Post op day 17

[RF]

First off I would like to thank everyone all their posts on the site and Patricia for starting this great site!.  It has been a huge help to have this resource available before, during and after my hip resurfacing. 

I am post op day 17.  Dr. Ball at UCSD did my left BHR on June 3rd.  I have nothing but great things to say about him and his staff/hospital at Thorton UCSD. It was a very good experience. I had narrowed it down to SU, Rogerson and Ball. I went with Ball after talking with him and realizing that he has perform a good number of BRH (over 500) and was up to date with all new aspects of the BHR.  I could not have gone wrong with either of the three surgeons and was able to get in sooner with Dr. Ball and did not have to fly so this helped with my decision.

Currently at Day 17.  I am up to a 45min walk (just over 2 miles) using a cane.  The last few days I have been barely touching it on the ground but plan to keep using it for the next week as a safety precaution.  I can walk moderately comfortable up and down stairs and have been performing all my exercises as I have had in home PT.  I will have one more week of this in home PT and then move to a local PT that Dr. Ball has recommend here in Encinitas. I have felt a little more sore the last two days and am thinking that this is due to some new abduction exercises I started as well full walking up and down stairs.  Nothing crazy sore, just starting to feel all the muscles around the hip (hip flexors, glutes, IT band).  I will see what the therapist has to say but after I get up and moving for 5-10 steps it loosens up and I can almost walk without a limp.  My hip extension is still very limited, at about 0 but this was where it was at before surgery.  I am sure this is common as it hurt very bad the last 6 months when I would try to extend backwards.  Still hurts but a different kind of hurt, more muscle/tightness rather then the sharp pain I had before.

I did get on the bike trainer (I have a computrainer that I mount my road bike on) at day 8.  I put flat pedals on it and spun very easy, around 40rpm, for 10min and it felt great, all at 50 watts so almost no resistance.  I did get on yesterday afternoon for 20min and up to 120 watts and almost broke a sweat.  No pain at all, felt good to spin as I was up to 85rpm and feeling fine.  I did also put on my cycling shoes and cleats (speedplay) but locked in the Left shoe in the cleat beforehand and did not twist out at the end but rather pulled my foot out of the shoe when I dismounted.I have also been lifting upper body exercises, all light weight and do this during my morning exercises.

Still have trouble sleeping through the night as I rarely sleep on my back, but I was not sleeping very well the last 6 months so nothing too out of the ordinary.  I can now easily roll onto my non-op side and sleep for 1-2 hours and even roll onto my front and get some sleep. I have tried to roll onto the Operated side and can lay for 5-10min until it starts to hurt so will hold off on that for a while.

I did get a massage on day 14, just a very light flushing massage and not at all touching the operated area.  My back has been getting very sore and this helped a lot.  I plan to keep this up once a week until around 6-8 weeks out when I can start ART massage to help really loosen things ups.

Totally off meds.  I had Oxycontin the first 3-4 days post opp then switched to Tylenol for 3-4 days and don't seem to need it the last 3-4 days.  I do Ice 6-8 times a day which has helped a lot with the pain and I have had no swelling in the quad or lower leg.  Swelling it completely down on the hip and just the incision looks like there is a small rope under it.  I see Dr. Ball on Thursday (post op day 20) and hope to get the tape off and the OK to hit the water.  If he gives me the okay I plan to start some very light swimming with a pull buoy and exercises in the water.  I am also an avid paddle boarder so plan to start prone paddling as soon as I can.  Not in the ocean, but will go down to the bay and stay out of the surf for several more week.

I am 44 years old, was big time into triathlons from the age of 15 doing many IM races and ultra runs and now still do a lot of cycling (road and mountain bike) and a lot of traditional paddling boarding (prone and on the knees) and SUP.  I have raced the 32 mile Molokai to Oahu race the past few years on a prone board and look forward to getting back to this as well maybe even some running in 6-12 months time.  I coach triathletes and work for Ironman as a race director for several events. 

I think that is about it.  Hope this can help someone as well feel free to let me know if I am doing anything good or bad.  If there is anyone out there that does SUP (stand up paddling) i would love to hear when you got back on a board.

Roch Frey

[sroberts]

Hey Roch,

Congrats on your recovery. Sounds like you are right on schedule for a great recovery. Dr Rogerson did my right hip back in 2008 after talking to S.Tinley and doing some research. Don't worry, sleep will become easier as your body heals.

You'll notice some big improvements by week 6 and some huge improvements from 6 months- 1 year. The only thing I had to realize was that my recovery was not linear at first. Overdid some days and even took as step or two back for a couple of days. Just rest when you need to and keep us updated on your recovery. We ought to get an all hippy tri team going from this site!


best,

spencer
Tucson,AZ

[ScubaDuck]

Great update.  I love to hear these recovery stories.  It gives me some idea of what will be in store for me.

I am surprised you got on the bike.  Did you raise the seat so as to not break the 90 rule?  I want to be spinning on the bike as soon as possible but figured it would have to be after the six week check up.

Dan

T-41 days and counting.

[KirkM]

Hey Roch -
Glad to see you over here on the board. 

Dan -
I don't know about Dr. Ball, but Dr. Su has no 90 degree rule.  Most resurfacing surgeons threw that out a while back.  It was a relic from small-ball THR's that tended to dislocate easily right after surgery so it doesn't apply to large head MOM devices.  The PT at HSS had me on a lifecycle with low resistance at day 5 and each session after that.  It felt great.  I am going for a 30 minute light spin again today at the gym.  I will probably put my tri bike on the trainer this week and do more cycling at home.  It is just easier to get on a step-through lifecycle right now as I am only on day 9.  You will be surprised at how much you can do and how soon.  Roch was giving me the play-by-play the week before my surgery since his was 8 days before so I really had a great information channel that was completely current and relevant.

[hipnhop]

Whoa, two miles wals at day 17. I am scared of you. What's next? A marathon at day 60.  You got me beat.  COngrats and keep up the PT and exercise.  Listen to your body and rest a lot.

See you on the track man!

[FlbrkMike]

Dr. Ball did both of my hips earlier this year and he gave me a 120 degree flexion limit both times, which is basically not really a limit because I couldn't do 120 degrees anyway.  I think the 120 was there so the PTs wouldn't be confused and think he forgot something.  I also had no weight bearing limit on my left hip but had 4 weeks of "toe touch only" on my right because of some difficulty in placing the acetabular cup.

You tri-athlete guys are amazing.  I was happy just to be able to get back on my Concept 2, which I haven't been able to use for the past 2 or 3 years.

[Anniee]

Roch,

Sounds like you're doing really well!  I understand the sleep problem - that was really my biggest issue after surgery, because pain was minimal.  People on this site gave me some good pointers that helped some, but the problem pretty much resolved itself after about 3 weeks, so I think you'll do much better in that respect in a few days.

As Spencer said, recovery is not linear, and you probably will have days when you feel you're not making progress or even taking a step backwards.  Like a lot of people on this site, I tend to want to overdo, and sometimes pay the price. 

Kirk, Dr. Gross has been using the large head MOM for years and still has the 90 degree rule for the first 6 weeks.  Is he just extra cautious?  I'll have to ask him when I have my next hip done!

[RF]

Thanks for the feed back everyone!  As Kirk and Mike mentioned, Dr. Ball doe not have a 90 degree rule but 120 and key is not to turn the knee or foot inwards when flexing so riding my regular seat height on my road bike was totally comfortable with no pain at all. I tried a recumbent bike on day 7 and the large seat was painful at the incision where as the bike saddle did not hurt at all.

Good to hear that there will be times when the healing is not linear.  Listened to my body today and backed off 75% with everything and will see how it all feels tomorrow.

Not to worry, have no marathon goals in mind but do look forward to going on 30min runs with my wife and dog :)

[KirkM]

Roch has clarified my comment nicely.  Although I do not remember Dr. Su's office saying specifically 120 degrees, they did say DO NOT cross your foot / knee inward since this is the motion they use to dislocate the femur during the procedure.  I don't know about anybody else, but the few times I mindlessly moved in a natural way and started to cross my knee / foot across my center line, the stabbing pain reminded me instantaneously.  I could do a complete squat at day 6, so that would have violated about any degree rule there is!  No problems with it at all, but turning inward was and is still a different story.

Anniee -
Since Dr. Gross uses the cementless Biomet device instead of a cemented BHR, maybe that has something to do with it.  Perhaps the bone ingrowth needs to establish itself to keep the cap secure and a 90 degree limitation protects it from twisting forces that might loosen it, whereas a cemented device is permanent within minutes of it being hammered on.  I really don't know, I am taking a wild guess.

It would be great for one of his patients to ask him and post it here for all of our education.  I, for one, am endlessly fascinated by the mechanics of all this and especially the differences between cemented and cementless devices.

[Lopsided]

Since Dr. Gross uses the cementless Biomet device instead of a cemented BHR, maybe that has something to do with it.  Perhaps the bone ingrowth needs to establish itself to keep the cap secure and a 90 degree limitation protects it from twisting forces that might loosen it, whereas a cemented device is permanent within minutes of it being hammered on.  I really don't know, I am taking a wild guess.
It would be great for one of his patients to ask him and post it here for all of our education.  I, for one, am endlessly fascinated by the mechanics of all this and especially the differences between cemented and cementless devices.

I did not get Biomet, but I did get uncemented. There is no glue, but it is so tightly wedged on that there are no additional restrictions.

[KirkM]

You are pretty unique, I think.  Isn't C+ usually a cemented device?

[FlbrkMike]

Thanks for the feed back everyone!  As Kirk and Mike mentioned, Dr. Ball doe not have a 90 degree rule but 120 and key is not to turn the knee or foot inwards when flexing

Yes, the main warnings I got from Dr. Ball was about turning inwards or bringing my knee up towards the opposite shoulder.  Both of these types of motions tend to rotate the ball out of the socket and present a danger of dislocation before the muscles are fairly well healed.  My ROM was so poor before the surgery and the new hips are so smooth I felt for a while like my legs wanted to flop around in just about any direction, so I had to be careful about the inward rotation thing.  The outward rotation I have now is amazing to me.  I can sit comfortably on the floor cross-legged, which is something I haven't been able to do for years.

[Lopsided]

Isn't C+ usually a cemented device?

About a year ago, Wright introduced an uncemented version of the C+, I think only for certain surgeons. Dr. De Smet said he was going to use it regularly, and I believe Dr. Migaud in France has done many.

D.

[hernanu]

Congrats, Roch - your recovery sounds like mine on both hips, transition to Tylenol and then off it. I had sleeping issues until about twenty days. Like everyone says, there are plateaus, even slight setbacks, as your mind and your hips are probably still ahead of your muscles. You are retraining your muscles, and some of them are not great pupils at first.

I'm at six and nine months along, and am now getting more deeply into more intense training. I just finished 20 minutes on the punching bag at high intensity. You'll get back to your goal in due time, the hardest thing is to be patient.

[Anniee]

Hernan,

You are so right!  Being patient is one of my greatest challenges.  I would really be looking forward to having the first 6 months behind me, except that I'm having my other hip done about that time, so here we go again!  However, I have to say again that my operated hip feels so much better than the other one after about 8 weeks, that I know it will be worth it, and a small price to pay to hopefully get rid of the arthritis for good (I'm thinking positive - no revisions).

Kirk, if nobody else on this site does it before my next surgery, I will ask Dr. Gross about his 90 degree restriction next time I see him, which will probably be in October.  Like you, I am very interested in this whole subject.

[David]

Thanks Roch for joining in on the forum.....  So glad you are doing well.  I just got a SUP board a month ago when I realized my running days were over until I did something about this hip.  I'm loving it for sure.  Aside from the Ironman stuff, I've got a bunch of time windsufing so it was an easy transition.  I've got a consult with Dr. Su 7/20 and am looking forward to an operation date.
I'm signing up for a SUP paddle from Montauk, NY to Block Island, RI end of August if I don't have the OP before then.
Have to admit I'm having a very difficult time mentally, just giving in, even though I'm trying to move forward...
Best...
David

[dwbitt]

Roch, Kirk,

Thanks for posting your info, as a cyclist I'm excited to see your progress on the trainer, I remain concerned about clipping out and how soon I will be able to get outside and ride.
I had a consult with Dr. Su and scheduled the surgery for Oct 29, need to get the rest of this riding season in!

Any suggestions for ice machines for therapy post surgery?

Dave

[jjmclain]

Hi Dave,

Some of the hippy cyclists on this site were back on the road as early as 5 weeks post-op. I waited until 5 months and clearance from my surgeon because I didn't want to risk falling!!! But there are many who have been out sooner! Good luck to you!

June

[KirkM]

Dave -
I got the OK from Dr. Su's office to do 30-40 minutes on the trainer at very light resistance.  They did say to stop if anything got sore or gave me warnings.   I was 10 days out and did 30 minutes total.  I rode for 10 minutes, did some light stretching and then rode for another 20.  I then did my PT exercises in the gym stretching area.  It all felt pretty good, although I was a little tired after that.  I didn't pay any big price for it the day after either.

Yesterday was 11 days out and I walked 2.3 miles in 1:02.  Not as fast as I could go, but I think it is more important to focus on form and gait and also not strain things at this early juncture by pushing hard.  I still always walk distance with two crutches (forearm type), even though I can walk very well with just a cane.  I only use the cane for around the house and use the two crutches to practice even gait and balance when doing the "mileage".  It's like anything, you don't want to do a ton of mileage with bad form since all that does is teach you to do it improperly.

I would love to ride my bike, but at this point, I can't see getting on it for many weeks.  There is just too much at stake to get impatient and stupid.  I will get on my road bike when I can do full sprint intervals on it when locked into the trainer.  Again, I don't see that happening for many weeks / months.  Don't know about your pedals, but with my speedplays, clipping out is the least of my worries.  I can easily rotate my heal outward at more than 45 degrees with no pain or problems.  I will be back in the gym today for the same routine as Tuesday and may kick it up to 40 minutes.  My goal is to get to an hour and then put on very slow increases of resistance over time.

I saw a lot of talk about ice machines in the forums but it was never discussed with HSS or Dr. Su.  They ice you the whole time you are in the hospital and then you just get a couple of large, reusable ACE ice packs and use them all the time for the first couple of weeks out of surgery.  I had virtually no swelling and the tiniest little bruise just below the incision that only lasted a few days.  I went off the painkillers at day 3 and never took anything since, no Tylenol, Advil, nothing.  ALWAYS ice for the first few weeks and ALWAYS after doing any walking or PT.  It will make all the difference in the world.

Good luck with Dr. Su.  He and his staff are excellent.

[dwbitt]

Kirk,
Thanks for the info, I'll be following your progress. I planned to rehab over the winter hoping there would be fewer missed chances to ride, as you say, it would be stupid to get impatient!

Dave