30 years old. 11/11/2009 Left hip Biomet uncemented by Dr. Thomas Gross.

It has been exactly 7 days to the minute since I had my left hip resurfaced and I just walked my first mile so this seems like a good time to write this note. My story is similar to many of the stories on the Surface Hippy website. I could never thank Patricia Walter and all the other contributing Surface Hippies enough for this invaluable resource – it was the #1 resource I used while educating myself about my situation and available options. What an awesome example of how technology can empower the patient community!

At the age of 29 I was diagnosed with severe OA in my left hip, likely due to a slight malformation of my femoral head which caused uneven pressure and eventual breakdown of cartilage. The news was very unexpected and I was absolutely crushed. The tears started coming once I got back to my car. It wasn’t that I was thinking “why me” or anything like that but that I felt a huge sense of loss. Everything about my life was active – a normal week might consist of 50 miles of single track mountain biking, soccer, softball, yoga, and the gym. Being active was how I relaxed – it was my only real hobby besides reading. My journey to the diagnosis was a long one and started with groin pain as a college soccer player – trainers and myself would assume the pain was due to a strain or pull and I would rest. Several weeks and I would always be fine. A blown knee and approaching graduation took the focus off soccer and on to academics. Once I stopped competing at a high level I paid little attention to a progressive loss of speed and agility. I was athletic enough to compete just fine in recreational sports and the years passed while I immersed myself in my professional life. I naturally transitioned to sports that better fit my changing abilities – yoga and mountain biking. I though I had just been slacking and yoga would bring back my flexibility. It didn’t. I continued to loose flexibility, was unable to run at speed, and groin pain had become a constant part of my life. Eventually I realized I could not remember not using my hand on my knee to pull my left leg into my car or picking something up without lifting my left leg in the air behind me. Putting on socks and shoes was one of the hardest aspects of my day. “Are you limping?” questions came from all directions. It hurt to exist – awake, asleep, sitting, standing – chronic hip pain now defined who I was.

Before I found the Hippy Surface website two themes defined the messaging I received from medical professionals. The first was that I was too young for this to be happening and that my situation was weird (fascinating insight). The second was that this was a big shame, none of my options were ideal and I should wait as long as possible to consider surgery because of my age. I have enough experience in healthcare to know doctors are constantly wrong, information disseminates at a snails pace in medicine, and there were other people like me and I needed to find them ASAP. Finding the Surface Hippy website was one of the best days of my life.

At my age I never considered traditional THR – if you’re reading this neither should you! There are situations when THR is the only option but they are rare. It is important to note that THR is a massive industry – there are billions of dollars and lifetimes invested in this procedure. If you think most physicians who have built their entire practice, professional career, and sent kids to college by performing THR’s are going to be impartial regarding resurfacing you’re nuts. I asked a physician at Washington University why anyone in their right mind would ever consider THR if resurfacing was an option. He seemed almost offended, stated it was a perfectly good procedure (for him maybe) and I should consider it as a very viable option. Doctors are people – its your hip, you’re the expert and must take on the responsibility of the role. Ask questions and know the answers you’re looking for.

In choosing my surgeon I met with teams at Washington University in St. Louis, Dr. Su at the Hospital for Special Surgery in New York, and Dr. Gross at Midlands Orthopaedics in South Carolina. The surgeon at Wash U was primarily a THR surgeon who basically does resurfacing on the side. He had completed about 60 cases in 3 years. I wanted someone with more experience. I met with Dr.Su in New York. I left the meeting feeling very confident he would do a great job and enjoyed our meeting. However I passed on Dr.Su for several reasons. I wanted to go with an uncemented femoral component and Dr. Su only does cemented. The Hospital for Special Surgery is an extremely difficult facility to navigate (one appt. had me visiting 3 completely different buildings) as is Manhattan (awesome town, unless you can’t walk) – this seemed like a nightmare scenario after surgery. Some of the staff at the Hospital for Special Surgery were also extremely unprofessional – staff members making fun of and arguing with patients definitely had an impact on my perception of the facility.

I choose to have my surgery with Dr. Thomas Gross in South Carolina for several key reasons. Key factors included: surgeon’s experience specifically with resurfacing; uncemented femoral component option; an incredibly friendly staff throughout the facility; and easy access to facilities.

THR and resurfacing are two completely different surgeries – skill at one DOES NOT necessitate skill at the other NO MATTER what any doctor might say – the entire process, tool set, prosthetic components, etc. is completely different. Resurfacing is going to continue to gain in popularity which means more and more inexperienced surgeons are going to start doing the procedure – I personally wouldn’t want to be someone’s practice. Ask your surgeon how many times they have performed the specific procedure with the specific components. The experience and skill of your surgeon is the single most important factor in your success. It is only day 7 and the only pain medication I took today was two Tylenol 7 hours ago and I’m sitting on my couch with ZERO pain. I have almost ZERO bruising. I walked one mile today without crutches or a cane and didn’t have any pain – I could have walked another one, the last step didn’t feel any different than the first. I have not heard any popping, clicking or other unnatural noises coming from the joint. The OA pain is GONE! I know my joint and recovery still have a very, very long way to go and I’m far from out of the woods – anything could still happen – but I could not be happier with how things have gone thus far. These results are all due to the skill of Dr. Gross.

While the contemporary uncemented femoral component option is so new data is not yet available on outcomes it was an easy choice for me. I believe it will become the standard. While a 20 year lifespan for a cemented component is a great outcome it would still have me moving to a THR relatively early. I need both components to become parts of my body – I need the connection between the components and my body to be alive – I need the connection to be bone. I personally saw cement as one more point of failure which added variables to the overall system. Cement is not alive and cannot regenerate itself.

Everyone at Midlands Orthopaedics was extremely professional – from the front office, to x-ray, Nurse Nancy Smith, Nurse Practitioner Lee Webb, and Dr. Gross himself. After having visited Wash U and the Hospital for Special Surgery this professionalism was a giant relief. I finally knew I found the team I wanted to work with. Dr. Gross was the first surgeon who seemed genuinely excited about the components he used for the surgery. I asked other surgeons, “What components do you use and why?” The general answer before Dr. Gross was “I use ‘x’ mostly and it seems to work OK” – I absolutely hated that answer! These guys should be experts on the options and choose their tools of the trade with passion! I wanted to hear extremely specific reasons why, of all the options, this doctor thought I should have a particular piece of hardware in my body, potentially for the rest of my life. No doubt they’re getting paid by the component vendors but I wanted to figure out what other specifics they used to pick their horse.

I’ll share some of my advice for anyone facing the difficult situation of needing a new hip(s).

 

• Find ways to get into or stay in shape. Your body is a system – the stronger the overall system the better you will be able to cope physically and mentally with the challenges before and after your surgery and recovery. Find exercises you can do – swim without kicking, use adjustable elliptical machines to find a bearable setting, do upper body exercises, walk as much as possible. Rehabbing a hip is a difficult task – you don’t want to have to rehab a quad, hamstring, calf, etc. all at the same time too. My left leg was still very strong at the time of my surgery – I can already tell this is an excellent help in my recovery. You also want to get into the habit of a daily exercise routine before surgery so you will have one less change you have to make after – you’ll already feel comfortable with the daily routine of rehab.

• You are the foremost expert on this planet regarding your hip. Nobody else. Embrace this role and become an expert on every aspect of your situation. Don’t let doctors intimidate you or pressure you into any procedure or timeline. Ask specific questions and demand specific answers, “how many hip resurfacings have you done?” – I had a doc answer this question by lumping THR’s and resurfacings together 3 times and would not tell me the specific number eventually stating the surgeries are basically the same which we all know is nonsense. If you’ve studied the Surface Hippy site carefully, you have expert knowledge and know more than a vast majority of doctors.

• Take your time in choosing your surgical team. I remember just wanting to get the decision over with and move on with my life. If not for my very supportive family challenging me to make sure I felt comfortable with my surgeon I probably would have gone with the easiest option which upon further reflection would have been the wrong choice.

• Remember THR is a multibillion dollar institution – there are vested interests and a great deal of economic momentum working to keep THR procedures as the standard. Just because your local doctor isn’t up to date on modern resurfacing doesn’t mean it’s not the better option in many cases. Personally I do not see any reason why someone who has the option of resurfacing would ever choose THR.

• Keep a positive attitude. Life is difficult. Always has been, always will be. I’m in a good place right now with my outcome but a fall on ice, an infection, or some random car accident and the game changes. Before I had my surgery I had reserved myself to accept the worst possible outcome (well death is the worst but that would be easy on me) which I saw as a long fight with infection, zero weight bearing, and ending up with a THR . This situation would suck but I’d need all my mental strength at hand to fight to get my health back. I entered the hospital ready to battle. My right hip isn’t too far behind my left so I’ll be on this journey for a while.

If you’ve found this site consider yourself lucky. Take your time, get prepared, and take your life back from pain. I am so very thankful for my supportive family and my beautiful girlfriend Meghan who traveled with me to South Carolina. I am eternally grateful for and humbled by all the love and support I received from Meghan, my family, and our friends.

Best wishes on your journey!

Sincerely,

Joseph P. Tierney
Surface Hippy Newbie

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July, 2010

Follow Up to 11/11/2009 Left hip Biomet uncemented by Dr. Thomas Gross.

I’ve been meaning to write this for a while but it’s been nice not to think about my hip. It’s been about 8 months since I had my left hip resurfaced by Dr. Thomas Gross. There’s only one thing I would change about the procedure, I would have done it sooner. I am completely pain free and my left hip is nearly 100%. In fact, I rode my mountain bike 10 miles yesterday evening and 8 miles today on some of the most technical single track trails in the Midwest. I have ZERO pain in my hip even after 2 big days (and several big falls) of riding at Landahl Nature Reserve in the Kansas City area. The only time I feel any discomfort what so ever is at a full running sprint, although it had been more than 5 years since I was capable of a full sprint so it makes sense this will take some time to come back. Mountain biking was my biggest hobby so it’s been great to have such a wonderful gift given back to me by Dr. Gross. If I had listened to doctors at Washington University in St. Louis I’d still be living in agony and would have given up mountain biking all together. The guidance from The Hospital for Special Surgery in New York was also to wait as long as possible and to put life on hold. If you’re taking the time to research Patricia’s wonderful site, then you’ve likely put your life on hold for long enough and it’s time to act. After meeting with several teams I’d highly recommend Dr. Gross and team.

Hip resurfacing is a major surgery and it is important to be prepared to be in a significant amount of pain immediately following the procedure. I had my ACL done in my right knee and would say the pain and rehab are comparable. I had my surgery at Providence Hospital in South Carolina. The staff and accommodations were outstanding. Considering the circumstances, I was extremely comfortable durning my stay. I was up on my feet the day following surgery and, walking with crutches, was able to put a substantial amount of weight on the leg immediately. I’d recommend paying very close attention to the guidance from your physical therapist regarding navigating stairs, getting in and out of the shower and doing other everyday tasks. Her suggestions were very helpful. After several days at Providence my girlfriend and I stayed at the Courtyard Marriott hotel, there on hospital grounds, for one more evening before our flight home. They were extremely accommodating as well and we made sure to stay in a handicap accessible room – you’ll want this because it’s much easier to shower. I know the raised commode is recommended but they always felt extremely unstable to me so I never used one. You will definitely want to take full advantage of the Polar Ice device – it is invaluable in the hospital as well as when you arrive home. I’d recommend drinking a lot of water once you leave the hospital to stay hydrated. I didn’t drink enough and had a pretty severe headache during the flight home as a consequence. I wasn’t drinking much because getting up to go to the bathroom was such a process but getting up is good for you and your hip so definitely stay hydrated.

I was religious about my rehab from day one. I started with the simple exercises recommended by the physical therapist and continued to expand the exercises based on comfort and the suggested timelines. Dr. Gross said to use two crutches for at least the first two weeks, but I was down to one within a couple of days – it was just easier. I had surgery on a Wednesday and had an unexpected job interview that following Tuesday – I actually left my crutch in the car and even walked up a couple of steps. Obviously this isn’t recommended but I was absolutely amazed I was back on my feet and hardly limping just 6 days later. As I mentioned in my first post, on day 7 I walked 1 mile, very slowly, without crutches. You definitely don’t need to rush anything, and this was not recommended by Dr. Gross, but I just wanted to share how quickly you can begin to feel comfortable on the new hip. I moved very slowly and if I felt pain or became sore I immediately toned things down a bit. I walked about a mile nearly every night for several weeks and then began to walk further until I was walking about 3 miles comfortably. I don’t recall the exact date, but it was sometime between the 4th and 6th week when I noticed my range of motion was much better than prior to surgery. The very first thing I noticed was my lower back which had always hurt prior to surgery – it felt better immediately. Rehab was pretty boring for the first 6 months – lots and lots and lots of walking. At about week 8 I also incorporated an elliptical machine. I started very slowly but over several weeks added more resistance and incline – if I was sore at all following the exercises I would tone things back again. I walked and/or rode the elliptical machine at least 5 days a week. At a couple of months I continued to incorporate more and more stretches as well as lunges and standing squats with no weight besides my body weight. At 6 months I jogged for the first time – I took this very, very slowly as well. At first I would literally just run a few steps, then a few more and eventually the better part of block. After a few weeks I could run a mile relatively easily (I’ve never been a distance runner in any sense of the words). About a month ago I started mountain biking again, single track to be specific. In the past month I’ve ridden advanced single track trails at Castle Wood State Park in St. Louis and the Blue River Trails and Landahl Nature Reserve in Kansas City – I’ve put about 60 very rough miles on the new hip and feel great.

Arthritis is slowly taking my right hip as well. I won’t wait nearly as long as I did with my left. I also don’t need to talk to other doctors this time around as I’ll be seeing Dr. Gross again. If you’ve found this web site be extremely grateful. Total hip resurfacing, by a physician experienced in the specific procedure, is everything it appears to be. If you don’t like what you hear from your doctor, find another doctor. It’s your hip. Best wishes in your journey.

Sincerely,

Joseph Tierney