Hip Resurfacing on December 7th with Koen de Smet

[vonhouser]

Well, I have about a week before my surgery next week. I'm a 49 year old female, born with hip dysplasia. I'm an avid rower and a cyclist and I've had bone-on-bone arthritis for at least two years. I was able to ride and row all season, and even got in one of each over the holiday weekend, which I'm happy about.


If it weren't for this site I'd be having a hip replacement, I'm sure. I'm most looking forward to being able to stand, walk, and sleep without pain. Oddly enough I can row hard and ride hard easier than I can just stand around. The weight bearing is a killer.


That was my poll that Pat posted about how long until you are in less pain. I'm very curious about the folks who report that the next day the bone pain is gone (though of course there is now incision and muscle pain).


My Dad will be going with me to Belgium. Quite a twist, the 83 year-old with no orthopedic problems accompanying his athletic daughter who will then be on crutches.


My plan based on all of your good advice is to make sure he brings me edible food while at Jan Palfin, and after that to just go with the flow of de Smet's rehab protocol, which sounds like a good one. I'm currently doing Feldenkrais and have found it very helpful for normalizing my gait, so I've identified a practitioner who should be able to visit me once or twice at the hotel, just to help my brain remap things.


I'll update once I've had the surgery. I'm planning to do a separate blog, so I'll give the short version here, and then link (if the site allows it) to my external blog for more details. That way folks here at home can follow along without it cluttering up my Facebook feed.


Wish me luck!

[Pat Walter]

Taj   I wish you the best of luck.  You have chosen of of the best hip resurfacing surgeons.  I know you will do well.  Enjoy your time in Belgium.  The chocolate is to die for and if you like beer - you will enjoy the over 450 kinds!  A beautiful place to visit.

Let us know how you are doing when you can.

Good Luck.

Pat

[blinky]

Yes, good luck!


As unbelievable as it sounds, yes, you may be pain free post op. Sure, you have the new, surgical pain, but only when you move the wrong way. Post op I felt weak and wobbly, didn't trust my legs to do what I wanted, but I wasn't in any pain. Every day I felt stronger and better. The first week I had times when I took off walking without my crutches and then said "whoops! can't do that yet" and went back for them.

[catfriend]

It is just weird how all that pain associated with the dysplasia/arthritis disappears once you have the surgery. I think part of it is you're just so used to the chronic pain that once it's gone it seems abnormal. Yes, there is surgery pain and muscle pain, etc. That type of pain just feels so different. I think you have to experience it to understand. Think of it as recovering from an injury (surgery is a kind of injury, albeit purposeful). The weak and sore muscles will become stronger and less sore over time.

If you want to read specific recoveries blinky's is on the website someplace, as is mine. Mine can also be found at hipresurfacingwoman.com

NB: not all recoveries are the same. Some people are fast, some people are slow. Some people have more post op pain than others. Some are free of the walker/crutches after a few days, some need them for weeks. All of these things are normal. Your recovery will be yours alone. It's not a competition. What's most important is your long term outcome.

Good luck.

[vonhouser]

My Dad and I are on the train to NYC, where we will catch a direct flight to Brussels. The waiting is almost over.


I will update here, but also feel free to check out my blog post, where I will put more detailed information.


tajcarson.wordpress.com

[vonhouser]

Tomorrow is the big day! Already met some other hippies which helps so much. The anesthesiologist seems to think general is better than regional.


Met de Smet in person, and he is just as confident (but not arrogant) as everyone says.


He told me he's only had four femoral fractures ever, but did not hesitate to tell that his last one was only three weeks ago. I appreciate his honesty. Apparently every fracture he has had has been with men, which is interesting.


Check out the blog post for more details and a picture of my new swedish friends!


tajcarson.wordpress.com

[blinky]

Best wishes for tomorrow. It will be great!

[Quig]

Good luck! Everything is going to go great.

[vonhouser]

Everything went well! I ended up with general anesthesia because the anesthesiologist did not like the idea of regional, even though Koen was ok with it. It worked out fine.


Food was exactly as described by I'm really not hungry so no big deal. I'll see Koen tomorrow I hope. He said he doesn't visit people the day off because they are all drugged up.


I was surprised that they don't let you get out of bed the day of surgery. Hope that's the protocol snd not just for me.


My lower back was hurting and the back of my hip some, but not in the hip. The morphine seems to be doing its job. I wonder when they tske you off the IV?


More details on the blog. Met some other hippies from Sweden which was fun!

[blinky]

Hey! Congrats!


How do you feel after the general? I had a spinal and it felt like I woke up from the best nap ever. I didn't get to walk the first day either, though, because I got too much numbing juice (technical term there) and my legs didn't wake up until the evening. The PTs had gone home. It was okay because I was the first one up the next day.


Look forward to following your progress.

[Pat Walter]

Glad to hear you are done with surgery.  Time will go by fast now.  Take it easy.  Good Luck.

Pat

[vonhouser]

It was a rough night. Pain management sort of failed me around 2 am. The nurse came and the morphine iv was empty and she seemed unsure if it was working, but I couldn't get her to take me seriously. This morning they took out the iv and gave me a codeine pill so I'm feeling better.


PT is supposed to come and move me to a chair before noon today.

[vonhouser]

Coming up on 48 hours and seeing good progress. Got the IV out yesterday morning, pain pills are working fine, lower back not bothering me anymore.


Yesterday started using crutches, walking and stairs. Today we go to the hotel!


For more details, see the blog.
Tajcarson.wordpress.com

[hernanu]

Sounds like it's going well, good luck and keep it up...

[vonhouser]

Feeling a little better every day! I may switch to Tylenol today and take codeine at night. Last night I got better sleep, and was even able to alternate from back sleeping to side sleeping (with the pillow).


I have PT with Lynda at 12:30, and may finally venture outside to walk a block to the coffee shop, we will see!


I'm so glad I read on here about "log leg". That is exactly what it feels like and so strange! Knowing that it lasts about a week is very helpful. Even that is a bit better though.


So far, so good!

[blinky]

That's great progress! Hope your next post is about crutching down to the coffee shop.


When do you leave the hospital? And then when do you leave for home? How is your dad doing?

[vonhouser]

Even better, Blinky! I crutched past the coffee shop and down one more block to the Indian restaurant! Then stopped for coffee on the way back. It was lovely. I could see the cathedral, which will be my goal tomorrow. Just a little more each day.


I thought maybe I would turn myself into a rat, creating food rewards that are slightly farther down the maze each day...

[vonhouser]

Day Five!


So, I've been lucky enough to have slow and steady progress with strength and walking. Yesterday was pretty bad, because I started to have major stomach problems from the anti-inflammatories. This happens to me sometimes, and I forgot to bring my Celebrex, which I'm kicking myself for. I just figured they would have an alternative, but Jan (the nurse) just told me to stop taking them. So I feel generally better today, but a bit more pain and stiffness in the muscles, which makes sense since I don't have any anti-inflammatories. He's going to bring me some Celebrex tomorrow. No major issues wiht the hip, though.
The big news today is, I get to go to one crutch! The PT watched me walk and said as long as I'm indoors where the floor is even, I can just use one crutch. This makes life so much easier!
Every day Linda, the PT comes for half an hour. She does basic exercises, everything from stuff in bed, to walking sideways to (if you can imagine) tiny walking lunges. Just the tiniest. She watches and gives feedback, it's pretty straightforward. Apparently hydrotherapy isn't offered unless you ask for it. I'm going to do hydrotherapy with her once this week, just so I have some guidance for what to start with when I'm at the pool back home. Jan, the nurse, also comes every day. He brings his bag o'drugs, checks the incision, changes if you want, and answers questions. This was helpful because I would have been really reluctant to go off the NSAIDs except that he clearly thought it was no big deal.
Two things I'm wondering about. One is the anti-inflammatories. They are used to prevent heterotopic ossification. Based on my readings, this occurs often, though less in women, and often HO happens with no limit in ROM or symptoms. NSAIDS can lessen it, but there seems to be come discussion about whether NSAIDS might also inhibit bone growth that's needed to have the device grow into your joint. So there's a bone balance it seems. Some things can promote bone growth, which you need for the device to implant, but if it happens too much, you have bone growth in your soft tissues, or heterotopic ossification. The consequences of too little bone activity are a loose acetabular cup or femoral component, and potentially the consequences of too much are HO. So to me it seems like if you don't take the NSAIDS you save your stomach, probably have a zero net sum game between HO and loose components, but you do lose some in terms of managing pain and inflammation. So far I haven't had much swelling in my leg, but if one did, that would probably also be a factor. There also is some question about whether NSAIDs limit muscle growth, which you really need, because your glutes and probably some other hip muscles have been out to lunch for quite a while, and building them back and getting them firing is a key part of your recovery. Koen de Smet's theory seems to be that surgical technique also plays a role, so, once again, if you have an experienced surgeon it might matter less. The bottom line for me was, the surgeon isn't adamant, the benefits over the risks aren't all that clear, I'm also female so even lower risk, and I was on them for the first four days so I'll go with fewer medication rather then more, whenever I can.
The other gray area is related to the hip precautions. Standard hip replacement precautions include annoying things like not having your hip at more than a 90 degree angle, not crossing over the midline, and a few other things. The 90 degree precaution make just sitting in a normal straight backed chair quite challenging. So the issue is, most hip resurfacing surgeons follow those precautions to some degree. Two of the 10 most experienced surgeons, de Smet in Belgium and Su in New York, do not. Su actually argues that the build up of scar tissue that can restrict motion is more likely than a dislocation caused by not following the precautions. It's generally agreed on that dislocations are much less likely with hip resurfacing. Here it's even more confusing, because the PT is VERY strict about the precautions, but Dr. de Smet was just as clear that they aren't necessary. Interesting. Su actually goes so far as to give clients stretching exercises to do that specifically break the precautions.
Anyone have any thoughts or experiences on these two issues? Pretty interesting stuff....

[Pat Walter]

The only med I took was ibuprofen since their meds make my stomach upset.  I did not take my Advil with me and went to one of their pharmacies to buy some.  Interesting experience.

Using one crutch is much easier.  Believe it or not, one of the bilaterals that were with me was down to using one crutch.

Enjoy the Ghent experience when you can.  Beautiful place.

good Luck.

Pat

[catfriend]

From your reports they seem a little backwards on the drugs in Belgium. Never heard about this bone growing problem post-op with NSAIDs. Dr. P prescribes an anti-inflammatory after surgery. Celebrex is the only one I can tolerate. Everything else (advil, any naproxen types, aspirin, etc) result in stomach and intestinal pain so horrid it is often worse than the pain it was meant to treat. Hence, I took Celebrex for 30 days post-op. At my check up around the 6-8 week mark (I'd have to look up the exact dates) my bone and implant had grown together. At the time Dr. P told me the only way the implant was coming out was with surgery, so I wouldn't worry too much about it. I still take Celebrex when my left hip arthritis flares up. Celebrex is certainly available in Belgium. I've bought it in many countries.

I was under the 90 degree rule for six weeks. It was a pain, especially towards the end. I considered it one of the worst things about the surgery. I purchased a cushion from Amazon that I took with me everywhere. It raised the seat height such that I never violated the 90 degree rule. I have noticed that different docs have different rules on this, and there are competing theories, etc. I went with it, but I was so glad when it was over.