Right hip BHR - Mr Treacy - 29th March

[Mouse Potato]

Hi Folks,

I have already posted in another thread but Pat asked me to start my own story so, save your eyes and don’t bother reading if you’ve read my other post!

For me, the final decision to have my (right) hip resurfaced came when I was struggling to complete a round of golf because of the pain. I am just about able to complete 18 holes if I load up on tablets but I am losing the enjoyment and am practically dragging my leg for the 2nd 9 holes. I am in severe discomfort afterwards and can barely move after enjoying a post round pint!  Also, I am unable to place my body in the right set up position because the pain is too great so I am swinging from a more comfortable position which is causing significant swing faults.  My handicap has crept up from 11 to 17 over the last 4-5 years as a consequence.

First signs of OA in my hip were about 12 years ago at age 40.  I was a keen footballer (Soccer to the peeps across the pond) but noticed sharp pains when stretching for the ball.  My Dr diagnosed OA and subsequent X-rays showed I have shallow hip sockets, inherited from my mother, which was the root cause of the problems.  My mother had her first THR at age 46.

I am unable to walk fast, let alone run and I walk with a pronounced limp which has been the cause of much mirth amongst my friends.  They are all pleased for me that I am taking the plunge because they can see the pain that I am in.

I am having the operation tomorrow (29th), with Mr Treacy at the Priory Hospital, Edgbaston Birmingham (UK).  I am absolutely petrified!  Mainly because I accidently watched a video, on this site, of a UK superstar of TV â€" Bob Warman â€" having his operation a few years ago.  I though it was going to be a nice cosy chat with Bob but they showed some of the gruesome details which is not what I needed!

Mr Treacy thinks, looking at the X-rays, that I should have had the operation about 2-3 years ago because my bones are showing the stress and losing density.  He said just rest and walking for the first 4-5 weeks, with no PT at all.  Surprisingly, he said I should be able to pick a golf club up again at around 8 weeks.

Thanks for reading, I’ll post an update when I’m up to it.

Russ

[jimbone]

Hi Russ-

Choice of surgeon is the most critical decision with this surgery and from all I hear your man is one of the top docs with lots of experience so you are in good hands.  These top guys stats are generally so good at this point that they have reduced the risks exponentially.  Risk still exists, but are far outweighed by the loss of life quality without going forward with surgery.  I relate to your reaction to videos of the gruesome details.  I tried watching a few before my own surgeries but shut them down immediately in horror of what was about to be done to my body.  I finally manned-up a couple of nights before hospital but only enough to watch an animation- paltry stuff.  All together different now that I have two new working pain free hips.  I regularly tune in to various surgical feeds and watch orthopedic procedures on the hips with complete emotional immunity.  Hell, sometimes I even bring a sandwich to do it.  You've got a great doctor.  You're going to love your new hip and life on the other side.  Probably even lower your handicap past pre surgical level.  Best of luck and let us know how it goes.

[evant]

I wish you the best for tomorrow.

You've already met Mr Treacy so you know you are in good hands.

Go easy on yourself in the first few weeks, then allow yourself to look forward to a good future with your new hip.

[Mouse Potato]

Thanks Evant and Jimbone,
I was going to update over the weekend but the hospital wifi was not playing ball with my iPad.
So I was all ready and in my gown at about 12pm. One of the staff came in and said that as I was the only one ready and in my room, she was going to bump me up the list. Apparently I was down as last of 6. I pleaded to go first as I was ready both mentally and physically.

I was taken down for surgery at about 6pm, in a right state by then! The theatre staff were all marvellous and the anaesthetist tried to put my mind at rest before the injection went in. I had a light sedative/anaesthetic with a spinal.

The surgery was 40 minutes long and I was back in my room at about 7:30. I'm glad I had it, but the spinal is not a pleasant sensation. Everything waist down is completely numb and paralysed. I couldn't move my big toes even a couple of millimetres. That wore off by about Midnight and I then had the morphine button to press. I didn't get a wink of sleep.

Saturday is all a bit of a blur. I think a combination of the anaesthetic and the morphine didn't go down too well. My wife said I looked yellow and poorly and I couldn't concentrate on anything. People would talk to me and I could sense myself 'phasing out' and having to ask them to repeat what they said. The physio got me out of bed but it was a real struggle, not because of the hip, but mainly because my glutes - the muscles at the top of my backside - were incredibly sore on both sides. Any movement was very painful and this impeded everything from getting out of bed to getting back in and everything in between. I had no appetite at all and so didn't eat much that day.

Saturday is best forgotten about. So onto Sunday... I wasn't in too much pain from the surgery so I had stopped taking the morphine and after peeing several times to get it out of my system, I felt much better. The glutes, although still sore, had calmed down a bit so I was able to get out of bed and walk a bit with the physio. I was taking some regular painkillers but was not in too much discomfort from the surgery. I managed a porridge breakfast and a small lunch and dinner.

I had quite a good nights sleep and on Monday it was time to go home. I managed to shower myself and get ready and was shown stairs management by the physio (easy peasy). My wife came to pick me up and we made the 20 minute journey home which was uncomfortable as my wife has bucket seats.

Since arriving home, I have been mostly resting with periods of physio and walking around the house. I am in very little pain although am keeping up with the co-codamal tablets. My range of motion is already much better than before the op but I am using muscles I've not used in a long time so it is going to take time. My family say my walking gait is much better than before and although I am getting tweaks and spasms of pain, the arthritis pain appears to have gone.

Mr Treacy wants me to be partial weight bearing only for about 5 weeks, because I have osteopenia, due to leaving the operation too long. He said in about 6 months my bone density should be back to what it was 5 years ago, so I just have to be patient. He also said I could be swinging a golf club after 8 weeks so I have set myself a target of 12 weeks to be swinging properly.

Anyway, enough typing. Happy to answer any questions anyone might have and I'll update the thread in due course. Thanks for reading!

[Mouse Potato]

Hi all,

Well it's 3 weeks today that I had the op so I'm thinking it's time for a short update.

Things seem to be going quite well so far. On instruction from Mr Treacy, I continue to be partial weight bearing only and am sticking with the two crutches, although I do short distances around the house on the one. I am able to do more with the operated leg now such as getting it onto the bed without having to hook my other leg under it.

The swelling and bruising has completely gone.

Range of motion still has a long way to go as I cannot move my thigh past 90 degrees when lying down (edit... it's not as far as 90 degrees), even with help. It is as though it locks at that position and will not go any further. I am not going to push anything until I have had my follow up appointment which is scheduled for April 29th.

I have tried a couple of steps without the crutches, but it scares me because of my bone density issues so I am going to wait.  A question I will have for Mr Treacy is how will my bone density improve whilst I am partial weight bearing? Does anyone here know the answer?

My wife says she can see big improvements in my mobility and self sufficiency. I can do everything for myself now, except for carrying cups and plates, which is good because my wife is back at work after Easter.

I am still having aches and pains overnight which means broken sleep. When does this go away? I am able to sleep on my non operated side, for a short while, as long as I have a pillow between my knees.

As already mentioned, I have my first follow up appointment on Monday 29th so I'll provide an update after then.

All the best, Russ.

[petemeads]

Hi Russ, sounds like things are going well. My BHR from 4 years ago was installed into slightly osteopenic bone and I was given strict 'partial weightbearing' instructions to be followed up to the first physio appointment at 2 weeks. I found I could walk a mile with 2 crutches at day 6 (very slowly) and by the time I saw the physio I could wobble along without assistance - and she was horrified! Nevertheless, no harm was done and I was jogging at 8 weeks and things just kept improving - range of movement takes ages to re-establish, probably over a year for me.
When I went for my second BHR two years ago I discovered just how lucky I had been first time around - my femoral head snapped off during the operation and I got a ceramic THR instead. Given my bone quality this was probably a good thing as I might have broken it myself during recovery by being too cavalier...
The THR came with a cast-iron 'you won't break this' guarantee from my surgeon so I was jogging at 5 weeks this time and range of movement came much quicker. The only downside is some residual thigh pain that might relate to a slight lengthening of this leg, still troubling me occasionally at 2 years, not enough to stop me running, climbing and having long days in the mountains.
So - do as Mr Treacy says, take care until restrictions are lifted, maybe take Vitamin D with K2 as a bone supplement, and don't take stupid risks...

Good Luck!

Pete

[Mouse Potato]

Hey Pete,

Thanks for responding and for the advice. It's only 10 days till I see Mr Treacy so I'm not going to take any chances.

Im glad your operations are giving you a better quality of life and I'm looking forward to the day I can say the same, which is hopefully not too far away.

Russ

[jimbone]

Hi Russ-

I somehow missed your hospital/surgical report so it's good to hear things went well and your recovery continues.  The couple of questions you asked are hard to answer except that everyone is different.  I was encouraged to bear weight on my hip straight away after surgery- with crutches and Dr. Pritchett generally removes all restrictions at 6 weeks.  Your doctor and your case warrant a different protocol and I think you are being smart to take things slowly and carefully.  One lesson I think all HR patients learn is patience- the body will determine the rate of healing not our personal schedules.  The pain/discomfort you feel bending the leg- I get that as well.  It felt from the beginning with both of my surgeries that my thighs/quads were just "full"- don't know how else to describe it- maybe hypertonic is the term the PT used.  It's lasted 9 months now on the first leg and 7 on the second but also continues to improve.  They do dislocate the leg during surgery and I imagine that can do some serious trauma to the muscles but just speculating.  What I know is that with consistent, gentle effort I make continuing improvements to my strength, ROM, balance and agility.  Everyone heals at their own rate- mine has been slow and steady and I'm truly pleased with it.  You'll find what works best for you one step at a time and the best part is how interesting and fun it is to regain the use after years of not having it.  Glad you're well.

[Pat Walter]

Hi Russ
I am with Jimbone - I missed your post too.  LOL We were out fishing!  NOT  Well, maybe when the river doesn't look full of mud.
Anyways, I wish you the best. I am sure you will start being more active and walking more. The weight bearing activities, according to the surgeons, helps build bone density.
Looking forward to your updates.
Pat

[Saddlepal3]

hi Russ,
I had an HR by Dr. Pritchett in 2006, and a revision on that joint in Sept 2018. I also am osteopenic. Dr. Pritchett suggested taking a 4 month course of Tymlos to build bone. In the USA, this medication is sometimes prescribed to patients with severe osteoporosis. Dr. Pritchett acknowledged that my use would be “out of protocol” and therefore “out of pocket.” It was expensive but I decided that it was worth it since I have an HR in one hip and a THR in the other, and I want my bones strong enough to support them.
You might ask your surgeon about Tymlos or Forteo (similar drugs).
Good luck.

[Mouse Potato]

Hi jimbone, Pat and Saddlepal3,

Thanks for responding. I think some proper physio will improve the ROM concerns but Mr Treacy didn't want me doing any for the first 4-6 weeks so I am just doing some of the basic stuff shown to me at the hospital.

Saddlepal3... thanks for the drug advice. I looked at Tymlos but it has not been approved for use in the EU/UK as there are concerns about its effectiveness and risks of heart palpitations. It's also $19,500 for a year's supply!

When I see Mr Treacy in 8 days time I will ask him whether there are any supplements that he recommends, to improve bone density. He has already told me that he expects my bone density to be back as it was 5 years ago, within six months and back to normal levels within a year.

Once again, thanks for taking the time to respond and Pat... great site, keep up the good work. I'll post an update after my appointment with Mr Treacy.

Russ

[Mouse Potato]

Hi all,

Well I saw Mr Treacy yesterday at 4 weeks and 3 days post op. He studied me as I walked into the consultation room (still on crutches). He said that I could immediately lose one of the crutches, and the other one I would be able to manage without after another week or two.

He said that I would likely see a lot of improvement over the next 2 weeks and that this was an important stage in recovery (4-6 weeks).  I have noticed a big improvement over the last week. I can now easily raise my leg from a sitting position and walking is much improved. My sleeping is much better and it is now that can see the light at the end of the tunnel.

When I mentioned the ROM issue I.e. My leg seems to lock at a certain point when raising it, he said that it will not be the joint but the muscles and tendons that need stretching. He said not to do this until 6 weeks has passed, when I should stretch it upwards by gentle pulling.  Mr Treacy is not an advocate of PT and says that walking and gentle stretching where required, is sufficient.

I can use a static bike now if I like so I am going to join a local gym for a few months. My golf plan, 8 weeks till chipping and putting and 12 weeks for full swing, he said should be easily achievable. He said I can drive now but recommended going back to work (city centre office) in another 2 weeks. I am doing a bit from home at the moment.

When I asked Mr Treacy how long he expected the joint to last he said that he has a survival rate at 20 years of 98%, and half of the failures are in the first 6 weeks. So, as long as I can get past the 6 week milestone, there is a 1% chance of failure over the next 20 years. There are no guarantees but I'll take those odds!!

So, I am extremely happy with how things are progressing and am looking forward to enjoying a pain free future. Mr Treacy wants to see me again in 4 weeks time so I'll post an update then, if not before.

Thanks for reading.
Russ

[Mouse Potato]

Hi,

A couple of things I forgot to add in my update above.  I asked Mr Treacy if there were any supplements he recommended for the osteopenia but he said not to take any, just walking.

I asked whether it was too ambitious to attempt a 'tough mudder' event around this time next year. This is an 8-10 mile run involving 25 'obstacles' and obviously lots of mud! Apparently I can start running at 6 months and this should be absolutely fine. Whether I do it or not, I don't know but it is a good target to have.

https://toughmudder.co.uk/

Cheers
Russ

[Rn2md]

Ive done Spartan races in the past, which are probably very similar.

You have to remember that in addition to running, swimming, and mud crawling, you might expect to climb high walls, ropes, monkey bar obstacles, where a controlled fall is involved to get off the obstacle, unless an accident occurs and the fall is worse. You may also lifting a heavy object and walk with it at some point.

So if I were you, I might hold off until a year for something extreme like that. But you could definitely start training for it at 6 months. One is probably best served to train well in advance anyway, even without a new hip.

Running long distances in Woods and uneven terrain is helpful for training, stopping intermittently to do sets of burpees or pull ups, before immediately continuing on the run worked well for me.

Given the new hip and possible need to regain some proprioception, finding an indoor climbing facility to practice for the climbing parts might be helpful too. A fall would be especially problematic with the new hip.

[Mouse Potato]

Hi Rn2md

Thanks for the tips, the event is usually in May in my area so that will be 13-14 months post op. I'm not going to take any unnecessary chances so obstacles can be skipped if you don't fancy them. I'm more worried about the obstacles where you need to crawl under netting and stuff as I just can't see myself having the range of motion required to do that. But it's a long way off so plenty of time to work on that.

The tough mudder website has training videos to help you prepare for the obstacles.

Thanks again.
Russ

[Mouse Potato]

Hi hippies,

6 weeks post op now and I am seeing progress, but also some mild concerns. I am getting around the house without aid now but still need a stick when walking outside as the joint still feels a bit ‘weak’.

The main problem seems to be the outer part of the hip which I presume is soft tissue related, rather than joint. When lying on my non operated side, I cannot lift my operated leg away from my body as there is no strength and a lot of pain from the outer hip.  The odd thing is I can lift my leg away from my body from a standing position with no issues.

Any thoughts on what this could be and are there any exercises that could help?

Thanks for reading
Russ

[jimbone]

Russ-

It's mostly gravity.  Laying down you're fighting it more than standing, also you are starting from a more neutral position upright- you have more moment to overcome when laying down.  I used clams to build those rotators as well as band walking-sideways/front/back.  6 weeks the tissue is just begun to heal [for me at least] and as you know there's a lot of trauma involved.  I also was doing regular hill climbing on hard smooth surfaces to work the glutes.  I walked unaided but kept a cane with me for occasional relief.  I could do a mile flat surface at 7 weeks unaided but I felt it.  Postponed my 6 week consult to make sure I was in the right direction.  You might try the side lifts with a pillow/support between your ankles so you don't need to overcome the leverage disadvantage.  Start with easy and it might surprise you how quickly that advances things.

[Rn2md]

It sounds a lot like the exact problem I’m working through right now, abductor muscle weakness.

I saw Dr. Gross got 7 week follow up yesterday and reviewed it at length.

Basically I need to do the standing side raises with body weight, then work up to ankle weights, then after that, then try again to do the side raises in the side lying position.

So that was the plan I was given. Right now, doing those in the side lying position is very uncomfortable and frustrating. I feel your pain.

Hope this helps!

[Mouse Potato]

Thanks guys, it’s actually comforting to hear that it is normal and expected. I will have a look at those exercises you suggest. Hopefully this is also the cause of the joint weakness and why i am still limping when walking without an aid.

[catfriend]

Those assorted lateral hip muscles are hard to heal up at first. As others have said you need to build to side leg raises and clam shells. I found it hard to do those initially, but worked on building the reps and frequency. They will help. Six weeks is still pretty early. If you need a stick to help walk outside securely or to improve your gait there's no shame, you just do. The cane will also keep other people from getting too close to you.