New Hip on May 6th...

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Personal: 47 year old male; 5’6” about 165 very fit.  Active in sports most of my life.  Last few years mainly focused on skiing, golf, and cycling.  “Several” years back I began to have limited range of motion on my right side.  Here are some other details pre-surgery. 
 
Symptoms: Sore IT band, sore glutes, and what felt like a groin pull with periodically knee soreness.  I thought that I was just “tight.”  I tried 6+ months of physical therapy then a year of yoga.  All to no avail, but I can do some great Yoga possess now! Then I thought that I had femoral acetabular impingement.  I went to an orthopaedic surgeon in January 2010, and he confirmed that I had impingement that had progressed to far for arthroscopy.  My bone quality is very good overall, femoral neck and head also very good.  My main issue is that in my acetabular region the bone has closed the gap and is causing the pain and limited range of motion.
 
Pre-Surgery Regime:  I work out 6 days a week: weights and cardio.  I have been doing this for years and figured why stop now.
 
Two days post surgery: I feel surprisingly well.  As many have said before me, all my pre-surgery symptoms are gone!  They have been replaced by soreness [no surprise].  Everything feels connected as before.  Not yet up for writing anything significant but I have no restrictions except no resistive abduction [leg away from body] as I had an anterior lateral approach.  My rehab consists of walking with crutches and 6 exercises of 10 - 20 reps each 3x daily.  I have home healthcare for 2 weeks then out patient therapy for 4 - 6 months.  I did get a Game Ready icing device [based upon this site] and it is awesome.

Day 4 - ROM is increasing as is strength.  Nurse just removed the bandage today.  All looks great.  Hip feells like it belongs there no odd sensations.
 
The surgeon is Dan Snyder, MD.  He operates from mainly at Newton-Wellsley Hospital in Newton, Massachusets. He is experienced with both the BHR and Cormet.  He has done over 1,000 cases and trained with Dr. Derek McMinn. 

All the best to everyone. I will lprovides updates.

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Day 7 - I thought that I might continue to provide an update for others who wonder if they are uninque or having the same recovery - some rolling perspective.  If a few say no value then I will stop.  Don't want to bore anyone.

(1) Swelling - going down.
(2) ROM - increasing as well as strength. No stiffness at all.
(3) Working on proper gate: heel to toe transition.
(4) I seem be get the chills a bit more these days.  Wheather in Mass a bit colder than normal?
(5) Pain - None to speak of really. If anything, at the surgical site.
(6) Meds - use narcotic at night to help sleep. Tylenol once or twice. I can get on non-operated side but not for long. 
(7) Enegry level - comes and goes.

[MO]

Solid value; Please keep the updates coming until you get tired of it.  I will be getting a Cormet in my left hip on June 11th.  I have been limping for several years, so I look forward to trading short term surgery pain for long term relief.  One question; why is side sleeping so uncomfortable (with pillow between legs)?; I am unsure why it would hurt more than being on your back.  Thanks.

MO

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One reason for me is that I had a anterior-lateral incision as opposed to a posterior.  The muscles and tendons that are spread or cut along the way to the femoral head are all impacted.  I would also surmise that all the work on the head and acetabulum contribute as well.  I tried last night to lie on my "good" side and it uncomfortable.   I am not a back sleeper so that is not natural but I do fall asleep.  Good luck...

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Week Two -

I left week one with two nice changes: (1) walking on one crutch and (2) the ability to rest on my non-operated side with pillow in-between.  Also, interesting to actually feel like I am sitting upright.  I always felt that I was leaning to one side.

Swelling - now only around the incision
ROM - Increasing; my leg do no longer is externaly rotated when walking or pulling knees to chest
Gait - much better with single srutch; able to push off
Med - take one narcotic to sleep; none to speak of

As far as rehab, the PT added 3 new exercises to my list (@ 10 total).  One exercise that seems interesting is as follows: pump ankle and calf (20X) then progress to the thigh and then glutes followed by icing.  She said this will help push out fluids that are causing the swelling.  Good luck to everyone.  GO FLYERS!

[ptaylor]

hi im 48 and played sport all my life especially squash until i got more injuries than pleasure and needed a bhr which happened on 1st april. im based in the uk and there may be some interesting variations in advice given. the points i have noted are firstly that my father in law had a full hip done and was advised to sleep on the operated side. at 4 weeks after my op i decided to "man up" and try sleeping on the operated side. this lasted until i woke up uncomfortable...but the time extended very quickly. secondly i have noted a lot of people on this site talking about a 90 degree rule. i saw my surgeon for the first time last week and he wanted me to improve my flexibility with the knee to chest even though i have ignored any 90 degree limitation. finally he has said that i cant do any impact sport for 6 months post op and started with tennis and then went on to running etc. this limits me to walking swimming cycling and gym exercises. has anyone had different advice?
phil

[Jeff]

Phil, I am nearly 5 week post op (LBHR) and have the same limitations as you.  My Doc says flextion of knee to same side shoulder (no crossing centerline).....so no 90 degree rule either.  Yes I have same exercise limitations......... walking, bicycling, swimming and exercises (as much as I like with pain as my guide).  I mainly listen to others on this site and my Doc of course,...and just continue what I am doing, increasing length or time slowly, and be patient. I have to keep remembering that I just went through a major surgery and my body needs time to heal......and I will help it all I can, but will be patient with the healing.  It really sounds like you and I are having very good recoveries!!!

Good luck,  Jeff

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Day 14 - Post Op  (surgery was May 6th)

This is the feel good update...

Last week I transitioned to a single crutch, and I am now using a cane.  Feels great!  No pain.  Limited inflammation over the incision.  ROM progressing well... No stiffness even after sitting or waking in the am. Sleeping all night on the non-operated side.  I have been off all meds [except for a one a day aspirin] for a few days.

New this week from PT are (1) the cane, (2) more difficult strength exercises, as well as (3) cycling.  Did two 10 minute  sessions yesteday on the stationary bike.   

Best of luck to all... Keep the faith as you all rehab... Resurface

R Hip May 6th; Dr. Dan Snyder at Newton-Wellsley, MA

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A day short of 3 weeks...

All is progressing well.  The cane remains a companion.  I guess it will be needed for another couple of weeks.  I have been surprised at how much atrophy occured in the glutes and lasteral portion of my thigh.  There coming back, but slowly.

The PT has moved from static contractions & leg lifts to more active movements.  ROM is quite good with no stiffness.  Now riding 50 minutes (25mins X 2) a day on the stationary bike.  A few observations:

(1) I felt so good one day that I went too far and had to take the next day off!  Note to self: on a good day... don't push it! Just enjoy it.

(2) I had a tingling sensation at the incison point (the day after the PT asked if I had this sensation) and it went away a few days later.  The PT told me this is the nerves regaining their life.

(3) We discussed dropping the cane and walking through the limp.  PT said that the muscles, ligaments, etc. that were affected have not yet recovered enought so don't form any poor habits by trying to walk through the limb.  Seemed logical.

I hope you are all doing well....

R Hip May 6th; Dr. Dan Snyder at Newton-Wellsley, MA

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4 weeks, 3 days and 1st doctor follow-up...

All looks great.  New hip x-ray and implant seems to be just where the surgeon wanted it! We discussed metal ions and testing.  He said the following: Mass General is looking at a testing protocol that may come to fruition soon.  If so, we can put you on it.  Otherwise, don't worry, the implant placement is perfect, and this is most critical. I guess I am convinced.

Free to cycle on the road after the 6 week mark.  A few additional PT notes:

(1) 45 minute PT sessions are exclusively focused on deep tissue messages to address any adhesions, as well as manipulations [I won't call this a message!] to further increase ROM. They expect that I will subsequently perform the strength and stretching exercises after.
(2) There seems to be a significant focus from PT on manipulations to increase ROM deep in the joint at the capsule and the surrounding muscles.  More than I expected.  The rationale I am told is that the muscles / tendons/ etc. have "shortened" and they need to be lengthened. This further affects a proper gait.
(3) They also told me not to give up on the cane until the limping is gone.  Walk in the office and practice but try not to get into any bad habits.  Not so bad as it is amazing how courteous people are when you have a cane!

At this point, I would not hesitate to suggest that anyone considering the procedure in New England have a look at Dan Snyder, MD (http://www.nwoa.com/our_physicians/dr_snyder/index.htm). He told me has perfomed 700+ resurfacing cases.  

Finally, my 16 yo son seems to be talking way too much trash about his kicking my a## up and down the fairways.  As if I need more motivation to keep going...

All the best to everyone for a speedy recovery....

[dbhearts]

Thank you so much for the post-op diary.  I have my first evaluation next week, with Dr. Snyder as I wish to have the surgery in Boston, and it feels good to hear of your positive experiences.  I am completely new to surgery of any kind, even of any stay in a hospital.  Next week I will find out if I am a candidate for HR and if Dr. Snyder seems right to me.  I look forward to the new ROM you speak of so joyfully .

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Week 6 update...

Saw Dr. Snyder and was cleared for on-road cycling [thank god] and golf.  I am just back from a 9 day trip to Germany.  No problems sitting on a plane - none at all!   Did not use the cane.  I kept it with me just in case I get tired.  Limp is virtually gone.  As far as rehab my outpatient therapists continue to focus on stretching and deep tissue messages while I focus on strength. 

One exercise that has been added is standing on one foot on an "bosu" ball [they are semi round and provide an unstable platform].  Stand on this and throw a ball against the floor and catch it.  30 times on each side of your foot [not behind].  Works great.  I was sore after day 1 but it got easier after.

I did set off the alarm going through security.  TSA guys almost made me miss my flight.  I may need to add time to my travel schedule...  this may be the only downside to the procedure...

R Hip May 6th; Dr. Dan Snyder at Newton-Wellsley, MA

[dw]

you must have flown out of Manchester initially - they almost made me miss a flight to Seattle recently.

There are a few NWOA clients that have been on this board in the last year (Hanmer did mine Dec 31 2008)

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Another update at the 8 week mark

Progress is good with some set-backs or maybe my expectations are skewed:

(1) I have been cycling about 80 miles a week for the past 2 weeks... the good
(2) Range of Motion is slowing in terms of weekly progress... the ok
(3) I am often sore in the piriformis [backside] area and can't seem to stretch it well enough... I guess the bad.

PT says this is normal and I should be grateful for the progress to date, for which I am but... it seemed like such a linear direction to being normal again.  My rehab now is foccued on:

(1) stretching overall
(2) glute strengthening
(3) lateral quad strengthening


I am wondering [especially from the hard core athlethes] did you experience the same plateauing? Did it then excel again?  Thanks...

PS - The American Journal of Sports Medicine (June) has a very insteresting article on resurfacing.  Below is the abstract.  If you can get teh entire article there is a great deal of infromation.  I tried to post the PDF but the article is just over the limit for this site.

Background: Little is known about sports activity after total hip resurfacing.
Hypothesis: Patients undergoing total hip resurfacing can have a high level of sports activity.
Study Design: Case series; Level of evidence, 4.
Methods: The authors evaluated the level of sports activities with a standardized questionnaire in 138 consecutive patients (152
hips) 2 years after total hip resurfacing. Range of motion, Harris hip score, and Oxford score were assessed, and radiological
analysis was performed.
Results: Preoperatively, 98% of all patients participated in sports activities. Two years postoperatively, 98% of the patients participated
in at least 1 sports activity. The level of sports activity decreased after surgery. The number of sports activities per
patient decreased from 3.6 preoperatively to 3.2 postoperatively. Intermediate- and high-impact sports, especially tennis, soccer,
jogging, squash, and volleyball, showed a significant decrease while the low-impact sports (stationary cycling, Nordic walking,
and fitness/weight training) showed a significant increase. Physical activity level at the time of follow-up as measured by the
Grimby scale was significantly higher than in the year before surgery. Duration of sports participation per week increased significantly
after surgery. Men had a significantly higher sport level than women before and after surgery. Eighty-two percent felt no
restriction while performing sports. One-third missed certain sports activities such as jogging, soccer, tennis, and downhill skiing.
The Harris hip and Oxford scores showed a significant increase postoperatively.
Conclusion: The results of this short-term follow-up study show that sports activity after total hip resurfacing surgery is still possible.
Physical activity level increased with a shift toward low-impact sports. Duration of sports participation increased. Highimpact
sports activities decreased. These findings can be important for the decision-making process for hip surgery and should
be communicated to the patient.

[Tekka]

Hi Resurface

You are at a very good level, you should be very happy with your progress.

I coach MMA and box twice weekly, I would say I am nearly back to my level before surgery....but I would be cautious not to push to hard. I actually stopped stretching for 2-3 weeks and I found things settled down really well for me.

Your symptoms of soreness in the backside are similar to what I experienced, take it a little easier and it will improve..honestly.

You are doing really well...

Best Terry
 

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Terry

Thanks.  Given the need for flexibility with MMA stuff (I wrestled in college myself), what did you do to open the piriformis?  Seem like so much kicking at least requires great flexibility and especially in the piriformis.

[Tekka]

I'm not a huge kicker but axe and cresent kicks are 6ft and i'm 5'8" " depends which leg i stand on "...

Stretching is a strange one after this massive operation, the balance between scar tissue forming and over stretching is difficult. I concentrated more on the strengh stuff and my stretching was very mild for the first six months or so.

Good luck mate

Terry

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Just a week shy of 3 months... Ups & Downs along with expectations...

The last number of posts have been about a very fast recovery with all being well after HR.  Riding upwards of 80 miles a week. Walking great with no limp at all.  Feeling great.

It seems that the next stage is more difficult - getting real range of motion that is equivalent to the non-operated side.  Turns out that it is easier to just excise old worn out cartlidge and replace with metal BUT the muscles, tendons & ligaments still remain.  Getting these puppies stretchded is a bigger undertaking in my opinion or maybe just for me.  I still go to PT 2x weekly and need to do more stretching on my own. 

I just mention this for those trying to gauge what a recovery is like [at least my experience] or considering this course of treatment.  It has been aweseome getting rid of all the old ailments along with getting back on my bike, but it seems that that is only the first part of this journey. 

Have a great day...

[sharleen]

Hi Todd - I have been trying virtually everything to get the strength back as well as having a good stretch. I have found that Pilates has helped a huge amount as well as having a Neuromuscular treatment massage once a week.
best
Sharleen

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Just an update on my exercises as I thought that I keep this going until one year post-op.  These are all per my PTs guidance.  I still go 2x weekly.  This seems to be helping me a great deal.   I am back to cycling 100+ miles a week, no pain while sitting on long flights, no start-up issues, lifting 2 days a week... maybe luck, not sure.  If this helps someone then all the better.   

At 3+ months

(1) increasing times on a Bosum ball for instability strengthening - single leg
(2) side walks - with a band around ankles move sideways stretching the band and back.  If you go in one direction with the leg going out on the cycle back that leg is the stability side.  You will see that it makes a difference.
(3) bridges - standard and then progress to single leg in front, switching back and forth.  I hope that I won't get into trouble, but guys, this is why we look into the studios when the ladies are working out! Anything for motivation.
(4) stretching - focusing on IT band and piriformis
(5) foam rolling

At 4 months

(1) added lunges.  Found that full lunges were a bit much so we are doing half-lunges.
(2) lunge variation - using 3 rings: one in front and one at each side a few feet away... use a bat to reach and touch each, rotate your trunk for the side reaches - adds a bit of instability.
(3) drunken sailor - with band around ankles, go to one foot with the other at your side with tension.  do other side.  One rep. 30 of these.
(4) standing lift leg forward to strengthen the hip flexors.  I have a particular need here.
(5) foam rolling.  I really like this.  I do this even on my off days.  I have a soft and hard roller.  Just do enough to stay on the sore site.  I also do my non-operated side.