Left hip resurfaced for osteoarthritis by Jeremy Latham in Southampton U.K.

[pc]

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.

[toby]

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

[pc]

great advice!

[gary2010]

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.

[gary2010]

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.

[pc]

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

[Lopsided]

... 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.

[gary2010]

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!

[toby]

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

[gary2010]

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.

[sfinrecovery]

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

[gary2010]

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.

[Lopsided]

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.

[gary2010]

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.

[Lopsided]

it'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.

[pc]

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

[gary2010]

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.

[gary2010]

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.

[toby]

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

[gary2010]

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