I am 4 days post-op (in 4 hrs) and doing fabulous. We are all different patients, but Mercy Mt Shasta and staff is the best hospital I’ve ever been in and Dr Ure’s office staff is stellar. Don’t let the small town keep you away. The hospital is the cleanest and pristine and nursing staff has a lot of ortho experience. Here’s my story, but feel free to get back to me with questions. The more knowledge you have going in the more relaxed you will be. Their pre-surgical joint class is an all-day affair but you get to meet the nursing and therapy staff and they get to know you. It also included lunch, pre-admit, lab work, and discharge planning. The staff is totally committed to you and your care/recovery. They are fun and personal – I knew all about their families, etc. by the time I left, and they mine. The OR nurse John Palmer even took photos, at my request, of the surgery and made me a CD – way cool! Don’t get me wrong, there’s a lot of work to do after surgery. For me, the first 6 hours after surgery your spinal is still in effect so really no pain. Thereafter, until 24 hrs post-op, was a bummer for me. Nausea/vomiting, feeling comfortable in bed, etc. I only used the PCA (patient controlled analgesic) for pain 4 times then went to extra strength Tylenol. I don’t do well with heavy meds and I really didn’t need them. That has a lot to say about the surgeon and his technique. Yes it’s uncomfortable, tender and sore, but not super painful. At 24 hrs I had in-bed therapy and got out of bed and stood with a walker, but that was it for the afternoon. At this point you are asking “was I right to go through this?”, but just wait until the next day – wow! By the next morning I WAS A DIFFERENT PERSON. I had bed therapy and started to walk with a walker, not very far grant you, but it really felt good to move your legs. You are hooked up to 5 external devices that slowly are removed; mine by the end of day 2. You have your incision blood drain, which is re-infused if 300cc or more is collected. I luckily only incurred 250cc’s – another feather in the surgeon’s cap I think. Of course there’s your IV with antibiotics and fluids, foley catheter, TED hose, and your calf-squeezers that apply continuous massage via air. By 48 hours I was taking short walks in the hall, with the walker, and got outside for fresh mountain air and beautiful scenery. I enjoyed a tasty Chef’s Salad (ask for it) that evening and began eating more, which really helps! All the staff was surprised at my 24 hours of progress and I began preparing to leave the hospital the next morning as long as I was released from therapy. Cleared medically to discharge, but still needed the blessing of therapy, I was able to SHOWER. Dr Ure uses sub-cutanious sutures with a telfa pad and waterproof cover, another plus. I was sent home with extra supplies to change the dressing if it did indeed get wet. I still cover it with a towel during showering though. After showering I was up with therapy walking a much longer distance, with proper posture, and clear to make the 6 hour drive home to Merced CA – whoohoo!! It was comical getting in and out of the Yukon but the ride fairly comfortable. The key was frequent stops, moving your leg, and iPOD tunes of course. Once home it was very nice to have all your assistive devices already there and set up. Here’s my list of have-to-haves: Walker, reacher/grabber, sock aid (I took to hospital), shower chair, raised toilet seat with handles, straight-back chair with handles, wet wipes, hand-held shower head, bed tray, Standard Size reusable ice pack. Dr Ure’s office wrote a prescription ahead of time so the durable medical equipment items could be ordered and at home before I left for Mount Shasta. Of course I have a LONG way to go but you truly see daily progress at this point. Today I am walking-through my steps, actually a stride, with the walker and can almost get myself in/out of bed – every thing is in slow motion and takes forever to accomplish! You will definitely need help at home, not sure for how long, so be sure that is in place. That’s my story for now but will post weekly update on Surface Hippy and the Yahoo Discussion Group 🙂 My husband was concerned initially by my location selection, small town and all, but quickly got on board with my decision. Without all the input from everyone on this and the Yahoo Board I could of not made the right decision for me; my thanks go out to everyone who provided information and supported me!!! Melissa Martin Merced CA L BHR Ure 10/10/07 My 20-day update I have been waiting for some dramatic change to occur but realized that I’m down to a snails-crawl with improvements lately. I still just take Tylenol but only a few time a day rather than every four hours. I just can’t seem to get onto one crutch and cannot bear much weight on the leg. Paul (my PT) passed along a weight-bearing exercise that should help – see below if you are not aware of it yet. As far as encouraging weight bearing on the surgical leg, try standing straight and tall in your walker with hands positioned above the handles of the walker. Use your hands on the walker ONLY as a safety net. Shift you weight slowly back and forth from one leg to the other. As you shift your weight to your surgical leg make sure that your hips and shoulders both move over the leg. This is what occurs on your non-surgical leg. Look in a mirror if you feel you are compensating. This technique allows you to confidently find how much weight you can put on the leg. Using a scale under the surgical leg will allow you to objectify the process. If you use a scale, make sure your non-surgical leg is standing on a phone book or piece of wood equally as high as the scale so you are standing on level ground, so to speak. I can definitely tell if I over do it as my knee hurts like heck at the end of the day. Also, if I sit too much, or at the wrong angle, I am uncomfortable at night. I still wake up every three hours and am very stiff. I take a short stroll and use the bathroom, then back to sleep. I suppose I walk about 400′ or so at a time, during the day, but need to hit the streets rather than just right around the house. I live on an acre lot so it will be easy to log feet in the neighborhood. It doesn’t hurt to sit on the toilet anymore, and I can do my morning routine, including showering, alone now (as of day 14). Doug took me to the store Saturday and it was still very difficult to get in/out of the Yukon. I was thinking I might drive this week but that’s not happening seeing I can’t get into the car alone; a downfall of an SUV I suppose. I prefer the forearm crutches to the walker, unless I’m needing to move stuff around then my big bag on my walker is the best. Tips: Taking the dogs food, in a baggie to the bowl, works great. Keep the phone with you in a bag attached to your walker or crutches. Even if there is no one around to tie your shoe you can loosely tie the laces then use a long-handled shoehorn to slip the shoe on. You should be able to bring the non-operated leg up to tie that side 🙂 Each day I look for a little improvement and remember back to the early days to reinforce that yes, I am getting better. Good luck to everyone, this is amazing to say the least! Melissa Martin LBHR Ure 10/10/07 4-Weeks Post-Op The visit with Dr. Ure was fun and informative. As a couple of you know I was determined to walk into the appointment on ONE crutch and I did accomplish that. The day before I just did it, and I suppose I was just chicken. As long as my body alignment and posture is good it does not hurt AT ALL. As of today I’m doing about 1/2 my walking on one crutch and the other 1/2 on two. When Dr. Ure saw me he asked “when are you getting rid of the other one?” – he’s too funny! I first asked Dr. Ure to explain what my OA looked like and how it had progressed. The morning after surgery when he checked on me, I was feeling just awful and couldn’t think of questions to ask. He said that the damage was not bad, but average, and it made the surgery easier than having to try and repair extensive damage if I had waited too much longer. The time was right! The x-rays look perfect, beautiful I might add and made me smile. He pointed out that there was about a 1/8′ gap between the cup and the bone, in just a small portion, that will no longer exist once the bone grows into the cup and at six week I do not need to observe the hip precautions – I’m going to work on tying my own shoes 🙂 Regarding PT – at 6 weeks post-op I’ll be good to go. His office will fax the Rx to the therapy office of my choice. I asked about aqua therapy and he was not pro/con; again my choice. I feel I will only need help regaining ROM and strengthening – pretty boring. I have a dental cleaning in a few weeks and he recommends following the ADA guidelines for antibiotic use, he thought a three-day dose, so I will be in touch with my DDS. FYI the ADA guidelines are 2 years following hip surgery. I shared with him how quickly the leg length is decreasing and since I started using one crutch I notice very little; I’m thinking less than 1/4′. I wear orthotics in both shoes, to help with ankle pain after a calcaneous fx many years ago. If there is still a length difference in about two months the podiatrist could adjust my inserts accordingly. BHR ID Card: I asked about obtaining my serial numbers for the devices and he said that is a VERY good idea in the event there would ever have to be a revision, etc., as the surgeon would need to know what size the devices are. His office can get me the information. Note: Denise in his office did fax me copies of my device information. My next follow up will not be for one year post-op. I will not need to personally see him, but he would like an x-ray at a minimum. On my way home to Merced I actually WALKED (with crutches) the Sacramento Zoo, for two hours, with my daughter and granddaughter as I felt using a wheel chair would be a step back. Thank goodness my 21 month old granddaughter walks slow, and I really surprised myself. The hard part of the zoo was getting into the little train that drove around the zoo, not to mention the tiny low seat – oh my! I’m feeling so much better, more energetic, no Tylenol at all, back on my side of the bed, sleeping on my non-op side, incision tenderness just about gone, easier getting in/out of the Yukon, and I’ll be taking a test drive tomorrow; I’m sure I’ll be fine (I was)! It’s hard to believe everything that has happened in only four weeks. 6-Weeks Post-Op Every two weeks just gets better! I returned to work about five-six hours a day the week of Thanksgiving then will have four days off. Other than feeling exhausted my hip is great. I noticed many more muscles that need improvement after working in my desk chair and moving around – oh my! I’m on one crutch exclusively and it’s great to have that extra hand free. I ride the stationary bike daily for about six minutes and am increasing the time daily; I love the way the muscles feel when they are truly working correctly. On Thanksgiving day, feeling SO thankful for my new hip, I took several unassisted steps – it didn’t hurt! My muscles still need more strengthening to support me for any distance but it was good. I’m closer to tying my shoe and am quicker moving around these days. Life is really getting better!! FOUR MONTHS I am now 4 month post-op and rarely think about my hip. What I didn’t realize was how different my life had become pre-op. I am continually active again and quick in my actions – that was not the case before my new BHR. My ROM now exceeds the normal ranges and all the therapists cannot believe how quick I recovered. Given they are use to older THR patients, and had not had a HR patient before me, they are all on the bandwagon for the HR procedure! They all have Dr Ure’s name now The one area I continue to work on is putting more weight on the leg. Tasks such as lifting a laundry basket, 40 lb dog food bag, or heavy objects, remind me that I am still healing. I find daily exercise, in some fashion, absolutely necessary to stay on track; if I don’t my hip will become stiff and noticable. I continue to walk, ride a stationary bike, and complete my exercises learned post-op and during therapy – this is a constant reminder of how far I’ve come – it’s quite a motivating factor. My husband Doug will head to Whistler in a couple weeks, this year without me, but next year I’ll be skiing the glacier with him
21 MONTHSOver the last couple of months I began to occasionally have some mild groin pain and popping of the hip. I contacted Dr Ure and x-rays were ordered. After nearly two months, and several phone calls to his office for the results, Dr Ure finally contacted me. Per his chart document he stated that the x-rays “show components to be in satisfactory position and alignment without evidence of loosening or other failure. There is, however, some mild narrowing of the femoral neck.” He also noted “some degree of discomfort with resurfacing is not uncommon in the smaller size ranges such as what she has.” He instructed me to contact him if pain or discomfort increases. 4 YEARS – THE HONEYMOON IS OVER The last two years have brought increasing groin pain, instability, and popping/clunking on a regular basis. Two months before my 4th anniversary I became so alarmed at the consistent instability that I contacted Dr Ure as well as patient advocate, Vicky Marlow, for direction. Vicky recommended x-rays and cobalt and chromium blood tests, which I coordinated with my PCP. I found out that Dr Ure had had relocated to Port Angeles, Washington, from Mt Shasta, California. Dr Ure returned my call, and explained that since my surgery it has become apparent that misaligned cups are causing issues and that my smaller size is no longer a positive as once thought. He recommended a surgeon in Los Angeles who enjoys “challenges” in the event I needed surgery. I offered to send him my x-rays once received, and he provided me with his email. That was the last I heard from him and I am extremely disappointed at his unprofessionalism when he did not reply after I sent my x-rays twice. It was obvious, from the x-rays over the years, that there were problems from the day of my BHR, at year two, and year four. After I had my x-rays and lab work in hand Vicky had several surgeons review them for possible causes of my pain and instability. The following are excerpts from the surgeon’s emails:
- She needs a revision ASAP before the neck on the femur breaks
- Neck narrowing due to high ions and there will be some acetabular osteolysis at revision. Yes, early revision is indicated
- The inclination and version angles are high to start with. The cup appears to have migrated
- At the time my BHR was implanted the acetabular was prepared too deep which left a void between the cup and acetabular. Sometime, during the first two years, the cup tipped into a position of excessive anteversion (malpositiones).
- My revision surgeon, Dr Scott Ball, felt the femoral neck narrowing was due to excessive wear of the device following the tipping of the cup, causing metallosis, and subsequent osteolysis.