Leslie’s Hip Resurfacing with Dr. Poole 2009

I am a 57-year-old female who had her right hip resurfaced by Dr. Colin Poole of Boise, Idaho, about 5 weeks ago. I want to share my story, as so many have, as a way of "paying it forward" in appreciation of the guidance and inspiration I received from so many who have already posted here.

The first indication that I had anything wrong appeared quite abruptly 3 ½ years ago, when I was diagnosed with sacroiliac joint dysfunction. I suddenly could not walk upstairs – or anywhere else, for that matter – without excruciating pain in my right lower back. Before long, pain radiated to my right hip, knee, thigh, and buttocks, until at some point everything from my bellybutton to my ankle was screaming at me. A physical therapist eventually connected the dots on the initial diagnosis, explaining that my back was compensating for what my hip couldn’t do, resulting in the overload that masqueraded as a back problem.

I consulted with Dr. Poole, who took an X-ray that indicated no significant arthritis. He wisely suggested at that point that I get an MRI, and I unwisely chose not to. Thus began my painful 3-year quest to avoid surgery at all costs. I sought treatment from an army of physical therapists, a massage therapist, a rolfer, a gal calling herself an orthobionomist (don’t ask), a sports doctor, and a chiropractor. All meant well and did their best (with the exception of the chiropractor, for whom the term "quack" is an insult to ducks. The lesson to pass on from him is that if anyone promises you they can grow your cartilage back in 2-3 years, as he did, grab your wallet and run for the nearest exit). After no lasting relief, the sports doctor finally convinced me to get the MRI, which showed significant degeneration in the hip. Knowing I had exhausted every other alternative at my disposal, I threw in the towel and scheduled the surgery.

It’s worth noting that three years ago, my husband had a hip resurfacing done by Dr. Poole – in fact, same hip, same hospital, and even at the same age as me (be careful who you marry; you never know what you’ll wind up sharing!) – so I had been through the entire process as an observer and caregiver. Suffice it to say that my husband has been a very happy camper ever since his surgery, which made it that much easier for me to accept the inevitable.

The Procedure

By the morning of the surgery, I was so certain this was what I had to do that I was not only ready, but almost eager. The surgery went smoothly, and resulted in a couple of interesting surprises: First, Dr. Poole discovered an unexpected cyst, which he was able to remove without incident. Second, and more important, he found a pebble-sized chunk of bone that had been floating around in my hip, that hadn’t appeared either on the X-ray or MRI (see picture below). Apparently there had been a significant trauma that chipped off a piece of bone, acting as a major contributor to my cartilage loss. The other contributing factor is that I have a mild case of hip dysplasia. I may never know which ultimately caused my hip to go south.

Bone chip being removed from hip joint

Pleasant Surprises

We all go into surgery as a last resort, aware of the risks we are assuming, and often fearfully anticipating what the recovery will be like. Happily, this is a summary of all the things that went much better than my worst imaginings.

1) Many of the restrictions I assumed I had to follow during recovery turned out to apply only to total hip replacement patients, not resurfacing. The literature my hospital gives hip patients to review pre-op still doesn’t fully address the differences between THR and BHR. I was thrilled to learn, for instance, that I could both squat and bend from the waist during recovery, as avoiding those seemed like pretty daunting challenges.

2) Sleeping on my back post-op, which I could almost never do beforehand, suddenly was not a problem at all. What a relief!

3) I never expected to nap as much as I did the first couple of weeks, and I haven’t been a napper since infancy – but boy, that was a deep and refreshing sleep when I was zonking out for a couple of hours in the middle of the afternoon every day.

4) The automatic foot-squeezer machine in the hospital turned out to feel mostly like a pleasant massage. (Okay, it did wake me up a few times – but mostly it felt pretty good.)

5) One of the biggest, most pleasant surprises was courtesy of my physical therapist at the hospital. The first time he got me up and ambulatory after surgery, watching me wobble down the hospital corridor with my walker, he commented, "You’re doing fine with the walker. But the truth is, you could walk unassisted starting right now if you wanted to." When he saw the shock on my face, he added, "Really! I see resurfacing patients leave the hospital unassisted all the time." Wow! Here I was, assuming I’d need a walker for the standard couple of weeks, then crutches, then a cane until about 6 weeks post-op. I pretty much did what he suggested, and have been walking unassisted almost since I got home. I still take a cane on longer walks (I’ve been going 1-2 miles a day since 2-3 weeks post-op), or when I feel fatigued, or in crowded public places where I just want to alert others to give me margin. My PT says that should last another week or so.

6) I wasn’t sure how quickly I could negotiate stairs, but that has turned out to be in almost no time. We have a two-story house, so it’s been great being able to get up and down so quickly.

Unpleasant Surprises

I would never want to mislead anyone into thinking this was all fun and games, so here are the things that turned out to be not so pleasant:

1) I never expected the amount of bruising that covered my leg for the first 3 weeks or so. It wasn’t even black and blue; it was charcoal black, and covered such an alarming area that I called Dr. Poole’s office to make sure it was normal. (It was.) Some people have swelling – I only had a little; my husband had a ton – and some bruise. No way to predict it. The bruising didn’t hurt, but it sure looked awful.

2) The nausea from all the meds surprised me. The first time I was upright after surgery, I was pretty green around the gills. The ginger ale a nurse brought was a great help.

3) I was initially pleased when Dr. Poole told me I didn’t need to donate any of my own blood prior to the surgery, as he found that patients under age 64 lose so little blood that he never needs it. Well, almost never. Turns out I lost enough blood that after surgery my hematocrit level was quite low. Dr. Poole first recommended a transfusion – meaning someone else’s blood – but when I expressed my concern over the risks, he agreed that we could go with a potent iron supplement. Which leads us to our last unpleasant surprise, which is…

4) Potent iron supplements have nasty side effects. I was thrilled when Dr. Poole took me off them.

Things I’m Glad I Didn’t Buy Before Surgery

1) A fancy shower chair. Our plastic, stackable lawn chair worked just fine.

2) The Polar Care 300, or Ice Man. I know that people love this, but my hospital only had them for knee patients, and the local medical supply house sold them for well over $200. The 10 X 15 ice pack I had purchased for $13 – which I highly recommend, since you can wrap it around your hip and it stays cold for hours – was a very decent substitute..

3) Silk sheets or silk pajamas, for ease of movement in and out of bed. I found our smooth, nicely worn percale sheets worked great.

4) The sock putter-on-er, or reacher. Once I realized I could bend over during recovery, the reacher became irrelevant, and I found I could put socks on fine by bending my foot up behind me and fumbling around with it from that angle.

Other Tips and Lesson Worth Sharing

1) Don’t put too much stock in DEXA scans – and if yours are not so great, as was the case with me, see if you can get a surgeon who’s not rigid about them. I had reason to be skeptical of my scan results, as I had gone to two different machines within a month or so of each other, and got wildly different results. Why aren’t they calibrated the same -and which do you believe? Add that to not knowing what group of people you’re being compared to, the potential for technicians’ errors, the fact that they don’t correct at all for patient size (meaning large people get results that are too high, and petite people – like me – get results that are too low), and you begin to see why these are controversial, and not an exact science. Bottom line with me is that I went in with a DEXA reading of severe osteopenia, but came out with Dr. Poole’s proclamation that my bones were just fine. He even took a picture during surgery so I could see for myself:

Head of femur being drilled and prepared for BHR

2) Ask the night nurses if they can combine some of their tasks in order to minimize sleep interruptions. For instance, could they arrange to change the catheter at the same time that they take your vital signs-and maybe even do that at the same time that they draw your blood? It can lead to a lot better night’s sleep if they can.

3) Give your own blood, even if the surgeon doesn’t think it’s necessary. It’s worth it in case he’s wrong.

4) Ask about alternatives to medications that are causing problems. For instance, the intravenous anti-inflammatory they had me on the first day caused a painful burning sensation in the vein in my arm every time they administered it. But when I followed a nurse’s suggestion of asking the doctor if I could switch to an oral anti-inflammatory, he readily agreed.

5) Stay as hydrated as you can during recovery. There’s lots of new, strange stuff to flush through your system after surgery, and good hydration helps at every level.

6) It probably goes without saying, but getting in as good shape as your hip will allow prior to surgery makes a big difference in your recovery.

7) Ice and elevate your leg as much as possible for the first week.

8) Try arnica after surgery, a homeopathic for muscle trauma. It comes in cream and pellets.

9) Consider having the surgery done during warmer weather, if possible. I’ve been a lot happier rebuilding my walking skills outdoors without having to negotiate ice and snow.

Final Thoughts

This was the first time in my life anything physical ever went wrong that could not heal by itself. It took me three years to make the mental transition from "oh, God, I need surgery for this?" to "thank God there’s surgery for this!" That intervening three years, however, was arguably the most miserable time of my life. I think we underestimate the toll chronic pain takes on us, both physically and emotionally. Even though this is an elective surgery for a non-life-threatening ailment, the long-term effects of chronic pain can alter your body in potentially life-threatening ways – through sleep disturbances, hormonal imbalances, blood pressure spikes, and more (a book called The Body Broken documents this in a very poignant, heartbreaking manner).

So my closing thoughts for people who know they have a hip gone bad, and are in terrible, life-altering pain as a result, is to get resurfaced and get on with your life.

Good luck and good health to you.