December 23, 2014
I’m 33 years old. I was an active mountaineer and runner through most of the 2000s but developed severe chronic deep aching in both of my hips (right-side much worse) in late 2008 and was diagnosed with FAI (cam) -caused osteoarthritis.
I ended up having bilateral hip arthroscopies with Dr Sampson in SF mid-2009. The left hip was relatively straightforward (femoral neck resection to “fix” the cam FAI and labral repair). There was only minor articular cartilage damage and it’s holding up reasonably well to this day (it’s not a perfect hip, but I only have occasional and minor complaints about it). The right hip was much more severely damaged. There was a medium-sized area of articular cartilage which had delaminated, so that was removed and I got microfracture (in addition to resolving the underlying FAI). Other areas of articular cartilage had thinned at that point also.
The right hip also actually did very well until about 18 months ago (it was a *drastic* improvement from pre-surgery and I returned to full activity). About 18 months ago, what I call “museum sightseeing” started to end in a very acute stabbing pain deep inside my hip. While walking I would get intense sharp, but unpredictable pains from inside my right hip. Strangely, at this point I didn’t get any chronic ache afterward. Fast-forward to the last 3-6 months and now the same thing happens far more frequently. I cannot hike more than a mile or so anymore without provoking this, and I do get a moderate-level chronic ache again, just like I did before the arthroscopy. The chronic ache comes and goes, but I am very concerned about the rapid deterioration in my condition.
I understand that the consensus is that regular repeat microfracture isn’t really a workable solution, so I have been investigating a hip resurfacing as I wish to remain very active and I need the implant to last as long as absolutely possible given my age. To be fair, I am still relatively active (I do crossfit a few days a week, for example, and I scuba dive very regularly). However, I cannot hike, traveling is very difficult (as it tends to provoke the stabbing pains that cause me to almost collapse), and I am guessing that somewhere in the next couple of years I am going to have to further modify my activity to maintain my sanity.
October 14, 2014
Dr Gross said that everything went well and the internal state of my hip was as expected. Now begins the recovery road! Numbness almost completely gone so should be up and out of bed this afternoon!
EDIT: I should add one thing. Despite being a male in my early 30s, who’s done weight training on and off over the past few years, I actually had low femoral neck bone density which came as quite the shock. Thankfully I was better than the cutoff for the modified recovery program, but if it had been my other hip I wouldn’t have been. So, a big wake up call there, I’m going to have to start taking bone density seriously and working on it.
In the hotel I found getting in and out of bed to be very difficult initially but it’s already getting easier. My operated leg is much heavier than I expected when I try to lift it with the leg lifter! Showers, and a non-raised toilet seat are also pretty challenging at the moment. Things have improved drastically in the past 24 hours, but it’s still fairly easy to move my leg in a way which causes some stabbing pain, so I need to be very careful. Sleeping is also difficult as I’m not used to sleeping on my back and ended up with a bunch of lower back pain by early morning.
My walking is going very well. I can now walk with a two-step gait (crutches and operated leg move simultaneously, then I step through with good leg, repeat) although obviously there’s still some stiffness in the operated leg.
I went out with my wife this afternoon for some coffee. It felt good to get outside even though it’s a little intimidating.
I haven’t needed any immediate release Nucynta for the last 24 hours, but still taking the extended release ones. I’ll probably need some extra tomorrow afternoon for the flight home. I’m lucky enough to have been able to use points to get first-class tickets back and we have AC sockets in the seats — has anyone tried to use the ice machine on the plane? I’m pretty tempted to try to get it filled post-security and plug it in on the plane.
It’s the morning of post-op day 4 and pain levels are pretty low. I’m working on weaning off the Nucynta now. I haven’t had any immediate release since right after discharge from the hospital, and now I’m cutting back the extended release from 100 to 50mg per 12h. Try for zero tomorrow day, maybe 50mg again tomorrow night, then done. Obviously we’ll see how that goes though!
Zero pain directly connected to just weight bearing on the leg. The muscles are still all fairly sore so stabilizing while weighting the leg occasionally tweaks a bit but the bone/implant/bone part of it doesn’t seem to have any pain which feels great.
Psoas is still the least co-operative and painful of all, and very obvious when getting in and out of bed or a car (where I need to lift the leg and swing it to the side) but it’s definitely better. Heel slides on the bed are now pretty easy and no longer painful.
I can sleep maybe 6 hours in bed at home before my back starts to get sore so I did that last night and then moved to the recliner for a couple of hours in the early morning.
I’m definitely less terrified of hurting myself now as things are clearly moving back toward “normal”, but I keep reminding myself that it’s only a few days and I really do need to be very careful still!
Alright, flights. We’d decided to splurge on first-class tickets back on American from Columbia to Charlotte and then to home in California (It was several hundred dollars cheaper to start in Columbia than Charlotte, but I knew that first hop was economy regardless). It all turned out OK as I wasn’t in much pain anyway, but I would recommend against doing that. Frankly, it was almost comical how rude and incompetent the vast majority of airline and airport employees we interacted with, with a couple of notable exceptions. My wife and I both felt this, as did a few other couples we overheard venting to each other. I know this sounds ridiculous, but I’ve just never seen anything like it. I’d read about how great Delta had been helping post-op patients — I felt the opposite with American. We were essentially ignored, given wrong information about how to get a ride around Charlotte (“just go and sit in those red chairs” — 15 minutes later we’re still sitting, ask again, “just sit there”, another 15 minutes ask again, “well, why haven’t you flagged down one of the carts?”). The gate agent in Charlotte was just plain rude when we asked if she thought we’d be able to get some ice on the plane and then lectured me about how stupid I was to fly after surgery. Anyway, there’s lots more than this. The flight attendant on the main flight was much nicer and helped us out and everything worked out in the end, but I needed to vent since it was such a hugely frustrating day! Since people have seemed to have great experiences with Delta flying home from that area after surgery, I recommend following their advice!
I still like using the ice machine. That, combined with Tylenol, is plenty for managing pain now. Particularly if I go for a walk and then do exercises, I’m ready to get on the ice machine afterward although it might just be my own paranoia about doing too much! Anyway, ice machine is great.
I know that I’m far from out of the woods at the 1 week point in my recovery (serious understatement) and who knows what muscular issues I’ll have to deal with as I work on coming off the walking aids and re-learning a normal gait. But, I’m cautiously optimistic and very happy overall. First two days weren’t the easiest of my life, but I’ve been cruising the last couple so I thought I’d share my optimism!
I occasionally do something which causes a sharp spike of pain (for example, I pulled my skin taught above the incision which clearly pulled on something and was rather painful) but otherwise things feel good 95% of the time.
I definitely put quite a lot of weight through the cane but I don’t have much of a limp once I get walking with it which I’m very happy about (I’d still limp without the cane though).
I still get pretty tired by evening, and sometimes a little mopey then, but overall psychologically feeling reasonable also.
Headed back to work on Wednesday which is the 2 week mark. Hopefully things keep improving and I’ll be able to handle the mental load of a full work day!
Sleeping is still tricky. I’ve only once managed to find a position on my side that doesn’t cause an incision ache (even lying on the non-op side). I tend to try that first and then unwind it toward my back a bit which let’s me lie mostly on my back but in a more flexible, movable position. Lying directly on my back with a pillow under my knees/calves tends to immobilize me and causes my back to ache after a few hours.
Really smooth day overall. No issues on the commute (25 minutes in, 40 minutes in bad traffic to get home), no issues walking around at work or sitting at my desk. Feeling good, and other than 500mg of Tylenol with breakfast (and the mobic Dr Gross has me on), no other painkillers all day.
Yesterday I also thought I’d check the distance on my new walking route and realized I messed up calculating my old one! What I thought was 0.28miles, was actually 0.56 miles, and my new route which I thought was only a little longer was actually 0.95 miles. So I’ve basically been walking a mile/day for 4 or 5 days no.
Thankfully sleeping has improved quite a bit this week, although it’s still not ideal. I can now sleep for a few hours on both sides, with a large body pillow between my legs. The main remaining issue is that I can’t get through the whole night in one position, and moving positions with the pillows isn’t something I can do while asleep, so I wake multiple times to re-arrange through the night.
There isn’t really any pain normally at all now. I would say normally I am at a 0/10, with occasional 1/10. I take one tylenol before bed and one with breakfast, but that’s it (oh, and I guess I still have the 1/day Meloxicam Dr Gross has me on).
The only real muscle pain I have is perhaps 5% of the time when I overdo things a bit, my psoas flares up and gets sore (noticeable with each step). But if I take it easy, it settles back down easily.
I’ve just increased my walking to ~0.9 miles, twice/day, unaided + all the little walking around I do to go to work and to lunch, etc. No real issue with that so I’ve decided that every couple of days if everything still feels OK I’ll just add a block or two to the walk. If things feel overstressed, I’ll hold back. Still doing Dr Gross’ phase 1 exercises religiously twice/day also (except for the ankle pumps which I figure have become obsolete with all the walking and other activity I do).
Psoas and abductors are still the weakest/angriest muscles, but they’re definitely improving. I have a little limp when I stand up after sitting for awhile but it’s usually 95% gone after 5-10 steps. Sometimes I have to remind myself to be careful because I momentarily forget about the hip and pivot on it, but that feels pretty normal now too with no pain which is great.
Last night I finally managed to fall asleep with only a single pillow between my legs (vs 2, or 1 + a huge body pillow) without feeling an ache around the top of the incision. This was fantastic! It simplified shifting positions enough during the night that I could do so while barely waking up vs completely waking myself (and my wife) up each time.
Mostly I’m waiting for a tiny piece of scab to fall off my incision so that I’m allowed to go swimming, and more importantly, waiting for the 6 week point so that I can start doing more!
The next phase of my recovery is getting started in earnest now. I’m allowed to bend past 90 degrees, and generally do anything with the following exceptions:
– No “extreme” flexion
– No crossing legs at the knees
– No impact
– No lifting more than 50lbs routinely
I think I can live with that for the next 4.5 months. I think the main thing is to remember to ramp up slowly. My psoas has definitely continued to bother me so I need to pay attention to it. Start stretching it out more, work on strengthening it, etc, but not overstress it too much.
Got my 6-week x-rays and the components look to me like they’re in the same place as the ones taken at the hospital (phew).
The PT eval was a little frustrating and afterward I realized he didn’t cover everything on the form for Dr Gross (condition of incision, 45 degree internal/external rotation, tenderness, leg length). He was going to copy his notes onto the form after I left, but he talked me into coming back next week for some more guidance, so I’ll do that and hopefully fill in the missing details then. He spent more time on general mechanics looking forward and pointed out a few things with my feet and knees. He had a lot of generally interesting things to say but I’m feeling a bit wary and wondering if I’d be better off just starting with the basic leg raises and stretches Dr Gross prescribes and slowly adding in my own activities at the gym, swimming, etc. I figure I could come back to PT in awhile. Sorry for the rambling here, but I was a little frustrated about it all this morning and it’s just pouring out!
So, jumping back. I’m at 6 weeks and doing well as far as I can tell. My abductors around the incision are sore when I wake up in the morning, and my psoas bothers me a bit when I walk during the day, but overall I’m still happy with the progress. I don’t really have any trouble walking 2 miles at a time.
– I’ve been working on single-leg stability exercises (bilaterally) and finding them very useful. Things like standing on one leg then moving the other leg in front, behind, out to the side, lots of different motion. Also doing (light) bicep curls and other very basic upper body exercises while standing on one leg for balance (with a bent knee). I can really feel my glutes working to stabilize my body and getting a lot better at it
Basically, I’m salivating at the idea of being allowed to lift weights again in two months (although I will obviously start very slowly!), it just feels so much more rewarding.
I’ve also been considering working back into kettlebell swings. Dr Gross’ 3 rules aren’t violated by them (>50lbs, extreme flexion, impact) but I vaguely recalled something else about explosive exercises (which they definitely are) so I contacted the office and got a bit of a confusing response. First off they said it was A-OK as long as I didn’t violate the 3 rules so sounded fine to them (with a <50lb kettlebell), even after I’d mentioned it was definitely “a bit explosive”. When I responded to their A-OK saying that’s what I thought but was just being cautious, they wrote back a second time saying “avoid anything ‘too explosive’ until the 6-month point” so not sure what the story really is. I should probably follow-up for clarification.
Good news is I’ve recently gotten my diet back under control and starting to lose some of these excess pounds.
Most of my exercise/training has been a combo of walking on the 15-degree incline treadmill and hiking up some 1000′ gain nearby peaks. The hiking is obviously much more interesting, and I also think it’s much better training since it has rocks, uneven terrain, and I have to go down as well as up. Good stuff for stabilization. I suspect that the treadmill will disappear soon, particularly once I can start doing more strength-related stuff at the gym.
I think this weekend I’ll go ahead and start trying out the kettlebells, but will definitely take it easy.
Gluteus Medius still gets sore to sleep on, but it’s sore no matter which side I sleep on and it’s always been somewhat that way so I’m doing OK.
In a week or two I’ll also try doing some of the hikes with a <50lb backpack (start small, ramp it up) in preparation for my return to scuba diving where I need to be stable with ~80lbs on my back. Same thing with doing some squats like that for the sitting/standing/sitting portion. I can probably start working on squat form with just the 45lb barbell soon too.