2 1/2 weeks since right hip BHR with Dr Smalzried

[Elmo Te]

I am a firefighter/paramedic/inspector in Los Angeles who suffered OA and the avulsion of a large chunk of acetabular cartilage in my right hip over 15 years ago.  This left me in debilitating pain for over a year, when I was finally able to get a debridement of the loose bodies and torn cartilage.  That improved my condition to what I considered 90% of normal for a number of years.  Later as pain returned, it was treated (through worker's comp) in conservative, and gradually increasing degrees.  I had PT, constant Celebrex, a number of x-rays and MRIs, acupuncture, with TENS occasionally.  My research brought me to this site 7 or 8 years ago, and I began to lobby for resurfacing.  I visited Dr. Smalzried, who felt I was a good candidate, but thought I had not exhausted the injection approach, which was giving very effective relief for varying time periods.  Also at that time, W/C was not really supportive of hip resurfacing.  But as a paramedic, I had seen way too many people with THR fall in old age and re-fracture the
hip/femur/implant which then became a virtual death sentence.  The idea of conserving the bone, allowing for revision at a later date if needed really appealed to me.  Also, I had been very active, and did not want to live with all the restrictions of THR.  Finally, there was nothing wrong with my bone at all, and as I am a fairly large guy (6'4" 225, 60 y/o), I certainly fit the profile of the ideal patient for HR (tho some might argue I'm at the outside limit age-wise, Dr Smalzried does not share that concern).

Time passed since my injury, I promoted from the field to the office work of an inspector.  I gave up golf and skiing, and all but the easiest and accessible climbing (I was a very active mountaineer).  I worked through the above described years of therapies, and exhausted the number of injections that W/C was willing to give me (5)  So I lobbied again for the resurfacing.

W/C seemed much more receptive to the procedure in 2016 than in 2007, and my W/C Doc started the ball rolling with a revisit with Dr Smalzried.  Then the W/C Doc left his practice abruptly and I faced a year of fighting to get a new doc, reestablish my baseline, and get back to the place I had been in the red tape.

Finally, on Nov. 14th, I was given the green light, with surgery scheduled with Dr Smalzried for Nov 20th.  Kind of abrupt, ran around trying to get the ducks in a row, and popped into St Vincent's in LA in the wee hours that Monday almost 3 weeks ago.  The surgery reportedly went very well and I awoke in my room  around 12 noon.  I had been given a general (propathol) as well as a spinal and femoral nerve block, and couldn't feel or move much.  Later that afternoon they tried to get me up to walk, but I still had no control of the leg, and I felt to be passing out just sitting up.  So I did not walking on the day of surgery.

Overnight and the next morning the spinal wore off, tho the femoral block still had my leg pretty numb.  One advantage was less pain.  They did get me up and I was able to do a circuit of the floor with a walker then, and again that PM.  My leg was still very numb tho, and I was not able to satisfactorily use the bathroom, and was kept a 2nd night.

Wed morning the femoral had worn off and I was grateful for the pain meds.  I was able to get up and with 2 crutches get around the floor, uses stairs, etc.  Still no success in the bathroom, but they sent me home.  Thursday was Thanksgiving, and I was able to attend the big family dinner on crutches, tho I did not eat as much as I would have liked (still nothing happening in the gut department).  Friday I was able to walk around the block with my daughters and the dog.  Took about 30 min with the walker.  This was the last time I used the walker.  I got through the weekend, appreciating the very rapid pace at which I seemed to be getting better.  2 crutches gave way to just one, the incision was fully closed with no more bleeding and I stopped using bandages. Finally Tuesday, my gut did it's thing (over a week?) and i was very relieved.  That had been probably the worst aspect of the surgery.  I started picking up my daughter from school everyday, 3 blocks on 1 crutch, and doing more around the house.

Now, 2 1/2 weeks post, and after 2 PT sessions, I continue to improve everyday.  The muscles are still sore of course, and I have begun to notice a pronounced "clunk" in the hip  occasionally.  No hip pain as such, just tightness and there is still a lot of tenderness at the incision.  I feel like I am doing pretty well, and on pace of a bit ahead.

Thanks for the info in over the years as I researched the procedure.  I will be happy to contribute what I can in the future.

Greg

[packman]

I am really surprised at the rate of your recovery to exercise. We all heal differently but in the first few weeks the risks of dislocation are higher from what I have been told. The implant stem supposedly needs time to settle. From my experiences with Dr Gross and Dr Schemitsch, your progression would be categorized as aggressive. Not sure the length of your walks or how much weight you are putting on the non-op side. I was always warned about over zealous PT's, and time is on our side - what's the hurry.
I have been puzzled about clunking as I have never experienced it - is that audible or a sensation like a stiffening limb that has been in a locked position for a while?

[Elmo Te]

Hi Packman

The clunking is a sensation, kind of like a knuckle pop.  Not painful, and I doubt that is is audible to others.

Dr Smalzried seems to subscribe to a "do what you feel comfortable doing" approach.  In walking, I can not step through without an aggressive shoulder shrug to get the momentum going.  With very slight un-weighting via cane or crutch I can walk pretty smoothly.  I admit that after PT yesterday, which upped the ante with a few more movement exercises and 10 min on the recumbent cycle with almost no resistance, then helping with Christmas decorations at home, I went to bed last night with more soreness then I felt in about week.

The rush is multifold.  I hope to be back to work by mid January.  Have a conference to travel to Superbowl weekend.  And I feel a bit guilty sitting home while my city burns.  Plus my wife wants me pulling my weight like yesterday.  With 2 teenage volleyball girls needing to go to tournaments/practice/school/dates plus taking care of her dad, she is feeling it.

[Pat Walter]

Hi Greg

Thanks for sharing your story.  I know many people will want to read it.  I am looking forward to your updates.

I wish you the very best.

Pat