3/20 Biomet Uncemented Left Hip Resurfacing- Dr

[Rn2md]

Well, I took the plunge for the outpatient resurfacing by Dr. Gross earlier today.
All was a great success and happy with how everything went.  Currently resting up on post op Day 1 at the hotel with pain controlled.
Just visited by the visiting nurse as well...just when I thought i couldn’t be any more impressed.

Five stars all the way around for Dr. Gross and team.

Here’s the story:

41 yo male with left hip OA mild to moderate symptoms and Fapreventing favorite activities such as weighlifting, running, and martial arts.
Symptoms of stiffness and during the job when I had to  stand for periods of time.

So I first sought local opinions from various Orthopaedic surgeons, who initially offered either steroid injections, stem cell injections, or total hip replacement. Tried steroid injections and PT first, with limited and temporary improvement. Then fortunately the Ortho who did my injections mentioned the option of hip resurfacing since I’m relatively young.
So I began looking into it and first went to the HSS website to find Dr. Bryan Kelly, who I saw had expertise with FAI.
But I later discovered after the office called me back, that arthroscopic solutions were typically no longer viable once OA has set in.
They offered to send my information to Dr. Su, who does resurfacing, and I agreed.
His PA called me a while later and said I was a great candidate.
However, various life circumstances prevented me from scheduling the surgery at that time.
Later, when I revisited the option, my insurance has changed and I was back to the drawing board.
I again looked around and this time found this website and various other surgeons such as Dr. Gross, who seemed to have both long experience and many great reviews from patients.
I saw he also took my insurance.
So I sent him my info.
3 weeks later I got a call from him and told me I was an excellent candidate. He spent
Surprisingly, I immediately received a surgical date, extensive preop instructions, and a hotel reservation for me made by Dr Gross staff. I was impressed with the level of service already.
So I began preparations for setting this up, arranging plenty of time off work in advance , I took 4 weeks.
During the time leading up to the surgery, I did extensive research on resurfacing, with particular emphasis on various information found in this website. On advice of some on the site, I got into the best shape possible with the OA for the surgery.
I put emphasis on weight bearing exercises like squats, even though they were painful, since bone density is so important for the surgery. I also emphasized Hip adductors and abductors and Psoas on my gym routine.
The initial consultation went well and Gross answered all questions and was quite personable and down to earth. A well organized office routine. Also met Lee Webb, who also inspired confidence with her knowledge and demeanor.
When the date finally came, I reported to the surgery center at 6:30 AM.
About 10 minutes later, I went back to get changed, bring my polar care unit and crutches for post op.
They started me off with a cocktail of OxyContin, Tylenol, and an antacid. Then they had me change into a gown and they placed the IV and drew blood.
Lee Webb cane and asked if there were any more questions, then the anesthesiologist explained her side of the procedure, including a spinal anesthetic and propofol. They gave me another cocktail of IV sedatives in prep, then I woke up and all was finished.
Once I was awake enough, I ambulated on crutches with the therapist and then attempted to void. I did get nauseated at that point, so they took me back to bed.
They scanned my bladder and it was full. But I did get to void successfully a bit later after the nurse reminded of the the potential need for a straight catheterization.
So the trip to the hotel was uneventful and kept on top of the pain meds. 
Had nausea again that first night after standing, but subsided eventually.
Did the bed exercises here and there and keeping up the schedule for post op meds.
Doing pretty well overall at the end of post op day 1, but will probably need to bump up the pain meds, as it increases toward post op days 2-3.

Wish me luck for a continued smooth recovery and rehab

[John C]

Congratulations, and welcome to the other side. For myself, and many others, it was one of the best things we ever did for ourselves.
I would suggest that for the next 6 months to a year you be prepared for the unpredictable. There will be aches and pains that come and go, worries about doing too much or not doing enough, and maybe some worrisome moments about whether you did the right thing or whether you did something to screw up the new prosthesis. The good news is that Dr Gross's wonderful support staff of Lee Webb and nurse Nancy are there whenever you need them. If you email them anytime you have concerns, they are always there for you. My experience is that Nurse Nancy is able to get back to you the fastest, and is very knowledgable. In the rare event that it is beyond their comfort zone to answer, Dr Gross is there with his wonderful and patient phone calls. In the same way that you were impressed with the surgical experience, the aftercare is also five stars.
From what I have read, you will be the ideal rehab patient. Just take the time to allow healing, and be prepared for the surprise ups and downs along the way. If you treasure the tiny improvements that happen on a regular basis, it is a fine journey.

[Rn2md]

Thanks John.
Your comments, as always, are helpful and welcome. :)

I’ll be sure to keep posting periodically about the progress.

[Rn2md]

Yesterday on Post op day 2, I noticed being more awake and able to ambulate several hundred feet on crutches. The 9 hour drive home from SC to Florida went surprisingly well too. Keeping the routine with the pain meds was very important, which helped keep a positive mood and do ankle pumps and quad/glute sets with minimal to no pain on the drive. I also was using portable ice packs and placing them near the incisional area for the ride, 1 hour at a time. (The kind you activate by popping them, so no ice and water messes in the car) I think not having an interruption in the ice therapy helped progress too.
I had elected to stay at the hotel for 1 additional day just to get over the hump on pain control, lingering anesthesia side effects, and movement. Glad I did. I also wanted to get a few doses of the Eliquis on board before a long car ride, as DVT or PE would foil the whole plan.
Got home last night by about 7pm and had a nice juicy roast beef sub, which I think my body thanked me for. I’m sure I needed the protein, calories, and iron for healing.
Today, my ROM continues to improve and I’m ambulating independently on crutches around the house. Not for exercise yet, just for necessities. Pain is virtually zero and I think I’m going to titrate off the narcotics completely by tomorrow. Still taking it easy with the polar care on as much as possible and there is really only minimal swelling.
Next item on the agenda is getting the bowels to move, which should be facilitated by the colace, movantik, fluids, prune juice, and increased walking.
Will keep posting on progress, and things are definitely moving in the right direction.

[John C]

As I am sure you know, getting off those narcotics is another big key to getting the bowels moving again. If you need something more than Tylenol for another day or so, I found that Tramadol was sufficient with fewer side affect for me. If you can get by on Tylenol without negatively affecting your sleep or exercises, all the better.

[Rn2md]

Post op day 4 and pain controlled with Tylenol and Mobic alone.  No narcotics today.
Had a scary slip with the operated leg last night when crutch walking to bathroom, due to the crutch being inadvertently placed onto a hand towel that fell on my tile floor. Didn’t fall, thank goodness, but it did require a reflex contraction of my operated glute and adductors to stay upright, which was somewhat painful. I don’t think it caused any real problem though, as there doesn’t seem to be any undue soreness or pain today. Have to be real careful for the first few months to avoid disrupting any muscle or soft tissue repairs that are not yet healed.
Continuing ice therapy, fluids, crutch walking, and prescribed leg exercises.
Range of motion continues to improve today.

[Pat Walter]

Glad you are home and your trip went well. Many of us had strange, small problems like your bathroom slip.  It really scares you to think you could injure something in the new hip.


Take it easy.  Looking forward to your posts as you progress in the healing process.


Pat

[Rn2md]

End of Post op Day 7 and still making incremental improvements in mobility.
Bowels we’re moving on post op day 4. So that’s no longer a concern.
Started walking with 1 crutch last night and today, taking it slow but doing fine.

I notice that the glute on the operated side is still slow to activate or incompletely activating? It feels funny putting more than 50% of the normal load on the joint when walking. So I still use the crutch to offload it some.

I’m thinking it will just take a little more time for that to normalize.

Had my first outside walk with one crutch, several houses down the street and back, with my wife walking along side me holding the other crutch just in case.
I’m now able to get in and out of bed without using the aid for lifting your leg, just taking time.
Continuing the simple hip exercises as prescribed.
Still zero pain.

When should walking feel normal again?

[Philbrd]

Hi Rn2md,
I am a little ahead of you - this is week 8 post op (Bilat) with Dr. Gross.  I can tell you when I started feeling better walking. 

At week 3 I walked about 1/4 mile without crutches.   That was certainly tentative, slow and did not feel normal but felt good to be able to do it without crutches. At week 4 I was able to walk about a mile without crutches.  At 4 weeks,  I could also walk around the house and it felt pretty normal.   I live in the northeast so this was all inside as we had a snowy winter and I could not walk outside.  Between week 4-6 I would say walking started feeling more normal and I was able to walk a 1-2 mile at week 6 without crutches.  This past week I have been walking about 3-4 miles per day.   Walking has definitely felt pretty normal between for the past 2 weeks.  I am still somewhat stiff if I have been sitting for a while.  Once I get walking it feels normal.   

[Rn2md]

Thanks. That helps.
I’ll continue to listen to my body and walk as much as I can. It seems to be a slow and gradual process.

Lying/ sleeping on my non operated side causes a slight tightness/achiness even with pillows between my legs. I’m guessing that’s because my gluteus medius and minimis muscles are still recovering.

For now I’m primarily sleeping on my back, which I don’t prefer, but I’m starting to adapt

[Philbrd]

sounds familiar.  I slept on my back for at least 3 weeks.  sounds like you are doing great.  This is certainly a process.

[John C]

Regarding the question on walking: Dr Gross just says that you should be able to walk a mile unaided at 6 weeks; before that everyone is different. For long walks, which I tried to do twice a day; 2 crutches for the first two weeks, one crutch with my wife carrying the other one for week 3, one crutch with short stretches of my wife carrying that for week 4, and walking without aids during weeks five and six, while carrying a cane just in case. At week six I would say that walking was still a conscious effort to try and make everything function ideally. I am a little strange that way, but I really enjoyed making walking a very conscious process, trying to internalize and be aware of every detail.
Walking "normally" is a relative statement. For me it took a couple of months to work through getting a natural stride, and trying to get rid of the limp I have had for years. After a record snow winter here in the mountains with spectacular skiing, I went for my first spring walk the other day, and am so delighted with the youthful springy walk that I have not felt in 20 years of having bad hips. You are still in the starting gate of a very long journey.

[Rn2md]

Post op day 11-
Still getting around easily with 1 crutch. Definitely could go to the cane. Drove yesterday for the first time since pre-op and also walked 1/2 block. Was slowly progressing with walking distances over a couple days.
Today, I’ve noticed slightly increased swelling of the lateral upper thigh, and a little at the upper medial thigh as well. Also some mild soreness of the vastus lateralis.
So I decided to rest up today and do only minimal walking today, keeping it elevated with plenty of ice.
I guess this is my body telling me to slow down. It didn’t really feel like an unreasonable amount of exertion at the time though.
But I’m listening to my body anyway.
Glad I took plenty of time off work, so I have time to wait these things out.
Still no significant pain. Taking Tylenol morning and evening, Mainly for prevention and for comfort in transfers and necessary ambulation

[John C]

Don't be surprised if the swelling slowly works its way down your leg as you spend more time up and around, and gravity gets ahold of any fluids from the surgery site. The vastus lateralis (and the IT band), were definitely the sorest area on me for a month or so. Nothing serious or that got in the way of rehab, just noticeably tender. I massaged up and down the leg, and used a hand roller, and both of those felt good. Doing lots of quad extensions also felt good for that area.
Glad to hear that you are doing well.

[Rn2md]

Took a walk with one crutch about 2 blocks, which felt ok.
Finally went out shopping at Walgreens for a cane, which felt a little weird, since I had no idea how to really pick one. Lol. But I finally settled on one. Then I looked on you tube to see how to use it.
Walked around with a cane later in the day, which definitely feels like a step up. The hip feels mildly sore  and stiffer. I feel a slight weakness in the hip now and again, if the timing of the cane with the step of  operated leg is slightly off. Not painful though, just stiffens up suddenly. Odd sensation.
Definitely feels like the vastus lateralis on the operated leg is being put to work.
I do think things are still coming along well though.

[Pat Walter]

Hi
You use the cane on the opposite side from your surgery.  It goes forward as your operated hip and leg go forward to take a step.  Don't use it on the same side as the surgery.  Many people do.  It is hard to believe, but there is much more support and assistance using it on the opposite side.

Here are some articles:
https://surfacehippy.info/how-to-use-walking-aids-and-equipment-after-surgery/
Good Luck.
Pat

[Rn2md]

Now 16 days post op.
Still using a cane to walk but seeing daily improvements in the ease and speed of walking.
Getting in and out of bed and shower is much easier too.
Still tricky to get a shoe onto the foot of the operated side, but that’s improving also.
Had another upper body gym workout, followed by the normal hip exercises for phase 1 and that all went well. Feels weird walking around the gym with a cane, but whatever.
I think I’ll be able to lose the cane in the next couple of days, the way things are going.

[jimbone]

Most people are not in the gym at 16 days post op and and the result for a lot of people who push recovery faster than their body will tolerate is lost ground and additional pain and recovery time- them's the lucky ones- some injure themselves. 

[John C]

I think that Jimbone's thoughts about not pushing the early recovery process too fast and hard is wise and makes a lot of sense. I also think that Rn2md's description of his gym session involving an upper body workout, combined with the Dr. Gross's Phase 1 exercises sounds like an ideal program for 16 days out. There are many healing benefits to getting the heart rate up, breaking a sweat, and pushing those parts of the body that were not involved in the surgery, and that balance can work for someone who understands their body and knows their way around a gym. Within a week, I was doing daily upper body workouts, and at the same time was very cautious to not allow those workouts to stress my healing hip. It sounds like Rn2md has found a good balance of getting a good workout for the upper body which will benefit his whole system, while protecting the early hip healing process by sticking to the Phase 1 exercises. It is always a tricky balance, and that description sounded like a good start.

[Rn2md]

Thank you for the comments.

The quads/vastus lateralis seem to be the Achilles heel of this part of recovery.

It is the first area to become sore and mildly swollen as walking and activity increase in general.

I have also been at a conference for the last couple of days involving sitting in a regular auditorium chair, but with a fairly decent amount of intermittent walking as well. Walking down declined walkways or stairs remains a little tricky, as the quads occasionally cramp and strain, particularly toward the latter part of the day. That seems to be lessening in frequency through

I would say the quads are probably the factor limiting a more rapid recovery of my preoperative stride.

At least walking with the cane is becoming easier on a daily basis. The first part of the day seems the prime time for walking, getting more difficult as the day wears on.