradually fade away, as hip functionality and lack of pain becomes normal.
It’s been a great 7 yrs with fake hips (well the first couple months were a bit of struggle, but mostly forgotten now).
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.