Left hip resurfaced for osteoarthritis by Jeremy Latham in Southampton U.K.

[gary2010]

Background
I am a 47 year old martial arts enthusiast and instructor. I was diagnosed with OA about 10 years ago; I now realise that this was due to femoro-acetabular impingement, and that my left hip had never been quite right. I started running and weight training at about 21 and always experienced some stiffness and soreness on this side. I'm sure that this problem has held me back in my sporting endeavours, and that I might have achieved more, possibly with less effort, nevertheless my fitness effectively peaked at age 45.

[gary2010]

I am writing this in 'chunks' because I am on a somewhat ramshackle computer in a hospital room. I intend to blog my recovery and progress on here from time to time.

My diagnosis of F.A.I. came from a tutor at the anglo-european college of chiropractic in bournemouth, I'd had about 3 months of treatment for an incresingly stiff, sore and unresponsive hip, to no avail. At that time I was kicking Thai pads 2-4 hours a week, training and teaching Kali, and sparring, mainly with much younger partners. I used to run a 10k circuit around my home town, uphill and downhill, once a week as an indicator of my general well-being, I last did this on new year's day 2009. I came in about 2 minutes late and it took me about 3 days to recover.

[gary2010]

Last year I had arthroscopy to relieve the impingement; the results were initially positive but as I integrated my usual training routine after a lot of rehab work the problem returned as before.

At the time I knew nothing of resurfacing, I was desperate to stave off replacement as long as possible, but with hindsight the joint was already too far gone. Arthroscopy might have solved the problem if I'd had it 10 years earlier, but had only been available locally for about 18 months.

The one year follow up X ray showed end stage OA, with no cartilage and cysts on both sides. I was now limited to upper body training only and static cycling, which I found relieved the pain somewhat, but did nothing for the range of movement.

[gary2010]

Through this site and others, I researched BHR and its variants, and selected Mr Latham as my surgeon, fortunately this hospital is only 40 minutes drive from my home, I had already obtained e mail quotes from Drs Bose and De Smet but after speaking with Mr Latham and viewing his site I was confident he would do a good job.

I also had an N.H.S referral, but decided I could not afford to wait until the middle of next year.

I had the operation yesterday, 10th September 2010, I had been told that if the bone stock was unsuitable, I would receive a large bearing ceramic THR, as a last resort, but that this was extremely unlikely.

Meeting with the anaesthetist the day before, he proposed to use a spinal injection with IV sedation rather than general anaesthetic; I was happy to go along with his recommendation.

[gary2010]

I went for the procedure at about 08:30, the spinal was a little uncomfortable, though sedation was already taking effect; I woke up in the recovery room at about 10:30, with no sensation below the waist.

T+3hrs: Feeling beginning to return in non-op leg, I'm back in my room, I receive a short visit from Mr Latham who says the resurfacing went very well, I can get out of bed as soon as I have sensation in both legs. I'm wearing pressure pads on the left foot and right calf which squeeze alternately to prevent blood clotting; I flex my feet and calves as much as I can.

T+ 5:30hrs With P.T. and nurse in attendance I stand briefly to relieve myself, I can support my weight evenly distributed and unaided. I manage to fill a bottle with a young lady on each arm - not something that happens every day.

Having experienced both spinal and general anaesthetics I can report that each has it's drawbacks. The general has more and longer lasting 'head' effects; the spinal, with a couple of milligrams of diamorphine produced ferocious itching, which started in the groin and spread over the body, I felt as if I had an entire flea circus dancing on me. Total constipation and most alarmingly, extreme difficulty in passing water, these effects lasted for 24 hours and tapered off over the next 12. On the plus side, I was fully compos mentis with no dizziness or pain.

[gary2010]

At some point duriing the day I am visited by the anaesthetist; as I am concerned with the constipating effect of the Dihydrocodeine I've been recieving he agrees to change my prescription to Tramadol, which suits me better.

T+ 13hrs: I start course of anti-clotting injections, I also get periodic doses of antibiotic through the cannelure which is still in my right arm

T+ 24hrs: I am mobilised on crutches, walk to the bathroom and wash then start circulation and rehab excercises with P.T.

Foot rotations, clenching leg muscles in turn, seated quad sets, a short leg raise over a rolled towel, heel slides and lying abductions; I am to repeat these approx every 2 hours. I am delighted to find that although stiff and sore, my range of abduction is already better than in the last few weeks.

Mr Latham follows the rather conservative McMinn protocol, with movement restrictions for 6 weeks, 90* restriction, operated leg not to cross centre line and no closed-chain rotation on that side. I have a procedure for everything, getting out of bed, sitting and standing, in or out of a vehicle. As part of the package I've purchased, an occupational therapist visited the flat, supplied some mechanical aids, and demonstrated all this, so I've had a chance to practice beforehand.

[gary2010]

 T+ 36hrs, the blood drain has been removed, the antibiotics are finished, and I'm able to get about on crutches by myself. I've done the bed excercises about 5 times today, and using an Ice pack constantly; I have no swelling and minimal bruising.

The spinal jab seems to have worn off, the unpleasant side effects of the heroin now gone, it beats me how people can get stuck on that stuff!

I feel as if I've taken a few good kicks in the trochanter region, or maybe walked a long way with the old injury, comfortable with the tramadol, just enough pain to stop me doing anything reckless.

Mr Latham is pleased with the X-ray, I should have a good range of motion. The pressure pads will go on again tonight, and tomorrow we start standing exercises.

I find myself more optimistic than I've been for a long time, I'm looking forward to tomorrow.

[Pat Walter]

Hi Gary

Thanks for your posts.  People like to read about real experinces.  I hope you continue to do well.  Take it easy.  You will heal in time.  HOpefully, be home soon and able to do some walking.  Good Luck.  Pat

[gary2010]

Cheers Pat, and I hope you are doing well too after your recent procedure. You can put this on the main site if you like or I could tidy it up and write you a proper article when I get home.

A comedy of errors last night: woke up about 0400 feeling uncomfortable; I really wanted to change position but with the pressure pads hooked up to the machine and a triangular block between my legs this is impossible. I decided to have some ice instead. I have been using a large pad which is refreshed by gravity feed from a bucket sized thermos flask full of ice water. You connect the hose to the flask, siphon the warm water out then reverse the positions to recharge. There is an air vent in the top.

I'd been using this thing all day with no trouble so I didn't bother to put the light on, hence didn't notice the vent was left open and managed to pour the contents of the ice bucket over myself!

So a nurse had to come in, change the dressing and put a fresh sheet on, I found standing for a few minutes relieved the discomfort. She then fixed the ice pack for me; unfortunately she left the hose coupled so I had to do it again anyway.

[gary2010]

This morning, T+48 hours, got up, walked to bathroom. Washing, shaving etc. takes ages while observing the protocol and keeping the dressing dry. A nurse washes my feet and I have some blood taken for heamoglobin test.

I have some swelling today, which i'm told is normal, I do the bed excercises twice, once with P.T. in attendance. The range of motion is diminished from yesterday and I feel a lot less flexible, so I don't push it.

P.T. gives me a pair of stout walking sticks to replace the crutches and I practice a more fluid, natural gait instead of the shuffling 'cripple step' I've adopted with the crutches, walking is getting more comfortable. I feel that's enough progress for one day.  

In the afternoon the P.T. comes in and demonstrates the standing excercises which are pretty straightforward; front, side rear, I run through it once over a very short range which is pretty challenging in itself. I can't see any point in repeating it and suggest we crack on with it tomorrow.

I have another consultation with the surgeon, we had discussed discharging me tomorrow but I'm not in any rush as I still have a little bleeding from the wound, he takes a look and decides I could come out on tuesday if I'm ready. We also agree to lay off the excercise for the rest of the day.

I lie flat for an hour with the ice pack on, it's necessary to do this every so often to stretch out the scar. I've been advised not to remain in one position for too long; in practice I've found it uncomfortable to do that anyway, so I alternate lying, reclining, sitting, standing, and take a few steps with the sticks when I feel like it.

.

[gary2010]

On a tangent, the food at Spire hospital Southampton is never less than superb and often outstanding - I mind what I eat and have enjoyed every single dish so far. The staff are friendly and welcoming, and everyone has a great sense of humour. No surprise then that I don't mind staying another day!

[bothdone]

Enjoying your posts Gary.  Best wishes with your recovery.

Ed

[gary2010]

Cheers Ed, I had wondered if anyone would make it through all that! More to come.

T+ 3days: Slept 7 hours, which is plenty for me, vivid dreams, presumably enhanced by the opioid painkillers. The effect of the pressure pads on the feet & legs while dreaming is worth mentioning. I've aquired earplugs, so the noise doesn't bother me, but it creates peculiar sucking, clutching and wringing sensations.

I remember one dream: I was walking on a wooden bridge, which was moving under me and slowly collapsing, my foot went through and I couldn't pull it out. Eventually I got loose and trudged across a muddy field, with deep tractor ruts, stumbling and periodically getting sucked into the mud. I woke up, looked down at my feet and all became clear!

[gary2010]

Anyway, I got up at 07:30 took painkillers and went through my ablutions, breakfast at 08:00; sat in chair for 20 minutes, then did the bed excercises, interspersed with some upper body work on the bar over my bed. My range of movement is back where it was the first time but I didn't push it any further.

I have been warned that the flexibility will fluctuate like this for a while, so resolve to take it as it comes, I still have some swelling, it's confined to the upper thigh and outside of the hip but I haven't seen the 'elephant leg' some folk report. My digestion and other functions are back to normal.

Walking is much easier today, I can move around the room comfortably with one stick, but expect to use two when I go outside; gripping the window frame for support I did the standing movements I was shown yesterday, which are still fairly challenging to be honest. I did 5 reps of each then lay flat for a while with the ice on.

I find I really enjoy just standing upright and still, much more comfortable than sitting. After 10 mins lying flat I stand by the window, stretch my shoulders and back, do some breathing excercises. Then, in a plain, neutral stance, very slowly and gently, I run through the top half of the Siu Lim Tao from Wing Chun. The bottom part would break my movement restrictions and it's static anyway; my legs do not move throughout. I feel good (I'll qualify this in my next post.)

[gary2010]

Subjective thoughts.

There's a strange kind of claustrophobia that comes from not being able to move freely, of course, some people have to live with this for a lifetime. I had a sense of it as my injury took hold and the range of activities open to me diminished, but right now it's a lot closer.

The sensation is intensified by being dependant on others, and especially by being dependant on drugs. I wrote the last post after my morning dose had taken effect; half an hour earlier I was feeling weak and sore, my backside seemed to have been roasted, and I approached the prospect of getting out of bed with some trepidation.

I am taking a fairly substantial opioid painkiller with 2 paracetamol, 4 times a day and an anti inflammatory once a day; I don't ask for it, although I could, I let the staff regulate the timing. After all, I spent 25 years building up my pain tolerance, and I don't want to ruin it.

So life has a rythym, and it's mediated by pharmaceuticals, not only the physical but the emotional sensations tend to follow this cycle. Tramadol has a distinct mood lifting component, (which is why I requested it) and I get on very well with it. I believe I read somewhere that it has a mild S.S.R.I. effect - that's anecdotal, by the way, don't take my word for it!

Right, time for another walk.

[pc]

My left hip was done last Tuesday. Hooray, almost one week. We live in Park City, Utah a small ski town. I have been able to beat the closed in feeling that you have mentioned by taking walks and seeing the beauty of fall in the mountains. My hope is to visit the slopes more intimately in a few months when there is bountiful fresh fluffy powder. The more I walk, the more I feel unrestricted. Careful though not to overdue. Your writing skills indicate a background in literature or perhaps publishing. Very descriptive choice of words. I am enjoying your posts as well. Good luck. Rick

[gary2010]

Cheers Rick, I'm highly encouraged that you're walking in the mountains already, my vista is limited to the hospital corridor! I did a flight of stairs this morning under supervision and I should be out tomorrow if the wound is in order. Do let us know how you get on.

I'm a test engineer actually, basic factory fodder, but I do enjoy writing and it fills in the gaps between the rehab exercises. I hope I've still got a job to go back to so I can pay for all this!

Dom,
the N.H.S. is a blunt instrument but I'm glad it's there, I know there are plenty of people who'd like to do away with it. I was told that NICE wouldn't fund arthroscopy for impingement so I had to pay for that as well.

Now I'm a professor of hindsight, having wasted 6.5 grand and a year of my life; my non-medical opinion is that arthroscopy works well if it's done on the athlete before significant OA sets in. It's a very new treatment for a relatively new diagnosis, so you and I are part of the learning curve. My original surgeon was a pleasant chap who told me I had an 85% chance of getting another 5 years out of it. I've only myself to blame, I was clutching at straws, no one told me to have it done, but then no one suggested resurfacing either.

Now to your problem, resurfacing on small-boned women is controversial and many experienced surgeons won't touch it, but there are a few who have a high success rate. I urge you to get your X rays looked at soon by one of the top blokes and see what can be done to avoid revision. Best wishes G

[gary2010]

Thanks Dom, I replied on the other thread, just a quick thought - it wasn't an ASR device was it?
Take care, G

[gary2010]

Tuesday morning and time for discharge. I'll rephrase that, I've been signed off by the surgeon, P.T. and nursing staff, the wound is healing well.

Slept a few hours overnight, from 04:00 I was decidedly uncomfortable; the nurse came in for the usual checks and gave me a couple of paracetamol, I did my best to conceal my disappointment, spend the next few hours repeatedly iceing everything.

At 07:30 I get up and go for a wash, I really don't feel like it but need to get sorted before breakfast at eight, and I can't stay still much longer. In comes the lovely Holly, my favourite student nurse; "tramadol for you!" I'm out of the bathroom like a bullet out of a gun. In 15 minutes I'm my old self again.

Breakfast, short walk, then excercises, I do my 20 mins lying flat while I call the personnel manager at work. I have a sick note for 3 weeks, I'm allowed 6; I suggest that I might return sooner if I am sufficiently mobile and my protocol can be met, I've already done a quick risk assessment on my work area and I can see this is perfectly feasible. I've got 6 outpatients appointments included in the price so I will be reviewed weekly anyway.

[gary2010]

Hi, The ASR device was made by DuPuy, and has been withdrawn because of it's high failure rate, though some surgeons swear by it for small patients; it seems that there is no margin for error in positioning and the instrumentation is poor - or maybe some of the devices were just faulty, opinions vary, as with everything else in this game!

I've got a Finsbury Adept; as I understand it, Finsbury were the original maufacturers of the BHR. Derek McMinn sold the business to Smith and Nephew. Finsbury remain faithful to the original technology and my surgeon knows them well so he trusts the device, he is really a disciple of McMinn, the rationale being that his series has the longest history of use and consistent success rate.

Finsbury is now owned by DuPuy - complicated eh? Let's hope they don't screw it up!

I'm glad you have a BHR anyway, should be ok if it's been put in straight. I've just had a look at my X ray and the angle looks spot on 45* to me.
G