My Story, left hip resurfacing Dr. Gross 05/04/2022

[Domer]

Hi all, in the hopes of giving back to the community here's my story...

At about 40yrs old I was an active tennis player, playing several nights per week when I started to notice stiffness and pain in my left hip flexor area sometime around Aug/Sep 2017.  There was no apparent “event” that caused an injury that led to the pain.  Just a gradual onset of tightness, soreness, and pain.  I went to a doctor in Jan 2018 and he diagnosed it as a hip flexor strain and prescribed physical therapy.  I went to physical therapy through June 2018 with little improvement, while continuing to play tennis.  Finally went to another doctor, this time an orthopedic specialist, in Dec 2018 and was diagnosed with osteoarthritis in my left hip (right hip looked fine).  I stopped playing tennis at this point.

Treatments suggested by that doctor included just getting cortisone shots every so often to cover up the pain or to get a total hip replacement.  I was a little shocked to be told at 41 that my hip needed to be replaced and was a little bit in denial.  So I researched non-surgical options available to me and ended up finding a stem cell trial at Mayo Clinic in Rochester Minnesota that I was hoping would allow me to avoid a hip replacement.  This trial was unique in that as part of the trial protocol they would be culturing my stem cells, multiplying them by many times (millions of times I think) what you would get if you just drew out some stem cells from somewhere and re-injected them in the hip joint (which is what the ”retail” options available offered and insurance didn’t cover).  At the time, culturing stem cells was not allowed in the U.S. (could go to the Cayman Islands and have it done) except as part of a clinical trial, so I was excited about this potential option.  I qualified for the trial and received the injection in Mar 2020 and noticed a little improvement at first, but over the next year my symptoms progressed.  My main issues were a lack of range of motion (difficulty tying left shoe), pain while walking in front and back of hip, and generally pain when I do anything that requires range of motion (bending over, squatting, etc.).  I also had lower back pain that I think might have been related to my lack of range of motion and favoring one side.  I had one of my last check-ins with the Mayo trial doctors at the end of April 2021 and they thought the path forward for me would be hip surgery given the advanced stage of my osteoarthritis and they recommended a total hip replacement.  I spoke to surgeon at Mayo about this option.

I then did more research to look at the surgical options available to me.  A lot of good things were being said about the total hip replacement…materials are much improved, no real restrictions on activities after recovery, given the new materials it may be a lifetime implant (don’t have old enough data to know how long it will last, but looks really promising).  Luckily I told a co-worker what was going on and she told me that the husband of a friend of hers had a hip surgery done and I should talk to him.  I did, and it turned out he had a hip resurfacing (BHR) from Dr. Su around 2010 and was super happy with the outcome.  So I started researching the differences between a total replacement and a resurfacing.  After reading tons of materials including research papers on all of the pluses and minuses of each I decided that resurfacing was my best option.  I won’t go into all of the details, but the main pros on total were easier procedure and no metal ion issues.  Main cons on total were potential restrictions on activities after recovery (despite what I mentioned above about no restrictions with the new materials…different surgeons appear to have different opinions on whether restrictions are necessary or not), plastic debris that your body can’t get rid of and can cause localized tissue damage/bone destruction, potentially a non-normal joint geometry that doesn’t allow you to return to your normal leg motion, and a more difficult procedure if the implant wears out and needs to be revised/replaced in the future.  Main pros for resurfacing were more natural hip geometry after the procedure, no restrictions on activity, easier ability to revise to a total hip replacement many years in the future if needed (more bone conserved), decades of data available with high joint survival (unlike new materials for total).  Main cons on resurfacing were that the procedure was trickier and placement of the acetabular cup is very important so you needed an experienced surgeon, and the metal ion issue.  On metal ions I was able to get comfortable that your body naturally removes the metal debris (it can be measured in your blood) unlike with the plastic wear debris in a total hip replacement.  Heck, we have recommended daily allowances for metals (iron, magnesium, manganese, nickel, etc.).  I know cobalt and chromium (the metal ions that come from these resurfacing implants) are not on there, but it just seems more natural for our bodies to deal with metal than with a plastic which is pretty far from naturally occurring.  Also after reading research papers on metal ion issues I was able to get comfortable that it appeared that faulty devices (Depuy) and poor surgical technique on cup placement were the main issues leading to these problems.  In the process of all of that research I found surface hippy and also found all of Dr. Gross’ published papers.  Read all of those and decided that his data-driven methods and excellent published track record for lack of complications and implant survival was the best option for me.  Also liked his theory behind using an uncemented femoral implant, namely cement might cause bone death due to its heat, and that over the long term cement is likely the weak link in the entire system (sounds like surgeons are pretty unanimous for most other implants, including the acetabular cup and total replacement femoral component, that cementless is the way to go).

Next up, my surgery experience...

[Domer]

On to my surgery experience…

Day -2 (Monday)
Arrived in South Carolina on a flight from Michigan two days before the surgery (Monday evening) to get checked into the hotel.

Day -1 (Tuesday)
Tuesday was a pre-op appointment to get my Dexa bone scan, take my standing x-ray, and fill out some of the last paperwork.  This included the option of participating in a trial that Dr. Gross was conducting on two different types of anesthesia for the surgery (spinal block or lumbar block).  I ended up deciding to participate in the trail which means I was randomly assigned to one of them whereas others are presented the option of which one they wanted.  I couldn’t see a huge difference between the pros/cons of each in the time I had to review the materials so decided to help Dr. Gross continue to fine tune his techniques and be a part of the trial.  I ended up getting the spinal block, and think I did experience one of the listed “cons” of this method which I’ll go into later.

Day 0 (Wednesday May 4th)
Surgery Day.  Report time for surgery was 6:30am.  We showed up at about 6:15am and ended up waiting until around 7 or so before I was called back (my wife stayed in the waiting room).  Changed into gown and they got the IV setup and gave me some pills and a few liquid shots into the IV (can’t remember what they were for).  They also drew some blood during this phase which I learned was for them to spin it down to platelet rich plasma (something some places will do to potentially help hip arthritis on its own instead of a cortisone shot) which they spray in the hip area during surgery to help minimize bleeding and/or help healing.  They also asked me several times and marked the leg that was going to be operated on to make sure it was crystal clear which hip was being done (glad they do this!!).  I waited there for a bit (think I was wheeled back sometime after 8:30am) and would have been nice to have my phone with me to help take my mind off of the upcoming surgery.  They told you not to bring anything in on surgery day, so I didn’t but think you should keep your phone with you in case you’re waiting like I was.  They will put your phone in your personal belongings bag with your clothes (they did this for other patients).  I think the anesthesiologist came over and they gave me a lidocaine shot in my back where the block would be put in and then think they started taking me back to operating room.  I vaguely remember being asked to scoot off of the hospital bed I was in and onto another surface (assume it was the surgery table), but was pretty foggy at this point and don’t remember anything else until I was waking up being carted back to the pre-op/recovery area.

Once I was mostly woken up they brought in lunch.  I had chosen a sandwich, but it was extremely difficult to eat because they give you something pre-surgery that dries up all of your saliva.  So a bite of sandwich basically turned to sawdust/paste in my mouth that was impossible to swallow without filling my mouth with water.  In Dr. Gross’ post surgery survey I suggested they add soup to the lunch menu (don’t think it was an option) and recommend patients choose it because think that would have been a perfect choice.  Each bite would come with it’s own hydration and soups are typically salty which they wanted me to have (salty foods and drinks) to counteract the low blood pressure issues I describe below.

Others have said that they have relatively little pain right after the surgery, but for me the day of surgery and the day after were the most painful.  During the initial walk test I got really light headed and felt like I was going to pass out.  My blood pressure dropped really low and this is apparently a side effect of spinal block anesthesia.  I’ve always had low blood pressure and always thought that was a good thing, but in this case I think it might have made me worse off than others.  I think one of the pros of the lumbar block is that it doesn’t have as much of the low blood pressure problem, but think it has more of a nausea problem.  I had zero nausea with the spinal block…so not sure which is worse, having nausea or having low blood pressure/light headedness/fainting issues.  The nursing team didn’t want to give me more pain relievers (oxycodone) with my blood pressure so low because I assume the pain relievers also lowered blood pressure.  I needed to pass the walk and stair tests before I could go home.  So I just had to tough it out.  Eventually was able to do the stairs and head out. 

Day 1 after surgery (Thu)
Still had quite a bit of pain and had light headedness, mostly when standing to go to the bathroom.  This concerned me because my flight was the next day.  Sitting to go to the bathroom did not seem like an option because (surprisingly) the hotel room we had was not a handicapped room and so had a standard super-low round (not elongated) toilet with no toilet seat riser or useful grab bars/handles which looked like it would be impossible to get down onto and off of for my 6’2” self.  For this reason I was a little glad about the narcotic-induced constipation which meant I didn’t need to sit on the hotel toilet at all (I paid for that later on though).  Also didn’t use the shower while I was there which was a tub/shower combo with only one grab bar way up against the wall with the shower head and controls which didn’t seem super useful placement. Not sure how I would have navigated crutches into and out of that tub…opted not to take a shower Friday when it was allowed because of this and general level of pain and fear of light headedness/fainting in the shower with no shower seat or anything to catch me.

Eating was difficult on day 1 because I had really bad heartburn…this is a side effect of some of the meds I believe.  They have you start taking Prilosec either the day of or day after surgery (can’t remember).  In my experience with past heartburn, Prilosec takes a few days to be effective, so I suggested on Dr. Gross’ survey to have patients start a couple days before surgery (as long as it doesn’t interfere with the surgery/anesthetic in some way).  So I would suggest asking about this if the protocol hasn’t changed.  Also would recommend having some alka seltzer gold and/or tums on hand to supplement.  They recommended alka seltzer gold when I contacted them about the heartburn, but my wife went to two stores in the area and neither had it….they had regular alka-seltzer, but this was not allowed because I think it has a pain reliever or some other drug that you’re already on in it.  So I went with chewable tums which did help a little.

Had to sleep exclusively on my back and had to wake my wife up a couple times to help with pain meds and to help me get in/out of bed for a couple bathroom trips (and to make sure I didn’t pass out with no one to help ease me to the floor).  Sleeping was better than expected but was not uninterrupted.  A note on the pain, I had a really bad shooting pain that went down the outside of my left leg all the way down to the outside of my knee that occurred when I moved my leg in a certain direction…problem is I couldn’t tell which movement caused the pain so was super careful moving in and out of bed which is where it mostly occurred.  I assume this was a nerve that was irritated during the surgery and this gradually got better over the next week or so.

Day 2 after surgery (Fri)
Thankfully the pain reduced by Friday and light-headedness subsided and was able to make the 2hr drive to the airport (Charleston) and the flight home without issue and in relative comfort.  Used the garbage bag trick on the car seat and it did help to swivel in/out of the seat.  I’ll just say that the airport wheelchair seats are hard as a rock with zero cushioning.  So sitting in one place waiting for a long time did get a little uncomfortable, but nothing super painful thanks to pain meds.  Arrived home mid-afternoon.  One of my biggest concerns was our second floor master and navigating the stairs every day.  Surprisingly the stairs were not an issue.  Followed the “up with the strong” and “down with the weak” sayings and was able to get myself up and down to/from my second floor master bedroom without issue.  This allows you to use your good leg to do all of the lifting/lowering while your crutches stabilize your operated leg.  Worked like a charm.

Day 3 (Sat)
Pain continued to decrease and felt pretty good Saturday.  It also helped that the weather was fantastic so spent some time outside (we brought some South Carolina weather back to Michigan!).  No real light headedness remaining.  Noticed that swelling did pick-up.  Has felt like there’s a tennis ball under the incision since the surgery from local swelling I assume.  But also felt lots of swelling on the inside of my operated leg and all the way down to my knee.  Was told that day 3 would be the worst pain day, but for me the day of surgery and Day 1 after surgery were the most painful.  First bowel movement post-surgery was not fun.  Felt like trying to pass bowling balls.  Would maybe suggest starting stool softeners a few days before the surgery to soften stuff up (if the doc allows).  I was told to start them the day after surgery.

Day 4 (Sun)
Little bit of improvement, stopped taking the long duration narcotic and using the short duration when needed.  Noticed lots of swelling still…still had tightness in my leg all the way down to my knee from the swelling.  Still passing bowling balls.

Day 5 (Mon)
A little improvement.  Able to get into and out of bed myself routinely using the leg lifter.  Up until this point needed assistance to slide my leg sideways into and out of bed being very careful not to go too far either way (for fear of triggering the nerve pain) before I scooted my butt in the same direction.  Sleeping still exclusively on my back.  Still passing bowling balls.  Swelling seemed to start to subside and tennis ball swelling under incision seemed to shrink a bit.

Day 12
Switched to one crutch today and walked a ¼ Mile.  Painful to sit in car and anywhere other than recliner for more than a couple minutes.  Feels like I'm sitting on a tennis ball right on a sore spot/nerve.  Hip is clunking/moving around a lot since yesterday.  Swelling went down quite a bit over last couple days.  Ankle isn't puffy at end of day anymore and operated leg doesn't feel as tight.  Think swelling reduction is what is allowing hip to clunk around and feel loose.  Switched to one Tylenol per dose yesterday I believe.  Was able to get my leg into bed without leg lifter for the first time today.

Day 13
Still on one crutch, did a couple fairly long walks today (maybe ¼ - ½ mile total) and lots of clunking/movement in the hip, not painful just a little disconcerting.  Checked with Lee and she said this was normal until the hip capsule tightens back up.  Pretty much on one Tylenol, but not needing to make sure I have full coverage…sometimes forgot to take a dose when one ran out.

That's it for now, will try to post periodic updates at different milestones.

[PalmettoGolfer]

Domer,

Glad everything is working out for you!

You could have pretty much copy/pasted my experience.  I had a few different issues during recovery but pretty much the same as you.

It only gets better from here.

Please keep us posted.

-PG

[imgetinold]

Great recap, Domer!  This is perfect for anyone investigating resurfacing.

I had the same exact feeling when sitting......like I had stuffed a softball in my pack pocket.  That goes away soon enough.

Stay the course and follow Dr. Gross' restrictions and you'll have a fabulous outcome. 

Godspeed!