Update December 2021

I’ve been busy playing at ”Lumberjack” cutting trees damaged in the recent storm and for sure without you/Koen de Smet/MatOrtho ReCerf -I’d not have been able to do so.

AUGUST 2 2021 – BRIAN’s YEAR 2 POST OPERATIVE UPDATE  C on C Re Cerf with Dr Koen De Smet -June 2019 Johannesburg

OVERVIEW

I attended Dr Koen De Smet in Johannesburg 2 years ago and had a Mat Ortho  Re Cerf Ceramic /Ceramic left hip resurface procedure -it was a unknown entity -but my own research and consultation with the very accommodating Koen (backed by Mat Ortho communications ref Re Cerf) -gave me the confidence I was making the correct decision –rather than opting for a  NHS THR prosthesis by a less than engaging Surgeon (subsequent communications with other patients re-inforce that decision was a sound one  -some NHS patients I have spoken to who had THR -have leg asymmetry and have had infections and revisions)

YEAR 1

Post op I was very conservative in the management of my hip recovery and progressively ramped up exercise to a point at 12 months post op I was carrying on as if Id never had any hip OA

YEAR 2

Has been a continuation of my progress in terms of my own psychological confidence and comfort -I have returned to Flight Instruction, Sailing, Cycling and Ski Instructing next season is on the agenda -assuming its viable ref CV19/Brexit

Just recently I’ve been engaged in heavy labour clearing an old house/garden and enjoy the ability to have the capacity to do a hard day’s work ,sweat profusely and enjoy the cold beer as it hits the back of the throat at the end of the day!

Simple pleasures -but highlights the simple things in life that are important -which can be taken from you if you suffer OA

I’m fitter than I’ve been for the last few years -because I have the ability to do all I can within reason (I’m 67)  -and that in itself is the tangible bonus -weight loss and blood pressure reduction with associated benefits of less bio mechanical stress on joints (each Kg of body weight is amplified 4 x on hips and 6 x on knees)

X RAYS

I recently had X rays of the hip at a 2 year anniversary and Koen’s review was all positive -no stress shielding or other changes visible

Dr KOEN De SMET CERAMIC LEFT HIP RESURFACING JOHANNESBURG JUNE 2019

12 Month Update

Brian 52 weeks Post Operation Koen De Smet 27th June 2019 Re CERF Johannesburg
12 month X Ray
12 MONTH UPDATE
I’m now 12 + MONTH post operation as I write this and I am walking, cycling and exercising
normally I have adhered to the protocols of physiology and tissue recovery following major trauma
/surgery and have not exposed my hip(s) to impact sports –for the simple reason of self judgement,
conservatism –rather than prosthesis restriction
As previously reported I followed a strict regime of re-habilitation based on external resource
information and education in addition to professional guidance from Koen –my surgeon –and Physio
–I wont repeat the in detail but the following is a precis
WEEKS 1-6
Effectively when a person exercises – particularly resistance weights – you are micro tearing the
muscles – its Ok to be mobile and do the Physio stretches only
WEEKS 6-12
The bone is still progressing through the Osteo Blast stage –and despite ‘’feeling good’’ I was
moderating my activities and exercise to low stress and movement rather than loading
WEEKS 12-26
12 weeks since the operation I felt confident in the Prosthesis and even more so that my surgeon
did a very good job and normal everyday mobility felt great –Id gradually increased activity/exercise
–especially stationary cycling, walking and resistance weights-Id spent 2 months in Spain working as
Flight Instructor –and that helped –lots of walking, lots of good weather
WEEKS 26-52
I decided not to go on my annual Ski Instructing in Europe -as I just was not confident that an
external collision from another Skier (or my own mistake) would be detrimental and I just did not
wish to return to restricted mobility Id experienced as the OA had progressed
COVID 19 reared its ugly head –and with hindsight it was fortunate I had not gone skiing –otherwise
Id have been locked down in Northern Italy for months
I was fortunate that back in UK I could at least still go out Cycling and help others as an NHS
Volunteer –which gave me a great deal of satisfaction and ‘’purpose’’ –it also was interesting as I
was talking to people who’d had a THR at the NHS local trust–and I have to say their outcomes
shocked me –and made me realise Id definitely made the correct decision to have a re-surface with
Koen –out of 6 patients –ALL have leg length differences –2 had infections –resulting in one having 3
further revisions –and another almost lost her leg
WEEK 52
Koen emailed to ask the group (4 ) whod had the Re Cerf in June 2019 to obtain Pelvic,AP, and False
profile X Rays –I asked my NHS GP for a referral –it was granted –but the lead in time was not
available
WEEK 54
Given an undetermined timeline to get NHS X Rays I decided to have the X Rays privately –I called 2
local Private clinics –and a referral from my GP –and within 24 hrs had all 3 X rays (cost £310) –the
day after received via email and I onpassed to Koen for review and his feedback was all ‘’Positive’’
LOOKAHEAD
I have the opportunity to go Sailing UK –Gibraltar in August-so based on the positive outcome I am
now happy to get Koens feedback and look forward to hopefully getting the most out of Life I can –
even as an old man!!
CONCLUSION
Hip –or any other –Arthritis is debilitating and destructive –it robs the individual of the ability to
function
As it is not initially visibly obvious –externally empathy and support is rare
The restriction on leading a life once taken for granted is also mentally challenging –and also
destructive
I see people all the time now struggling with arthritis and I wish I could have a magic wand I could
help them with –as I empathise what they are experiencing
Its easy –too easy—to just accept the status quo and ‘’soldier on’’ –but the longer it is left
unresolved the worse it gets –and also the window(s) of opportunity pass by to get the best option
to treat the issue –it takes courage –but one thing is certain –if it is left –it will get worse –and
hopefully one day will be that day you (as an arthritis sufferer) realise this and make the correct
decision for you
Research Research –and Research again –dont just take the first option you are given –or perhaps
railroaded into –especially if the option appears to cost you nothing (eg on the NHS) –but ask
yourself this –you have so many years left to live –GET THE BEST AVAILABLE –and in my humble
opinion Koen D Smet IS THE BEST AVIALABLE-you will realise this hopefully if you have a dialogue
with him and his team –he is a very ethical, caring and not least professional surgeon
Very Best Wishes
Brian
24th July 2020

26 Week Update

Brian 26  weeks Post Operation Koen De Smet 27^th June 2019 Re CERF Johannesburg

WEEK 26  STATUS

I’m now week 26 post operation as I write this  and I am  walking normally and my physical  life is Id say back to where it was c3 years ago

I have adhered to the protocols of physiology and tissue recovery following major trauma /surgery as follows

WEEKS 1-6

Effectively when a person exercises – particularly resistance weights – you are micro tearing the muscles –hence whilst its Ok to be mobile and do the Physio stretches – it’s not good to over stress the body in the first 6 weeks post operation – otherwise the already traumatised muscles/tissue have little chance of recovery – and can lead to inflammation/infection

WEEKS 6-12

The bone is still progressing through the Osteo Blast stage –and despite ‘’feeling good’’ I’ve been moderating my activities and exercise to low stress and movement rather than loading

WEEKS 12-26

I have been carrying out my normal daily activities and gym routines without any real conciousness of fragility or discomfort of my new hip

I have however been acutely aware that I take nothing for granted and because of this Ive been conservative in my exercises and other activities as I consider myself to be still within the ”recovery period’

LOOK AHEAD

It’s only 26 weeks since my operation –so too early to make any further observations –but I feel confident in the Prosthesis and even more so that  my surgeon did a very good job

I’ve decided I’m still not Ski Instructing in January /February – (6 months Post Op) despite being advised I’d be fine – I’m just so concerned of others who are out of control – and have an impact

CONCLUSION

I am more than happy with my decision to ask Koen to do the surgery – he delivered everything I expected –and more

I appreciate 6 months is a very short time post op to make conclusions about the efficacy and longer term prognosis -but so far ‘Im happy

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OVERVIEW Original Story

Where do I begin?

The fact you are reading this already says a lot about you –and you are Id suggest inquisitive and seeking guidance on the best option to resolve your hip issue

If there is anything I have learned over the last c 2 years –when I was diagnosed with Hip OA –is take your time (if you have that luxury –see later) ,ask questions ,and research ,research until you are as certain as you can be that you are comfortable not only with the prosthesis –but the surgeon –its like having a car break down –the spares to repair it are the same –but there are competent and not so competent mechanics .

BIO

My Name is Brian I am a 65 year old Male  UK citizen ,I am not an athlete –but I do value good fitness and health –and I attend spinning aerobics and cycling in addition to ski instructing and sailing when the opportunity presents in addition to flying instructing

I have historically placed my health care in the hands of the UK NHS (National Health Service)

DEVASTATING NEWS

April 2017 I had been experiencing Left Upper Quad cramping and tension –sports physio did nothing to resolve –and only after several visits /requests to my NHS GP did I get an X Ray

I was summoned to the GP clinic for a consultation with an NHS local trust Orthopaedic Surgeon – where there were no X rays present–only a radiologist report –Within 2 minutes I was advised I needed a new hip –and little else in terms of engagement –but the prosthesis would be a conventional THR stem

I said Id consider it and contact the Surgeon within 6 months–after about 8 minutes I exited the room totally demoralised and uncertain of what the future held

I was able to walk reasonably well but with some stiffness  and I decided to research further before committing

THE INTERNET

The Internet has its critics –and despite my dislike of too much social media (I try to keep privacy as much as possible) –I find it is a valuable tool for research

I literally punched in ‘’Hip Operations/Procedures’’ and was given lots of options –one that did spark interest was ‘’Hip Resurfacing’’ –I researched further and it looked a sensible design –and it ‘’looked right’’ (I am from an engineering back ground and there is a saying –‘’if it looks right –there’s a good chance it is right’’)

6 MONTH REVIEW

I revisited the NHS trust Surgeon again and I still felt little engagement –despite my research that indicated his volume of Hip procedures was above average for the UK –we agreed mutually Id defer decision and revert at a later date

DATA

There is a lot of data out there as are lots of studies/papers –the thing to remember is DATA isn’t

INFORMATION –and some data don’t show the true picture of patient outcomes –and satisfaction

H1 –CERAMIC/CERAMIC RESURFACING

I came across the H1 trail –conducted by ICL which looked very interesting

I contacted the POC and was welcomed with encouragement as a Cohort Study Patient –but Id need my GP to refer me to one of the clinics outside my own local trust — that  was collaborating with ICL

My initial request to my GP was not received with enthusiasm –as there was a comment that it would cost my local NHS trust money –It was only after I advised it would cost nothing that I was eventually referred to SWLEOC in Epsom

Comment by the GP was ref the Birmingham Ion issues –and to exercise caution

I attended  SWLEOC  October 2018 and I have to say the engagement was very good –2 sets of X

Rays and a long discussion with the Consultant who kindly placed me on the ‘’list’’ for the H1 Trial

I returned Home happier than Id been since April 2017 and with some hope

Unfortunately I received a letter in November 2018 advising the H1 trial had been suspended

I was devastated –but requested to remain on the ‘’pending list’’ when they restarted

DOWNHILL

I was offered Ski Instruction work  in January/February 2019 –but decided that I should be conservative as my hip was getting worse –I did only 1 week in February –and then only 5 mornings to reduce impact

On completion of this week I had had enough procrastination and decided to make the push to get some resurfacing procedure

OPTIONS

By March 2019 I had made lots of research into prosthesis/surgeons/patient outcomes and it was clear that Id have to fund a private treatment from my own savings –and this I think is where – certainly in the UK –we are reluctant to do so –due to the history of relying on the NHS –and not least having paid tax and national insurance for a lifetime –the expectation is to get some reciprocation and that can cloud good judgment

Given my enthusiasm for the resurfacing prosthesis –the only options were BHR/ADEPT Metal on Metal –and the 2 surgeons with any reliable track record /enthusiasm for this were  my chosen options

NHS

I decided to try the NHS for one last chance and had an appointment with a different surgeon who had shown some interest in resurfacing

I attended late May 2019 –his engagement was much much better –he had the recent X rays that indicated further deterioration (my left leg was now shorter  than the right –I hobbled rather than walked)

He listened to my request for resurfacing –but was not keen –(I could say more but it would be unethical of me) and I was offered an Exeter THR –in 4 months

THE SCENE IS SET /NOW FOCUSED

My mind was made up –Id self fund Metal on Metal RESURFACING by one of my 2 options

I then learned that Dr De Smet had carried out Re CERF Ceramic/Ceramic and I thought fantastic — this has to be an option

CONTACT/VISIT

I made appointments with both my options –and physically visited both  to gauge the ‘’person’’ and engagement—however based on the excellent responses to my (very ) numerous emails Id almost but made my decision to chose Dr Koen De Smet

DECISION

Koen gave me over 1 hour of time in Ghent to discuss the procedure , his method  of  surgery ,after care and I literally told him during our discussion ‘’Im yours’’

I departed the meeting with Koen —and for the first time I felt I had been fully engaged and treated as a HUMAN rather than a Statistic

COMMITTED

I returned Home –transferred my payment and booked my KLM flights to Johannesburg (Business Classs on KLM is excellent value if you book far enough in advance and Id recommend it –even if its only on the return –as its a flat bed)

Flight arrival/departure details were emailed for Koens agent in Johannesburg

FLIGHT

I flew out 24^th June and felt happy at the prospect and confident in my decision

HOTEL

Koens agent/POC in Johannesburg Grant (also an Orthopedic Surgeon) was there to collect me and drove me to the HOTEL –St Andrews –Its a 5# Hotel –it is quiet and the rooms are like apartments – best of all the showers are huge and walk in –ideal for post op .Staff are nice as is the food and excellent value

COLLEAGUES

Over the next day 3 other patients arrived –2 Swedish women (+ 1  partner)  and 1 American man  All were fit people and 1 was an athlete

D DAY !!

Grant arranged transport to the Roseacre Hospital am on 27^th –I was able to leave a large bag at the

Hotel

HOSPITAL

We all arrived and completed the preliminary paperwork assisted by very helpful staff

Following  X rays we were shown to our respective Wards/Beds and asked to take cleansing showers and put on gowns

Over the course of the next few hours Koen had arrived and had an audience with each patient to discuss the X rays and procedures –as I had already met Koen in Ghent our discussion was brief as I was happy with the process –However Id suggest if you haven’t met Koen before he does take time to explain everything fully

Pre op Blood Tests/Blood Pressures taken and other admins done by very nice nursing staff

Anca –anaesthetist came and discussed in detail the procedure and epi dural/general

PROCEDURE

I was the last of the 4 to be operated on –Koen started on no 1  at c1300 and I was wheeled into theatre  c2000 –I was given a sedation pill before which was welcomed –the last thing I remember was the anaesthetist asking me to think about something ‘’pleasant’’

WAKE UP

I awoke and felt no real pain –or discomfort –I did panic a bit as I couldn’t feel/move my feet and had a fear that I had ‘’dropped foot ‘’ –I asked the nurse and she assured me it was due to the epidural

DAY 2

Koen and Supporting Surgeon Dr Frey attended us individually on ward to discuss the procedure and confirm all well –I was advised I had lots of Osteophytes and these were dressed off the Femoral

Head –bone density reaffirmed and Koen  was happy with his work –that was good enough for me!!

PHYSIO

Leanne came and assisted us out of bed to attempt the first post op steps –I managed better than Id hoped –up and down the corridor assisted by Leanne –whilst some slight discomfort –mainly stiffness –it was good to test things still ‘’worked’’ !

AFTERCARE

The Hospital staff were very  good –as was the attendance of the Catering staff –and food

DISCHARGE

Day 3 we all said farewell to the Hospital staff –took photos and shared them with the staff  HOTEL

Day 3 –Day 10 Transfer to St Andrews and on medication for pain –opium based and anti coagulants

Koen and his admin Hugo met us by the Hotel pool in the afternoon and discussed the procedures – which was a nice way to close out the process and once happy they departed for their flight

Most of the group slept/relaxed for the first couple of days

Most days we had breakfast in the restaurant and dinner in the evening –food is good and not expensive

2 of the 4 decided to rest predominantly in their room and had room service –but it was good to have the support of other patients and the Swedish girls partner was very helpful –going to a local shop for items

We all subscribed to a group Whats App which made communication easy

PHYSIO

Physio came on day 3 and 8-and was good advice –encouraging to use the walking aids to prevent poor gait if discarded too soon

LOCAL VISITS

Once we had better mobility and reducing the medication some of us  booked a local taxi to go to a local mall –which is of a high standard –with the usual franchises and food outlets –one visited the Mandela memorial in Soweto –a c1 hour drive –Rosebank -also an open air market on Sunday was nice with local produce and souvenirs

DEPARTURE

Grant was kind enough to redo my dressing on the last day as it had become wet –he took a photo of the scar and showed me –it looked tidy

Grant was very kind to take me to the airport –I was last to depart

KLM were good –I had special assistance so the journey to the Flight Gate was faultless by wheelchair

I was glad  Id booked a flat bed business flight –it made the flight to Amsterdam comfortable and I slept the majority of the way with no swelling (I did not use compression  socks)

HOME

I arrived Home feeling relatively fresh but have been listening to my body and sleeping as I need to – the only medication being the anti coagulant injection daily

GYM/REHAB

I have returned to my local Gym and its nice to get the support of my friends –however I am not excessively exercising –merely ‘’dry runs’’ with little or no weight or resistance –and Ive driven (I have an auto) to a local riverside to walk as far as I can with the aid of the stick

GP

I visited my local GP to request physio input and await this –but in the interim Im being sensible and listening to my body

FUTURE

Its only 2 weeks since my operation –so too early to make any further observations –but I feel confident in the Prosthesis and even more so that  Koen  did a very good job

CONCLUSION

I am more than happy with my decision to ask Koen to do the surgery –he delivered everything I expected –and more .

Koen made me feel  like a ‘’person’’ rather than an ‘’item’’

The process of choice is daunting and my advice is to research as much as you can and if possible visit and talk to your surgeon before you decide

However if Ive learned anything its that whilst the choice of prosthesis is important –equally –or more important is the choice of surgeon –and it may seem obvious –but choose a surgeon who has high volume and continuity –its a one stop opportunity –so get it as right as you can

THANK YOU

Koen for just being ‘’you’’ –my opinion is you are a very professional and humble ethical

/competent  and empathetic  person –may you continue your excellent work

Prof Frey for assisting Koen and reaffirming  the  successful  outcome of the operation

Grant –for your excellent support and liason

Anca –for your excellent anaesthesia

Leanne for the post op Physio

Hospital staff –for their excellent care

St Andrews Hotel-for an excellent post op stay

KLM –for excellent flights/care

Pat Walter –not least for this excellent website to help people make the best choice

Mat Ortho –Re Cerf manufacturers –thanks  Michael/Simon for all your very  helpful pre decision technical clarifications /communications and the fact you actually make this prosthesis !(so also not least  to Mike Tuke – MD)

FUTURE UPDATES

With permission from Koen (who has reviewed this post) I will endeavour to update Pat Walter over the next relevant milestones –c3 month/6 Month/ 12 month post op and I sincerely hope it helps at least 1 person make a good decision –to ask Dr Koen De Smet to be their Surgeon

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12 Week Update  September 18, 2019

I’m now week 12 post operation as I write this  and I am  walking unaided after being in Spain for 2 weeks where it was hot and I did a lot of progressive walking – and also worked as a Flight Instructor

I have adhered to the protocols of physiology and tissue recovery following major trauma /surgery as follows

WEEKS 1-6

Effectively when a person exercises – particularly resistance weights – you are micro tearing the muscles –hence whilst its Ok to be mobile and do the Physio stretches – it’s not good to over stress the body in the first 6 weeks post operation – otherwise the already traumatised muscles/tissue have little chance of recovery – and can lead to inflammation/infection

WEEKS 6-12

The bone is still progressing through the Osteo Blast stage –and despite ‘’feeling good’’ I’ve been moderating my activities and exercise to low stress and movement rather than loading

I did my first Stationary Spin Bike  Class 2 weeks ago –and advised the Trainer Id be ‘’doing my own thing and cruising’’ –luckily I have a good gym where everyone is very friendly and supportive –so they understood – so that’s what I’ve been doing – stationary cycling – but with low resistance

I’ve also been doing some basic swimming –which is great – or support and gentle exercise

LOOKAHEAD

It’s only 12 weeks since my operation –so too early to make any further observations –but I feel confident in the Prosthesis and even more so that  my surgeon did a very good job

I’ve decided I’m not Ski Instructing in January /February – (6 months Post Op) despite being advised I’d be fine – I’m just so concerned of others who are out of control – and have an impact

I’m planning on returning to Spain to Fly and explore and maybe Sail too

Next Year I’ve been offered a post as Skipper  (I’m RYA Yachtmaster) on a Sailing Yacht in the Med June –Sept –so that I am looking forward to!!

EAA FINANCE

The UK NHS has a scheme that will refund a percentage of ‘Overseas’ medical treatment –provided it is carried out within the European Union –I applied for this via the EAA system –and was refused as the procedure was performed in South Africa –despite the Surgeon base in Belgium and the funds remaining within the EU –as it is Id not have been re-imbersed the full amount –but maximum £6,000—and it is disappointing –given the amount of Income tax and National Insurance Ive paid into the system for many decades –seems you have to be a ‘’newcomer’’ to the UK who has contributed nothing to the system to get all the freebies and benefits

CONCLUSION

I have been told by my friends in Gym/Leisure Centre I look Younger – maybe because I drink less and I’ve lost a few pounds too – but I think a lot is due to not compensating for the pain – and also the psychological effect the return to some ‘’normal’’ pain free mobility has had

I am more than happy with my decision to ask Koen to do the surgery – he delivered everything I expected –and more.