John’s Hip Resurfacing with Dr. Antoniou 2009

March 3, 2009

 I first heard of hip resurfacing back in 2002 when my brother-in-law had one done in England. At the time I had no hip problems so his descriptions, whilst fascinating were purely academic. Yes hips were fine then. Knees, that was different – had cartilages removed from both 40 years ago, before the days of the arthroscope, and had a ruptured ACL 15 years ago, been bone on bone for some time, so I had always imagined myself an inevitable candidate for knee replacement. But funnily, knees have never restricted my from hiking, cross country skiing, or trout fishing. Then, about 3 years ago, something started catching in my right hip, everything became increasingly painful, even driving. Moderate arthritis quickly became severe, and the once active, fit, outdoor loving, optimistic 56 year old became a miserable, short tempered cripple. I looked into the possibility of hip resurfacing here in Nova Scotia, and the only surgeon who did it gave up because of a high failure rate, and he tried to dissuade me , citing metal ions, allergies and the large number of revisions.

I was pretty disappointed. I know several people with THR and they all are disappointed that they had to compromise their life styles much more than they were initially led to believe. Meanwhile my brother-in-law was hiking up mountains, downhill skiing, horseback riding as if there was no tomorrow. And I asked myself, what would happen if I was 5 miles up a trout stream, in the middle of nowhere, and a THR dislocates? And what if we go back to Fiji, where my wife is from, and I have to sit on the floor? No I was not yet ready to make excessive life-style compromises, especially since we have the technology and skills needed to minimise such compromises. Yes resurfacing had to be the way to go. The question was how do you access it?

A local doctor friend mentioned about a fellow in Montreal who does resurfacing and gave me the name of one of his patients who lives nearby. He had a wonderful experience. And so I contacted the office of Dr. John Antoniou at the Jewish General Hospital in Montreal and luckily managed to get an early consultation, back in October 2008. He confirmed the all too obvious state of my hip and assured me that given my age, health etc I was a good candidate for resurfacing. I was really taken by his quiet, confident demeanour as well as by the efficiency of his assistant, Maria, who made all the arrangements which are a little complex given my out-of-province status.

Four months later, after a little jab in my spine, I could smell the cauterised flesh, hear the reaming and hammering, as my new ASR prosthesis was installed to replace my worn out hip. Now the two days before that, I was a nervous wreck. I have never experienced anxiety like it. The irreversible nature of the procedure, the potential side effects and complications that run through your head, replayed over again and again. Yes I knew the odds were heavily on my side but I just could not shut out that “what ifs”. So in the recovery room with my long suffering wife, as the sensation slowly returned, and I found I could move my toes and feet it was all a huge relief. One of the operating team informed that the femoral head was a little misshapen, and that the leg was one cm shorter than the other, but they corrected for this. Was also told that the post op x-rays looked really good. More relief.

For the next few hours the morphine pump kept me pain free, if stupid. An intense thirst crept over me, which I heartily slaked. This coupled with the intravenous, introduced a considerable volume of liquid, but , despite my best efforts, the old body could expel none. I did not know of this inconvenience associated with spinal anaesthetics and morphine, and neither had I experienced the delights of a catheter. I found out that night.

Day one after the surgery I was quite nauseous. The dinner of the night before came up and the nurses administered some anti-nausea drugs. These made me even more light headed. I had a good book to read but could not concentrate with all the drugs in my system. In the afternoon, the physio came around to get me up walking. Very pleasant, indeed cute, but she was barely up to my elbow when I stood. Took a few hesitant steps with the walker and then she asked my to sit in the chair beside my bed. I did this dutifully but the sweat rolled down my brow and I started to feel weak. I told her I needed to lie down and she inquired as to whether I could get up. I thought I could but I did not trust either myself or her ability to catch me if I fell. So a few burly orderlies were press ganged into the room. Just as well as no sooner had I stood, I was out cold, as if from a Mike Tyson left hook to the jaw. I remember the pain in my hip, and voices, panicking, but it all seemed detached, as though happening to someone else. The blackness dissipated and I found myself again in bed, indeed no sooner was I horizontal, and the blood flowed back to the head, and I was fine. Not an unusual occurrence I was told, especially given the morphine and anti-nausea drugs. So that was it, out with the drip and just some tylenol and advil for the pain.

Next day was much better walked 4 times along the corridor, and with the aid of a suppository managed a good crap. Despite my now clear head, I couldn’t help feeling quite overwhelmed. I thought of the entire system that made my new hip possible, the skill of Dr. Antoniou and his surgery team, but also the nurses, the orderlies who washed me, the floor cleaners, the food providers, the administrators who fast tracked the paper work, indeed the whole integrated system of specialisations all of which had to function flawlessly for a good outcome. A veritable united nations of a system, featuring individuals of every race, from every continent. Indeed as this realisation washed over my I actually cried. Me, a cold, rational economist, overtaken by emotion – overwhelmed, tired, but incredibly relieved and thankful.

I left hospital on day five, once the physio had determined that I could comfortably manage stairs without passing out! I remained in a hotel in Montreal for another 5 days, looked after by my lovely wife, until my staples were removed and Dr. Antoniou gave me the all clear to fly home. The wound was good but continued to weep in one spot until day 8, the day before the staples were removed. Dr. Antoniou said the x-ray was great and there were no restrictions on my activity. Wonderful news, especially given my earlier fainting episode which left me with that awful feeling that I might have damaged something .

Tomorrow it will be 3 weeks since my surgery. My exercises are progressing well and I can finally do straight legged leg raises (something I could not do before the surgery given the arthritis pain). I can walk a fair distance now, perhaps a mile, with one cane. Every day my wife takes me down to the university ice rink where I walk around the concrete path above the seating. There is still too much snow to walk outside, indeed we had 2 inches of freezing rain yesterday which kept us inside. Still get tired in the evenings, and am pretty well wiped out by 7 pm. Some days are better than others but the trend is unmistakably upward. Take no painkillers, except the solitary aspirin which I take once a day as a blood thinner, after finally packing in the Lovenox injections. Can’t walk without the cane, and when I do walk, I get some mild pain in the incision site and sometimes around the hip. Hopefully this will go away soon, along with my cane.

Must say I was very thankful to come across this website. Learned a great deal. It’s great to read of other folks’ experience and to find out that what I have been going through is not unusual but mirrored in the experience of others. That is a great relief. Good luck to all surface hippies.

March 4, 2009

Wednesday March 4 was my 3 week anniversary. celebrated by taking my first, hesitant, steps without a cane. Quite a struggle. Yesterday was a bit better and managed about 80 yards. However, I was even more tired than usual in the evening. Exercises are progressing well, and, lying on my unoperated side, can managed a few lateral leg raises now. Would love to walk outside, but another damned snow storm is howling.

April 6, 2009

I was 7 weeks last Wednesday. On that day, I was back in Montreal seeing Dr. Antoniou for my 6 (really 7) week check up. All is looking good. Put away my cane for good at 4 weeks, though I do use a couple of hiking poles on rough ground or snow. Put away my raised toilet seat and can now tie shoes and, when properly warmed up, can put on socks. Walked 4 k this morning and felt great after it. Am trying to balance on the bionic leg but that is not easy. I do not have any real pain but I am still aware of each step. Am looking forward to the day when I can get up and be totally oblivious of the new hip.

April 16, 2009

Been 9 weeks now and generally things have been good. Last Friday I hiked out through the woods to a buddy’s cabin, with a light pack (just sleeping bag – he carried the beer!) . Rough ground with many trees down, and 30 minutes each way. Had no problems and felt great the next day. On Monday I felt great too, and walked 4k in the morning, in the afternoon did 20 minutes on the statioanry bike followed by the usual hip and butt strengthening exercises and also some balancing exercises on the operated leg. In the evening had PT and the physio concentrated on range of motion, bening the knee up to my chest as i lay down. Got up to 95 degrees, felt a little more uncomfortable than usual. Well the next couple of days have been bad, sore round the hip and some pain down the groin. Bummer. Don’t feel like doing much now except sitting in front of the box. The problem, I guess is that some days you feel so good you push things, perhaps too much and then you suffer.

June 12, 2009

Yesterday I was 4 months post op, and over the last 6 weeks have been pushing things more – going to the gym and using various machines. I have also noticed clunking which I did not have early on. It does not hurt and I just try to ignore it. At the time of my operation on my right hip, my left had moderate arthritis, and it did not bother me. But now that I am walking farther than I have in several years, it is starting to hurt – indeed it is the limiting factor on my hikes.

September 24, 2009

I am 7 months post op now and am pretty happy with my new ASR hip. I have no pain, just the very occasional twinge of discomfort when overdoing things. I have hiked 10 miles on several occassions without problems, have no limp, and, after 6 months started to push things a bit, doing light squats, walking with a 25pound pack etc. So I was feeling pretty pleased with myself. I did, however try to do what Jeannie suggested, balancing on my operated leg and bending over to touch the ground. Well I could barely get halfway down before the butt muscles started complaining. I now see only too clearly the need to work on my ballance. On reflection I think the fine motor skills are equally as important as overall strength. So from now on I am incorporating bendng over to the ground on one leg as part of my exercise routine.

November 16, 2009

I’m 9 months post op and doing really well. However the other day we were rearranging some of the furniture to make way for a new flat screen tv. Moving furniture was fine but my wife and I lugged our old tv down to the basement and it was huge, must have weighed 200 pounds or more. I did think twice about it but my surgeon had no problems with me portaging my 80 pound canoe so I thought this short lug would be ok. Well no problems moving it but next day I had some discomfort, mostly muscle aches I would say but also around the site of the scar and a bit of a feeling of weakness there.

December 4, 2009

It’s been about 3 weeks since I first hurt the hip and it’s been up and down since then. After a week it seemed really good, but then 2 hours in a car and lugging some shopping, and it set it off again. A week later it settled down and once more, slight activity set it off. Another week, settling down, only to be provoked by again minimal activity. No pain at all bearing weight or going up and down stairs, but carrying anything down stairs seems to easily set it off. Gone on the celebrex to help settle it down. I guess I’ll have to really baby it but it is so hard once you have got used to activity again.

February 10, 2010

Tomorrow, February 11, will mark the one year anniversary of my right ASR. The first 9 months were great, worked it hard, and it responded. Did several 20k hikes in the summer, and some quite heavy labouring in the fall – putting firewood in basement. Lots of weight- training and specific hip exercises too. No problems at all. Then in November, the day after carrying a very heavy tv, and moving some other furniture, had some discomfort. Rested it and the pain went. But a week later putting some shopping in the car, it hurt again. After that it was snakes and ladders. I would rest, pain would go, I would think I was better, only to do something quite innocent that sets it off again. And with each recurrence, I sunk lower and lower, and it took longer and longer for the pain to go.

I’m pretty sure it’s a problem with hip flexors as I have no bone pain, and no problem putting weight on it. The muscles and tendons seem so inflamed and so easily provoked.

I’ve tried resting, celebrex, ibuprofen, gentle stretches, light exercises, nothing seems to work. I feel I am stuck in quicksand and anything I do makes me sink deeper. After 3 months of this I am getting out of condition, flabby, and drinking too much. Before that 9 month incident I was so optimistic, positive and full of life. Now I’m morose and depressed, worse, in some ways, than I was before the surgery.

Next week I am going back to my surgeon for my one year check up and am going to physio tomorrow. I will be clearly putting all sorts of questions to them but I was just wondering if anyone out there has hurt their hip flexors and struggled like I have.

February 19, 2010

Well, was up in Montreal yesterday getting my one year check up with Dr. Antoniou. The good news is that the x-rays and physical tests showed there is no problem at all with the joint, which is a huge relief. The problem, he thinks, is the sartorial muscle, not the psoas, which is chronically inflamed. He prescribed some arthotec and suggested I see a rheumatologist as sometimes a propensity to inflamation can be triggered by some difficiency in the blood that can be treated easily.

April 22, 2010

In February 2009, 15 months ago, I had my right hip resurfaced with the now withdrawn ASR device. I have had some problems over the last few months, after injuring the hip, though these seem to be slowly subsiding. My GP did, however order some blood tests, and the chromium level came back at 10.38 and the cobalt at 11.20 (parts per billion I presume). I know these are slightly higher than concern levels expressed by Dr. Schmazried, in his advice to ASR patients, though I assume he was being conservative.