Roemer Visser’s Hip Resurfacing with Dr. De Smet 2013

Friday, Oct 11, 2013

It’s strange, but I have a new hip. That is to say, just three days ago, Dr. Koen de Smet resurfaced my left hip using the Birmingham method. I’ve just entered the last two hours of my hospital stay in the Jan Palfijn hospital in Gent.

Some background information about me: I am a 44-year old male, living in the Netherlands, and I was diagnosed with congenital hip dysplasia in December 2010. The diagnosis occurred after an apparent groin injury just kept persisting for nearly two years. I had walked with pain and a slight limp for all that time when my GP referred me to the orthopedic surgeon. I was told I’d need a new hip in 3-5 years.

I started informing myself about my options. The most common is total hip replacement, which I could have done in my home country of the Netherlands. Problem is, the prognosis for the new hip is not as good with people in my age group. So if you add up the total life span of two hips, I found myself looking at a wheelchair-bound life at the age of 75. No thanks!

I became excited, however, when I read about the Birmingham resurfacing method on the Surface Hippy website. As it turned out, there is a world-renowned surgeon only two hours away from me! After several months of deliberation, my wife and I decided it was time to go for it. The remainder of this post describes my experiences with the procedure so far, and I do this as a way to give back to the Surface Hippy site – the site to which I am indebted.

Monday, September 23: Initial consultation with Dr. de Smet

I had already contacted Dr. de Smet by email prior to this consultation, and had sent him a copy of the x-ray taken in 2010. He had responded that I was an excellent candidate for a resurfacing, so when I set up the consultation, I also scheduled the surgery for two weeks later.

On Monday, September 23, I drove to a small town outside Gent to find his office. The office was sort of hidden away in a rather non-descript, generic office building. Dr. de Smet’s suite was marked with a piece of paper inside a plastic sleeve. I had seen on his website that he had recently moved offices, but still this first impression gave a distinctly temporary feel to his office. Inside, there was a receptionist hidden behind a tall counter, and behind her were rows of filing cabinets. There was a copying machine, a water cooler… this did not at all look like a doctor’s office to me. I joked with another patient in the waiting room that if we were to come back tomorrow, we might find the whole office suite empty!

But after a short wait one of Dr. de Smet’s assistants called me and took an X-ray in a separate room. And soon after, I met Dr. de Smet himself in his office.

The surgeon was polite, soft-spoken, and a man of few words. He had the new X-rays on display and said, “yes, you are an excellent candidate for a hip resurfacing.” I asked him some questions about recovery and some additional practical things, but the visit was fairly short because I had already done my homework on the procedure and there was not too much more to be said or done. One very nice surprise was that he gave me a bottle of champagne: I was (am) his 12,000th patient (!). I left his office about 30 minutes after arriving, feeling reassured that this is what I needed to do.

Monday, October 7, 2013

The procedure was scheduled to be done on Tuesday, October 8, at the Jan Palfijn hospital in Gent, but I was expected for admission on Monday the 7th. I set out to make the four-hour trek by train in the morning.

Monday was rather uneventful, with the exception of the inevitable encounter with typical bureaucracy. The hospital is undergoing a major renovation, so the check-in area had been moved to a temporary location. The whole atmosphere there did not inspire much confidence. Especially when they told me that they had no information about my admission on file.

“Please, sir, have a seat, while we figure this out.”

“Well, how long will it take to figure this out?”

“I suspect we’ll know something by 6 pm.”

“6 pm?!?! You mean I have to sit here for up to four hours?”

“Afraid so. But I hope it won’t take that long.”

“What if you cannot find me a room?”

“I’m afraid I don’t know what I can tell you.”

“Is there Internet in this area?”

“No, I’m afraid there is no Internet available anywhere in the building.”

Completely flabbergasted, I went to find a seat. I had brought a laptop to keep my mind occupied during the dull moments, but without wifi – heck, without a hospital bed – I was staring down a deep, dark hole.

About 15 minutes later, they called me forward, and told me that all was taken care of. But because the orthopedic ward was full, they had placed me in the cardiology ward. Fine by me – as long as I’d have my procedure done on Tuesday!

I met my rather colorful Flemish roommate – a 73-year-old local with lung problems and a nearly unintelligible dialect, and we had a pleasant evening. Still, I was a little disoriented, because I did not know what to expect for Tuesday, I did not know what time the surgery would start, how long it would take, and I had not seen Dr. de Smet or anyone from his office. The whole thing felt a bit odd in that respect, but it helped a great deal that all the nursing staff knew Dr. de Smet and his work.

After the nursing staff drew some blood, they took me to the old part of the building for X-rays – a dark, poorly lit hall with many doors that somehow was reminiscent of a scene from the Matrix. They said to have a seat and wait, as they returned to the cardiology ward. As I sat in the hallway, outside door five, many people sat down after I did but were helped before I was. I was starting to think I had been forgotten and was starting to wonder what kind of hospital this was. After almost an hour, I was finally called and the x-rays were taken rather quickly. The courteous staff apologized for the delay.

Then it was time for dinner. With all respect to the hospital and the good work they do, the food was dreadful: a couple of dry, old, tough slices of factory wheat bread, something to put on it (cheese or jelly or something), a glass of water and a cup of weak coffee. Wow. I am used to some uninspired cooking (mostly my own), but this took the cake.

At some point after dinner, I met the anesthesiologist. It was a very brief meeting in which he told me next to nothing and he also asked me next to nothing. He glanced at a form I had filled out and I had to extract from him whether I was having a full anesthetic or partial. It was going to be a full anesthetic. Still, that meeting marked a shift in my experience: all of a sudden, it hit me that I really was going to be operated on, and I was getting a slight case of the jitters.

Tuesday, October 8

Tuesday, the big day, started rather uneventfully. My roommate got for breakfast exactly the same thing as I had gotten for dinner. Funnily enough, he was happy with it. But since I had to refrain from eating or drinking, for me the first half of Tuesday was characterized by waiting.

Around 2:30 pm, they came and got me. I put my surgery clothes on, was given a hair cap and a pre-operative pill, I took off my wedding ring, and was wheeled down the hallway into the elevator. I went through a construction zone and my thoughts ran away with me: where are they taking me? Is this all a scam? Will I wake up somewhere underneath a bridge on the north side of town with an eye ball and a kidney missing?

But then we entered the inner sanctum of the hospital: the refrigerator also known as the OR. I recognized the anesthesiologist and then, a few seconds later, Dr. de Smet. My last memory was having a mask over my mouth and then I was out.

Wednesday, October 9

The surgery had started around 4 pm or so, and with the exception of a dream-like memory of waking up in the pre-/post-op area, I remember absolutely nothing. What I do remember, however, is waking up at 07:30 on Wednesday morning – with no pain! In fact, in my sleep, I had turned onto my stomach, which caused a bit of a ripple among the nursing staff. I was completely lucid and had breakfast. Those same slices of bread were now simply not digestible, as my ability to salivate had not yet recovered. I was drinking all morning to fight a very dry mouth. I also could not urinate either, which meant a most unpleasant catheterization.

Soon after breakfast, I got a crash course on how to use a walker. Between that and the frequent naps that were part of recovery, it was lunch time very quickly. They served a hot, non-descript meal. For sure all the fruit and vegetables they serve come from cans, but beyond that I could not tell you what it was. I took a few bites and just had to leave it. In all fairness, this was more because my digestive track was not yet active than because of the food itself. It did taste better than what they served for breakfast or dinner, but it was too much for me.

After lunch, I had a second session with the physical therapist, this time on how to walk with crutches. She also gave me a few exercises to do while in bed. The big thing: keep those feet moving to ensure proper circulation.

Most of this day passed fairly quickly; between frequent attention from the excellent nursing staff, I dozed off quite often, still completely painless. And in the evening I scored a nice victory: I was able to urinate by myself! No more intrusive hoses where they don’t belong…

Thursday, October 10

This morning started with a bit of a reality check, in the sense that the pain barrier made itself known. Obviously, the morphine had worn off. It was as though I did not have full control over the movements of my left leg, and whenever there was an involuntary motion that moved beyond the pain barrier, well, it was startlingly painful. So I became a lot more careful about how I moved on my crutches and how I get into and out of bed. A good thing, really.

But I felt a lot better than the day before; I had more energy, and I was more alert. I looked at some of the emails I had sent out the day before, and even though earlier I had said I was lucid, I can honestly tell you I wasn’t. Not completely. My bodily functions were now almost all back to normal (the ones affected were GI track, urination, salivation, and my ability to read, especially smaller font) and when sitting or lying, I was completely pain free. The wound looked very good and in fact, it never hurt. The main source of pain was from the muscles surrounding the incision whenever the leg made a move that approached the pain barrier.

Late afternoon, I had two more sessions with the physical therapist. First was a series of in-bed exercises (lifting your leg with a pully while bending it and then stretching it again), and soon after was the instructional session on how to walk the stairs with crutches. And I received my discharge papers, which meant that for sure I would be leaving on Friday.

Friday, October 11

I woke up quite stiff. With my colorful roommate having been discharged the day before, I had had the room to myself and I watched movies until it was time to get some sleep. I had forgotten about doing exercises, and so now it felt like my range of motion had decreased. But as soon as I got out of bed, the stiffness disappeared. After showering and getting dressed, I walked up and down the hallway. To my pleasant surprise, I was able to keep going for much longer than just the day before; my stamina had increased ten-fold!

It is now 9:30 am on Friday, and in an hour and a half I will leave the hospital. I can do almost anything I need to. The only thing I cannot do is touch my left foot (washing, tying shoelaces, etc). Other than that, I have figured out how to pick things up off the floor, I can stand on two legs without support from crutches, and I can generally move about to do what I need to do.

I am not concerned about violating the three golden rules that the staff have really hammered into me: don’t turn the left toes toward the right; don’t cross the left leg in front of or behind the right leg; and don’t pull the left knee past a 90 degree angle. The reason is that the shot of pain I will experience will remind me automatically. As long as I stay away from those thresholds, I am happy to say that I am completely pain-free. I am looking at one to two weeks of walking with two crutches, followed by a similar period with only one crutch. And I can’t wait to get back home.

October 21, 2013

It’s been nearly two weeks since the surgery, and ten days since my discharge from the hospital. And it’s been an interesting ten days.

To sum it all up: I’ve had to eat my share of humble pie. I totally underestimated how debilitating this procedure really is. Obviously, I already knew about the crutches in the hospital, but it wasn’t until I actually got home that I realized how completely useless I was around the house.

Actually, this already started at the discharge: I had told my wife she didn’t really need to come get me, as I could take the train back. I thought it might be more comfortable than the car, what with the seats and all. But thank goodness she showed up. I needed her to pull my suitcase! I was unable to move anything. Once we got home, I couldn’t get myself a cup of coffee. I could make it, but then I’d have to drink it standing up since I couldn’t move it. Can’t do household work, can’t do groceries, can’t tie shoe laces, etc etc. Putting on underwear and pants is a job that requires either help or patience. I went with patience. Putting on the TED stockings by myself was even more difficult (I managed to pull it over my foot with my other foot – my wife calls me monkey toes). Picking things up from the floor was easy; just push the recovering leg out backwards, stretch it, and then bend the leg you’re standing on – easy peasy. But in the shower stall, there is no place to stretch the leg horizontally. Picking up the soap then requires opening the shower door. Oh, and getting to the bathroom in a hurry is something you can just forget about.

And even though from day one I could stand on both feet, with my weight equally distributed, I was always aware of how fragile my balance was. It’s like I was a house of cards; one whiff of wind in the right direction and down you go. On top of that, I experienced that “clunking” that has been described on other sites. It feels as though there is play in the joint, so that when you shift your weight from one leg to the next, and you reach a critical point, all of a sudden the joint corrects itself and shifts. And when your balance is already this precarious, you had better have something to hold on to pretty darn quick. It’s all very unsettling.

I guess at some level I must have thought that I would be one of those miracle recovery stories. "Yeah sure, take it easy, give it time, and listen to your body – that’s advice for wimps. Not for me. I’m special." But actually, I think it’s the best advice.

So the bad news, if you want to call it that, is that I underestimated the extent to which I would be disabled as a result of the surgery. The bad news is also that for that reason, it’s going to take some serious time to get back to full strength. Oh, and sleeping, that’s tough too. I like to sleep on my stomach, and I am struggling to get used to sleeping on my back. The first few days at home, I definitely needed a nap.

The good news, however, is that I have been pain free, as long as I stay within the boundaries of allowable movement. And every day, I can do a little more. Every day, I have a little (but noticeable) bit more range of motion in my left hip. I can now touch the top of my foot without overstretching anything. I can put more weight on my leg as I walk; my physical therapist calls the progress significant. I can move up and down the stairs much more easily. I have regained enough strength in my left leg to be able to lift it and then stretch it as I get into / out of the car. And for me, the really good news is that my body gives me a very clear signal when I (am about to) do something silly. All of a sudden, the adage to listen to your body no longer sounds New Age, but instead it becomes very concrete and actionable. And that gives me the confidence to make my own choices. I have some people around me who appear to want to continue treating me as less than able; they continue to warn me against all the risks associated with overdoing it. I know they care about me, but they don’t have my hip. They don’t have my muscles. They can’t feel what I feel, but I can – and that’s very empowering.

I have been hitting the gym every day. I started on the home trainer (stationary bicycle) and rode very carefully. Until I lost my patience a few days later, and I started bumping up the resistance levels in larger increments. I am now breaking a serious sweat when I cycle and it feels great. I get off that thing and the pain is gone! Mind you, I have no pain in the hip like I used to – that is gone, but the leg is swollen and sore to the touch, and the muscles are achy, stiff. Half my leg is black and blue, especially around the knee. I think that cycling, and the circulation that ensues, must have a healing effect.

I am still walking on two crutches, but am putting much less weight on them. So the confidence is clearly increasing. I have no idea when I can go down to one crutch, but hopefully in my next update I will be able to report out on that.