Pablo’s Hip Resurfacing with Dr. De Smet 2013

February 04, 2013

I’m a 46 year old male, and will need a hip resurfacing this year. The arthritis in my case is apparently due to the combination of three factors: developmental dysplasia (mild I guess), femoroacetabular impingment (FAI) and joint hypermobility.
This process was accelerated (inadvertently) by practicing sports all my life (swimming, then basketball, mountaineering / climbing, running, cycling, and lately back to swimming -the most forgiving of them all-), until I found out about the arthritis 5 years ago. I’ve had a hard time accepting this…
Fortunately, as I’m a light weight (62 kg), I kept going for longer than my bad mechanics would have suggested.

The first two factors (dysplasia and FAI) are probably quite common among us "hippies", but hypermobility is a little bit unusual, even for the general population.
Only 2 years ago I found out that some rhematologists in consider the joint hypermobility syndrome as a mild version (i.e. not life threatening) of the Ehler-Danlos syndrome, in particular type III. As this is a connective tissue disorder, it affects not only tendons and muscles but also skin, veins and organs.
In my case I’ve noticed for many years poor scarring, soft skin (easier to break), slightly fragile veins, bleeding that tends to keep going for a little longer, being prone to suffer muscle and tendon injuries and overload, so this was an eye opener.

September 4, 2013

Once in the op theatre I was asked to move to the op table. Next thing I’m in the recovery room several hours later. Now its 12h post op and no pain at all. There is a morphine drio on demand but I havent used, possibly it releases some qty anyway. The only inconvenience so far was that I had to be sonded. We’ll see tomorrow how it feels on the first steps. Tired now.

September 5, 2013

So this morning all the pipings were removed (drain, needles), then got out of bed for the first time for a few minutes with the walker, sat in a chair for 1h, still no pain at all.. More exercise afternoon guided by the PT, some in bed and then walking out of the room with the crutches for first time. It all looked good! Until I went back to bed.. Then the hip felt in discomfort for a good while.
It seems there is a backlash post exercise, so must take a conservative approach.

Tomorrow I’ll be leaving hospital and go to the hotel for a few days, as recommended, hopefully is not too early and will manage ok!

September 6, 2013

This is quite incredible.. Out of hospital after barely 48h, this morning learnt to manage stairs, had the first shower on my own, and out the door! Yesterday definitely was a shock to the system, after all the guided exercise with the PT, I was in a bit of pain for first time, later had some temperature, leg quite warm and stiff.. Worried for a few hours of infection or something. But this morning no sign of any of that. Nice chat with the doc before I left. He tells me I’ll walk with one crutch in 1 wk and will ditch the second 3-4 weeks later. He says I can start with impact activities (such as running) in 3 months but I’m in no rush for that, and will take it easy.
Mind me, my walking is pretty poor right now, as it should be.

September 7, 2013

The two most difficult things for me at the moment are byproducts of the surgery, I mean it’s not the hip itself. One is sleeping, as I’m still lying on my back all the time, the second is the bowel, it went quiet  both can be helped with some pills but I’m avoiding that for now.
I also realized without the painkillers the hip gets quite sore after a few hours (I skipped a pill or two to check it), particularly towards the evening, so I’ll keep taking them regularly for a few more days.

September 8, 2013

Yesterday the nurse that visits me daily to look after the wound, heparine shot etc gave me a ‘light laxative pill’ that should work within 24h, and it did indeed! I won’t get into the details ha ha!

So Day 5 went well again. Of course, you have to understand this in this context we are in.. Tend to get tired and achy in the joint area towards the evening, but that is what I would expect. The joint feels stiff when I start moving, but eases off quickly. Earlier we had dinner at the hotel’s restaurant, after 45′ I was ready to go leave but had to hold on for a while. Sleeping could be better. And things like that. The physio says I walk pretty well with the crutches at this stage, which is encouraging.
I’m in no rush to go back to full form too quickly, being happy as long as I perceive progress on a daily basis first, then weekly, then monthly. Fingers crossed.

September 10, 2013

On Day 6 I felt not as good as in previous days, the main worry being the operated leg started to swell, and I had very little swelling up to then. The nurse that visit us daily at the hotel told me this is very normal (and I read this in various post here) once you increase the activity, and eventually it will disappear rapidly.

Today is Day 7, and new improvements have been made. I walked (well, the way we do with crutches, slowly and robotically) without pain or tiredness for around 1 km, that sounds pretty good to me! Secondly, last night I lied on my good side for around 1h, in the middle of the night, to break the two big stretches on my back, where most of the sleep happens. Third, the physio encouraged me to ditch one of the crutches, I already had tested this for a few steps, and can walk the same as with 2. Well, when going out on the street, I will still use both for a while, to "warn" and protect better myself from the crowd. Tomorrow starts week 2, the highlight will be if I’m able to inject myself the heparine injection for first time, instructed by the nurse.

September 13, 2013

 I’m on Day 10!
The peak of the swelling was reached on Day 8, since then it has eased off. It’s there, particularly in the evenings, but mainly gone by the morning.
The doc visited me a couple of days ago at the hotel, the scar he says is perfect (so he said the nurse), and everything looks good at this stage. I asked about going to a PT once back home, and he suggested I could keep doing the exercises by myself, at least for the first 6 weeks. He warned not to try forcing mobility, particularly hip flexion, as if done too early can result in permanent groin pain/discomfort. It would be better for that to start on the static bike, with high saddle first and then gradually lower it down.

Also, very gradual progress is key at all times, and take it easy when coming back to sport activities. I started giving myself the heparine shots, the first one it wasn’t easy at all!! Big psychological barrier.

Yesterday I walked quite a bit adding all up, I’d say around 4 km.. Only the upper body (opposite side of the operated leg) was really complaining in the end, not used to the crutches. And today we travelled back home, moved around the starting and destination airports without problems, a bit tired but that was all. Ahhh, and first (of hopefully many) metal detector alarm went off at security!

September 19, 2013

Two weeks yesterday… Lots of positives:
No swelling down the leg.
Walking ~2h a day, 5-6km, one crutch.
Doing PT exercises 2 x 30-40′, gradually increasing reps and intensity.
I stopped taking painkillers 6 days ago, so I’m only on the mandatory antiinflamatories and heparine shots (1 week left).
Sleep got better, I turn on the good side sometimes, which helps.
Moving around better, less sensitive to little turns and twists.

Still, there are few niggles and I have some doubts:
The "good" hip is getting increasingly sore.
The scar area is still a bit swollen, no idea when to expect this to disappear. It gets worse towards the evening, and "resets" during the night. Ice does not seem to make much difference.
While walking I lean a bit towards the good side, finding it difficult to take pressure off the crutch.
I cannot sit for too long, and the hip feels a bit "rusty" when I start walking again.

Anyway, I’m quite happy, I expected things to be a bit more difficult but can’t complain so far.

October 2, 2013

I’m 4 weeks post surgery today (Wow!), I’ve been checking the Hip Talk daily but haven’t posted about my particular journey for a couple of weeks.

Here are the positives:
So far I feel it has gone very well, with steady progress and no setbacks.
There is no pain in the operated leg, but of course some stiffness or discomfort at times (more towards the evening).
I walk ~2h per day in two (sometimes three) sessions, generally covering 8-10km, using just one crutch since week two.
Also I do some PT exercises ~2h per day (increased repetitions and sets overtime, but not intensity).
And started on the static bike, built up gradually up to 15’/day (~60 rpm, no resistance), this is just to gain mobility gently.
Since a few days ago, I can walk around the house unaided, but with a noticeable limp.
Mandatory medication stopped a week ago, and since then I haven’t taken anything at all.
The hip is less sensitive to little turns and twists.
The wound looks very neat and shows no signs of issues.
Sleep is alright, I wake up a couple of times when changing posture, but got into a decent pattern.

And here are the doubts (probably all normal, but would like to confirm):

– Sitting for long is not comfortable, particularly during the second part of the day. It seems no matter what chair or sofa (maybe there are better chairs?). This worries me slightly as my job involves sitting in front of the computer for long hours.

– The only pain I have is on the opposite side (in the rib cage), and also the lower back, surely because of the crutch, but I find it difficult to control and apply less force with every step.
The unoperated hip also complains at times, again due to overuse (particularly when doing the standing PT exercises).

– Around the wound it’s always bulky, like if I had a gel pad under the skin. In the evening it feels more tight (or "hardened"). Will it take weeks or months until this disappears?

– I don’t use much ice (between 1-3 times a day), but when I do it doesn’t seem to make much difference, is this the general feeling?

– Still having spasms down the leg (actually, it could happen in both legs) during the night, generally when changing posture. Is this something others have experienced?

– Since ~2 weeks ago I feel really tired when I wake up, but after a few minutes I’m fine again.

– I believe using one crutch after four weeks is fine, but wonder what has to be done or happen so the limping without aid goes away. Is it that the gluteus is too weak yet?
If I tight the gluteus there is an uneasy feeling that tells me to not do it…

– I haven’t visited my local Physiotherapist yet, but probably should go to make sure I’m not getting bad habits or muscle strength imbalance, but at the same time I’m a bit worried as try to avoid forcing mobility too early?

October 16, 2013

6 weeks post surgery today!

Things keep going well, progressing steadily, haven’t suffered any setbacks or major problems. Every now and then there are niggles that last for a few hours or a couple of days, then I tend to worry a bit, but so far all go away eventually.

I’m still using one crutch to walk, but not indoors. The limping has diminished now, so I walk freely maybe 20-25% of the time, and use the crutch the rest. I think I will be ready to ditch it in 1 week or so.

Regarding exercises, they are focused on gaining strength, but the gentle way: low intensity, high reps (20-25) or less reps but hold 5-10", low angles. I don’t do any stretching or exercises to specifically force mobility.

A typical daily exercise routine:
Walk x 2: total 2-2.5h, 8-11km. I might reduce this gradually to 1-1.5h once no crutches are needed any longer.
Static bike x 1: total 30′, 65-70rpm, lowest resistance (around 35 Watt).
Hip exercises x 2: total 2h. (Glutes, quads, calf raises, toe raises, standing hip flexion, squats low angle no weight, lunges low angle no weight, abduction standing, standing leg forward and backward, lateral lunges, step laterally).

If I had to mention ‘buts’, they would be: sitting for long is still unpleasant, particularly in the evening; the area around the incision is bulky (like having a gel pad under the skin as mentioned in a previous post), and gets harder as the day progresses; and can’t sleep on the operated side, I tried but is uncomfortable.

Overall very happy and hopeful, fingers crossed!

November 6, 2013

9 weeks post surgery today! It’s going well, here are some notes:
– Between weeks 6 and 7 I put away the crutches. This was a gradual, natural transition.
– Restrictions were lifted after week 6: leg can bend over 90 degrees, toilet seat riser removed, no more pillow between the legs during sleep. I can cross the legs (but I don’t).

– After week 6 I visited a local physiotherapist, following up once a week since. Initially he kept most of the routine, gradually adding harder exercises and removing easier ones. Daily exercise routine right now:
1 long walk (1h+, 5-7km)
1 x Hip exercises (1h): bridge on heels, "clam shell" abduction, leg abduction (lying on the side), leg extension, calf raises, toe raises, standing hip flexion, wall squats, lunges, squats low angle, standing walking, abduction standing, lateral lunges, lateral steps on stepper, front steps.
1 short walk (30′) + Static bike (30-35′) + Cross trainer (up to 10′ now).
Is hasn’t been easy to put the time (3-4h/day overall!), but it’s worth as I can see the progress. In the coming weeks I will have to compress the schedule (less time, more intensity).

– Regarding "sporting" activities, the surgeon says I can start cycling outdoors, swimming, cross trainer (elliptical machine). Running after 3 months. However, this is on a "feel" basis and must happen gradually.
I don’t feel cycling outside yet for a while (don’t want to fall!) and will wait few more weeks before swimming. About running, as much as I like it, I’ll postpone the internal debate (should I, shouldn’t?) at least until 6-9 months out. There is no rush.

– Mobility is good for daily life as-is. I’ve recovered ~80% of my range of movement and not doing any stretching at all. Being hyper mobile helps here…
– Around week 6 I discovered the famous "clunking"! For me it’s like a sudden shift. No pain, discomfort or noise involved, just feels weird.
– No pain getting in and out of the car! This is great, after 4-5 years used to those few dreaded seconds every day…
– Is not comfortable sleeping on the operated side, so I don’t.
– The incision area is still bulky and numb.
– I can sit for longer before the discomfort kicks in.
– Some days I can do without ice therapy in the evenings.

– The non operated hip keeps complaining more than usual. I want to hold on for a few years before resurfacing it, but is hard to tell. At this point the operated side (still tender and weaker) almost feels better than the "good" side.

March 5, 2014

Yesterday it was my 6 month ‘half anniversary’… Yes, time flies!
This website has been a source of support and inspiration, and I try to contribute when I can.

I feel very good, daily life is definitely much better than it was 6 and 12 months ago.
From the start I decided to be on the cautious side, but it doesn’t mean I don’t put the hours! Basically I do hip exercises, a bit of static bike and cross trainer in the gym, swimming twice a week since 2 months ago and will start now cycling outdoors on weekends. But the intensity is low, I’m not pushing hard yet.

Not all is perfect yet and I feel there is a lot of room for improvement, but certainly the recovery has been quite smooth with no complications or major setbacks.

On the wish list I have a few things to improve:
– The incision area is still tender, it’s not comfortable to sleep on the operated side. The scar developed a bit of a keloid in the middle section, but nothing dramatic. At times it feels a bit itchy, specially if I’m sitting for a long time.

– The issues I had with hip flexion (discomfort / mild pain around months 3-4) are gone, but the hip flexors are still not very strong.

– The other hip has behaved badly, but with ups and downs. The first few months I walked a lot and it seems it didn’t take it very well. I wonder what will happen when/if I start jogging again (around summer time is the plan), probably it’s not going to be pretty, but we’ll see.

If I had to put it on numbers, I feel like 90% recovered for daily life and 70% for sporting life.

May 20, 2014

I’m 8.5 months post surgery, started cycling outdoors at 6 months, but I’m getting back to it slower than you. I only cycle once a week (in the last 2-3 weeks sometimes 2), now around 40km per session, and avoiding hills for the most part.
Generally not having any issues, and the hip is not sore during or after exercise, although for the first 5-6 weeks since I got back to it I had a bit of ITB (Iliotibial Band) irritation it seems, so I’ve been careful. Lately no more ITB issues.
I’m going clearly harder than 2 months ago, but still try to limit the session to under 2h, I tell to myself there is plenty of time to increase duration and intensity.

July 16, 2014

At 10 months I feel very well and back into swimming and cycling, improving all the time.
Most of the hip muscles are pretty much recovered and as strong as in the other hip.
However, the groin / psoas / hip flexor is still weaker and sensitive to changes in activity, intensity or duration. So I’m finding difficult to bridge the gap because if I push the hip flexor exercises then it will complain.

September 10, 2014

I hit the 1 year anniversary last week!
The key fact: no hip pain. That’s the main reason why most of us go through this procedure.
But, human nature, once the pain is gone we ask for more and more, and I’m no different. I’d say I’ve recovered 100% for daily life, 90% for recreational sporting activities and 70% for competitive sporting activities.

100% -> there isn’t anything "normal" people do that I can’t do, and don’t think about the hip anymore for daily activities.

90% -> I haven’t cycled hard, couldn’t run any meaningful distance (I pulled my calf a couple of times) and haven’t tried any hiking or climbing (yet). I’ve no doubts I will reach 100% before the second anniversary.

70% -> only pushing hard on the swim, not so much on the bike and running is still pending.
In this department it’s yet to be seen how far I can go, I hope 100%, but that would be a bonus…

I’ve actually improved my swimming times since last year. For example in 2 open water races (3.7 and 4.0 km) I cut my times by 5 and 3.5 minutes.
Cycling was a bit slower as I started outdoors after 6 months and still building up pace and distance very gradually. Going uphill was not great for a while, the psoas feeling sensitive, but it gets better overtime.
Running is the big question mark.

On the worries front, there isn’t much:
– I’ve had 3 episodes (over the last 4 months) of pain in my hip flexor after exercise, they lasted 24h or so and then disappeared completely.

– The other hip has behaved badly on and off for the whole year, hopefully it settles but if not I will have to follow up closely (maybe it will require surgery earlier than I’d have hoped).

– Clunking happens quite regularly, I’m not sure what to make of it.

Other than that, happy days!