Neil’s Hip Resurfacing with Dr. Kohan 2014

I am a physician and 51 years old and extremely active. I had been trail running, biking, snowboarding and weight lifting with hip discomfort for a few years. I finally got an X-ray when I could not sleep after a 4 day walking tramping trip. I was told I had advanced arthritis and needed a replacement. I was depressed and I tried to pretend it was not happening to me. After another 18 months, all I could do was ride a stationary bike and I had to do something. I have several close friends that are orthopedists in the USA. They said my best option was a THR. The BHR is relatively new in the USA and they did not do hip resurfacing and had read all the negative publicity associated with it. They were concerned and advised me against it. I also had another friend who recently had a hip resurfacing at 58 and he was doing really well and back to running again. I wanted to run again and so I remained interested in resurfacing and read all the literature I could find. I went to see a surgeon who did resurfacing and he explained to me some of the subtle things about the literature and how so much of the negative publicity was related to metal on metal THR and also products other than the BHR. He seemed capable and had done over 600 BHR surgeries and said he had about 98% success especially in younger athletic males. I was still doubtful and influenced by my orthopedic friends. They convinced me that an anterior approach for a total hip was safest and that I could get a new polyethylene liner through another anterior approach in the future if I wore out the THR through overuse with my active lifestyle. My orthopedic friends did not perform the anterior approach themselves, but one of them recommended Dr. Kohan in Sydney, Australia, who had taught a course to orthopedic surgeons on how to perform an anterior approach. I also searched his name on the Internet and found out that he had many publications in orthopedics and was a professor and seemed to be very academic. I also contacted a former patient of his that gave him glowing reviews. I found out that he had performed several hundred anterior approaches with good success. I sent him my x-rays and a letter and he then emailed me that I would indeed be a candidate for an anterior approach and I scheduled an appointment to see him.

I met Professor Kohan and explained my situation. He informed me that he also did hip resurfacing as well as the anterior approach for a THR. In fact he had done over 1300 resurfacings and had over a 98% success rate at 13 years and was preparing to publish his results. I also discovered that Prof Kohan had trained in London with Derek McMinn and that he and Dr. Dennis Kerr, his anesthesiologist, had published a chapter on how to perform anesthesia for hip resurfacing. It seemed to me that both he and Dr. Kerr had a genuine interest in perfecting the procedure and took great pride in his work. He also knew all of the literature regarding the BHR and was extremely knowledgeable and I really liked that. Prof Kohan felt that there was a risk of the THR loosening with my activity level and that it might not be a simple anterior approach to replace the liner in the future, but could be a big revision with less than optimal results. He did not think a THR would last with my young lifestyle, which I was not planning to give up. He agreed that the anterior approach was minimally invasive and had quick recovery but he felt that I should reconsider the BHR and was a strong advocate of the procedure. He was quite happy to do either surgery and was clearly the best judge on what surgery was best for me. In the end, I really trusted Prof Kohan’s advice and I found him very compassionate and understanding. I decided to get a BHR instead of an anterior approach THR and to have it done by him. I started going every day to the gym and forcing myself to do weights with my painful leg and to cycle hard to be really fit for surgery.

Being a physician myself, I was quite nervous about surgery and all the potential complications. Prof Kohan said to me that when he had to have surgery himself, he found the right surgeon that he had confidence in and then just relaxed and trusted them. He said he and Dr Kerr had done so many of these cases that I could relax and just trust them. This actually made me feel better. I met with Dr. Kerr. He is mature and has many years of practice under his belt. He had trained at Harvard University and worked there for several years. He also showed me a textbook chapter he had published about using different pain control techniques for the BHR surgery. He also knew all the literature and was very academic. He works alongside Prof Kohan on all his cases and they both have worked together for years and were a team. He was very complimentary of Prof Kohan and said resurfacing was a very difficult surgery to do and that Prof Kohan was very good at it. I was very relieved again by this. He explained that I would get a half strength spinal anesthetic so that it would wear off enough for me to walk 4 hours after the surgery and that I would also get intravenous narcotics to be unconscious but would not be on a breathing machine. I was happy to avoid this risk of complication. He also planned to leave a catheter in the wound for local anesthesia for 24 hours. The night before the surgery, Prof Kohan called me to see if I was doing OK and to allay any fears I still had.

I arrived in the morning with my wife at St Luke’s hospital and Dr Kerr saw me shortly after. He started an iv and gave me something to relax me and that is all I remember. The surgery took about 2.5 hours and Dr. Kerr met me in the recovery and said all had gone well. I had some discomfort immediately on awakening but then the local anesthetic started to work. My pain was easily managed by a pain patch and ibuprofen and paracetamol. After 4 hours, they tried to get me out of bed, but I felt still light headed from the drugs and was unable to walk for a few more hours. I finally got up and was amazed to be able to walk. The leg was weak but not really painful. I spent 1 night in the hospital and went back to a rented apartment the next day with my wife by taxi. I should have gotten a disability taxi because I am tall and it was rough getting into a standard taxi. I rented an apartment on Bondi Beach and it was great to be able to get up for short walks to see the sea. Dr. Kerr called me daily for the first few days to make sure I was doing OK. I was able to walk around the block with crutches by about 3 days and by the end of 2 weeks I was walking almost 4 km mostly on 1 crutch and even able to climb stairs bearing weight. The nights were rough for the first week as I needed help getting out of bed to go to the bathroom and I had some discomfort finding a comfortable position. I rode the public bus standing up with crutches and made a few excursions to pass the time. Prof Kohan said my only restrictions were not bending more than 90 degrees or carrying more than 10 kg. I even went into the local gym with crutches and did a few pull ups and dips to keep from going out of my mind.

I am now 4 weeks out from surgery and I am walking several km a day with no crutches. I have also been walking hills and steps daily. I really think being a bit younger and working out so hard strength training just before my surgery has made a big difference. I just have to be sure I don’t over do it, which is wht I always do. I think that the fact that I am doing so well is a testimony to what a skilled team Prof Kohan and Dr. Kerr are. He obviously put me back together perfectly! I wanted to write this experience because I was so impressed by both Prof Kohan and his skilled anesthesiologist Dr. Kerr. Being a physician myself, I am glad that I was able to research and find the best team to do my surgery. It was terrifying to decide to do surgery to my body and I am so relieved that it appears to be working well so far. I am so grateful for their excellent work.

June 2014 Update

It has been 3.5 months now and my new hip is fantastic. I am more flexible now than before the surgery already. I can actually tie my shoe laces again! I have been exercising and stretching religiously and I found ankle weights great to strengthen my hip muscles. Using the machines at the gym is an easy way to keep the upper body strong. I have been spin cycling and walking up and down hills and trying to do the stairs as fast as possible. It is great to get the heart rate up again. I find I am still stiff when I sit at a desk and then get up, but I assume it will get better with time. I am not requiring any pain medication at all. Unfortunately my other knee has been troubling me because I have been favoring it for so long, so now my operated leg is the “good” leg.

 I saw Dr Kohan at my 3 month visit and he was happy with my results. 3 more months to go before I can run and jump and start lifing some weights again!  So far I am so happy that I decided to get a resurfaced hip rather than a total hip and I am so happy that I had it done with Dr. Kohan