August 2008 Problem hips….not me I’m only 38

OK, so where do I begin? I’m pretty average really, I’m a family man, I play a little sport, mostly golf and a bit of cycling and walk my two dogs regularly. My weight is only slightly more than it should be for my height (175cm).

I visited my GP last year after playing golf and feeling a sharp pain right down my left leg that was severe enough for me to abandon my game! My GP diagnosed a trochanteric bursitis and prescribed anti inflammatory medication. I carried on with the medication for about a year but I decided that although there were good times the drugs hadn’t addressed the problem.

Upon revisiting my GP in January 2008 I re-explained the symptoms I had been experiencing; which had become more regular and painful these included:

•Sudden loss of strength in my leg •General and shooting pains •Inability to walk any real distance •Driving pain (my car is manual) •Prolonged aching and restricted movement

This resulted in me being a real grouch!!! my poor family went through it.

Fortunately I saw a different GP who pulled me about a bit and suggested he refer me to our local hospital to see an orthopaedic specialist.

March 2008 my hospital appointment came through, it was a two part appointment with a visit to X-ray first, followed by the consultants appointment a week later.

The consultant laid me down and checked ranges of movement in both my legs, this took minutes and then showed me the X-ray, it was conclusive that there was arthritis in my left hip. Now being 38 – an ex serviceman and physically fit, this was unbelievable to me, I couldn’t really take it in, what did it mean? I was assured by the consultant that within about 5 years he would see me again for a hip replacement, and in the meantime he would make me an appointment to see his colleague regarding pain management.

July 17, 2008 Operation Day

I have adopted a positive view of having the operation since day one. The way I view it is that this is a RESET POINT in my life, so that I can regain the normality I had prior to the arthritis limiting my abilities. This is simply one day out of my life which might cause me pain for a few hours, I don’t think that’s enough of a reason to get anxious or stressed.

My instruction was to report to the hospital ward for 7am, as per usual I was early and prepared. The Staff Nurse showed me to my bed, I was on a clean small ward made up of only 6 patients. I was one of three new intakes (all hips: one traditional, one revision, and my BHR). My operation was scheduled for 4pm, but due to the consultant wanting to meet and greet his patients I had to be in early. Early on the consultant and his registrar visited and explained the procedure; they were going to make a traditional incision, from the rear. They marked my leg, asked If I had any questions, I signed the consent form, and I might then see them later. It was very welcoming.

I was unprepared when at 12pm the porters came to get me! there had been a change of plan, it was my turn. Quickly, I undressed and put on the slightly bizarre open backed gown that I would get used to.

When I arrived at theatre the anaesthetist greeted me and explained the options available to me; they were: •General anaesthetic •Spinal sedation from the waist down

I elected to have the latter and there was then a further question, did I, or did I not want to be conscious for the operation? It didn’t take long for me to elect to stay conscious! I have always been curious and I figured that if I didn’t like what was going on they could top up the anaesthetic and I would be no worse off.

The spinal injection didn’t hurt a bit, and then I was wheeled into theatre. The team rolled me onto my side, and fitted pommels to secure my position. The sheets went up and I could see no more, and it happened really quickly.

At that point I think I dozed for a bit. I remember later talking to the anesthetist, and the consultant then started asking me some questions, he then explained the part of the procedure he was carrying out, for those interested he was coring the head of my femur to accept the new cap, he then “tapped” the new cap into place and fitted the acetabular component “cup”. It wasn’t unsettling or scary in the slightest.

Soon after they closed the wound using removable staples and I was wheeled through to the recovery room.

Because I had generally stayed awake I was offered water, I also was hooked up to a patient operated painkiller machine and oxygen. Feeling came back to my feet while I was in the recovery room and it was really exciting! I could wiggle my toes and the operation was over.

I was really keen to get back to the ward so I could ring Lynda and let her and my family know I was OK, this I did fairly soon afterwards.

The anaesthetist uses a nerve blocker there really isn’t too much pain on the operation day, and because I had my own means of administering painkiller it really didn’t seem to be obvious.

That night however is likely to be a long night, the nurses come round on hourly/ 2 hourly observation intervals, so if you get any sleep well done!

Day 1 Post Op – pt1

Day one of the rest of my life.

This is possibly the sorest I felt, the patient administered painkiller was removed yesterday and the only pain control required was paracetamol. My legs have been covered in delightful anti embolism tights since before the operation yesterday (these stay on for two weeks) and I have spent the first night’s sleep on my back (this has to be maintained for six weeks). There were two distinctly different types of pain in my leg, a dull muscular pain – like a heavy dead leg and a sharp pain at the surface where the incision was carried out. I couldn’t identify any specific pain at this time – more to follow.

I enjoyed my Weetabix and cup of tea for breakfast and was glad that my waterworks were functioning as normal, ‘cos I really didn’t want to be catheterised.

Day one post op the physios plan is for patients to get out of bed and do some very basic physiotherapy, i.e. transferring into their bedside chair, this I did, but gosh it was an effort, and if I’m honest quite painful.

The next thing that happened was that the porters came to take me down to X-ray, this is carried out to check the post operative alignment of the cup and cap. So off I went and when I arrived at X-ray was transferred to the table, this I found to be very painful, the X-ray was carried out. Immediately I realised that something wasn’t quite right because the staff all huddled round the monitor in conversation. It transpired that there was something showing up on the X-ray that shouldn’t have been there, I was taken back to the ward gathering as much information as I could along the way.

Once back on the ward a nurse removed my dressing to see if any item had been left under the dressing – it hadn’t.

Day 1 Post Op – Confirmation of Alignment Pin

I was visited by the consultant who didn’t waste any time in confirming to me that there was a problem.

When the operation is carried out the consultant fixes an alignment pin in the thighbone which is used during the operation and removed prior to closing the site. In my case somehow it was overlooked and the alignment pin (also known as a guide wire) remained in my femur and quadriceps muscle (see photo). September 23, 2009 I had a l/h resurfacing in July 08 which was complicated by an alignment pin being left insitu which was removed by a second op and further incision, I had an infection in the second wound which was treated by antibiotics due to a subcutaneous suture protruding through my skin! Recovery was I’m told normal, but June 09 I started suffering from sharp pain morning and evening in the wound area this has steadily and progressively got worse, to such an extent that I am unable to get out of bed or a chair without very strong sharp pain – now enough to make me reallly draw breath, its similar to post op pain. Furthermore I am unable to fully straighten my leg until I have carried a standing stretch!

I have seen a consultant who X-rayed my hip area and alignment appears fine, I have a MRI and US booked which may result in the area being aspirated if an infection is present.

October 9, 2009 2 weeks ago I had the US and MRI, followed by a guided aspiration of the joint and steroid injection. Since then the pain has subdued by about a third but is still occuring in the same pattern including lying in bed, getting on and off the sofa, stretching and certain flexing movements including car clutch operation.

The radiographer noted on the MRI that that the cause of the problem thank God is not a pseudo tumour and the fantastic ortho consultant Mr Peter McLardy Smith confirmed this morning that the soft tissue has not rejected the implant either but it is a trochanteric bursitis, which although difficult to treat is a great weight off my mind.

Unfortunately for me this was discovered on a Friday afternoon, a further operation was scheduled for me to have the pin removed first thing Monday morning.

It soon became apparent to me that I could feel a specific pain in the approximate position of the pin, and I was told that I would be unable to carry out and physio over the weekend, this really was my lowest point as I had hoped to be discharged on Sunday, but now had an extended stay and an additional operation to face.

Alignment Pin Removal Surgery

The weekend passed and early Monday morning I was prepped for theatre.

This time unlike the actual resurfacing operation I had no option for anything other than a general anaesthetic. I don’t like generals! but hey, all I wanted at this point was to have the pin which was causing me pain and physically restricting my movement to be removed (see photo) and to get up on my feet so I could catch up with the other patients who had surgery and were now mobile unlike myself, and I had a typically 25 year age advantage…just to rub salt into my metaphorical wound my neighbour in the ward, an 82 year old very independent man had recovered so much that he had been discharged on the Saturday which was less than 72 hours post operation.

I had serious concerns about infection, my original wound was still very fresh and it would mean further exposure to atmosphere, had the procedure been carried out correctly in the first instance this would not have been necessary and infection less of a worry. I felt aggrieved but maintained my outwardly positive attitude so I could move past my now delayed personal RESET POINT as previously mentioned.

The operation lasted less than an hour. I understand that the procedure involved cutting through the skin and muscle to expose the pin that was firmly set in my femur, extracting it then closing the wound. I came round in the recovery room and was to say the least very sore!

The consultants registrar had explained prior to the surgery that this would require a further incision, sure enough I have a smaller scar healing on my leg next to the main one, unlike the main incision which was stapled this one simply had sutures holding it together.

The nurse in the recovery ward administered morphine and tramadol for pain relief but this didn’t ease the soreness. I was returned to the ward to recover.

Day 1 Post Op – again

This then was my real first day post operation. The physiotherapists are keen to get patients moving as quickly as possible for various reasons, and muscle tone deteriorates quite quickly.

Today the physio visited me and helped me to my feet. Zimmer frames I have always associated with people who are far less ambulant than myself, but here I was using one to move around my bed area and the ward. This gave me even more client empathy – as I have previously said I am a stairlift and domestic mobility lift surveyor in my professional life!!!

I soon progressed onto crutches and was determined to demonstrate to the staff that I was safe, confident and more than ready to go home. The physio’s were happy with my efforts and gave me other flexion exercises to carry out, but I had to stay in for another night and because I live in a house with stairs (and kids, dogs and all other family paraphernalia) I would have to manage a flight of stairs tomorrow morning.

The bit was firmly between my teeth to pass this test…which I thankfully did without any problem. August 11, 2008 My incision size/s are 12″+ and 3″ which was for the removal of the alignment pin that was kindly left behind…

Maybe this is a record? but I had 42 staples in the main incision, how does this compare to others?

Dressing at the top is covering what the nurses called a “sluffy” area – a small area of surface infection, this will hopefully be removed asap, (about 4 1/2 weeks post op).

I hope that this doesn’t put people off, I still think that the BHR is fantastic