Left hip resurfaced for osteoarthritis by Jeremy Latham in Southampton U.K.

[gary2010]

I just rearranged the above because it didn't make much sense in respect of your post - I can only sit here for 20 mins at a time!

I did quite a lot of reading beforehand, most of the references can be accessed through this site and the other one. I have to point out that my research consisted of three months of 'cramming' for all I was worth so I've probably missed a great deal of background.

The classic BHR has a spherical femoral component and a parabolic acetabular cup. When the joint is in use it's filled with synovial fluid being drawn into the gap, which narrows towards the centre. Ideally the contact is in the form of a 'ring bearing' concentric around the axis of the femoral head, and this stays lubricated by said fluid, so the wear is minimal. If the cup in particular, or the spherical part is misaligned, the bearing surface will not be round but ovoid. in worst case it will just run back and forth in a line - called 'edge loading'. not only will the implant wear out before time, but metal particles leach into the soft tissues and cause problems, the extent of which varies according to the person's tolerance.

I hope if someone has a more accurate descripton, they will jump in and correct me at this point. But I've seen diagrams mapping the wear patterns of misaligned components. That's why I recommend you to arm yourself with a second opinion on your X ray from a top surgeon, before you tackle your consultant. Hopefully there is another explanation for your inflammation, which might be corrected by manipulation or soft tissue work, so I'd see a chiropractor as well.
G

[Lopsided]

The classic BHR has a spherical femoral component and a parabolic acetabular cup.

Nope.

Both the contact surfaces are spherical. The only way they could articulate is if they are spherical. The difference in diameters is microns. Two surfaces can only articulate if there is an minimal and even space between, and so the only way a minimal space can be made is if it is even. The types of surfaces where this can apply are plane, cylinder and sphere, and for a hip joint where we want a bearing, it is the sphere.

I have been reading your posts with interest and hope you continue to recover well. I am four weeks out today and my improvement has been continual, although not totally even. I hope you enjoy your new hip.

D.

[gary2010]

Ah, where did I get that from? An article by Dr Foulk, I've probably misread it, that's the trouble with cramming! Looking  into it now..

[gary2010]

You are right, thanks for that! The link on the above page goes to the Smith and Nephew website, and refers to the radii of the femoral and acetabular components. A parabola does not have a radius, so it looks like the illustrious doctor has misread the S&N blurb (fair play to him though, he's an example to us all).

The diagram actually makes the cup look parabolic, but of course if you put a small sphere in contact with a larger one, the gap will widen away from the point of contact, which is the point he's making, the process of viscous entrainment produces an even gap when the joint is in motion.

Best wishes, G

[gary2010]

T+5 Days: Swelling now into the calf as well, but range of movement still improving and the bruise has gone; I felt I might have overdone it yesterday as when I got home I couldn’t leave anything alone. I swerved one dose of tramadol and didn’t miss it; pain is greatly intensified by boredom. I think that sheds some light on the mechanism of addiction, how miserable it would be to have nothing to look forward to than the next dose of analgesic.

The sticks are a real encumbrance, and it takes a lot of discipline to keep using them indoors as I can move perfectly well without. To make up for it I had a 10 minute walk up the road with both sticks, concentrating on the gait. In the house I tried walking towards a full length mirror so I could check everything; I had been told that Mr Latham would make every effort to correct leg length and alignment. My shoulders are now parallel with the floor and my neck perpendicular to it; I’ve not been that straight for a very long time.

This morning I did the lying and standing movements, which are much easier now, tidied up a bit, lay flat with the ice for 20 minutes, then walked outside for 20. I won’t bore you with the minutiae of my daily life but the routine is exercise, sit, stand, lie down, walk, recline, repeat; and I just fit all other activities into those positions. There is a great temptation to collapse on the sofa with a crate of beer but I know I’d regret it when I got up.

I'm pleased to note that I didn’t put on much weight with all that Spire food, the swollen leg probably accounts for a couple of pounds.
As well as the sticks, the hospital gave me a pick-up tool - sort of remote claw with a pistol grip and trigger, a long handled shoe horn, and a device for putting on socks which almost works. I don’t expect to have much use for socks in the foreseeable anyway. In addition I have some kit on hire from the British Red Cross: a couple of orthopaedic seats and a board for sliding into the shower, a non - slip mat is a good thing to have as well. I got some elasticated laces for my trainers and fastened them with cord clamps.

By the way, if anyone’s on the same restrictions as me, calf exercises: raises (unweighted of course), ankle curls for tibialis anterior and standing calf stretch, don’t break any of them.
G

[gary2010]

Absent-mindedly scratched an old insect bite and bled like a fire hydrant! I stopped it by rubbing salt in, which always works for me. I'll have to be careful while I'm on the anti coagulant (5 weeks).

I now have a fairly swollen leg, it's not discoloured and doesn't hurt, just looks a bit odd. Any suggestions? Flex more, flex less, put feet up, spend the day in bed, hang upside down like a bat? Or just crack on and don't worry about it?

[Lopsided]

The diagram actually makes the cup look parabolic, but of course if you put a small sphere in contact with a larger one, the gap will widen away from the point of contact, which is the point he's making, the process of viscous entrainment produces an even gap when the joint is in motion.

Gary,

One up for you, only a couple of days out and you are considering the subtleties of design and engineering.

pain is greatly intensified by boredom

Yes, boredom is the main discomfort in the whole process. I was lucky, I was at the villa with other resurfacing and replacement patients. So I know interaction with other patients helps.

I now have a fairly swollen leg, it's not discoloured and doesn't hurt, just looks a bit odd. Any suggestions?

Ice, lying down with your leg elevated, ice, keep wearing those horrible TED stocking, and more ice. And then ice some more.

Dan

[gary2010]

Cheers Dan, i got it down considerably overnight by raising the feet, I have gel packs which go in the freezer, and that contraption i used in the hospital. Today i'm going to increase my horizontal time, and shorten the walks. Other than that I'm very pleased. G

[gary2010]

Friday morning, T+ 1 week: I took 50mg of diclofenac last night and elevated my feet overnight. Woke up this morning feeling awful (just for a change) took painkillers and went back to bed for 1/2 hour.

The swelling is greatly reduced and range of movement better than ever. Limited my walk to 15 minutes but covered a lot more ground. I'm still using the 2 sticks, as an experiment I covered a few yards without and my limp is barely perceptible, it will of course come back if I get tired.

My hip has his own facebook page! www.facebook.com/thehipleft

see you there?

[Lopsided]

Gary,

You there? I want to read your daily update.

How far can you walk now?

Dan

[gary2010]

Hi Dom,
Riding does seem harder on the hips than most activities. I haven't ridden for 10 years now, for a variety of reasons. I got quite into it at one time, enjoyed a bit of jumping, only up to about 4 foot, nothing really that I couldn't have jumped without the horse! There's nothing I enjoy more than a blast across a Welsh mountainside on one of their ponies.

Ok Dan, heres my daily update at T+ 8 days: I got the swelling down a lot in the ankle and calf by raising my foot ridiculously high overnight. I'm now on only 3 tramadol a day. I'm lucky to live very close to a public golf course, so I do my walking there, once I'm cleared to run I'll start with some uphill sprints on the grass.

This morning I walked out for 15 mins, then rested for 15 and walked back. It's a really nice day, and I could have stayed out for hours but I have to deal with the swelling. Here the summers are getting later so we get fine weather well into october, may and june typically being rather wet.

I would like to walk more but I'm committed to this routine, which seems to be making progress, so instead I see how far I can get within the time limit. I think I'm moving as fast as I ever did without breaking into a jog.

I see you're living in Thailand, Where did you start from?

[Lopsided]

I see you're living in Thailand, Where did you start from?

I am from London, mate.

once I'm cleared to run I'll start with some uphill sprints on the grass.

No you won't! You will start with slow even running on the level.

By the way, it is ten at night, thirty degrees and there is a yellow flashing lightning storm in the distance. I hope you are soon sprinting up hills. As for the approaching Welsh winter, rather you than me.

[gary2010]

T+ 9 days: I clearly overdid it yesterday, though it felt good at the time; stone me if my right hip isn't bugging me as well! Hardly surprising given the extra workload. Back to square one pain-wise, but still much more flexible than in the beginning.

Had a rough night, alcohol seems to clash with the anti-coagulant and I had too much of it, I feel hung over. Today I'll have 3 short (10min) walks on level ground and follow each with 20 minutes horizontal.

[gary2010]

No you won't! You will start with slow even running on the level.

PMSL, you sound like my mother!

Seriously I thought uphill to reduce impact, sprint to limit duration, once I start jogging it's hard to know when to quit; and they're not big hills, it's only a golf course!

@ Dom, I think it's down to familiarity, you've clearly done a lot of it, I don't ever remember getting off a horse and not feeling sore. Some people would question why I was comfortable with boxing when I'd struggle to climb stairs!

[gary2010]

Tramadol
Tramadol (Ultram) is a centrally acting analgesic with two modes of action: weak binding to the µ-opiate receptor and inhibition of norepinephrine and serotonin reuptake. Reports of serotonin syndrome in association with tramadol and SSRI coadministration appear in the literature

[Lopsided]

PMSL, you sound like my mother!

I do beg your pudding.

I have not started running yet, but you are right, walking up hill is much easier than walking down.

[gary2010]

I'm thinking about 6 months for running, there will be a lot of strengthening  and stretching to do before I start putting impact through it. Nothing much to report, I seem to have levelled out for the time being.

[gary2010]

T+12 days: Staples out, wound in good shape, had physio exam and cleared to use 1 stick only, she added glute bridges to the rehab (which I actually started yesterday) getting by on 2 tramadol per day.

[toby]

Gary,
It's a fellow UK Hippy here (coming up to 8 months-left Finsbury Adept-Prof Cobb- London-doing great). I have been attentively following your recovery and was thoroughly entertained by the eloquence, humour and narrative qualities of your earlier posts. I'm pleased to see progressing well-("I seemed to have levelled out"-remember not to expect daily progress, it's still early days. I like the positive thinking re- running in 6 months-this is a topic for discussion (Mcminn suggests a year!).   
Anyway, now that you're now on a single stick and that the physio's concentrating on your glutes, do you think we could see a return to a somewhat more extensive account of your daily experiences.
Keep Moving
Toby
ps Do you have access to hydro? It's fantastic!

[gary2010]

Hi Toby, no hydro I'm afraid only public pool which is hard to get into without breaking 90 degree restriction.

The ROM exercises are getting easier, I walked 30 mins on the golf course today which was enough, and flattened out immediately on my return. I don't find the single stick helps much when the leg gets tired so I might go back to using 2 with an alternating motion to increase duration. I'm used to marching cross country with a staff rather than a walker, sliding the grip position to cope with the terrain. I may try that as well tomorrow.

Since the staples came out the pain has migrated from the site of incision to a point midway down the quad, there's some bruising in this area too. I still find it hard to sleep on my back and I can't lie on the operated leg yet. The only relief available is to raise the knee, this creates a very uncomfortable sensation just above the knee when I put it down again - sound familiar to anyone? In the end I have to get up and walk about.

I believe Mc Minn has dropped the 12 month rule, my surgeon is a follower of McMinn and would condone me running at 6 months, apparently most femoral neck fractures occur in the 3rd month, my plan is to concentrate on strength and flexibility during this period.