7 1/2 weeks later - My Progress and Some Pics

[sgoulet]

On December 10, I had a Cormet Hip Resurfacing prosthesis using the direct anterior approach performed by Dr. Stefan Kreuzer.  The direct approach (also known as “Smith Petersen”) is relatively rare in the U.S. as many surgeons have not yet been trained with this approach. 

Here is some information about myself:

    * I am 43 years old, very athletic and am a competitive road cyclist and triathlete.
    * Over the past three years, my right hip became progressively worse, losing range of motion, the loss of ability to do basic life functions (tying shoes, lifting leg, etc.) due to osteoarthritis. Three months prior to surgery, I got to where I couldn't even ride my road bike and walked with a limp.  While my pain level and loss of function appears to be less than many others on SurfaceHippy, given my relatively young age, it was to point where I had to get something done.
    * I researched different surgical techniques and settled on the hip surfacing procedure considering my age and the minimal impact of the procedure on my femur.  Once I decided on the hip resurfacing procedure, I had to pick a doctor and the surgical approach (posterior, anterior, cemented, uncemented, etc.)  While I am definitely not an expert of these variables, I chose Dr. Kreuzer and the direct anterior approach.

I am now about 7 1/2 weeks post op and here is my status:

* Besides some stiffness at start-up (getting out of bed, up from sitting more than an hour, etc., I have no limp and walk pain free.
* I ride my bike 6 times a week (3 or 4 in a spin class) and a couples times on the weekends.  Today, for instance, I rode 65 miles at a pretty brisk pace (22 mph) with NO PAIN!
* I didn't have an formal physical therapy, but used my indoor spinning bike to get aerbic condition and strength back to my leg.  I combined it with a lot of stretching.
* My ROM is very good.  I can tie both shoes, put my sock on (sometimes I need to nudge my leg up a little and sometimes I can lift my leg up to my hands).  I can sit "Indian Style" which I never usually do, but have been doing a lot of stretching and stretching my operated leg inward toward my chest.  I can pull my knee to my chest, etc. 
* My incision is healing nicely. 
* Only issue I have right now is nerve "deadness" on the lower front and outside of my thigh over a fairly large area of approximately 9 inches, beginning just below my incision (incision starts at the front and top of my thigh at the top pants pocket and is about 5.5 inches  downward from there).  There was damage to my lateral femoral cutaneous nerve which innervates the skin on the lateral part of the thigh.  Some feeling MAY come back.  It doesn't affect mobility, but is dead to the touch at the skin.
* I feel like I could go for a run, but I don't like running and certainly don't want to put any high impact activity on the joint.

Here are a few pics of before and after. Don't worry, I edited the personal portions of the pic 

Before (Right hip is bad)


After


Right Hip After (with leg rotated at X-ray)


I may have to have a surgery on my left hip ("good" hip) to remove an impingement that may lead to the same condition in the right leg.  But for now, I am gooing to go go surgery free for as long as possible 

[Bionic]

Congratulations on what appears to be a fantastic recovery.  I hope it continues.

[Todd]

Great to hear recovery is moving along nicely!  Muscle pain sure beats joint pain doesn't it? 

With all the different approaches to HR surgery, what I have read is that there are pros and cons to each, and I didn't bother myself too much with trying to figure out which would be best, but instead chose the surgeon and trusted that his preference in approach served him well.  I'm curious if you saw any real benefits for anterior for your situation, or if it was more choosing the surgeon, and that happened to be the approach that he used? 
todd

[sgoulet]

Great to hear recovery is moving along nicely!  Muscle pain sure beats joint pain doesn't it? 

With all the different approaches to HR surgery, what I have read is that there are pros and cons to each, and I didn't bother myself too much with trying to figure out which would be best, but instead chose the surgeon and trusted that his preference in approach served him well.  I'm curious if you saw any real benefits for anterior for your situation, or if it was more choosing the surgeon, and that happened to be the approach that he used? 
todd

Hey Todd,

Although Houston tends to be considered a great city for medical technology, there are not a lot of physicians with significant hip resurfacing experience.  It just so happens that one of the surgeons in town (Dr. Kreuzer) does both anterior and posterior resurfacing using the Cormet system.  I had my choice of both procedures.  Given that the anterior approach avoids cutting or detaching the muscles, this was appealing to me.  I also believe it allowed for a faster recovery. 

Steve

[Todd]

Interesting. To tell you the truth, I don't even know what approach Dr. Palmer did with me, but I'm pretty satisfied with the results too.  Pat,  is there a good source of statistics out there that identify any clear benefits for the approach, or do they all seem to have their merits?

[stevel]

Interesting to have a new proponent of direct anterior.  Remember Big Bill aka C.A.S.H.?  He used to frequently post when I signed at the end of last July.  I notice several hippies have dropped in posting activity since last Fall, e.g. Big Bill, City2south, XOCY & B.I.L.L..  Of course we still got Obxpelican (Chuck) who was promoted to moderator.  Does this mean they heal up after a few months and are busy enjoying their new hips?

[sgoulet]

Interesting to have a new proponent of direct anterior.  Remember Big Bill aka C.A.S.H.?  He used to frequently post when I signed at the end of last July.  I notice several hippies have dropped in posting activity since last Fall, e.g. Big Bill, City2south, XOCY & B.I.L.L..  Of course we still got Obxpelican (Chuck) who was promoted to moderator.  Does this mean they heal up after a few months and are busy enjoying their new hips?

From what I know, Big Bill "CASH" is doing great now at 6 months post-op.  He was a great local resource to me just after my surgery in December.

I have to imagine that many Surface Hippies have more of an interest in the Board when they are pre-op or in the sensitive period from surgery to 6 months post-op.  After 6 months, many of us are doing so well that they move on to resume "normal" life.  It certainly is nice to continue to have the support and wisdom of those at various stages of post-surgery.

Regarding the direct anterior approach, what I like about the procedure is the muscle preservation aspect of the surgery.  From what I know, the surgical approach is relatively rare in the U.S. and there is not much data to compare results.  I will continue to share information to those interested and provide my experience. 

Steve

[B.I.L.L.]

Interesting to have a new proponent of direct anterior.  Remember Big Bill aka C.A.S.H.?  He used to frequently post when I signed at the end of last July.  I notice several hippies have dropped in posting activity since last Fall, e.g. Big Bill, City2south, XOCY & B.I.L.L..  Of course we still got Obxpelican (Chuck) who was promoted to moderator.  Does this mean they heal up after a few months and are busy enjoying their new hips?

I check the board all the time but still in limbo as far as a cup revision goes.  Getting 2nd opinions isn't as easy as I thought it would be, nobody really wants to make a decision based on an x-ray alone, or they want 350-400 dollars for an opinion, or I just get no response at all...  Revision is supposed to be in march but I want more opinions before I decide, so yeah I've been laying kinda low in the posting dept.  The good news is it's starting to work pretty good, so agreeing to a revision is a much harder choice now, I have lost faith in Kaiser but can't afford anything else so.....I'm still here but I'm a mental basket case over the whole deal,  at this point I would rather have a perfect thr than another F-ed up bhr.......kinda pissed and bitter so I try to keep it to myself rather than go on a 3 page rant.  But other than that it's all good !!  Ha Ha    Carry on..... 


Oh and sgoulet I had numbness in the top of my thigh till about 3 months, and it is slowly going away, as is the knocking.  Enjoy your new hip it will get better every week. I am a firm believer in resurfacing, just not done by my Dr. .....    It will get better

[obxpelican]

That approach is not as common in this country, although some doctors perform it and do extremely well, like Dr. Mont in Baltimore.  In Europe it's more common and there were studies out of Europe that proved it was a toss up on which approach was better.

From what I understand, the anterior approach is more challenging to the surgeon performing it for that reason I would not want a surgeon new to that technique to perform it on me.

As to the question of people leaving, it's a natural progression but we still have hippies checking back in.... I am sure once Summer comes and it's golfing, water skiing and softball season I too will be much more rare on these parts. 

I think it's important that we always have someone who is around 4-6 months post-op on this board as they are still near enough to their surgery date to accurately recount what happened to them...... the rest of the information can be looked up by using the search function.

As to my "promotion" I was more of a volunteer to help Pat through a tough time when she needed an extra hand with spammers, I actually do nothing now in the way of being a moderator on this site now.  I've even had discussion with Pat about taking the rights away from me because I do not want anyone to think that I am anymore than a patient who offers support, Pat is the queen of this forum.     I on the other hand am just a lowly minion.

This site is amazing in that for the most part everyone gets along really well.  I think I can speak for Pat in saying she has the nicest people around and that goes for any hip support site on the net.  I believe the good will comes from the fact that Pat does not push anyone towards and one doctor and she does not claim to be the "all knowing hip guru" of the net.  Pat's style is more of support, caring and more support. 

It's my hope that all of you continue to post for as long as possible to support those who are just looking into their journey of walking straight lines without pain.



Chuck

[sroberts]

Hey Chuck,

Does Dr Mont do the direct anterior approach? There are actually three approaches, direct anterior, anterior and posterior. The posterior and anterior use the same incision site. meaning you'd never know from the scar which approach was used. The direct anterior approach is from the front, which is what Big Bill and Steve both had. All are effective, the surgeon is the key.

take care,

spencer

[obxpelican]

Spencer,

Dr. Mont can do all of the approaches, read his Sept 17th 2008 chat.

Chuck

[Big Bill]

Big Bill here....FYI- all is good...had my 6 month check up in January. Strength and ROM is superb. Xrays perfect. I am still involved in the 2 year Cormet Study group. Went for my first jog a few weeks ago....1st one in over five years....NO PAIN    ( in my resurfaced hip)  !!! On the flip ....Hello to all my old fellow Hippies  and all the new ones....it is true...I am enjoying the #$% out of my new lease on physical activity !!! Even though I do not post as often as in the past--I still check in on you all on a regular basis   ....I am still walkin' the walk AND talkin' the talk 

   BIG BILL  C.A.S.H.     

[stevel]

Good points Chuck,

I'm doing so great at 4 months, 1 week post-op, that lately most of my research on this website is to figure out how can I get back on skis before 6 months post-op.  After reviewing all the posts from fellow surface hippy skiers that have older installations and researching bone densities, femoral cap loosenings, bone in-growth periods, etc., I've concluded its prudent to wait 6 months.  I continue to post to provide updates on my physical therapy progress, as my physical therapist finds items needing improvement.  I have two more weekly visits.

[obxpelican]

Steve,

You being prudent and conservative is a good idea, why cause a problem that will last you a life time for some temporary fun?  You have the rest of your life to be involved in higher impact activities, the more I read the more I've found that it can take up to a year for your hip to be fully 100%.

Dr. Gross does not allow biking on trains before 6 months, it killed me, but I stayed off of my mountain bike none the less.  One good thing is that Gross allows golfing 6 weeks post-op so I was allowed to partake in some Fall/late Fall golfing.

Chuck

[dw]

Dr. Gross does not allow biking on trains before 6 months, it killed me, but I stayed off of my mountain bike none the less.  One good thing is that Gross allows golfing 6 weeks post-op so I was allowed to partake in some Fall/late Fall golfing.

Chuck

is Biking on trains a new sport? cause it sounds pretty extreme!

[stevel]

Chuck,

You mean biking on trails.  I understand why Dr. Gross is so adamant about restricting impact activities for 6 months since the femoral cap is also uncemented.  What puzzles me is why other leading hip resurfacing surgeons allow impact activities at 3 months, e.g. Dr. Schmalzried and Dr. DeSmet whereas Dr. McMinn restricts impact activities for 12 months?  I'm following Dr. Su's protocol which restricts impact activities for 6 months and restricts lifting over 50 pounds for 6 months.  So when I traveled by air over Xmas, the airlines charges a fee for a suitcase that weighs over 50 pounds and I packed it to weigh less than 50 pounds so I meet the post-op protocol and save paying a fee.

Some Dr. chats are forthcoming, I suppose I could pick their brains a bit on this matter. 

[obxpelican]

Steve,

It was not the fact that the cap was uncemented, it's press fit anyhow, he was concerned about femoral neck fractures if I fell off, he did not want me biking (unless it was an excercise bike) period.  I really miseed getting out on my mountain bike, it's sitting in my garage collecting dust.  I love the Fall here in Pa, it all goes back to the days when I hunted small game in the Fall.

When you think of the femoral cap it's the component that is held the best because essentially you are pressing it in when you walk.

Yes, Pat has a bunch of chats, I'm going to try to check them out.   


Chuck


Chuck

[obxpelican]

DW,


Most trails we ride on are pretty easy going, some get a little crazy.


Chuck

[stevel]

Chuck,

Most of what I have read about femoral neck fractures are due to surgical technique rather than due to excessive loads while the bone is healing.  Cause of fractures are for instance:  notching of the femoral neck,  improperly placed femoral cap, lack of suction in the drill hole prior to installing the stem.  I realize femoral neck fractures are rare after 6 months based on the case history for all installations, good or bad.  I just wonder if femoral neck fractures are rare after 3 months for a properly installed device?  One would need to review a study of the patients for Dr. DeSmet or Dr. Schmalzried that returned to impact sports at 3 months and the incidence of femoral neck fractures.

Dr. Su has three periods of post-op protocol for physical therapy and activities, 1 day to 1 month, 1 month to 3 months, and 3 months to 1 year.  Each phase may overlap depending on the progress of the patient.  However impact activities and lifting over 50 pounds are restricted until 6 months.  Lifting over 20 pounds is restricted for 3 months.  This must be due to concern about fracturing the femoral neck.  They know more about it than I do, so I'm not going to buck their protocol.

In fact, when I inquired about skiing, Dr. Su's physician assistant (Blaire) responded "I would avoid downhill until you are 6 months from surgery.  The risk of fracturing your femoral neck decreases slightly after three months but the neck is not fully remodeled until 6 months to a year.  I'm sure you are a very good skier, but I am afraid of you falling."

[obxpelican]

Steve,

I actually thought the same thing, and yes, I've read where notching is an issue in fractures.

In my case they were afraid of a fall on my hip thus breaking the neck.  I wish I could have cruised some on the trails, but I'll make up for it next year.


Chuck