2 year update

[John C]

Hi everyone,
I just received my two year report back from Dr. Gross, and thought that I would take a moment to share where I am at 2 years post surgery, at the age of 58. I am just going to list some thoughts, in no particular order.
Bottom line is that I am extremely happy with the result at this point.
Dr. Gross says that the 2 year X-rays look perfect. It is worth mentioning that because I had waited so long to have the surgery, I had worn my socket deeper than normal. Since Dr. Gross wanted to be sure that my leg length came out normal when he placed the cup, there was a small hollow area behind the acetabular cup. Dr. Gross told me that this would fill in with bone by two years. You can see in the recent X-rays that he was correct once again.
A recent metal ion test showed that my Chromium levels are within the normal range for the overall population, and low for having a metal on metal joint.
Walking and daily activities are generally pain and limp free, though I still get occasional twinges and very subtle clunks. I can run, but prefer not to on flats or pavement. Instead I will train running stairs, or up dirt trails.
My range of motion is back to what is normal for me, but I am not naturally very limber.
Skiing hard for eight hours, seven days a week, for five straight months during the winter, in all conditions, is great. My only self restrictions are avoiding icy bumps, and no big air unless the landing is really soft. Skating on skis still causes some twinges in the soft tissue.
Windsurfing in high winds and surf every day during the summer is fine, though I have found that I have a couple of weeks of soft tissue soreness at the start of each season so far. Waveskiing (think of a hybrid between a small kayak and a short surfboard) is no problem, though the "hip flick" in my eskimo rolls was a little weak for the first year.
I have gotten back into tennis after a twenty year layoff due to my bad hip. It is going great, and seems to be about the best therapy that I have found. All of the quick turns and directional changes are great for tightening and strengthening all of the small muscles that are cut or affected during the surgery.
I still have some nighttime issues that have not improved much. I sleep fine for the first part of the night, but every night at about 3 or 4 AM, I start getting discomfort and small spasms in the scar area. When I roll onto by back, everything is fine in a few seconds, but when I roll back onto my side to get back to sleep, I only get a few minutes before it wakes me up and I need to roll onto my back again. This has improved a little in the last year, but not a lot.
I would have to say that overall, I still see continued small improvements after two years, which is very positive.
For anyone who is having a slow recovery during the first month or so, I would offer much encouragement, since I was a slow recovery case for the first six weeks, but have been very happy with the process after that point. (I believe that the initial slow recovery was due to a failed treatment that I had tried with another doctor before going to Dr. Gross.)
I will be forever grateful to Dr. Gross and Lee Webb for their superb skills, and dedicated caring attitudes.
At the two year mark, you can rate me as a very happy surface hippy.

[Pat Walter]

John

Great to hear how well you are doing.  I am glad you were able to start playing tennis again.  Thanks for the update.  I hope we get them for many years to come!  Good Luck.

Pat

[hawaiieric]

Great to hear your 2 year mark is doing well.

Noticed you are getting better wind then us this week...

Do you have any windsurfing pictures for us?  Thanks for the update, I look forward to all of me healing more and will look forward to my 2 year mark coming up in November.

Aloha from Kauai,
Eric

[Big Bill]

John....way to go & congrats on reaching the 2 year mark...sure feels good, huh . Hit my 2 year mark about 3 weeks ago.....sweeet  . Keep it up and thanks for sharing !

        Big Bill   C.A.S.H   

[powderhippy]

Nice report John.  Keep pushing that baby. Glad your ions are normal too. Strange about that scar giving you some trouble when sleeping. Have you had any deep tissue massage on it? Possibly break up some scar tissue?
Coming up to my right hip 6 week mark next Wed. Damn excited as I can start on the stationary bike and start the 2nd set of leg exercises that Dr. G and Lee have us do.  My 4 year left resurf is coming up Labor Day and it has been wonderful.
 Don't the years fly by when we're having sooooo much fun. Am grateful EVERYDAY.  All the best John on your 2 year check.
 Best, Shelly Perlmutter
         Left 9/6/06 cement
         Right 6/25/10 uncemented
         Dr. Gross

[Dayton96]

John:

Thanks for the update.  Congratulations on getting back into an active life.  I'm only a little younger than you and will need a hip resurface this coming year.  I've been reading everything I can find on the subject, I've talked to several doctors (including Dr. Gross), and I've even communicated with Pat.  I've read a huge amount of positive comments from Dr. Gross' patients, and I've had a really positive experience communicating with Dr. Gross and Lee.  The way they handle patients is so much better than other doctor's offices, that it's easy to understand why people are willing to travel from all over the country to have their resurface done by them.

Having said that, I read your comments with interest.  I was surprised to read that your walks were "generally pain and limp free."  You wrote about "occasional twinges and very subtle clunks" and at night you still have "discomfort and small spasms in the scar area."

John, I can't help wondering if this is normal for Dr. Gross' patients.  I've never read anything from his other patients concerning these long term recovery problems (although it would not surprise me to hear it about some of the other doctors doing this surgery).  Are your recovery issues simply a result of having waited so long to do the surgery, or are they similar with other patients of his, but just accepted (and not mentioned) as part of the recovery process?  So my bottom line question is: Is this a typical recovery for Dr. Gross' patients? 

Mac

[John C]

Hi Mac; I understand your concerns, and they deserve a thorough response, but my first response is that I think that Dr. Gross's patients have above average recoveries as a rule. For one thing, his incisions are almost always 4 inches, compared to 6-12 in many other cases. If you watch videos of his surgical technique, he is sometimes described as using the care and finesse of a plastic surgeon, and he takes incredible care to make sure that everything is repaired at its best. His attention to detail with everything from placement of the prosthesis, to how the soft tissue is repaired, to post surgical pain management is of the highest calibre that I can imagine. I personally do not think that you could find a surgeon capable of achieving a better result in any given case.
So what about my occasional twinges, etc., which I mentioned in an effort to be sure that my report was balanced. First of all, I doubt if you will find too many 59 year olds who are participating in high activity sports like mogul skiing, high wind windsurfing, surfing, and tennis, who do not have aches and pains. I think that you will find fewer still who are active like myself in these sports for an average of 8 hours almost every single day. I would have to say that the twinges in my metal hip are comparable to the twinges in my other hip, and a few other joints as well. Most athletes my age are taking Advil, etc. to cover up some of the aches, and I take none. The point here is that it would be amazing if my age and activity level did not cause some twinges, and I think that most of Dr. Gross's patients probably lead a more sane and balanced lifestyle. I do have two resurfacing friends that lead a similar lifestyle, and who went to other top resurfacing surgeons. I would say that our experiences have been similar.
As a realistic comparison, I have dislocated both shoulders in the past, and it took years before they stopped having aches and twinges, and allowed me to sleep on them for long without waking up. In resurfacing, your hip is dislocated, and sliced open.
The occasional limp that I mentioned came with two brief episodes of trochanteric bursitis that I had at around 10 and 20 months. Both coincided with the initial switch to my summer activity schedule, and would be common for many previously injured joints at the start of a new season. Dr. Gross did suggest starting each new sports season gradually, which is advice that I did not heed. Both episodes cleared up in a week or two.
As for the minor clunking, it is very subtle and very rare now, and usually happens when I step into the shower in the morning, before the muscles around the joint have become fully active to support it for the day. Dr. Gross did comment to me that it is after all a metal on metal connection, and that those who experience some clunking mention it less and less over time.
I believe that my night time issues are pretty unique to me. Like my initial recovery issues, I believe that it is related to an experimental treatment that I tried with another doctor, since this is when these issues really started, before I scheduled my surgery. Dr. Gross, in his kind way, made it clear that he did not think that this had been wise, and that it might have some unexpected effects. Also, as you pointed out, I did wait for almost twenty years, and had gotten to the point where I could not get around without crutches or a cane.
So I guess that the answer to your bottom line question is that both my pre-surgery history, and my post surgery activity level, would preclude me from being a "typical recovery". With all due prejudice, if you are going to have a resurfacing, and are concerned about recovery issues, I strongly believe that you could not do better than Dr. Gross. 

[Dayton96]

Thanks for your response John.  I have the impression you did your homework before choosing Dr. Gross and the  biomet device.  I'm curious why you were comfortable with the biomet and cementless (as opposed to the BHR)?  It has a relatively short history.  I'm 55-years-old and not nearly as active as you are.  I do want to go back to doing five mile runs in the morning, playing singles tennis with my son, and backpacking.  While I can still ride my bike, it can be a bit of a challenge getting on and off.   

[John C]

Hi Mac,
Yes, I probably spent well over 800 hours researching over a few years, and read every study and article published on resurfacing (yeah, I am a little neurotic about such things). As much as I like Dr. Gross, you are right in assuming that the Biomet cementless option also played a big part in the decision. I was comfortable with the Biomet design because of the metallurgy (as cast, not heat treated), the thin shell which minimizes loss of bone stock, the substantial anti-rotation wings on the cup, and the large arc of coverage whose importance has since been confirmed by issues with the ASR. Also the Biomet site has some interesting comparison graphics of the load transfer into the head of the femur with their internal cap design versus the BHR.
I know that cementless is still controversial, but it was a big part of my decision. Though he did not like to promote it because the case study was so small, Dr. Gross already had a 7 year study out which showed zero failures with cementless femoral caps, and this was before he developed the full plasma spray and hydroxyapitite with Biomet. There is also a seldom quoted study published by Dr Pritchet that showed zero failures at 20 years from a group of MoM resurfacings done back in the 70s, and some of these were cementless. These were definitely a different generation of resurfacing prosthesis, but it does show a longer follow up than most people are aware of. The bad news is that most of the resurfacings from that era involved some sort of plastic which led to the very high failure rates that most people are aware of.
For me the risks of cement, such as thermal damage to femoral blood supply and possible necrosis, and possible eventual breakdown of cement under repeated high impact loads, outweighed the lack of larger case studies of cementless.  My belief is that the absence of cement will allow the bone to continue to live and grow into the prosthesis for the life of the implant, allowing continual adaption to impact loads. For me the main argument against cementless had to do with the viability of the femoral head, and whether their was enough blood supply to support bone ingrowth, but Dr. Gross had studies showing that good blood supply returned after a short period following surgery.
Anyway, there is my quasi-scientific reasoning for being comfortable with the Biomet prosthesis, and the cementless option. Good luck on your journey.

[John C]

Hi Shelly,
Glad to hear that you are doing well with the second hip. Keep us up to date. I am curious about whether you will experience any differences with the more recent version.

[John C]

Hi Eric,
Yeah, it has been a windy season here. May and June were the windiest that I can ever remember. July had some lighter periods, but we were able to plane every day. The last couple of days were up around 30 in the afternoons, with some gusts to 40 a couple of days ago. Unfortunately, not much south swell hitting Maui this summer, so less surfing than normal.
I am going to attempt to attach some summer pictures. Sorry, no wavesailing shots, since the reefs that I like to sail are pretty far out for a camera, plus no one wants to take pictures if the surf is up

[powderhippy]

Will do John.  So far this new hip is following the same course as my other hip 4 years ago. I kept notes then and now. Looking forward to riding the stationary bike this week and the advance stretching exercise. 6 weeks goes by quickly..
Enjoy the surf....best, Shelly

[wayne-0]

Hey John ,
That was/is an amazing description of your last 2 yrs. I know how active you are because i have been reading your posts . I have to say that I get a little jealous knowing you get that many days in the water and on the slopes. But on the other hand I am very stoked for ya that you are always on the go. At 58 your tearing it up. You got 10 yrs on me and I hope to be that active when I reach 58. Keep it up and get some wind and waves for me.

Wayne     

[B.I.L.L.]

Sounds to me like your trying to wear the thing out as soon as possible. Surfing, skiing, windsurfing, tennis etc. all year long ? What are ya thinking your like normal now ?   

 Haha just kidding, charge it !!  Thats awesome you are staying so active and able to do the things you want to do. My 2 year mark is next month and I also have some sleep issues since my surgery, and some occasional knocking and maybe a twinge here or there, all minor problems compared to before right ?  Hope it keeps improving !!  I am stoked for you, keep charging !! 

[fenceman]

Thanks for the report John. I am a few weeks behind you and celebrated 2 years on 8/13.  Although not as active I to notice a few twinges here and there depending on the activity.  You have described my condition at 2 years in your report except for the sleeping problem. 

I too am very happy with my BHR and it has allowed my to continue a lot of my activities without pain.  Tried to make my 2 year appointment with Dr. Brooks 2 months in advance and he is booked until March of 2011. I won't know my ion levels until then.
Bill