Why does the new hip seem so foreign

[keithp]

Hello
I guess this is more of a curiosity question than anything;

Aside from some pain in my thigh I haven't had much pain at all in the area that was operated on.
I'm wondering why it's so difficult to walk normally after surgery, especially since there is not much pain in the hip. Realizing that there is a prosthetic implant that really just mimics the old hip, why does it seem so difficult to keep my balance. As far as I'm aware we cannot feel pain in bone, so the body shouldn't really know the difference between bone and the implant.

The Dr. said that I had tremendous muscle mass in my operated side and could even lose up to 30% of muscle and I would still be considered having normal muscle mass.
Is there something else that is done in surgery whereby the muscles and tendons are cut or rearranged that causes this lack of stability?

I was in top condition before surgery and my hip was ironically feeling next to no pain. I guess I was unusual in the sense that the pain in my hip over the years would come and go...for up to 8 months at a time. All I know is that I was close to bone on bone shown through the xrays.
Based on this I don't think it's a case of my muscles needing to be re-trained. I never limped or walked with an awkward gait.

Any feedback would be appreciated.

Thanks

[Pat Walter]

Hi Keith

I think you are expecting too much of your body after MAJOR sugery.  Have you by any chance watched any of the surgery videos?  Doing that might just answer your own questions. No matter how good of shape you were in before surgery, your muscles have been cut and liagaments possible cut - depending on what approach your surgeon used.  With any approach, there has been an extrememly large invasive attack on your body. You can't feel the metal hip and you can't feel where the bone was reshaped - but boy you can feel where they cut thru layers and layers of skin, muscle and ligaments to get to that hip. 

This is very major surgery and your hip is deep inside of your body.  It will take a great deal of time for you to regain your normal gait and activity level.  The state of you mind that you will heal quickly or that you were in excellent shape pre op, won't make your healing that much quicker.  Sometimes the very in shape athletes have more trouble than us couch potatos.  It is all up to your body.

I would suggest that you watch the surgery videos and then you will get an appreciate of what happened to your body.  They are very interesting if you don't mind watching them. Dr. Weeden made a video of a full surgery for my website.  You might enjoy watching it  http://www.surfacehippy.info/shvideos/videossurgery.php

No one is superman and when they cut deep into your body - it just will take time to heal.  It actually takes one year to heal completely and somtimes more.  Normally there is enough healing at 6 months to resume most activities.

You did not say where you are in the post op healing process.  Abduction exercises where you move your leg out to the side are normally very difficult.  It took me a number of weeks before I could do abduction easily.  You don't have to really retrain your muscles - you just need to wait for them to heal so they can work properly again. You will lose some muscle mass, but as far as I know all the athletes have recovered it.  I am sure you have read the stories of all the athletes http://www.surfacehippy.info/athletes.php  I have not heard of any that did not regain their original strength and activities.

Good Luck.

Pat

[keithp]

Hi Pat
Thanks so much for your response. It's excellent advice. I have seen the videos, and yes it makes sense that my body has gone through a lot of trauma. I guess I was just having trouble connecting the idea that my muscles aren't working properly and at the same time they don't feel very painful.

I am at 2 weeks and able to do abduction exercises. I just went for half hour walk with no crutches. Maybe I am overdoing it but I think my body is handing it fairly well.

Thanks again.

[keithp]

On another note Pat, I was a professional athlete which is what likely contributed to my hip problem. I looked at the athletes pages and I think that the ones who push themselves to the same level as before are a little crazy.
I realize there is an inherent drive in these people but for the life of me I can't understand why someone would want to go through the ordeal of surgery again.
Not trying to judge, I guess I just don't see the point.

[Pat Walter]

Hi Keith

Thanks for your reply.  You are still very early in your recovery.  I was lucky and had a very easy and quick recovery. I went to Dr. De Smet of Belgium.  I took nothing but Advil after leaving the hospital at 2 1/2 days.  No major pain, just incision tenderness.  It is amazing that many of us are able to get around without much pain after such major surgery.  I noticed that my leg just would not do what I wanted it to or did it very slowly.  You just adjust until you heal.  I was walking over a mile a day by 12 days post op too.  We all heal differently.

I am like you and would not return to such extreme sports after a hip resurfacing in an effort to make it last a lifetime.  I guess some of the athletes just have a drive to keep doing what they did.  Many of the top resurfacing surgeons don't recommend such extreme sports, but know many patients do them.  I am just a conservative 65 year old woman that doesn't want a revision surgery, so I keep active and do weight bearing activities - but marathons, etc. are out for me.

Good Luck.  It will all get better pretty soon.  Just be patient for now.  You will be amazed how well you will be doing an a few weeks or months.

Pat

[DirkV]

Hi Keith,
I enjoyed your post, and I'm glad you're doing well. I've given some thought to the "foreign" feeling - it's my primary post-surgery symptom. No answers, just lots of layperson theories.
First, let me say that I'm delighted with my resurfaced hip functioning. But it still doesn't feel natural to me. Another factor is the athlete's perspective. I talked with a friend who is a serious cyclist who coincidentally underwent surgery the same weekend as I. His coach told him that Dr.'s, nurses, therapists, et al. might tell him he's doing fine. And for 90-some % of the population that doesn't push their body in athletic endeavors, you are doing fine. If you are interested in walking, hiking, maybe a little jogging, it's a complete success. But if you want to really get back to a pre-surgery state, be aware that from the athlete's perspective, you are at the far end of the bell curve. Recover is going to take a lot more work and a lot more time.
Inherent foreignness of the prosthetic.
* The complex of muscles that work with and in and around the hip, grew up with your body and with your natural hips to work with your previous hip joint. I don't know if they'll ever completely adapt, but I feel like there is still a bit of a mismatch between all the flexors and stabilizers, etc. and the fake hips.
* The prosthetic itself is certainly a marvel of medical technology, but I'm sure a properly structured, healthy, natural hip joint is far superior in many aspects. Just one aspect: the weight is different. Your balance will be off a bit. In a couple more decades maybe they'll be implanting natural bone replacements. Now the cobalt chromium is state of the art, but it's not the real thing.
* Aging and memory. Like you, my hips declined gradually. When I recall non-impaired hip functionality, I was probably 10-15 years younger. Even if my prosthetic hips were as good as my natural hips when I was in my early 30s, the rest of the body is that much older. Fake hips aren't going to make me feel like a 29-yr-old again.
* Prosthetic placement. I've read many opinions that computer aided placement isn't really the best placement tool. The best surgeons rely on experience. Placement is more an art than a science at this point. And when I consider the degrees of freedom or whatever in the hip - forward/backward, sideways - I can understand why the software for computer assisted placement would be difficult. Even if the software could be developed, I wonder if it would try to determine the best placement you ever had in your life with your natural hips, or optimal placement regardless of what your natural hips were like. You might have had somewhat defective hips from birth, so it's not a matter of determining what *was* your best hip placement, but what *would be* your best placement. And then you're in the realm of generalized formulas applied to you as an individual. E.g., optimal hip placement in the population at large might not be optimal for you given that your glutes are 32.5% bigger and your femur is 12.8% longer, and arms are 3.4% longer than population average. The body is such a complex thing that these calculations would be incredibly complex. Anyhow, what I was trying to say is that the prosthetic placement place and angle is probably pretty good, but it's probably not perfect. I don't think the medical state of the art is there yet.

Surgical symptoms.
* Most resurfacings involve pulling muscles out of the way and cutting some. The cut muscles are stitched together post surgery, but I'm sure you can imagine that it takes a long time and rehab work to recover. My Dr. mentioned that patients report significant improvements as much as 2 years post op, and speaking from my perspective 1 1/2 yrs out, I can attest to continued, noticeable improvements from the 12 month to 18 month period.

I hope this doesn't sound depressing. I get regular reminders of how great the new hips are. I'm a better cyclist than I was pre-surgery. I can plan backpacking trips to the bottom of the Grand Canyon, where I couldn't physically consider that pre-surgery. I can play pickup hoops and badminton and such with my kids. But when I went with a couple of my hockey buddies to watch them play a couple weeks ago, I told them that I'm not going to try to return to my former primary athletic endeavor - goaltending - until my hips feel more natural.
Life is good,
-Dirk

[keithp]

Hi Dirk
Thanks for taking the time to explain this in so much detail.
It makes more sense after your explanation

I don't expect that I will go back to the level of activity that I had in the past, primarily because I want the hip to last as long as possible. I am realistic in that I am aware of how increased wear will occur if I push things too much.

I can live a happy life with moderate exercise and don't feel the need to prove anthing to myself at this point.

Thanks again

[marinheiro]

Hi,
although this post is old, i would share my vision on this. I am a martial artist since 1996 anda a cpoerista since 2000.

First, at now i cant imagine NOT going back to most of the athletic performance i had before. No, i didnt say it well.
I cant imagine NOT TRYING to go back to my previous athletic performance, and even better.
Second I dont want to hurt my body more than necessary.

This said, i had the luck to find a surgeon who is part of a sports medicine department, and operated many martial artists and professional athletes. So i know i will be supported on that side to take the most out of my situation. If there is something i cant do i cant. stop :D I can live without aerial acrobatics, but not without preparing me to do and trying in the most cautious way to reach them.

The way you use it after the first months doesnt affect the longevity of your prosthesis.

All this to say, take care of your body and trust it. It will pay you back in unexpected ways ;)

I would be courious to know how's it going now for you :D
Bye!