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Author Topic: FDA approved device and experienced hip resurfacing doctor  (Read 109755 times)

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stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #60 on: December 29, 2008, 04:53:50 AM »
Mudpro,

According to Dr. DeSmet's website, incision length has no effect on post-op rehab.  His hip resurfacing patients' incisions vary from 6 to 12 inches.  See FAQ's #27 & 28.

My incision was 6 inches and Dr. Su used the NCP (neck capsule preservation) approach which allowed me to bend without the usual restrictions after surgery.  Although my left leg was atrophied, I used the ellipical machine for 40 minutes every other day prior to surgery.  So I was in fairly good shape before surgery, which helps in my post-op recovery.  I used a cane until 8 weeks post-op.

As Chuck said, everybody recovers at there own rate, so as long as you are making progress, you are doing fine.
« Last Edit: December 29, 2008, 04:58:48 AM by stevel »
Steve
LBHR 60mm/54mm Dr Su 9/29/08
RBHR 60mm/54mm Dr Su 11/1/19

Pat Walter

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #61 on: December 29, 2008, 05:55:30 PM »
Hi Mudpro

The size of the incision has no bearing on a patient's recovery.  In some cases, like De Smet, he uses a large incision to get in and get out quickly doing most single surgeries in 45 minutes.  The large incision gives him good exposure so he can do what needs to be done and not bother any muscles or ligaments in the surrounding area.  It is his surgical technical which allows for the quick recovery - not the large incision.  You can read many of the De Smet stories on the Hip Stories section to learn how quickly De Smet Patients recover.

I was on one crutch at 4 days and none at 4 weeks.  Typical of the 8 patients I was with.  I was sight seeing at 5 days post op and flew 8 1/2 hours back to the US on day 9 post op.  By day 12 post op I was walking about 1 miles at a time with one crutch.  I thought I would try some PT, even thought De Smet said I did not need it, and they only kept me 2 sessions. They could not find anything to do with me since I had recovered so quickly.  They did not even think I needed a crutch at 3 weeks post op.

Most De Smet patients have typical recovereis with large incisions.  The incision is covered with a waterproof bandage and patients are in the pool the day after they leave the hospital - usually at 3 days post op for one hip.

Sometimes the mis surgeries actually cause more healing problems because the doctor has to push everything around and manuver in such a small incision.  They still have to do the same proceedure as the doctor using the large incision.  So think how much more difficult it is to stretch and push everything thru a small incision.

Larger muscular men and people overweight also need larger incisions.  THey just have to be able to get exposure to do the acetabular portion of the hip device and the less they can easily see - they more difficult it is for the surgeon - especially the newer surgeons.  So normally the less experienced surgeons are also working with larger incisions, then as they get more experineced they start using smaller incisions.

Dr. Gross explains that in the video interview I did for him.

So don't worry about your incision size - it has almost nothing to do with your recovery. 

Good Luck.

Pat
Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #62 on: January 07, 2009, 07:06:29 PM »
Visited my physical therapist on Monday and I have a much improved gait and the left calf has increased in size to more closely match right side.  My pelvis was stiff at 9:00 AM so she had me warm up for 8 minutes on the elliptical.  I need to work on improving strength and flexibility for my left hip.  I have a variety of stretches and strengthening exercises to do.  I can alternate on different days.  I will continue physical therapy, once a week, for another month.  I am 3 months, 1 week and 2 days post-op. 
« Last Edit: January 07, 2009, 07:08:03 PM by stevel »
Steve
LBHR 60mm/54mm Dr Su 9/29/08
RBHR 60mm/54mm Dr Su 11/1/19

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #63 on: January 19, 2009, 10:34:36 PM »
16 weeks post-op, today, and I'm seeing my physical therapist once a week on Mondays.  Today we analyzed my gait when I walked a distance of about 35 feet toward full length mirrors in the aerobic studio at the local health club.  My left side (operated) leg was a bit stiff and straighter than my right side.  She attributed the stiffness to a stiff lower back on my left side which affects my pelvic rotation and my gait.  So she gave me stretching exercises to regain my range of motion for my lower back and pelvis.  The back stiffness is due to limping and favoring my left side for so many months (years) prior to surgery.

I sure am pleased to have a physical therapist diagnose my problems and return my left hip function back to normal.  Some hip resurfacing doctors have said patients don't need physical therapy, but just walk for therapy.  This is BUNK!  Refer to my prior posts for the progress of my physical therapy. 
« Last Edit: January 20, 2009, 04:57:51 AM by stevel »
Steve
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RBHR 60mm/54mm Dr Su 11/1/19

obxpelican

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #64 on: January 19, 2009, 11:26:06 PM »

I sure am pleased to have a physical therapist diagnose my problems and return my left hip function back to normal.  Some hip resurfacing doctors have said patients don't need physical therapy, but just walk for therapy.  This is BUNK!  Refer to my prior posts for the progress of my physical therapy. 

Not to be argumentative but that is an awful broad statement.  Many doctors do not reccomend PT after surgery, some will allow PT after a period of time, some ask that you start soon after your surgery.  It's a mixed bag full of patients who had very succesful results.

At 6 weeks I was permitted to take PT if I asked for a script, but except for startup stiffness I am better than I've been for years by rehabbing on my own and working out at Bally's.  I'm feeling well enough that I am planning playing old man softball this Summer.

I think many doctors like Gross do give you phased excercises that get more difficult as you go on and of course in special circumstances PT is warranted.

Chuck




Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #65 on: January 25, 2009, 05:53:31 PM »
Pat's summary about "Everybody recovers at a different rate" under "Recovery Issues" on this website, sums it up well.  In my case, I had a leg length discrepancy due to loss of cartilage and limping about for months before my surgery.  My physical therapy has pertained to restoring muscle strength and range of motion.  Lately, I've been doing back stretches since my back was out of kilter due to limping.

I suppose for some patients who are not athletic (e.g. do not do much sports other than walking and gardening) and who do not have much muscle imbalance due to leg length discrepancy, could get by with walking as physical therapy and not require a professional physical therapist.

My physical therapist gave me a lunging exercise to do where you attach a waist belt and pull a cable with about 40 pounds of weight.  I felt the weight was light and increased it to 60 pounds.  She cautioned me about the 50 pound weight restriction Dr. Su has from 3 mos to 6 mos post-op.  I replied this pertains to carrying or lifting weight, not pulling weight horizontally.  Anyway she wanted me to warm up with 50 pounds before increasing to 60 pounds.

I read about some spectacular recoveries by "Athletes" and I will need to visit Dr. Su to be evaluated in person before accelerating my recovery beyond his normal post-op recovery.  The only sport I'm missing is downhill skiing and I doubt he will say OK before 6 months post-op.  I'm nearly 4 months post-op, so what's a couple more months?
« Last Edit: January 25, 2009, 05:57:25 PM by stevel »
Steve
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RBHR 60mm/54mm Dr Su 11/1/19

Todd

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #66 on: January 25, 2009, 06:44:51 PM »
I'm looking forward to the PT to get my flexiblity back.  Seems like so long ago since I wasn't compensating for pain and truly active.  I would think that PT is warranted for most everyone if for no other reason than to reafirm that total recovery and function are met.  I'd love to go for a few weeks and have them say--we have nothing else to offer you that you can't do yourself.  You're right, 2 more months is a short amount of time to have to wait Stevel.  Consider the setback that premature return might cause...the only drawback to 2 more months is Springtime! 
good luck.

Todd  LBHR, Dr. David Palmer 1/7/09; RBHR 5/6/09 St. Croix Orthopedics, Stillwater, MN

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #67 on: January 25, 2009, 09:41:04 PM »
Todd,

I have four more weeks of PT.  I'm down to one visit per week.  I have PT on Mondays, so I'll see the physical therapist tomorrow.  Its great that my insurance is fully paying for the PT at $116 per visit (earlier visits were $205 per visit).  She has progress notes and has sent them to Dr. Su.  She has requested an extension of my prescription for PT a couple of times.  My intial prescription was for 6 weeks starting 11 days after surgery and I have had two six week extensions.  I am basically fine tuning my gait and range of motion by stretching my back, doing lunges and several other hip and leg exercises with Nautilus or Cybex equipment.
Hopefully at the conclusion of my last PT visit, she will say "Your gait is normal and your range of motion and flexibility is fine.  You have no leg length discrepancy and no Trendelenburg.  You are clear to resume impact sports at 6 months post-op (although she said to start with alpine hiking with a knapsack this Summer prior to alpine hunting for Dall sheep which involves carrying up to 80 pound backpacks - e.g. wait another season to hunt!)".  Also since the ski season ends April 12 at our facility in Juneau, Alaska, and I will be 6 months post-op on March 29, and since the facility is only open on weekends in April, I might just wait until next year to ski.
 

« Last Edit: January 25, 2009, 09:43:07 PM by stevel »
Steve
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RBHR 60mm/54mm Dr Su 11/1/19

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #68 on: January 26, 2009, 10:21:47 PM »
I saw my physical therapist today at 17 weeks post-op (I will be 4 months post-op on Thursday).  My gait has a bit of rotation in my left pelvis.  My back muscles on my left side are still a bit stiff which contributes to this glitch in the gait.  Nobody would notice this when I walk down the street, but she noticed it when I walked in the aerobic studio.  When I outstretched my left leg laterally to the side and turned to pick something off the floor, the stiffness was noticeable.  I was able to lean over and stretch my fingers to within 12 inches from the floor on my left side and to within 2 inches from the floor on my right side.  I have three more weeks of PT on Mondays.  She said I should be OK to continue stretching and strengthening on my own after my prescription for PT expires and I shouldn't need to extend the prescription for PT.  I have no Trendelenburg or leg length discrepancy (which I had earlier in my recovery).  I should not need a heel lift.  When I woke up this AM, my hip ached a bit from laying on my left side.  This disappeared after arising from bed.  I worked out yesterday at about 6 PM.  I did not notice any swelling on my left side.  The aching did not affect my sleep.  Otherwise I feel I'm nearly back to normal.  I just need to wait for 6 months post-op for the bones to fully heal and remodel before resuming impact sports such as downhill skiing, racketball and hunting in mountainous terrain. 
« Last Edit: January 27, 2009, 01:12:41 AM by stevel »
Steve
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RBHR 60mm/54mm Dr Su 11/1/19

Todd

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #69 on: January 26, 2009, 10:55:04 PM »
Stevel,

Back to normal sounds absolutely great!  Can you remember the first days after surgery and where you are at now?  Big difference I bet.  Hunting sounds good too.  We've got some pretty steep grades where I normally hunt near home, and in the last couple of years it has been unbearable to both maintain balance and get up the hills without falling down in a heap.  More than once last year I found myself on the ground shaking my head in disbelief as to what I had become. Thank goodness there was some relief out there.  I look forward to dragging a big whitetail up and down the ravines and staying on my feet...next fall!
Todd  LBHR, Dr. David Palmer 1/7/09; RBHR 5/6/09 St. Croix Orthopedics, Stillwater, MN

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #70 on: January 27, 2009, 12:14:45 AM »
Todd,

Yes, I remember the first few days after surgery.  In fact my sisters visited me at the hospital on the day after surgery (afternoon) when the physical therapist had me walk around the nurse's station with a walker.  My sister snapped a photo when I exited the hospital room into the hallway.  I look at the photo as a reminder as to how far I've progressed.  She also took photos when I walked in the hallway with crutches.  After discharge from the hospital on day 4 post-op, I spent the weekend in the hotel.  I walked several blocks with crutches to several nearby restaurants.  Lot's of good food within a few blocks at upper east side manhattan.

The hip resurfacing device is quite a miracle to allow patients to return to unrestricted athletic activity within 6 months.
Steve
LBHR 60mm/54mm Dr Su 9/29/08
RBHR 60mm/54mm Dr Su 11/1/19

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #71 on: February 03, 2009, 12:03:45 AM »
I saw my physical therapist today at 8:45 AM at 18 weeks post-op.  Stretching my outer leg laterally, pointing my toe outward and rotating my trunk over to the side to pick-up a ball (about 7 inch diameter) is much improved from a week ago.  I can reach down and touch the floor on my right side (unoperated side), but just barely pick-up the ball on my left side (operated side).  I need to practice this at 10:30 AM, 12 PM and 1:30 PM positions in addition to 9 AM and 3 PM positions.  This will improve my gait.  My gait was much improved from last week.  I needed to warm-up on the elliptical for 5 minutes as my hip is still stiff in the AM.  She said the stiffness could last until about 6 months post-op.  I didn't notice any aches or swelling during the week.
Steve
LBHR 60mm/54mm Dr Su 9/29/08
RBHR 60mm/54mm Dr Su 11/1/19

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #72 on: February 10, 2009, 11:55:10 PM »
I saw my physical therapist today at 19 weeks post-op.  I'm still a bit rickety when stretching over on my left side to pick-up 3 Kg medicine ball, but I'm much improved from last week.  She added an exercise to raise the side of the pelvis when standing on the opposite leg to strengthen gluteus minimus.  My left side was noticeably weaker as I could barely raise my pelvis on this side.  Yesterday, I walked a brisk pace (4.5 mph) on the treadmill for about 35 minutes.  This was my first exercise on the treadmill (I've been spinning, using the elliptical machine and walking outdoors) and I was stiff this morning.  My left hip ached a bit after 20 minutes but I completed the exercise as it ached a few more times every 5 minutes or so.  This tells me my muscles are still strengthening.   
Steve
LBHR 60mm/54mm Dr Su 9/29/08
RBHR 60mm/54mm Dr Su 11/1/19

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #73 on: February 17, 2009, 08:44:32 PM »
I saw my physical therapist today at 20 weeks post-op.  My range-of-motion is much improved.  My glutes and quads still need improvement in range of motion and since I expect to return to downhill skiing after 6 months post-op, I will be training on the Pro Fitter Cross Trainer next week.  This device simulates the side to side motion of downhill skiing.  My left hip ached a bit after 35 minutes on the treadmill (4.5 mph, 2% incline) combined with hip strengthening exercises so I need to pace my exercises better (10 minutes on treadmill followed by hip strengthening exercises followed by 20 minutes of indoor bicycling).
Steve
LBHR 60mm/54mm Dr Su 9/29/08
RBHR 60mm/54mm Dr Su 11/1/19

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #74 on: February 22, 2009, 05:36:52 PM »
Yesterday, I read BHR Surgical Technique - US.  This is a very descriptive outline of the procedures necessary to install a BHR device.  Illustrations show the special tools to align, drill, ream and cement bone.  On page 44, Important medical information, warnings and precautions, patient education, the following is stated:

"Caution the patient to protect the joint replacement from unreasonable stresses and to follow the treating physician's instructions.  In particular, warn the patient to strictly avoid high impact activities such as running and jumping during the first post-operative year while the bone is healing."

Warn the patient that artificial joint replacement devices can wear out over time, and may require replacement."

Now, this follows Dr. McMinn's post-op protocol, who developed the BHR device.  He has case histories and studies of the BHR device from 1997 in Australia, Europe and recently the US to develop this protocol.

I am following the "treating physician's instructions" e.g. wait 6 months post-op before resuming impact activities.

I wonder for all of us BHR hippies if we should wait 1 year or 6 months (several US doctors say 6 months is OK) before resuming high impact activities?

« Last Edit: February 22, 2009, 06:50:49 PM by stevel »
Steve
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RBHR 60mm/54mm Dr Su 11/1/19

Tekka

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #75 on: February 22, 2009, 06:07:08 PM »
Steve,

I have pondered, worried and sent myself near crazy thinking about this subject, as you know...different doctors have such different views on this subject.

I am mr impatient and for me not to train and coach is testing, however I have made the early decision to WAIT for the twelve month rule to apply, I know this is difficult but we have all had to endure pain for what may have been many years....why rush it now, for the sake of a few months, but I also appreciate if a patient has been given the green light at say six months then who would argue. I can understand the twelve month reasoning, so the bone has fully grown into/around both cup and ball.

I suppose were all in un-known terrain with regard to the long term, but with new advances always being made...who knows, we already have the mid head !!!

Regards

Terry

LBHR 23/01/2009 Mr Mcminn

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #76 on: February 23, 2009, 04:24:12 PM »
Terry,

Femoral neck fractures are rare after six months.  The femoral cap is cemented for a BHR, so bone in-growth is not an issue.  Bone in-growth for the socket is essentially complete at 6 months and socket loosenings after 6 months are also rare.  Bone densities continue to improve around the femoral neck, increasing from 95% at 6 months to about 120% at 24 months depending on the zone.  So I feel comfortable gradually returning to impact sports at 6 months.  About 3 weeks remain for the downhill ski season, and I'll visit the ski area on nice weather days and ski moderate slopes (I'm not going to push it this season).  It will be nice to be out there on a sunny Spring day.  I don't normally run or jog and I haven't played racketball for 13 years.  I'll begin playing racketball by getting my strokes back and play a moderate game or two.
Fortunately, I was able to ski the entire 2007-2008 season without restrictions prior to my surgery in September 2008, because my condition was not that disabling or painfull.  My condition really went downhill last Summer.  I was lucky to get the most out of my natural hip (and not miss out on activities) before replacing it with a BHR.
Steve
LBHR 60mm/54mm Dr Su 9/29/08
RBHR 60mm/54mm Dr Su 11/1/19

Tekka

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #77 on: February 23, 2009, 08:09:18 PM »
Steve,

Good luck mate and enjoy...

Best wishes

Terry
LBHR 23/01/2009 Mr Mcminn

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #78 on: February 23, 2009, 09:06:20 PM »
Well, I just saw my physical therapist this AM at 21 weeks post-op.  I had no problem using the Pro Fitter machine which simulates the side to side motion of downhill skiing.  My gait is much improved with hardly any pelvic rotation.  My stretching and range-of-motion is greatly improved.  I have about 4 weeks of physical therapy remaining (one visit per week) and I will work on the Pro Fitter machine.  In fact, since the physical therapy office is down the hall from the health club, I can use the machine when I visit the club.  The physical therapist is a bit cautious and believes I should wait until next year to resume skiing, since only about 3 weeks will remain for this season when I am at 6 months post-op.  I will gauge my strength, flexibility and weather conditions before I head up to the mountain at the end of March. 
Steve
LBHR 60mm/54mm Dr Su 9/29/08
RBHR 60mm/54mm Dr Su 11/1/19

stevel

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Re: FDA approved device and experienced hip resurfacing doctor
« Reply #79 on: February 28, 2009, 05:07:01 PM »
5 months post-op today :).  I still have restrictions to prevent fracture of the femoral neck.  No impact sports or lifting over 50 pounds until 6 months post-op.  Femoral neck fractures are rare after 6 months (no different than a normal hip);  perhaps they are unusual after 5 months.  I feel more at ease, nonetheless.

The progress note (2/17/09) from my physical therapist to Dr. Su says "Hip extension now is approximately 8 degrees.  External rotation still tends to get tight, particularly if we do not follow through with stretching.  He is showing improvement with gait, particularly since we started strengthening glute minimus."

I have three more weekly visit of PT remaining and I am using the "Fitter" which simulates the side to side motion of downhill skiing.

I have read several recent posts of surface hippies experiencing pain between 6 months to a year when returning to sports.

I wonder if Dr. McMinn's protocol is worth considering e.g. no impact sports until 1 year?

I need to ask Dr. Su about this.  I suppose it depends on the health and condition of the individual patient.  Some well conditioned athletes return to running at 3 months.
« Last Edit: February 28, 2009, 05:08:43 PM by stevel »
Steve
LBHR 60mm/54mm Dr Su 9/29/08
RBHR 60mm/54mm Dr Su 11/1/19

 

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