I am two weeks out today from my hip resurfacing with Dr. Coleman Fowble of Columbia, SC.
My road to a hip resurfacing has been uneven. I would guess that I first experienced hip pain eight or so years ago. I met a physical therapist and was given some exercises to do, although I confess I was not always so good about following through with them. It’s possible, of course, that my earliest pain was not osteoarthritis at all, but the pain would come and go. The last several years it had been worse, and I made more visits to a physical therapist. I was better about following her instructions this time, but wasn’t sure if it was doing any good. The pain did seem like it might be better after exercise, but it was tough to say. Sometimes I climbed stairs good leg first, then moving the affected leg to the same step. Sometimes I found it too painful to walk more than a couple of blocks. But then the pain, or most of it, would disappear, and I might take a hike up the mountain. To play hockey, I usually took aspirin or ibuprofen so that I could push off strong in my skating stride without the pain being unbearable – but then sometimes the pain wouldn’t be bad at all. The range of motion, however, was deteriorating throughout. My hip would also sometimes collapse on me as I went to take a step, and I haven’t dared take part in many deer hunts over the last several years for fear that I wouldn’t be able to make it back to the boat with a heavy pack on my back. I was starting to assume that that would be my reality for the future, or a downgrade from even that, and I was not very happy about it.
Fortunately, when I was visiting a sister who is an x-ray tech last spring, she advised me that if PT wasn’t taking care of my issues, I should get it x-rayed. This fall on an unrelated visit to the doctor I got a referral for an x-ray and found out that I had arthritis. The local orthopedist said I would be needing to get a THR, it was just a matter of deciding when it would be the most convenient to have it done. So I assumed I was in for a total hip replacement, but wanted to talk to as many people as possible who had had it done, so that I could make the best decisions going forward. A coworker told me that a mutual friend had had his hips done some 8 years before, so I phoned him and learned that he had had a bilateral resurfacing with Dr. DeSmet in Belgium and that he was thrilled with the outcome. He pointed me towards the surface hippy website, and I must have researched it off and on for a month before I decided that I would like to proceed with a resurfacing. Interestingly, my pain this last hockey season has probably been less than at any point in the preceding several years. Indeed, I played in a tournament a little over a week before my surgery.
I suppose three main things contributed to my decision to opt for a resurfacing rather than a replacement. First, since I am relatively young, it is highly likely that I will need to have a second procedure done some day. A second THR seems to be a lot less desirable, as they cut off even more bone and end up wiring the bone shut. Second the arguments about the unnatural loading of the bones in a total hip replacement were convincing. Third, I am active, and like to play hockey and hike. I was discouraged by the limits that a total hip replacement would place on my range of motion, and the increased risk of a dislocation that it would offer. Finally, the reading that I did was able to convince me that while the overall failure rate of resurfacings was higher, it didn’t seem to be the case with surgeons who had developed a skill for it.
My next decision was what surgeon I would have perform the surgery. Dr. Gross of South Carolina eventually obtained a position at the top of my list based on several factors. Unlike most surgeons, Dr. Gross posted his failure rate on his website. It was clearly very good, and he has been performing the surgery for long enough and has completed enough resurfacings for the results to be statistically significant. He offers a cementless resurfacing. It may turn out to be a mistake, but it makes sense to me that long-term, a cementless attachment would be preferable. I guess I opted to be a guinea pig on this one, as the part does not have as long of a history as the BHR. When I read testimonials, they on average seemed to point to rather quick recovery, and they were generally quite glowing. Finally, Dr. Gross and Providence Hospital NE were both in network. I submitted my paperwork, obtained an appointment and bought my plane tickets. The feeling of stress that had been ruling my life wasn’t totally gone, but I had a plan, and it was just a matter of waiting for the day of surgery.
A phone call at work punched my stress up to new heights. While Dr. Gross had been in network when I made my appointment and purchased my airfare, he was no longer in network. I was either going to have to cough up several additional thousand dollars or find a new surgeon and try to recover the cost of my non-refundable tickets. They also offered a third option. A second surgeon who performed the same procedure out of the same clinic as Dr. Gross was still in network for me. It was possible that they could find a spot in his schedule to perform the surgery. Making this all the more difficult, the phone call came during a class that I was teaching, so I by no means had time to talk about my options or even to fully process the situation. A 4 hour time difference further complicated our communication issues. I promised to weigh my options and to let them know of my decision by the end of the week.
Now, when I thought my plans were set, I was back to the point of choosing a surgeon and trying to recover airfare, or of deciding between Dr. Gross and Dr. Fowble. I revisited the surgeon lists and sent out a couple of x-rays and tried to learn all I could about Dr. Fowble. He does not have much of a presence at surface hippy. One doctor who received my x-rays requested a second set with something to scale the x-rays to make sure that I was still a candidate after the recent BHR size guideline change. I decided to stay in South Carolina, and without much more than a good referral by the office staff at Midlands Orthopaedics to go by, decided to have the surgery performed by Dr. Fowble.
The drama was not over. About a week or two out from surgery, I got a message that my appointment had been cancelled. I phoned – at the beginning of the school day, due to the time difference, which also guaranteed that I would not have much time to deal with the exigencies of the situation. Apparently the day that I had been rescheduled with Dr. Fowble was supposed to have been blocked out. Dr. Fowble had personal commitments on that day and would not be available for surgery. The paddle was dipped into my emotions and beginning to stir. I think this time, the feeling was less the panic or stress that I felt the first time and more a resigned sigh. I phoned my wife to see if she would be able to see about changing our airfare or changing appointments, and fortunately she had time to take care of things. She phoned Midlands. They understandably felt pretty bad for what I had been put through, and were able to reschedule me for Tuesday the 10th. We were able to keep my original plane tickets. My original appointment with Dr. Gross had been for a pre-op consultation on the 10th and surgery on the 11th. This had been bumped out to Thursday the 12th when I moved to have the surgery performed by Dr. Fowble. Finally the changes moved the surgery and pre-op to the day after I landed in South Carolina. On the upside, this gave me more time post-op for recovery before I left Columbia on Saturday the 14th.
I think I am happy with my decision to have Dr. Fowble perform the surgery. I say “I think” because my window on hip resurfacing is limited to what I have actually experienced. This is my first hip resurfacing, so the only thing that I have to compare it to is the anecdotal evidence offered by other surface hippies at the surface hippy website. I guess that as the pain in my joints due to the operation itself subsides I will have a better sense that all is as it should be. That said, my suspicion is that my recovery is proceeding better than average. I was getting around pretty well by the time that I left Columbia, which was only 4 days post-op. My 5 hour flight from Charleston to Seattle on Sunday was trouble-free. While I opted to fly first class on my return flight, I think it wouldn’t have been too much different in coach. (I think leg-room on Alaska Airlines is perhaps better than most.) I flew the 2.5 hours from Seattle to Juneau on Monday, again first class, and every day has been a little bit better than the last. My leg was still somewhat swollen when I got back to town, but within a couple of days of my return home that was mostly gone. At 1 week I was still using crutches – either one or two, it didn’t really matter – but mostly to make sure that I wasn’t limping. I wasn’t putting much weight on them. I have been going without crutches since about 10 days out. I feel some pain when walking, when sitting, when lying down, but not too much. The NSAIDS definitely help with that. I have been icing but did not get one of the Polar Care units. I don’t know if that has made a difference or not. I have been walking fairly often and been doing my short list of physical therapy exercises faithfully. At 9 or 10 days, I started climbing stairs alternating legs without crutches – pushing off my affected leg as well as the normal one. (I hope that doesn’t violate what I’m supposed to be doing.
My interactions with Dr. Fowble were pleasant. He was respectful in all communications with me. He was able to answer my questions. He assured me that I was an ideal candidate prior to the surgery and told me afterward that my surgery was uneventful and that it went very well. Now as a teacher I understand the value of telling students messages that are reassuring, but he seemed very sincere. He also shares my sense of humor and did not seem to take himself overly seriously. It was clear from our conversations that he believed in the Biomet device and in resurfacing in general, but it was reassuring to me that he did not seem to have the close-mindedness of a true believer. He recognized that resurfacing was not the best choice in all circumstances. He also mentioned recent trips to other surgical centers to stay abreast of any advances in technique. This is a characteristic I would desire of my surgeon. I was also reassured by the fact that he had trained under Dr. Gross and was deemed proficient to operate out of the same practice. Moreover, he had clearly evolved, and was continuing to evolve, his ideas about hip resurfacing separately from those of his mentor. At this point he has completed in the neighborhood of 800 resurfacings. I believe I was the fourth resurfacing the day of my surgery. He told me the surgery took about 1 hour.
I feel somewhat less enthusiastic about the interactions with Midlands Orthopedic that eventually turned out all right and led to a successful surgery. The emotional roller coaster that I went through as I was initially given an appointment and then had my plans put on hold twice at potentially great expense to me: I wouldn’t wish that on anyone. It seems like it would have been possible to confirm that I was no longer in network before I purchased my tickets, rather than a month later, or indeed, to proceed with the prior commitment to perform the surgery. The same thing applies to the cancellation of my second appointment. It seems like that was a mistake that should have been recognized when I was first scheduled. That said, I understand that mistakes happen and aren’t always avoidable, and am willing to cut people some slack. And I certainly appreciate the office staff’s concern for my situation and ability to schedule a solution that enabled me to use my original plane tickets (indeed the Tuesday surgery ended up being preferable to the Thursday date from a recovery standpoint). So, perhaps, all’s well that ends well.
Dr. Fowble said I would be able to perform my 6 week post-op locally by providing him with an x-ray. As I continue to improve, I will post updates to verify that everything is as good as I think it is. Perhaps, if someone is patient enough to have actually read through this, they could offer me reassurance that my level of pain is what I should expect due to the rigors of surgery.
Thanks, Surface Hippy!