Welcome and Background

I’m starting this blog 19 days after enjoying Birmingham hip resurfacing. My goal is to record my experience with this procedure, including my decision to go ahead, my concerns and questions, and finally my still-ongoing journey through the procedure and its aftermath. I imagine that this will be an intensely boring and uninteresting story for almost anyone, anyone except those aching souls who find themselves with a sore hip and the dawning realization that they need to do something about it.

I’m particularly targeting active, athletic middle-aged types who are finding it a little hard to believe that they might be facing a major operation, and who are trying to navigate the piles of material on the web, a tangle of dated material, excerpts from technical medical studies, and mostly, information for more elderly people who are looking at conventional hip replacement. It’s important to realize that I’m not a medical doctor (I have a Ph.D. in tectonics and geochemistry that just makes me dangerous, and not an authority on medicine and orthopedics!). It’s likely that other people have done things better, and it’s certain that your hip and your condition will leave you facing details that could add up to be quite significant. So please, treat this as one person’s story, n = 1.

Back Story

Let’s set the stage for this hip story. This will be a longish post, intended to let you compare yourself to my case to see if anything jives. If you’re more interested in the surgery and the aftermath, you might want to skip this too-much-information report!

I’m a 51, male, and a college professor. To counteract the sedentary lifestyle, I try to road bike 4000 miles a year, which between travel and meetings, and the darker winter months here in eastern Pennsylvania, is about all I can manage if I include trainer mileage and can throw in some longer summer rides. I love cycling, and given the state of my knees (and hips), it’s the perfect exercise. I’ve never raced, but I try to average 15 to 17 mph on the hilly rides around here, which I’m proud of even if it’s a snail’s pace for really good riders. All the riding alows for robust eating and the chance to work out the tensions that accumulate at work (even professors bear their crosses…). I’m 5’10”, and seasonally fluctuate in weight between about 202 and 212 pounds with a fat content of about 25% (at least according to a Tanita scale in standard mode). (I told you this post would be boring!). The other reason I try to keep active is that for quite some time now my research has involved field work in the Himalaya and Tibet (see www.ees.lehigh.edu/groups/corners), and even in teaching we lead field trips, so being fit is important professionally as well as personally. As I recently learned, I have mild dysplasia in both hips and considerable osteoarthritis, partly as a result of the dysplasia. The angle of my femoral neck is also quite shallow. Before my hips became the main focus of my joint discomfort, I was more worried about my gimpy knees, which are missing some ligaments due to untreated ultimate frisbee accidents in grad school and in retrospect, too much jogging and running (leaping down trails in the Presidential range; humping out heavy packs of rock samples…). It’s hard to know when the hip pain started: probably back about 7-8 years ago I started noticing stiffness in my groin and thigh after a hard day trekking. Also, standing or shuffling about, like at art museums or during poster sessions at professional meetings, really started to hurt to the point where I was starting to avoid such events. But biking did not cause pain, leading to awkward explanations about why I could happily ride 50 tough miles, but would start whimpering if threatened with a visit to MOMA. About three years ago, a sampling trek in Tibet went wrong: we thought a route might gradually head up a glacial valley, but instead went straight up a vegetated cliff. It was a desperate few hours, requiring big lunging steps and unforgiving foot placement, and by the time we got up and back down, I literally could not walk due to the sharp hip pain. When I returned to the US I saw my GP, and she diagnosed osteoarthritis. She put me on two forms of Diclofenac (Voltaran and Cataflam). It was a miracle: little pain, much improved range of motion, and I could ride my bike or play 18 holes of golf walking and carrying. Time passes, and gradually the NSAIDs aren’t working as well. Walking a round of golf is a crap shoot in terms of pain, I’m avoiding museum-type standing, and meanwhile I am wondering about the long-term wisdom of eating the Diclofenac twice a day. In late 2006, I noticed at the end of the bike season that at the end of ride I was feelin very sore, and pulling off of agressive attacks on rises and hills. When the 2007 season started, the soreness was still there, but worse. Then in May 2007 I went to a conference in Hong Kong, and it was nearly a disaster. Getting off the long flight, I could hardly get through immigration, and the daily walk to the conference and the standing around were just crushingly painful. When I arrived back at O’Hare, I honestly thought I would have to declare a medical incident and ask for a wheelchair to get to passport control. In the weeks that followed I could only walk with a painful and obvious limp. When I tried to ride, anything more than 10 miles left me very sore, and I couldn’t push any power through my left side. The pathetic finale on June 18th was an attempted 15-mile ride where I got caught in a thunderstorm just as my hip gave out: I bailed, and crept home in a downpour, trying to spin granny gear long enough to get home. I revisited my GP, who had me go for X-rays, and after seeing them, said she was sorry, but really the only thing to do was to see an orthopedic surgeon. SURGERY

On the day of your operation, you will probably be asked to get up an unearthly hour, take your antiseptic shower, and report to the hospital for admission and preparation. This is one time that you do not need to worry about lack of sleep, I promise you.

I chose to avoid a final decision on anesthesia until meeting with the surgeon on the morning of the operation. Everyone was 50-50 about using a general versus a spinal. I decided that I had no interest in seeing the operation, even if my memory would get wiped. And, as it turned out, if the surgery takes extra time, like mine did, then a general is the better choice. You’ll have to make your own decision based on your condition and interests and the advice for your doctors. If you’ve ever had surgery of an kind, you’ll know that one minute your wheeling along in a cart on the way to the OR, and then suddenly you’re groggy and on your back in a different place. My surgery (on Monday 6 August) took 2.5 hours because the surgeon needed to work a little harder due to my hip dysplasia. I had been told that Birmingham patients do PT on the day of their operation. Well, sort of. It consisted of being moved out of bed to a recliner, maybe 1 meter in distance. I almost passed out on this long journey. Impressively though, my surgery ended at 10 am, and by 2 pm I was in the recliner, awake. My family visited and watched while I picked at my dinner (I had ordered the meatloaf selection as comfort food, but my appetite was beyond comfort, certainly by that meatloaf!). When I awoke, I had a urinary catheter, an IV for pain med, antibiotics and fluids, and a dressing on the incision but no surgical drain. The wound was closed internally by dissolvable stitches and externally by steristrips (compared to other Frankensteinian sutures I’ve had, the closure was gorgeous and tight; too bad this is not the most photogenic and oft-displayed part of me!). The catether came out the next morning (no real pain), the dressing got changed daily (no real pain), and I did PT morning and afternoon starting Tuesday afternoon (no real pain). Constantly asked about pain on the 1-10 scale (wtf is a 10 supposed to be: slowly being crushed by a truck??), I never went beyond about a 4, thanks partly to the opiates, including morphine over the first two days. Probably the most pain I had were brief sharp tugs in the area of the incision; these diminished over time as the wound healed and the sutures adjusted. By the way, there are various ways a surgeon can access the hip, but if your view of the hip is of the hands-on-your-hips variety, you may be surprised to find your incision is on your ass as much as anywhere else! One thing to be prepared for is an unpleasant norm for post-operative, opiate-filled life: constipation. They give you some palliative stuff, but really, in my experience from traveling over the years and using various “stomach” remedies, once an opiate gets into you, your intestines just go on extended holiday. What made my life worse was the toilet extender they had perched around the hospital toilet. I am not a huge guy, but sitting in there pinned my legs together in such a way that even if something was thinking of happening, it wasn’t actually going to. I had to get home to find relief. If you’re lucky this will not be your experience. The biggest post-operative issue I had and am still getting over is the trauma to my quadriceps. If you have the right constitution, find one of the surgical videos posted on the web and watch the Birmingham operation. You’ll see that fairly early in the procedure, Igor the Assistant gets the word to dislocate the hip, and this involves a rotation of the leg that ain’t natural. Your leg is twisted in a weird way, the femur is exiting the incision and I assume pressing up against connective tissue and muscle, and you are unconscious and not in a position to say ‘ouch — I’m cramping’. That goes on for like two hours. So I found that while I could bear weight on my hip, and right from the start could walk on my left leg with a walker or crutches, my quad was shot, and any attempt to raise it, say in a straight leg raise, let alone climb a stair, was hopeless. I don’t know if this is just something that happened to me, or is common to hip operations, but I was a bit surprised. I thought that all the pain and trouble would relate to the incision and the cut tissue there, but that has not been the case. I was discharged on Thursday (Day 3) and was able to crutch to our car (a Prius), comfortably get in, and escape to home. Day 3 Post Op

We have a two-story house, and it turned out to be no problem to live on the second floor. I was able to crutch up stairs without problems, and since the renovated bathroom, the bed, and our best easy chair were up there, this way I could withdraw and rest. Descending for meals and visits byh therapist and nurse made for some variety.

I set up a recliner next to my bed, and gathered together some pillows, a big mug of icewater (you will be thirsty for quite a while), reading material, cell phone and cordless phone, and my laptop (we have wireless, which is a great boon). This made for a pretty comfortable base with lots of options. I grew to hate the phone, because inevitably I would forget to schlep along the handset, and as I was expecting calls related to nurse visits and such, I could not ignore the wretched thing. So if you hate cold-calls by solicitors anyway, wait until you have to wrench yourself out of a chair, hobble to find the phone, and then enjoy a recorded message form some dufous… You will probably have arrangements made for a visiting nurse and physical therapist. It’s nice to be able to talk over your condition with someone, and to start work on mobility and strength. My therapist made the very good point to not rush things: form, balance, posture, and gait are important. If you were limping before the operation, it may have been a long time since you’ve walked normally, and the goal of the operation is restoration of full activities, not merely a return to gimphood. I know different people will heal at different rates, but I wonder if some of the miracle reports about people walking unaided after a week need to be asterisked: are they walking smoothly, or limping and gimping around? A few things to know about: First, it is very easy to feel lightheaded when you pop up out of a recliner, especially if you get into the shower and have nice warm humid vapors around. Make sure you have a place to sit or someone to help you, certainly the first time or two. Also, apparently it is common to experience post-operative temperatures in the evening, and you might find yourself with minor chills, sore skin, lower energy, or whatever symptoms you show when you run a temperature (we’re talking numbers between 99 to 100 F, not higher values that might indicate an infection and the need to contact your doctor). Sleeping sucks. Until you get loose enough to roll over onto your stomach you’re kind of stuck sleeping on your back or non-operative side, and for me that is a position that turns my brain on, not off. A pillow between the legs is not required for Birmingham people, but helped me when I tried sleeping on my side. Even once you can sleep in any position, I found that there was just enough tightness or discomfort that I would only sleep in blocks of 90 minutes or so, with lots of twisting and turning, which did not help my wife sleep. For a few days I reverted to taking a Vicodin at bedtime, but then I saw the recent news story about ramapant abuse and I decided to stop. If you can at all help it, do NOT nap during the day. Finally, I felt-and apparently this is not uncommon-sort of despondent and depressed for one or two evenings when back at home. I still felt sore, and incapacitated, and just miserable and sorry for myself and sorry to be causing such a fuss for everyone. This feeling passed as my energy returned and things healed up. So if you feel this way, tell people, but don’t worry: the feeling is likely to pass. Day 11 Post Op

On August 17th, 11 days after surgery, I visited the surgeon’s office and got the great news that a new X-ray showed everything looks good. The implant looks like a mushroom: can’t wait to deal with TSA at airports. As my left hip was involved, I was given the green light to drive (one of our cars, the Prius, is an automatic, so the left leg just has to cope with the parking-brake pedal).

Free to drive, I switched over to outpatient physical therapy, planning to go about 3 times per week. It’s good to get some exercise and beginning to push the leg with concrete goals like cycling and stair-climbing in mind. By about the 22nd, I was mostly getting around using just one crutch for a little support. On the 22nd, at PT I actually rode an exercise bike for about 2 miles worth of spinning. Here’s a timeline of how things progressed for me: Day 0 – surgery; up in recliner Day 1 – cathether out, first PT session, walking with some weight-bearing and two crutches; quadriceps stiff Day 2 – PT twice, antibiotic IV done; some swelling in leg Day 3 – discharged to home Day 4 to 6 – quadriceps sore; swelling in leg; evening fever and some depression; just occasional Tylenol and one nightime Vicodin for pain. Took short crutch-assisted walks in neighborhood (maybe 500′ total), Day 7 to 9 – more energy, more flexiblity Day 11 – visit doctor, ok to drive Day 13 – maximum likelihood of blood-clot problems is two weeks after surgery; so far so good Day 13 to 15 – start outpatient PT; participate in off-campus retreat for new program I am running Day 16 – go back to work for a half-day; able to walk down stairs leg-over-leg Day 17 – full day at work, several meetings Day 18 – start this blog, discover that I can walk up stairs, ride 20 minutes on wind trainer (low resistance spin). Day 19 – basically off all pain meds, including Tylenol. Am just taking 325 mg of Aspirin twice a day as pain killer. Back on wind trainer again, and am walking shorter distance around house without any crutches.