Ross Peterson Bilateral Hip Resurfacing with Dr. Shimmin 2005
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Having read with much interest the reports of others who were some way down the track, I thought I would weigh in with an overview report of my own first year. I am a male living in Melbourne Australia, and first realized that I had OA around 2000. It became a bit painful doing leg presses at the gym (so I stopped), and I started getting pains in my right thigh, even going down to the ankle. One doctor thought it was a strained tendon, but a few months later it had not healed so I went to a sports medicine doctor who sent me for an x-ray and diagnosed OA. He discussed treatment (exercise, physiotherapy, painkillers) and that it was possible that surgery might be needed down the track, with the options being THR, or the newly introduced resurfacing – of which he knew little (this was 2000). For the next 5 years I limped along, on physiotherapy, Vioxx, paracetamol/codiene, and glucosamine/chondroiton. All these worked to some extent and I no longer had referred pain. However, in the second half of 2005 things went downhill rapidly and I came to the point where I couldn’t go on – painkillers did not work properly, and at night I was waking up with pain every 1-1 1/2 hours, shuffling around and sleeping another hour on the recliner, then moving to the couch etc. I researched the internet on possibilities and decided that resurfacing sounded very promising (although I had not come across Surface hippies at this stage). My x-rays showed complete loss of cartilage in both hips, multiple cysts and so many osteophytes that each hip looked as though it was surrounded by a milky cloud. The woman who took the x-rays exclaimed “my God, how can you walk!!”. My sports medicine doctor had no problem in referring me for resurfacing and commented that he would go that route himself if he were in my position. Andrew Shimmin, the surgeon that I went to, is very experienced in resurfacing, having done about 500 over 7 years (up to Dec 2005). At my initial consultation with him on 29 Nov 2005 he went through the advantages of resurfacing (retaining an intact femur, much more stable joint, more rapid recovery, greater range of activities following recovery, easy conversion to THR if the joint failed at some future time), but cautioned that bone cysts that could be seen in my X-ray could be deep enough to make resurfacing problematic – in which case he would need to decide in the operating theatre to do a THR. He also cautioned that whether I could stand both hips being done in the one operation could only be seen in the theatre, and he would do one hip and then decide whether I could go on for the second. I went for it as quickly as I could. Surgery for a bilateral BHR was scheduled for 14 December 2005 at The Avenue Hospital in Melbourne. I went into hospital in the afternoon of 13 December as I was scheduled for surgery at 10am the next day. I was in the theatre for about 4 hours, under a general anesthetic. Although Andrew Shimmin said later that he had thought it touch and go as to whether I could sustain resurfacing (i.e. because of the poor condition of the hip surfaces), it turned out fine on both sides. Evidently I coped well with the operation and did not need a transfusion. As my red cell count dropped from 14 to 10 (whatever the units are) I was put on iron supplements for the next 3 weeks. I spent the first night in the close monitoring room, before moving to the normal room the day after. It was quite an experience to wake up with tubes going everywhere. There was one into my nose to supply a flow of oxygen. A saline drip going into the back of my left hand. Two drainage tubes coming out of small incisions to the front of the main incision on each side, and a catheter coming out of the place that catheters come out of. As I had both hips done it was the second day after the operation before the nurses tried to get me out of bed. Two attempts in the morning were followed by success in the afternoon. The next day I took a couple of steps with a walking frame, and two days after that moved to forearm crutches – much better than the frame. The wounds healed well with no infection, and over the course of the first week I learnt to get in and out of bed myself, have a shower myself and commence physiotherapy. While in hospital a physiotherapist visited every day and taught me exercises to do on the bed using a board and little rolled up socks to put under my heels to enable my feet to slide. I’m glad that my upper body strength was sufficient to fully raise myself from the bed using the dangling triangle. It would have been very difficult if I couldn’t do that……. The staples came out on day 7, and I was allowed to go home on day 8. I think that the final test (that I passed) was showing that I could self inject the Fragmin that I needed to take for 20 days after going home. While Andrew Shimmin had said 10 days in hospital, the hospital itself expected me to be there for 8 days. I think that Andrew was being conservative, so I would feel good if getting out in 8 days, but not disappointed if it was a bit longer than that. Pain? No pain!! The hospital had made clear that all pain relief up to self administered morphine was on offer, but I didn’t need that. Took panadiene forte for a couple of days, then dropped to straight panadiene, more as a preventative rather than because I really needed it. After I had gone home there was really no need for painkillers of any type. The worst thing about hospital was the food. I did not enjoy the experience of taking a bite of a rissole which gave me gas. Gas blocked by constipation is no fun! Eventually I was able to work it through by using the motorized bed back to raise myself up, and lower myself down many times, enabling the gas to work through the system. When I got home I made steady progress each day. I was careful to do the sets of exercises that I was given by the physiotherapist before I left the hospital, and got a new series of exercises after a month. It really was remarkable how, at that stage, I could tell the difference between the two legs when doing my exercises. My right hip was the first one that went, and so over time I favored that side. Though the left deteriorated at the end, there was still more residual muscle on that side. I could tell that the exercises were reviving muscle on the left, while starting from a lower base on the right. At 3 weeks my wife took our daughter to relatives on the south coast overnight, so I took the opportunity to drive into the city (about 20 minutes). Getting into and out of the car needed care but was OK, and driving was no problem at all! My wife was not impressed when she found out… By 4 weeks, I could walk around the house without crutches – although I did still use them when walking from one end of the house to the other. Andrew thought that I should use the forearm crutches for a bit longer so I tried persevering for another week or so, but it is difficult when you just feel that you do not need them. Up to the 4 week mark I still had to sleep on my back, which created problems in that I woke every 1-2 hours and had to stretch my legs before getting back into bed and having another stint. But there was no pain in the joints as there was previously. I started sleeping through the night, and at about 5 weeks I could lie on my side. Such luxury to sleep through the night, wake in the morning and just doze off again for a short while, with no pain and no pressure to get up!! Andrew Shimmin and the physiotherapist were very keen for me to do hydrotherapy, so I went to the local indoor heated pool and saw an exercise therapist for a program which I started at about the 5-6 week mark. That really did help and I would highly recommend pool work. I went back into the gym at about 8 weeks, and have continued throughout the year to go to the gym four times a week for about 45 minutes followed by another 40 minutes work in the pool. I returned to work after 7 weeks, and felt no difficulty in that at all (I work in a city office job). Flexibility has been something that I have been working on, and there has been gradual improvement. At 8 months I could cut my own toenails with difficulty, cutting some skin in the process. By 10 months the extra bit of bend was there to make cutting my own toenails easy. I felt that for the first 6 months I was engaged in rehabilitation. After that it has changed to general fitness and toning work. I feel no restrictions now in what I can do. On 12 December 2006 I had my 12 month checkup with Andrew Shimmin, which included x-rays. The implants look absolutely fine, and there has been good bone ingrowth into the implants. Carefully making no promises, Andrew implied that he could see no reason why the BHRs should fail, i.e. he could see no reason for me to ever have a revision operation. Now that is something that I want to believe in!! Of course, things need to be kept in balance. Over the first 6 months I was so keen to keep up my calcium intake (to promote bone ingrowth and maintain my good bone density) that I drank copious amounts of full cream milk – with the result that my cholesterol went too high. A change to low fat milk was indicated (sigh). Was resurfacing the right thing to do? Absolutely!! But if you have got this far in this lengthy report I’d just like to make a final observation. To me it seems that there are three critical stages facing someone who is coming to a decision that surgery is needed. The first stage is deciding what sort of operation to have, and who should do it. These are decisions that should not be left to others. If you are at this point do NOT become swept away by the system or surgeons’ own choices. If you want resurfacing, go to a resurfacing surgeon, do NOT go to a surgeon and ask “what can you do for me?” The answer may be “Come in next Wed and I’ll do a lovely THR”. The second stage is the operation. You have picked the surgeon, and now you have to trust in him (any female resurfacing surgeons out there?). The third stage, and where you are back in control, is the rehabilitation stage. I think that we do not focus enough on the importance of this ongoing process. Exercise and diet is needed that promotes healthy bone growth and the strengthening of ALL the muscles around the hip area. Strengthening of the hip capsule is needed, as well as strengthening of all the muscles around it. Varied exercise is needed, in all directions, not just repetitive exercise in one plane e.g. walking…. So, merry Christmas to all and a Happy New Year. Let us hope that the rain comes tonight and put out those bushfires that are threatening so many settlements in the High Country. Our thoughts are with them and the brave firefighters. Cheers Ross bilat BHR Shimmin Dec 05 Postscript On 26 December 2006 the Melbourne “Age” reported on page 1 “This was the Christmas miracle – or at least, the Australian bush version. For three weeks, locals and firefighters have sat trapped, ringed by fire, alone and vulnerable at the top of Mount Buller. Day after day, the bush burned in the valley below, the flames making charge after charge up the slopes, fanned by hot winds. But then, at Christmas time, it happened. The winds eased, the prayed-for rains came, and the fire threat abated. On Christmas Day itself, it snowed. A miracle. Lightly at first, but stronger as the day progressed, coating the mountain-top in an unseasonable white blanket. As it snowed outside, those on top of the mountain sat down to Christmas lunch, and relaxed for the first time in more than three weeks. |