Hip Talk Forum About Hip Resurfacing

Background
I am a 47 year old martial arts enthusiast and instructor. I was diagnosed with OA about 10 years ago; I now realise that this was due to femoro-acetabular impingement, and that my left hip had never been quite right. I started running and weight training at about 21 and always experienced some stiffness and soreness on this side. I'm sure that this problem has held me back in my sporting endeavours, and that I might have achieved more, possibly with less effort, nevertheless my fitness effectively peaked at age 45.

I am writing this in 'chunks' because I am on a somewhat ramshackle computer in a hospital room. I intend to blog my recovery and progress on here from time to time.

My diagnosis of F.A.I. came from a tutor at the anglo-european college of chiropractic in bournemouth, I'd had about 3 months of treatment for an incresingly stiff, sore and unresponsive hip, to no avail. At that time I was kicking Thai pads 2-4 hours a week, training and teaching Kali, and sparring, mainly with much younger partners. I used to run a 10k circuit around my home town, uphill and downhill, once a week as an indicator of my general well-being, I last did this on new year's day 2009. I came in about 2 minutes late and it took me about 3 days to recover.

Last year I had arthroscopy to relieve the impingement; the results were initially positive but as I integrated my usual training routine after a lot of rehab work the problem returned as before.

At the time I knew nothing of resurfacing, I was desperate to stave off replacement as long as possible, but with hindsight the joint was already too far gone. Arthroscopy might have solved the problem if I'd had it 10 years earlier, but had only been available locally for about 18 months.

The one year follow up X ray showed end stage OA, with no cartilage and cysts on both sides. I was now limited to upper body training only and static cycling, which I found relieved the pain somewhat, but did nothing for the range of movement.

Through this site and others, I researched BHR and its variants, and selected Mr Latham as my surgeon, fortunately this hospital is only 40 minutes drive from my home, I had already obtained e mail quotes from Drs Bose and De Smet but after speaking with Mr Latham and viewing his site I was confident he would do a good job.

I also had an N.H.S referral, but decided I could not afford to wait until the middle of next year.

I had the operation yesterday, 10th September 2010, I had been told that if the bone stock was unsuitable, I would receive a large bearing ceramic THR, as a last resort, but that this was extremely unlikely.

Meeting with the anaesthetist the day before, he proposed to use a spinal injection with IV sedation rather than general anaesthetic; I was happy to go along with his recommendation.

I went for the procedure at about 08:30, the spinal was a little uncomfortable, though sedation was already taking effect; I woke up in the recovery room at about 10:30, with no sensation below the waist.

T+3hrs: Feeling beginning to return in non-op leg, I'm back in my room, I receive a short visit from Mr Latham who says the resurfacing went very well, I can get out of bed as soon as I have sensation in both legs. I'm wearing pressure pads on the left foot and right calf which squeeze alternately to prevent blood clotting; I flex my feet and calves as much as I can.

T+ 5:30hrs With P.T. and nurse in attendance I stand briefly to relieve myself, I can support my weight evenly distributed and unaided. I manage to fill a bottle with a young lady on each arm - not something that happens every day.

Having experienced both spinal and general anaesthetics I can report that each has it's drawbacks. The general has more and longer lasting 'head' effects; the spinal, with a couple of milligrams of diamorphine produced ferocious itching, which started in the groin and spread over the body, I felt as if I had an entire flea circus dancing on me. Total constipation and most alarmingly, extreme difficulty in passing water, these effects lasted for 24 hours and tapered off over the next 12. On the plus side, I was fully compos mentis with no dizziness or pain.

At some point duriing the day I am visited by the anaesthetist; as I am concerned with the constipating effect of the Dihydrocodeine I've been recieving he agrees to change my prescription to Tramadol, which suits me better.

T+ 13hrs: I start course of anti-clotting injections, I also get periodic doses of antibiotic through the cannelure which is still in my right arm

T+ 24hrs: I am mobilised on crutches, walk to the bathroom and wash then start circulation and rehab excercises with P.T.

Foot rotations, clenching leg muscles in turn, seated quad sets, a short leg raise over a rolled towel, heel slides and lying abductions; I am to repeat these approx every 2 hours. I am delighted to find that although stiff and sore, my range of abduction is already better than in the last few weeks.

Mr Latham follows the rather conservative McMinn protocol, with movement restrictions for 6 weeks, 90* restriction, operated leg not to cross centre line and no closed-chain rotation on that side. I have a procedure for everything, getting out of bed, sitting and standing, in or out of a vehicle. As part of the package I've purchased, an occupational therapist visited the flat, supplied some mechanical aids, and demonstrated all this, so I've had a chance to practice beforehand.

 T+ 36hrs, the blood drain has been removed, the antibiotics are finished, and I'm able to get about on crutches by myself. I've done the bed excercises about 5 times today, and using an Ice pack constantly; I have no swelling and minimal bruising.

The spinal jab seems to have worn off, the unpleasant side effects of the heroin now gone, it beats me how people can get stuck on that stuff!

I feel as if I've taken a few good kicks in the trochanter region, or maybe walked a long way with the old injury, comfortable with the tramadol, just enough pain to stop me doing anything reckless.

Mr Latham is pleased with the X-ray, I should have a good range of motion. The pressure pads will go on again tonight, and tomorrow we start standing exercises.

I find myself more optimistic than I've been for a long time, I'm looking forward to tomorrow.

Hi Gary

Thanks for your posts.  People like to read about real experinces.  I hope you continue to do well.  Take it easy.  You will heal in time.  HOpefully, be home soon and able to do some walking.  Good Luck.  Pat

Cheers Pat, and I hope you are doing well too after your recent procedure. You can put this on the main site if you like or I could tidy it up and write you a proper article when I get home.

A comedy of errors last night: woke up about 0400 feeling uncomfortable; I really wanted to change position but with the pressure pads hooked up to the machine and a triangular block between my legs this is impossible. I decided to have some ice instead. I have been using a large pad which is refreshed by gravity feed from a bucket sized thermos flask full of ice water. You connect the hose to the flask, siphon the warm water out then reverse the positions to recharge. There is an air vent in the top.

I'd been using this thing all day with no trouble so I didn't bother to put the light on, hence didn't notice the vent was left open and managed to pour the contents of the ice bucket over myself!

So a nurse had to come in, change the dressing and put a fresh sheet on, I found standing for a few minutes relieved the discomfort. She then fixed the ice pack for me; unfortunately she left the hose coupled so I had to do it again anyway.

This morning, T+48 hours, got up, walked to bathroom. Washing, shaving etc. takes ages while observing the protocol and keeping the dressing dry. A nurse washes my feet and I have some blood taken for heamoglobin test.

I have some swelling today, which i'm told is normal, I do the bed excercises twice, once with P.T. in attendance. The range of motion is diminished from yesterday and I feel a lot less flexible, so I don't push it.

P.T. gives me a pair of stout walking sticks to replace the crutches and I practice a more fluid, natural gait instead of the shuffling 'cripple step' I've adopted with the crutches, walking is getting more comfortable. I feel that's enough progress for one day.  

In the afternoon the P.T. comes in and demonstrates the standing excercises which are pretty straightforward; front, side rear, I run through it once over a very short range which is pretty challenging in itself. I can't see any point in repeating it and suggest we crack on with it tomorrow.

I have another consultation with the surgeon, we had discussed discharging me tomorrow but I'm not in any rush as I still have a little bleeding from the wound, he takes a look and decides I could come out on tuesday if I'm ready. We also agree to lay off the excercise for the rest of the day.

I lie flat for an hour with the ice pack on, it's necessary to do this every so often to stretch out the scar. I've been advised not to remain in one position for too long; in practice I've found it uncomfortable to do that anyway, so I alternate lying, reclining, sitting, standing, and take a few steps with the sticks when I feel like it.

.

On a tangent, the food at Spire hospital Southampton is never less than superb and often outstanding - I mind what I eat and have enjoyed every single dish so far. The staff are friendly and welcoming, and everyone has a great sense of humour. No surprise then that I don't mind staying another day!

Enjoying your posts Gary.  Best wishes with your recovery.

Ed

Cheers Ed, I had wondered if anyone would make it through all that! More to come.

T+ 3days: Slept 7 hours, which is plenty for me, vivid dreams, presumably enhanced by the opioid painkillers. The effect of the pressure pads on the feet & legs while dreaming is worth mentioning. I've aquired earplugs, so the noise doesn't bother me, but it creates peculiar sucking, clutching and wringing sensations.

I remember one dream: I was walking on a wooden bridge, which was moving under me and slowly collapsing, my foot went through and I couldn't pull it out. Eventually I got loose and trudged across a muddy field, with deep tractor ruts, stumbling and periodically getting sucked into the mud. I woke up, looked down at my feet and all became clear!

Anyway, I got up at 07:30 took painkillers and went through my ablutions, breakfast at 08:00; sat in chair for 20 minutes, then did the bed excercises, interspersed with some upper body work on the bar over my bed. My range of movement is back where it was the first time but I didn't push it any further.

I have been warned that the flexibility will fluctuate like this for a while, so resolve to take it as it comes, I still have some swelling, it's confined to the upper thigh and outside of the hip but I haven't seen the 'elephant leg' some folk report. My digestion and other functions are back to normal.

Walking is much easier today, I can move around the room comfortably with one stick, but expect to use two when I go outside; gripping the window frame for support I did the standing movements I was shown yesterday, which are still fairly challenging to be honest. I did 5 reps of each then lay flat for a while with the ice on.

I find I really enjoy just standing upright and still, much more comfortable than sitting. After 10 mins lying flat I stand by the window, stretch my shoulders and back, do some breathing excercises. Then, in a plain, neutral stance, very slowly and gently, I run through the top half of the Siu Lim Tao from Wing Chun. The bottom part would break my movement restrictions and it's static anyway; my legs do not move throughout. I feel good (I'll qualify this in my next post.)

Subjective thoughts.

There's a strange kind of claustrophobia that comes from not being able to move freely, of course, some people have to live with this for a lifetime. I had a sense of it as my injury took hold and the range of activities open to me diminished, but right now it's a lot closer.

The sensation is intensified by being dependant on others, and especially by being dependant on drugs. I wrote the last post after my morning dose had taken effect; half an hour earlier I was feeling weak and sore, my backside seemed to have been roasted, and I approached the prospect of getting out of bed with some trepidation.

I am taking a fairly substantial opioid painkiller with 2 paracetamol, 4 times a day and an anti inflammatory once a day; I don't ask for it, although I could, I let the staff regulate the timing. After all, I spent 25 years building up my pain tolerance, and I don't want to ruin it.

So life has a rythym, and it's mediated by pharmaceuticals, not only the physical but the emotional sensations tend to follow this cycle. Tramadol has a distinct mood lifting component, (which is why I requested it) and I get on very well with it. I believe I read somewhere that it has a mild S.S.R.I. effect - that's anecdotal, by the way, don't take my word for it!

Right, time for another walk.

My left hip was done last Tuesday. Hooray, almost one week. We live in Park City, Utah a small ski town. I have been able to beat the closed in feeling that you have mentioned by taking walks and seeing the beauty of fall in the mountains. My hope is to visit the slopes more intimately in a few months when there is bountiful fresh fluffy powder. The more I walk, the more I feel unrestricted. Careful though not to overdue. Your writing skills indicate a background in literature or perhaps publishing. Very descriptive choice of words. I am enjoying your posts as well. Good luck. Rick

Cheers Rick, I'm highly encouraged that you're walking in the mountains already, my vista is limited to the hospital corridor! I did a flight of stairs this morning under supervision and I should be out tomorrow if the wound is in order. Do let us know how you get on.

I'm a test engineer actually, basic factory fodder, but I do enjoy writing and it fills in the gaps between the rehab exercises. I hope I've still got a job to go back to so I can pay for all this!

Dom,
the N.H.S. is a blunt instrument but I'm glad it's there, I know there are plenty of people who'd like to do away with it. I was told that NICE wouldn't fund arthroscopy for impingement so I had to pay for that as well.

Now I'm a professor of hindsight, having wasted 6.5 grand and a year of my life; my non-medical opinion is that arthroscopy works well if it's done on the athlete before significant OA sets in. It's a very new treatment for a relatively new diagnosis, so you and I are part of the learning curve. My original surgeon was a pleasant chap who told me I had an 85% chance of getting another 5 years out of it. I've only myself to blame, I was clutching at straws, no one told me to have it done, but then no one suggested resurfacing either.

Now to your problem, resurfacing on small-boned women is controversial and many experienced surgeons won't touch it, but there are a few who have a high success rate. I urge you to get your X rays looked at soon by one of the top blokes and see what can be done to avoid revision. Best wishes G

Thanks Dom, I replied on the other thread, just a quick thought - it wasn't an ASR device was it?
Take care, G

Tuesday morning and time for discharge. I'll rephrase that, I've been signed off by the surgeon, P.T. and nursing staff, the wound is healing well.

Slept a few hours overnight, from 04:00 I was decidedly uncomfortable; the nurse came in for the usual checks and gave me a couple of paracetamol, I did my best to conceal my disappointment, spend the next few hours repeatedly iceing everything.

At 07:30 I get up and go for a wash, I really don't feel like it but need to get sorted before breakfast at eight, and I can't stay still much longer. In comes the lovely Holly, my favourite student nurse; "tramadol for you!" I'm out of the bathroom like a bullet out of a gun. In 15 minutes I'm my old self again.

Breakfast, short walk, then excercises, I do my 20 mins lying flat while I call the personnel manager at work. I have a sick note for 3 weeks, I'm allowed 6; I suggest that I might return sooner if I am sufficiently mobile and my protocol can be met, I've already done a quick risk assessment on my work area and I can see this is perfectly feasible. I've got 6 outpatients appointments included in the price so I will be reviewed weekly anyway.

Hi, The ASR device was made by DuPuy, and has been withdrawn because of it's high failure rate, though some surgeons swear by it for small patients; it seems that there is no margin for error in positioning and the instrumentation is poor - or maybe some of the devices were just faulty, opinions vary, as with everything else in this game!

I've got a Finsbury Adept; as I understand it, Finsbury were the original maufacturers of the BHR. Derek McMinn sold the business to Smith and Nephew. Finsbury remain faithful to the original technology and my surgeon knows them well so he trusts the device, he is really a disciple of McMinn, the rationale being that his series has the longest history of use and consistent success rate.

Finsbury is now owned by DuPuy - complicated eh? Let's hope they don't screw it up!

I'm glad you have a BHR anyway, should be ok if it's been put in straight. I've just had a look at my X ray and the angle looks spot on 45* to me.
G

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

Quote from: gary2010 on September 14, 2010, 05:38:27 PMThe 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.

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..

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

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

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?

Quote from: gary2010 on September 15, 2010, 12:18:14 PMThe 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.

Quote from: gary2010 on September 15, 2010, 12:18:14 PMpain 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.

Quote from: gary2010 on September 15, 2010, 12:18:14 PMI 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

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

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?

Gary,

You there? I want to read your daily update.

How far can you walk now?

Dan

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?

Quote from: gary2010 on September 18, 2010, 10:14:55 AM
I see you're living in Thailand, Where did you start from?

I am from London, mate.

Quote from: gary2010 on September 18, 2010, 10:14:55 AM
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.

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.

Quote from: lopsided on September 18, 2010, 11:11:49 AM

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!

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

Quote from: gary2010 on September 19, 2010, 08:40:17 AMPMSL, 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.

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.

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.

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!

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.

Hi Gary!
Sounds like you are getting along quite nicely. Just an add to your last post; yes my quads get very tight after exercise and bending the knee while on my back pulls on the quads. So, I believe your tight quads are par for the course. I continue to massage and stretch the operated leg most of the day. I found the best message is to use my crutch (stick) and push the metal tube up and down the muscles. This really keeps things loose. Rick

My walk in the mountains of Utah this a.m was spectacular. Fall colors combined with a heavy rain last night made the morning so enjoyable. Our tempertures are starting to cool quite a bit. This a.m it was in the mid 30 Cecilius. Just gorgeous.

Gary and Rick,
Looks like you guys are doing just great.
Remember you don't have rush things but the best advice I can give you is to work at developing a perfect walking gait,hips even and aligned, try not to drop them. I had a significant and painful limp for several years prior to my HR, compensation had caused altered movement patterns, permanent pain in lower back and the groin. I was walking with a stick from day 2 post op and my surgeon and physio made it clear that the goal whenever walking was to do so without a limp and I was to keep the stick until I could walk perfectly without it. I remember reading the polls on Pat's site, where hip buddies were walking unaided in 4 weeks. Well guys it took me 6 and a half weeks-but my friends although I was a little disappointed that I wasn't able to tick the box after 4 weeks, I was delighted at how brilliantly I could walk. Plus all hip, back and groin pain has gone completely for the first time in years, I had a georgeous hip, beautifully aligned (by the way I had a major fracture of the femur 30 odd years ago-pin and plate-I was never properly aligned still did lots of sport and messed up my hip in past 30 years running mostly 1/2 marathons-had 3 cartilage ops too).
So it aint a competition-just do it well and you'll reap the rewards.
Gary-in both Vick Marlow's recent Interview with Derek Mcminn and still on his updated website he talks about waiting a year before running-where did you hear of him changing this advice? I'm nearing 8 months and I know I could run (tried couple of easy jogs-felt great) but although Prof Cobb (and Jeremy Latham) say ok after 6 months shouldn't we go by the godfather who has not had single loosening/wearing after 13 years?
BW
Toby

great advice!

I'm back on 2 sticks for the time being, using the alternating technique; I had a slow, rather difficult walk today and I'll leave it at that. I think such progress as I've made has been masked by cutting my painkillers from 6 hourly to 8 then 12 hourly, which makes an enormous difference to what I can do.

It's hard to know how far I'm walking at home and often not using a stick at all. Plus I'm spending a lot of time sitting at the computer although still following the 20 minute rule. I think sitting is the real killer, the only other option is lying flat which is tedious in the extreme!

Lots of people have reported that their anti coagulants prevented them from sleeping and I seem to be experiencing the same, I would have expected to have got used to it by now after 2 weeks, also an overnight headache, which could be a side effect, or maybe my neck getting used to its new position.

As for running, I expect it depends on the patient. The main concern seems to be femoral neck fracture, and the risk is significantly reduced at 6 months. I have read that bone remodelling is complete at 6-9 months, and also that it takes 12. Now this takes no account of bone density before the procedure, some patients will have been virtually non weight bearing for a couple of years, while others will have remained active. I squatted 12 x 100 kilos the night before I went into hospital.

Mr McMinn doesn't look like he does a lot of running, his advice is to start on the treadmill and I would strongly disagree with this as I find treadmills exremely jarring and tiring to the muscles, it will depend on your running action. Dr Bose says 3 months and he doesn't have any failures either. I'm sure I will know when I'm ready.

I've had 2 rest days now just doing the ROM exercises with no walking outside the house. The hip pain is easing off but the headache and insomnia is worse than ever. I spoke to Mr Latham on the phone regarding possible side effects of the anti-coagulant and he suggested I stop it for a couple of days and report back. Otherwise it must be the neck, I'm going to replace my orthopeadic memory foam pillow tomorrow.

gary, sorry to hear about some of your latest issues. as far as the headaches are concerned, i have been experiencing some as well. i thin that it is related to the blood thinners. i had to increase my dosage and that's when i started to feel the headache. i took Tylenol a couple of times and that seemed to to the trick. all gone! i hope all continues well. rick

Quote from: gary2010 on September 26, 2010, 11:37:34 AM ... but the headache and insomnia is worse than ever.

Gary you have just been through a big operation. Not only the blood thinners, but you might still have the effects of the general anesthetic and morphine in your system, and you could also be dehydrated, low on potassium. Try drinking a few glasses of water.

Thanks, I drink gallons of water, and a lot of orange juice. I had spinal rather that general anaesthetic and this wore off after 36 hours.

We normally use paracetamol for headaches and I've been taking 8 a day, which is the maximum. To chuck another variable into the mix I reverted to my own side of the bed last night and actually slept a few hours, the headache is tolerable today.

On the plus side, swelling's gone down, I've got my new pillow and I'm walking again!

Gary,
Glad to hear some positives emerging from the past couple of days. Sure hope you get shot of the headaches-now you're off the anti-co's-(I was never prescribed them so have no experience here) and -that you can line up some serious sleep.
Keep progressing
Toby

I slept well last night and the headache is almost gone, I'll go without again today and if all goes well I'll resume the treatment just to prove the point.

I've got the tramadol down to one a day now, if I could get out from under that I'd consider going back to work.

Thanks, Gary, for your detailed log.  It has given me a sense of comfort knowing what "it feels like" post surgery. 

I am waiting for my doctor's appointment to define the surgical approach and date for procedure.  I have had two labral tear/ debridement arthroscopies that have failed to give me back my motor skills and now the next procedure will involve the resurfacing due to avascular necrosis. 

Will keep in touch!

Juan

T+ 3 weeks: I've resumed the anticoagulant but I take it early in the day; I see from the literature that the half-life is 5-13 hours. I'm sleeping well and the headache comes and goes but is tolerable. If the effects turn out to be cumulative I might miss the odd dose.

Had physiotherapy appointment on wednesday, my range of movement has improved (though I can't say I'd noticed). Added supported lunges and step ups to my programme. I dropped into the gym last night to see how my Kali class was faring in my abscence, joined in with some footwork drills (forward, reverse and lateral triangles - no twisting.) I managed the stairs in normal fashion using the 2 sticks.

Today I had a good walk on the golf course, 38 minutes at a fair pace over variable terrain. I can walk a very short distance stickless without limping but I need two to make it perfect. There is definite progress, I can lie on the operated side, with a cushion between the knees, I can comfortably get on the floor and do press ups, which is nice. I've started to rub out the lumps and knots around the scar with a commercial manuka ointment so it looks a lot tidier.

Quote from: gary2010 on October 02, 2010, 12:36:01 PM
T+ 3 weeks: I've resumed the anticoagulant but I take it early in the day; I see from the literature that the half-life is 5-13 hours. I'm sleeping well and the headache comes and goes but is tolerable. If the effects turn out to be cumulative I might miss the odd dose.

Gary,

Three weeks is when I was told that I could stop blood thinners. Are you sure you need them now?

Keep walking.

D.

Here they prescribe 35 days after hip surgery; my surgeon is a belt and braces merchant, but he did say the risk was pretty low and I could stop if I wanted. It's not a blood thinner as such anyway - http://www.xarelto.com/scripts/pages/en/targeting_factor_xa/index.php
It's very specific and side effects are rare, though I do feel a bit 'wired' on it so I take it in the morning now, may as well finish the course.

I got on the static bike yesterday for 15 minutes, no resistance and still observing the 90* rule. That was in place of one of my walks, it's episcolating with rain here, couldn't justify bringing dripping waterproofs into the house for a short stroll. No ill effects from that today.

Quote from: gary2010 on October 03, 2010, 09:16:46 AMit's episcolating with rain here,

So that golf course has got good, bad and highly religious days too.

As for traveling abroad for surgery, I would recommend a warmer climate for recuperating.

It looks like the European team is staging a great comeback and set up for the individual play at the Ryder Cup. Hate to be bias here Gary, but go USA. Keep up the good work. Rick

Ha! They hold the ryder cup in Wales in october and it rains! No surprise there, many a time I've approached the Severn bridge facing a vast bank of black cloud, black as coal - it's the miners' revenge I think. I'm afraid my interest in golf is limited to having a large green space in the centre of town, but good luck anyway.

I'm about to try getting behind the wheel of the car; hopefully I can get out again without calling the fire brigade.

T+ 3 weeks 6 days: I can drive short distances, 20 minutes maximum, the seat is right on my 90 degree limit; I'm now down to one stick and no painkillers, operated leg won't quite take my full weight yet. I'm walking 90 -120 minutes a day, mostly on grass at the golf course; each walk is preceeded by 10 minute static cycle without resistance, this seems to loosen me up and minimise the limp.

I've made a lot of progress in the past week but it requires me to be totally strict with the exercise programme, walking, rest intervals, icing etc.

I'm convinced the anticoagulant therapy (rivaroxaban) has a cumulative effect; I've trawled the internet looking for an explanation but so far drawn a blank. I'd been using a small dose (2.5 - 5mg) melatonin to help me sleep; yesterday I forgot to take it and was up all night, despite having had a pretty tiring day. I took the A/C tablet in the morning, 2 cups of coffee and found myself overstimulated in a not entirely pleasant way - "have another stick of gum" etc. Blood pressure was normal, pulse slightly elevated (75).

My guess is that it works as an adrenaline agonist, or possibly a MAOI, subjectively that's how it feels, or maybe it's just me? It's certainly an appetite suppressant. I'm not taking anything else now exept a few paracetamol.

Gary,
Sounds like you're making very good progress. Just to compare notes and offer some observations. My post op protocol didn't allow me to drive for 6 weeks (check insurance covers this-something to do with reaction times etc in manual cars). Nor encourage as much walking as you're doing, instead the emphasis was to really concentrate on developing a good gait/perfect walking style-without a limp -when using the stick-I( had a stick from day 2). I didn't have the anti-co's (they sound pretty awful) I wore those beautiful ted stockings. I started on the bike just before 4 weeks-10  min's  a day and simply went up 5 min's each week-adding resistance around week 6-at 4 months I did the London Bikeathon 52 miles(without a twinge!). The other aspect of my regime was hydro, as I said previously it's fantastic for all rom, strengthening and particularly walking. Swimming started at 4 weeks including breastroke without full leg kicks.
Keep up the good work
Toby

Hi toby, that's interesting; I was strongly advised against breast stroke although I don't like it anyway. Getting in and out of the pool without breaking restriction would be rather ungainly I think as it doesn't have steps. It's a pity I'll be back at work by the time the restrictions end, early evening the baths are too busy to get anything serious done.

I wouldn't drive a manual car either, on mine I have a cushion on the seat and the operated leg is stretched out virtually straight the whole time. I won't be bothering the insurance company with it; they are useless and I'm still in dispute with them over an incident in february. Subjectively I would say driving is more comfortable than it was before surgery, and the hardest part is still getting into the car - though I'm more careful now.

I always seem to walk further than I intended, it's very pleasant out at the moment and I just get carried away, though I wil stop and sit for a while. Late last night I went for a long march in the hope that I might feel like going to bed afterwards. Stumping around the house doesn't give me much opportunity to work on my gait, I still have a significant limp and if I can't get rid of it by the time my sick leave runs out it could get stuck.
Best wishes G

Quote from: gary2010 on October 08, 2010, 08:20:14 AM
I was strongly advised against breast stroke although I don't like it anyway. Getting in and out of the pool without breaking restriction would be rather ungainly I think as it doesn't have steps. It's a pity I'll be back at work by the time the restrictions end, early evening the baths are too busy to get anything serious done.

I have also read somewhere on forums that you should not do breaststroke soon after hip surgery. But I do. And I think it helps. You are not crossing your legs over, extending passed ninety degrees or breaking any other post-op limitations.

D.

Gary,
Like lopsided said, I too read some postings from patients about avoiding Breastroke-but I checked it with my surgeon, heard of others who were doing after a month and also saw that Ronan Treacy recommended it in his booklet. Obviously the concern is dislocation caused by extreme movement (but dislocation's pretty rare with an HR)and as I said I started without full leg kicks. Tell you what though buddy, I swim every Saturday (2.3km in the hour-alternating crawl/breast) and now I'm swimming faster than ever cos I can breastroke kick fully and without any pain. Also, not all surgeons/patients have the 90 degree protocol (my surgeon's physio said don't be too anxious about it). As you're able to drive-is there a nearby hospital which has a hydro pool that you can book in for before returning to work? As Pat has mentioned (Dr De-smet has a strong pool exercise regime as does my surgeon)and I can't agree more that in the early weeks this is so beneficial.
Before surgery I had a significant limp, severe groin pain, back pain and my (right) unoperated hip was becoming increasingly painful and stiff. Since my HR and developing perfectly aligned walking-all these issues have disappeared and furthermore my right hip which has the freedom to be itself, feels brilliant. This is why I'm so convinced and try emphasise the importance of working at the gait.
Move Well
Toby

T+ 4 weeks, 2 days. My operated leg will support my weight comfortably for 10 seconds or so. Balance exercises, lateral stepping and walking backwards added to the rehab programme. I might as well just train the Kali footwork matrix! I had a Malaysian Kung Fu instructor once who said one step backwards is worth a thousand steps forwards - ever tried using the eliptical trainer in reverse?

I think the breast stroke advice came from a P.T. at the hospital, but they do err on the side of caution. I am still not supposed to lie on the other side, though I have been doing this by gripping a cushion between the knees and putting the feet together. I simply cannot lie on my back for long, if I don't turn over I just have to get up and walk around.

As a matter of interest, I absent-mindedly crossed centreline on one occasion; it's an old habit of mine to stretch the hip by placing the foot on the opposite side and leaning over it, I must have been doing this for a minute or so before it dawned on me - I experienced no ill effects whatsoever.

I'm going back to work on wednesday, at T+ 4 weeks 5 days, I shall continue to use a stick, observe the protocol and walk twice a day.

T+ 5 weeks 1 day; I can now walk for an hour at a cracking pace without wanting to rest. The limp is almost gone, I've swapped the hospital stick for my old curly handled cane, it rolls nicely in the hand and I can hit every other left step if I want.

I'm doing fine back at work and fit my exercises into my breaks 40 minutes driving is enough, I split longer journeys.

Taught Kali & Panantukan for 2 hours on friday no problem, lots of footwork drills. The only thing I can't do yet is turn on the ball of the foot; the gym has soft mats and the friction puts the torque through the hip. When this fades to a mild discomfort I'll use it to improve my mechanics, really looking forward to hitting things again!

T+ 6 weeks 4 days: Started hitting things again, just a little pad work with a mate in the back yard. No problem with the hip/legs but I feel it in the rib cage 2 days later, hurts to laugh! So that’s what it’s like when you stop for 6 weeks! Never stopped before.

This week’s progress is I now get in and out of the car normally, and sitting for long periods is no longer onerous, just a slight dull ache. I’m up and down out of the chair all day without thinking about it.

If I hadn’t done so much reading on the subject I would say it’s all over and business as usual; I can walk for miles, the stick is virtually superfluous but I’ll keep it handy for a while longer, I’ve got attached to it. I’m doing balance exercises on the operated side and a short one legged squat, I feel a slight lack of proprioception.

I feel like I could run if I wanted to, but I’m going to avoid impact for the next few months while I rebuild the muscle, if I catch the foot or slide on a wet surface it feels horrible, last time was about a week ago, but that’s the only reminder I get of the procedure.

Hi Gary

Glad to hear things are going so well and you are being conservative.  Remember 6 weeks is not the point you are healed yet.  6 months is when most surgeons turn you lose and some want you to wait a year before running.  So enjoy the new hip, but take it easy a little while longer.  Six weeks is a time when many people are very stiff after sitting.  That's the point I did the water exercises to get rid of that stiffness.

Good Luck.

Pat

Gary,
Amazing progress! What... feel like you can run-incredible!
Keep up the good work but follow Pat's wise words.
BW
Toby

Thanks everyone, update at T+ 7weeks: I saw the surgeon on thursday and he was delighted with my progress; I put this down to 3 months of preparation when I maintained my strength with cycling, isometrics, squats and negative reps, plus I've devoted myself completely to the rehab since surgery. I now have full resistance on the bike but not quite full speed, eliptical trainer forward and reverse, and bodyweight squats against the wall with the swiss ball behind me feels really good. I've been told I wouldn't get much benefit from hydrotherapy.

His advice was to continue with bodyweight excercises and stretching but avoid heavy weight training until the new year and no impact for another 4 months, I intend to take it, as it's worked out spot on so far; the movement restrictions became irrelevant just after the 6 week point.

Just managed to tie shoelaces and put socks on, I can squat deep and get up unaided but hold something to steady myself just in case. My feet are blistered from walking so far yesterday but the hip feels fine, went to reggae concert in the evening and had a bit of a jig about.

T+ 8 weeks 5 days: Can touch toes, use rowing machine, deep squat unaided, back to climbing stairs two at a time.

T+ 10 1/2 weeks: Can walk forever, still take stick but often put it on the other side to work the left a bit harder, no problem with steep inclines in either direction.

I can now get a leg workout at long last! Static bike full speed and resistance as before, running pace on eliptical trainer - stilll avoiding impact. Bodyweight squats with swiss ball against the wall, going slowly down to 90 degrees and up again, sets of 100 reps, surgeon has advised against heavy loading until the new year.

The only thing I still struggle with is getting up off the floor without using my hands, but I'm working on it.

T+12 weeks, the turning on the ball of foot is comfortable now, working on my boxing footwork which feels a little rusty. The only significant weakness I have left is with abduction with bent knee. I've been using one of these machines in the gym, seated abduction; it's on a 'ladies' setting and still quite hard work, easier if I lean forward. I intend to work on that with low resistance for a month before I give myself any new challenges.

Fantastic progress! Nice job.  (But don't get carried away....)  :)

Quote from: gary2010 on December 03, 2010, 06:03:43 PM
...before I give myself any new challenges.

You seem to be doing very well.

What new challenges Gary?

Hi Dan,

well those abductors are also stabilisers so I'd want to get them strong before I start running. The weakness is in the range of motion for the round kick, if you can imagine that; I just go through the motion lying on the floor at the moment, again I shall have that sorted out before I actually attempt to kick anything.

Also there is the issue of flexibility on the ground, I used to be able to circle my legs underneath the body (windscreen wiper exercise) and get up from any position without using the hands. Even before the op I could do it but it was extremely painful - that's impossible right now.

I've started a programme of balance exercises on my home made rocker board this week.

T+ 15 weeks 4 days,
rounded off the year with a vigorous sparring session with my colleagues at the Gladiator Academy. I opted for boxing only, no kicking or grappling at this stage but I was well pleased with my fitness and movement. Had a nice long walk afterwards to loosen off and I now feel absolutely fine. It's great to be able to play again. In the last week I am just able to raise myself off the floor with the operated leg. Still working on those abductors!

Hippy new year to you all! x

Quote from: gary2010 on December 27, 2010, 01:43:13 PM
T+ 15 weeks 4 days,
rounded off the year with a vigorous sparring session with my colleagues at the Gladiator Academy. I opted for boxing only, no kicking or grappling at this stage but I was well pleased with my fitness and movement. Had a nice long walk afterwards to loosen off and I now feel absolutely fine. It's great to be able to play again. In the last week I am just able to raise myself off the floor with the operated leg. Still working on those abductors!

Hippy new year to you all! x

Glad to hear about your return to sparring. I'm also thinking of the right way to return to it, thought that boxing only was the best way. How did your hips hold up on hooks? jabs? I imagine the straight punches were the least problematic.

Quote from: gary2010 on December 27, 2010, 01:43:13 PM
T+ 15 weeks 4 days,
... with a vigorous sparring session ... Had a nice long walk afterwards to loosen off ...

Gary, I enjoy the juxtaposition of your description of your exercise.

Does all this cold weather (that I am thankfully missing) affect your hip, or is the metal impervious to it?

D.

Hernanu, I've been doing heavy bag and focus pad work for a while now so I know I have sufficient range of motion. Before that I experimented with a slow, tai chi style movement of everything I wanted to do, which is a method I often return to when I'm injured. Sparring was a bit of a gamble, my friends are all MMA competitors and instructors so operating at quite a high level - but I just couldn't resist it!

The only problem I had was an occasional sideways stumble due to the weakness I still recognise in my abductors, I managed to keep my footing however. The turning motion is fine, there was quite a bit of clinching on and off the ropes going on; I wouldn't be happy about getting kicked in the thigh or having the foot swept just yet, I suggest getting reliable partner/s make them aware you're still in rehab and agree the format before you start - good luck!

Dan, the cold doesn't bother me at all, I've heard that it makes a difference to some people, it's been about -5 here at times and I go out marching in it every chance I get. I really don't feel as if there's anything in there, I only get the little 'twangs' occasionally which I imagine is a tendon moving over some scar tissue. By the way, my surgeon cleared me to have chiropractic in the new year, which I will do because my mid back is extremely tight.

Out of curiosity I enquired about the size of my implants, I have a 56mm cup and 50mm femoral component, I presume these are both measured on the outside surface. Cement was antibiotic Simplex.
Best wishes, G

Sounds good, Gary - I'm probably going to start on heavy bag work after PT, after talking with the therapists. I want to get back to all the bag work and at least be confident of the footwork in the short term. It will be really nice to get back to full power on the heavy bag and the pads.

Kicks will have to wait a while, I figure.

I agree, I think an effective round kick is going to be the last thing to master. For now I hand on to the wall, raise the knee and go through the motion slowly; Savate players do this, they have wall bars. Or you can lie on the floor and cycle the kick - I got this exercise from Guro Phil Norman who is a superb kicker. My abductors are still weak, Mr Latham "does not touch the gluteus medius" so I'm imagining it must be the retraction which is responsible, as of last week I still couldn't get up from the floor without using my hands.

Muay Thai is very important to me and I hope to return to it eventually. If you want a comparable power-based workout try hanging up a car tyre and get a pair of sticks, I use sledgehammer handles, remember the power comes from the body not the arms, or you'll hurt your shoulders, tether it top and bottom and it moves unpredictably, I've been doing this for years and still find it challenging. You can also punch and knife the thing for variety.

At 18 weeks I've added weighted squats, I started with 20 reps at 60 kilos then 12 at 70 and 80, that was enough (and I'd squatted 12x100 the night before I went into hospital). I'm still marching on the public golf course when I'm at home, the stick goes with the right leg to work the operated one a little harder. I confess I've started to break into a run from time to time on short steep inclines about 30 seconds at a time. I'd taken to swinging the stick in downward figure 8 on the uphill bits to get the lungs working and I couldn't resist a bit of a scramble.

I think this is safe because the incline a) reduces impact and b) causes the foot to fall directly beneath the body, the ground is very soft, it causes no pain whatsoever.

Having said all that I've found it helpful to take a step back every so often for a few days to consolidate the gains; next week I'm going to stick to bodyweight squats, static cycling and lunges.

Good suggestions. I've been going through the motion on the floor, although at 6 weeks, it's still slow going. The PT people had me doing 200 lb (90 kg?) leg presses at 10 weeks for 30 repetitions. Nowhere near what I was doing previously, but seemed good for both strenght and stretching. Unfortunately for a non-patient person, pacience is important now.

Well I weigh about 200lbs now anyway! I found stability a limiting factor in the squat. I have access to a Smith machine as well so I might try that for variety. I can find plenty of ways to torture myself without putting it at risk!

T+ 21 weeks 6 days.

I spent 4 of the past 8 evenings training with Guro Rick Faye, founder of the Minnesota Kali Group, on his annual U.K. seminar tour. The hip coped well; groundwork felt a bit creaky at first but got easier as I warmed up - it was never my strong point anyway.

Several times last night I unconsciously got up from the mat without putting a hand down. Now whenever I've tried to do this since the op I've been unable to 'feel' the start of the motion and just floundered around; I wondered whether this was just weakness in the abductors or if some nerve connection had been lost. After a few repetitions the muscle was fatiguing so I gently assisted with a light hand pressure, but the muscle memory is definitely still there, I feel fine today, I'll work on this for the rest of the week.

T+22 weeks 6 days:
Just to prove it's not all plain sailing, today finds me walking like Douglas Bader! Using the abduction machine last night, at quite a light setting I felt a sharp twinge in the left groin area, enough to make me stop immediately. I got on the bike which felt all right but found myself losing strength and slowing down, so I quit after about 12 minutes. Today I am very stiff and sore and can only raise my left knee with difficulty, curiously, abduction is no weaker than before. I've no choice but to back off for a while. I'm coming to the conclusion that the machine is a bit harsh for this stage of rehab.

Until that everything was going fine, last week I was jogging round the soft mats in the gym and ready to start proper running at the 24 week point. It does feel like I've torn something though, no idea how long it will take to heal.

Sorry to read this Gary. Get the ice pack out.

Given the location of the discomfort, I don't think ice would bring much relief! I resorted to voltarol and a bit of codeine last night because I was struggling to get in and out of the car. First time I've taken any medication since about week 3. I can walk today so I think I've got away with it, still a bit stiff, I wish I knew what was going on in there - tendon chafing on the edge maybe? When I did it I wasn't using heavy resistance or extreme range of motion so it's a mystery.

T+23 weeks:
Pleased to report that I feel a lot better today; my chiropractor diagnosed a psoas sprain. It seems this muscle can partially compensate for weakness in the gluteus medius so it all makes sense now. It follows that seated abduction machine is not suitable for rehab so I'll stick to side raises and 'air kicks'.

Looking around the forum trouble with the psoas and it's tendon seems to be very common among the newly resurfaced.

This was the worst setback I've had so far as it put me back to square one for a little while, but a worthwhile lesson nevertheless, as I was starting to feel invincible. I reflect that without the surgery, a prang like that would have left me lame for more than a week.

Gary,

You can abduct using resistance bands (the ones they give you in PT even) as well as adduct, and flexion and extension. My PT actually said it is better than the abduction machine and the cables. You can really isolate the muscles and work in all planes of motion. Just be sure to keep your core stabile and aligned. Work both legs, even the non-operated side because it will force you to use your stabilizer muscles on your operated side.

June

True, my PT has me do bands around my knees, then clamshells (knees bent, on one side, 30 raises without moving the hip) always do both sides. I've only had a twinge in that area once, while touching my toes once.

T+ 26 weeks
I saw the surgeon yesterday, he's pleased with my strength and range of motion, I'm making excellent progress notwithstanding my recent prang, which seems to be tendon or ligament irritation and recovering normally so nothing to worry about.

I'm going for a little run on sunday, not goal-oriented, just to work on my gait and see how it feels; I've loosely committed to a bit of cross-country at the end of the summer. I shall stick to grass for a month or two anyway.

I feel I'm about half way.

Gary - thanks for the detail documentation of the work it takes to get back to doing the "fun stuff"  I am just 2 weeks post op and enjoying good long walks and planning my next bike adventures.

Cheers - Phill - Cleveland - USA

Welcome Phill, good luck with it, I'm enjoying the running now!
G

That's good news, Gary - so no repercussions from the strain?

No, I lost about 4 weeks progress, but I'm back on track now. The surgeon actually said he'd never seen a patient doing as well at 6 months - and he's done over 700, so I think I can relax anyway!

Quote from: gary2010 on April 05, 2011, 06:32:36 AM
No, I lost about 4 weeks progress ...

No you haven't, Gary. Progress is not even and you cannot map it. A bit of up and down.

D.

I am 3 weeks post now this weekend

Walked 3 miles yesterday in an hour - good trip outside, also got on an exercise bike for a little time this week.  Still doing range of motion

Sounds good Phill, I'd say it's going well.

T+ 30 weeks 3 days
I started weighted squats again last week 20x60 and 12x90 kg, and kicked the heavy bag around a bit last night, maybe 30% power, but it's been a long time. I honestly didn't know if I'd ever have a round kick again, I feel a bit clumsy sometimes, as if I don't quite 'own' that leg, but now I believe everything will be possible eventually.

T +33 weeks 4 days

First road run last night, a modest 4k, the pace dictated by a much younger partner; no ill effects this morning, I can round kick with the operated leg quite comfortably, though not full power; squats now up to 12x100kg.

The interesting thing is that I can run on consecutive days without getting sore, although I'm only doing short durations at the moment. I've never been able to do that, even in my 20s I used to have a long one once a week, and the hip would always stiffen up.

Still a lot of work to do, it's so long since I've felt normal I can't remember what it's like...

Nice. I've noticed that I'm doing some stretching (carefully) that I was never able to do. I can get down to the floor palms to the ground with the legs straight like before, but I had problems with the stretch where you sit, pull your feet together towards you bending your knees and then let the knees go sideways.

I could never get a good stretch (my instructors could not figure it out, resorting to pushing sometimes). Now I can easily stretch those sideways (again - Carefully) and without any strain get past my best when I was in full training. Really cool.

I'm glad you can do consecutive runs without problem, seems like there are some things that we'll be able to do that we may not have been able to before.

T+ 36 weeks
Nothing much to report now, just enjoying training like a nutter again and wishing I had more time! Back to regular kickboxing class, extending the runs, squat 12 x 110Kg the flexibility is coming back as well.

Which hip feels better, your operated hip or the other side?

Quote from: gary2010 on May 20, 2011, 06:06:31 AM
T+ 36 weeks
Nothing much to report now, just enjoying training like a nutter again and wishing I had more time! Back to regular kickboxing class, extending the runs, squat 12 x 110Kg the flexibility is coming back as well.

Nice. I'm a bit behing as I'm about T +36 wks. on the left and T + 24 wks on the right. The left definitely feels better, the right is just now getting strong enough to do some more intense stuff. I'm doing some more advanced stretches (lay on the floor, do a circular stretch of each leg - think inside and outside crescent kick) with both bands and the roller. I still can't run yet, but can do the 30 x 210 lbs (95 kg) leg press.

How is the kicking in the kickboxing class? are you back to full contact on the bag on kicks? how about knees?
(Sorry for the barrage, but I'm excited to hear this).

Kick boxing - I continue to be amazed - just amazed. 

I thought I was doing good riding my 15 miles on the bike with clip in shoes.  Keep it up - congrats

Cheers - Phill

I'd say both hips feel about the same, I get a little stiffness in the glutes from time to time on both sides, knees are fine. I'm aware that the left (operated) side is not up to full strength yet. I ran 6k on saturday with my young friend who left me standing on the final hill! I was aware that I was starting to limp slightly so just dropped to a gentle jog and let her go.

A couple of hours later I'd recovered and taught martial art class in the afternoon. The important thing is that the hip didn't hurt afterwards though I've caned my legs lately and I can feel it in the quads and calves. I'm impatient to get back to my pre-injury level but it's been 2 1/2 years since I did any distance. I've done too much training at my own pace, need to start adjusting to other people's now.

Kicking feels like I'm starting from scratch, nowhere near full power, I'm working on accuracy, form and balance, when I spar it's 'light continuous' rather than full contact. I think it's worth limiting impact for a while longer, though I have taken some fair leg kicks no problem.

Good to hear, Gary. It sounds like you're making good steps, especially running and starting to get back to teaching.

I just started bag work with the hands, about 15 minutes, 3/4 power and it felt good. No problems with the hips, it probably helped that I did a good 1 hr workout before.

I've started the legs with some light front kicks about midlevel, working on extension, not power. Seems good. Pretty excited about it.

Yeah boxing's no problem, I'm enjoying that.

T+ 39 weeks
My running is limited for now by a recurring soreness in the hip flexor on the operated side. I am good for about 45 minutes on cross country or road, dropping to 12 minutes or so on the treadmill; if I take a short break, stretch everything and come back to the treader I can get another 12. I found pre-injury that 15 minutes on a treadmill felt like an hour on the road so that part doesn’t surprise me. The pace and incline don’t seem to make much difference; I’m running about 3 times a week, I tried cutting out some of my other activities but that didn’t help either. I’m disappointed with the lack of progress here as I used to be able to run all day.

I note McMinn and some other surgeons recommend treadmill over road running â€" why? Might it actually be harmful? If any surgeons, chiropractors or physiotherapists are reading this and fancy putting their five eggs in I would appreciate it. In the meantime I can’t think of anything to do but keep going.

Gary,

I am at 7 months post-op and running on the road. Are you strengthening the abductor and adductor muscles on the operated side as well as rolling them out and stretching them (but not overstretching)? Let me know what you are doing and possibly I could help. I am a personal trainer and group fitness instructor. Although, you sound on top of things and have probably already talked to your PT about this. I might be able to offer some additional insight into your problem.

I wouldn't cut out your other activities unless they are aggravating it...I tend to think the cross training of other sports helps strengthen all of the surrounding muscles. I hate treadmills and find them much harder to run on!


June

Thanks June,

For abductors I’ve been doing side leg raises only; I had a problem with seated cable abductions as mentioned in an earlier post, so I gave that up. I also do lunges (unweighted), squats (weighted, unweighted and isometric), step-ups (front leg), hamstring curls, calf raises, ankle curls, glute bridges, donkey kicks and static cycling. I don’t get time to do all that every week though! I struggle to get in the necessary recovery time for an old bloke like me.

The rest of it is a variety of martial art training and all the usual stretches. Some days I can stretch the glutes, sometimes not at all; I get a lot of triggering in the G. Medius both sides and G. Maximus operated side around the tendon insertion. I can usually get these areas rubbed down after a run, other times I’ve been known to work on it with the handle of a screwdriver! Between treadmill sessions I’ve been using a foam roller, also down the quad, which is extremely unpleasant.

Friday’s run was horrible, I went lame about 10 minutes from home, the pain didn’t last long though and I was rolling around on the mat Sunday.

Gary.

Hey Gary, I have actually been doing some releases that I was taught by my personal trainer. It involves using a tennis ball to do muscle release on my hip flexors. It wasn't prompted by pain, just something she thought I would need. It is much more comprehensively described in this Tennis article: http://www.examiner.com/la-in-national/myofascial-release-for-hip-flexors-to-relieve-low-back-pain , since apparently tennis players run into hip flexor problems quite a bit.

They also mention that:

"Tight quadriceps prevents proper hip extension and as a result generating more tension there. Be good about stretching your quadriceps regularly, and perform myofascial release on it, too. The quadriceps is very overworked muscle groups in a tennis player."

So the tenseness in your quadriceps may be contributing to the hip flexor issues. I use the roller and my hamstrings are not sore at all (my calves, on the other hand), so it may be that addressing both will get rid of the pain.

Thanks Hernanu that's a new one on me, I'll try it.

Gary,

The things you are doing are great as well as now incorporating the releases mentioned by Hermanu. You should also do clams, first without bands and then with bands. Instead of doing seated abduction, you should use bands (tie around a stable table or chair) and do standing abduction, adduction, flexion, and extension (on both legs because the standing leg gets just as much work) which will work the muscles in all planes of motion. I hope all of this helps!

June

Yes it's all good thanks, that article is extremely informative, I have several indicators: Trunk rotation from my exercise, imbalance because my left ankle is in poor shape and hypermobile, and although I go to sleep on my back, I usually wake up in a foetal position appropriate to someone anticipating an air raid!

The hip flexor soreness is accompanied by a low-grade backache which didn't bother me too much because I've had it on and off for years and always trained through it.

I didn't mention my hip flexion exercise, which is an isometric hanging knee raise at 90 degrees, I usually do 10 x 10second holds, maybe that's not helping.

Gary,

A bosu ball would help strengthen your ankles. You can do all kinds of things on it and the instability of the ball will help build your ankle strength. That hanging exercise sounds like it might be putting a lot of strain on your hip flexor! Ask you physical therapist about it.

June

T+ 40weeks
I discussed the hip flexor thing with the chiropractor and got some stretches. I'm sure that's my problem, exactly as described in the article.

Last night I spent 1 3/4 hours in the gym for only 22 mins on the treadmill, the rest was all stretching, I did the above technique and attacked every trigger point I could find with the foam roller; I basically gave myself a full body massage by dragging myself back and forth across the accursed thing, extremely unpleasant, especially the quads.

After warming up I got 16 minutes running at paces up to 13 KPH at various inclines; when the pain became unreasonable (what, exactly, is unreasonable?) I slowed it down and tried to walk it off finishing at maximum incline. Then I went and stretched everything again, I would have tried another run but ran out of time.

So that's a 30% improvement on last time and equates to about an hour on the road, a step in the right direction at least.

I have access to a bosu ball and a podiatron machine, also I made a rocker board to use at home. I put in a bit of stability work when it gets bad, then I get bored with it.

Sounds like you are making great progress.  I think the stretching is the most important part of recovery.  This routine will pay dividends.

Keep the inspirational posts coming.

T-43 days.

Dan

That's great Gary! one thing this has done is made me more aware of the mechanics within my body. I find myself doing much more of the stretches for the harder to reach muscles. I just know I'll wind up in Yoga and my martial arts crazy family will disown me...  ;D

Lots of martial artists do yoga, Guro Inosanto does it every day, some of the Brazilians like it as well. I'm going to look into it.

Do you know the stretch from Muay Thai where you place your shin on your partner's hip in round kick position (partner should support the leg), then grip hands (right hand for right leg) and turn the upper body away from the 'kicking' leg as you push your shin in against his/her resistance. This opens the hip right out. Remember the heel of the support foot should be turned fully towards your imaginary target as in a Thai round kick.

I appreciate a diagram would help here but I don't have one!
We used to do this all the time, just had a go and it feels great.

Sounds good, I was just kidding about yoga, I have a lot of respect for it.

I haven't seen that stretch, although I have done some mutual stretches, including a similar one before. I'll have to check it out.

Ok I’m on the ponce now, but it’s all in a good cause! I trust the admins won’t object.

My friends and I have decided to use our passion for martial arts to raise money for Macmillan Cancer Support.

On the 15th of October I shall be taking part in the first ever 'Beat The Crap Out Of Cancer' charity stick fighting event in the UK, which will be running alongside simultaneous events in Canada, USA and Hawaii.

We will be sparring with weapons in various formats but I shall be using rattan canes and minimal protective equipment.

For all I know, I’m the first surface hippy to do this; if you’d like to donate to this excellent cause, you can do so here:

http://www.justgiving.com/Gary-Stacey0

Much appreciated, G x

Congrats Gary! sounds like a great thing to do (fun as well). Can you post some pics afterwards?

I hope so, there may be a video as well, I would like to have been fitter, but this pesky ankle has been holding me back, nevermind - I'm coming back!

One of my friends / instructors has this problem in the family now so it's kind of personal, and I think we all know someone who's been through it; our original target was £1000 but that's been beaten now so we're going for 2k

T+ 1 year, 3 weeks, 6 days

Just had an x ray, I haven't had a chance to show it to my surgeon yet; as we're just past the year mark I'm due a follow up appointment. The femoral neck looks a little narrower than immediately post-op. A little research reveals that femoral narrowing is very common in the first 2 years (about 80-90% of patients) then it stabilises, apart from that it looks ok (to me) so hopefully I get the all clear. I'm still a bit disappointed with my athletic perfomance but the ankle isn't helping.

Good to hear that things look good - like you said, the femoral neck thing seems to be common, if everything else looks good, then time to tip one for you! (I'll be doing that in my local pub).

The athletic performance will come, I also had an issue with my second metatarsal on my left (supporting) leg after my second procedure. Apparently I was overbalancing on that foot, placing too much stress on the middle toe and it began to hurt. I went to a podiatrist and he noticed that the bone had actually thickened from the extra stress put on it, causing pain when I walked. It lasted for a good 5 months until it worked itself out over the last couple of months. I had to redo my walking, get good shoe inserts, etc.

I feel that delayed me also, but things are getting back on track. I know it's a pain, but that freaking "patience is a virtue" thing keeps popping up in my mind, and eventually you'll geto to where you want to be. What's wrong with the ankle?

Quote from: gary2010 on October 05, 2011, 09:45:50 AM
T+ 1 year, 3 weeks, 6 days

A year plus and you are still counting the days!

Quote from: gary2010 on October 05, 2011, 09:45:50 AM
I'm still a bit disappointed with my athletic perfomance but the ankle isn't helping.

Gary, from your regular account on this thread, it seems your return to sport has been outstanding. And as you know recovery is not an even process.

D.

T+ 1 year 4 weeks 6 days.

I sprained the (right) ankle about 3 months ago for the first time ever; I've done the other one loads of times in the past and is now quite misshapen. The right one now looks pretty much like the left, I can't remember how long it took to recover first time but I'm sure it wasn't this long. It swells and bruises with activity and I get a fair amount of pain, I've had a bit of ultrasound on it.

The limiting factor on running and kicking is still my operated hip, the muscles tighten and my flexibilty is impaired, I also get pain in the psoas region, but this goes away quickly when I stop. Before the arthritis set in I found running as comfortable as sitting in an armchair; I would set off without worrying about distance or duration, now every step seems like hard work.

Anyway, I've seen the surgeon and he's pleased with the x ray and my range of motion, so all clear for a year. He says it will continue to bed in for another 6 months and be patient. As you probably realise I'm not a very patient bloke! The other hip shows some signs of degeneration, but doesn't look much different from last year, so it can wait (good).

Hey Gary, I also had an injury (metatarsal, left foot) that seemed to take forever to heal. It took me about five months before it settled. My operated hip is ok, just flared up a couple of times when I did a roundhouse punch on the swinging heavy bag and missed  :-[ . I went around full speed and the hip sort of said "what the f... ?" . It took a couple of days to quiet down, but it did.

I think my supporting muscles are still coming back into shape, since after about 20 minutes of kicking, I get a little wobbly. I figure a full two years for full recovery; the flexibility is pretty good but it'll be a bunch of months before I can kick any higher than waist level. It'll be interesting to see how we fare in recovering. The psoas does kick my behind some times, more when I do leg presses on the weight machine (30 reps X 220 lbs X 3 sets) if I've done some running before hand. It usually quiets down after an hour or so. I'll probably alternate running and that particular exercise.

Running probably seems like hard work because it is, I think our large muscles are coming back fine, it's the important little supporting ones that need our comfort and attention  ::). Anyways, good on you that everything seems to be in good shape.

Sounds like you're doing the right stuff for your ankle, maybe your body is a bit overtaxed with recovering from the resurface and is downshifting on anything else that comes up.

T+ 1 year 16 weeks 2 days

New year's day 2012 I ran my old 10k circuit around bournemouth, half downhill half uphill, for the first time in exactly 3 years. I didn't worry about speed, just plodded comfortably along and pleased to say no problems, even the steep zigzag path off the beach; once I'd been convinced I would never do this again and I must admit felt rather smug.

When I got in I looked at the clock in disbelief - one hour 9 minutes! A full 15 minutes longer than my worst ever time, the whole thing should take about 3/4 of an hour. I'm aware my stride is quite short and gets shorter as I go along, but at least I've got something to work on now.

Garry mate times canbe brought down it's your first 10k for 3 years I'd be over the moon if I were you that's awesome! I find it inspiring that your making such a strong recovery. I hope that I too can make a similar one. You still managing to train your arts much?

Awesome Gary! I'm not there yet, but I never was a runner.

Like Danny says, doing your first 10K in three years, you can ignore the slower time. I'd bet in a year you'll be doing a good clip. Congratulations!.

Just checking in at the 2 year mark (yesterday); I honestly never think of the hip now. Crewing on festivals in the summer I was squatting 3 foot iron tent stakes out of the ground with a bit of rope. I can run and kick, it's true my fitness isn't quite where it was but I put this down to lack of time to train, while I was injured I aquired other interests.

I know some people have had bad results, but I count mine as a success.

Hope everyone else is doing well,
Best wishes
G

Gary mate that's awesome!

Great news, Gary!

I'm rebuilding fitness as well, did my two year a month back. Good to hear you're back to kicking; good also to hear you've picked up other interests. I've resuscitated some old interests as well (friends and family are receiving lots of paintings for birthdays).

Really good to hear from you and that you're fine.

I finally got my 2 year x-ray, had it done through the NHS - we still have one for the time being, though the GP said 'don't expect to get a free one next year', we had a short chat about the state of things and he said he's retiring and glad to be out of it - it's always a bit of a performance getting the disc off them but it only costs 10 quid.

The radiographer didn't seem terribly busy so I told her my story and she let me have a look; I could see it was fine so I saved it as a jpeg and e-mailed it to the surgeon. He would normally charge me about £60 to sit in his office but replied that it looked great and I could get away with filling in the questionaire, which I did, maximum score for everything.

Jeremy Latham, top bloke!
G

The right looks like it's got a bit of life in it still.

I emailed him when I was in a quandry and looking for a advice. He replied 2hrs later at 11pm with great encouraging advice and highly recommended Holland to me due to my location and situation. Certainly is a top bloke and a great surgeon who has his patients best interest at heart.

Great to hear everything is good.

Quote from: gary2010 on November 01, 2012, 06:41:34 AM
I finally got my 2 year x-ray, had it done through the NHS - we still have one for the time being, though the GP said 'don't expect to get a free one next year', we had a short chat about the state of things and he said he's retiring and glad to be out of it - it's always a bit of a performance getting the disc off them but it only costs 10 quid.

The radiographer didn't seem terribly busy so I told her my story and she let me have a look; I could see it was fine so I saved it as a jpeg and e-mailed it to the surgeon. He would normally charge me about £60 to sit in his office but replied that it looked great and I could get away with filling in the questionaire, which I did, maximum score for everything.

Jeremy Latham, top bloke!
G

Sounds  great, Gary. I was told after my two years to come back in two years anyways, they didn't see a need for a three year look.

How's the hip feeling?

Sounds like your doing great!

Feels completely normal

Are you back to any muay Thai Gary?

Quote from: gary2010 on November 05, 2012, 05:13:52 AM
Feels completely normal

Love to hear that.

Muay Thai, I can do it, though I haven't felt the urge for the lengthy beasting sessions I used to go in for. I'm training Phil Norman's 'Ghost' system at the moment, which is likely to be the next big thing in stand-up.

I'm not really into fads like new systems. I don't think that anyone system is ever complete or really better than any other. Fashions come and go.
Glad your back to doing what you love tho!

Here I go again, after eight years one month I'm having the right one done on 15th November, by Jeremy Latham, I wouldn't let anyone else touch it.

7 weeks in on the right hip and I'm back at work. I didn't bother posting meantime as my recovery followed exactly the same sequence as last time (q.v.)

I'm walking cross-country at least an hour a day and using static bike now. No pain whatsoever, no drugs required. I still can't quite touch my toes but driving is comfortable again.

It's a pity this operation is going out of fashion, if you get a surgeon that knows what they're doing it works!

Congratulations Gary,  good to hear you're doing well.  I'm bilateral at just about 4 and 6 months and still making progress.  ROM is a larger and more challenging issue than strength but does seem to be getting there, just slower than I'd expect.  Daily exercise and practice seem to be the answer.  So damn satisfying to be able to walk, hike and just plain ambulate without the OA, limp and pain.  Life is so much better.  Keep getting stronger Gary.  Best wishes.

Congratulations Gary,
I haven't posted for a while but remember some discussions during your first HR.
Delighted it's going strong ( just like my 9 year old Adept), and that you've returned to your surgeon who has a great HR reputation in the UK.
Best wishes
Toby