Hip resurfacing: warning NSFW!

bompington

That stands for "not safe for wusses", of course.


There have been a few threads over the years from people undergoing hip replacement. Most of them seem to have been people with serious trauma or pre-existing conditions leading to hip fracture, very few appear to have been the common elective surgery that you get for degenerative conditions like osteoarthritis.

AKA worn out MAMILS.

So I thought I'd log my experiences of hip resurfacing in the hope that it might be beneficial to anyone who's facing up to anything similar.

bompington

I am a classic gorilla in shape: short legs, barrel chest. Over the years since my teens I have been involved in (limiting to things I've trained for regularly for at least a year) in Rugby, Hockey, Karate, rock climbing, kayaking, skiing, running (up to half-marathon distance) and of course cycling.
Some of those (rugby, running, karate) involved a lot of impact on joints; some (rugby, kayaking, karate, climbing) a lot of strength work; some (climbing, karate) involved a lot of work on flexibility. Some involved a few major wipeouts.

So I wasn't very surprised when I was told, eight years ago or so (aged 44) that my aching left hip was on its way out. I first noticed it on a grand day out around the Applecross circuit: apart from just being knackered there was a new and persistent throb in the joint.
The Orthopods told me that I had what is known as cam impingement - extra bone growth on the outside of the femur that causes wear on hyperflexion. In other words all those box splits I used to do to improve flexibility for karate and climbing...
By the time it got to the specialist and x-ray stage, it was already bone-on-bone on the left side; the right, they said, would go sooner rather than later.

I couldn't help observing that I had had a few wipeouts through the years that involved the left leg flailing wildly outwards - couple of major skiing ones, a climbing fall, even a major bike crash. Of course it could just be post-event rationalisation though, because who wouldn't want their injuries to be caused by big adventures rather than just middle-aged wear?

Anyway, the damage was done. Over the course of the last eight years the symptoms have varied as first the cartilage disappeared, then bone spur growth caused all kinds of problems (the worst? regularly getting locked in position sitting on the toilet) and finally regular cycling at least restricted the wear to a smooth and relatively comfortable shape.
In 2011 I did my last "adult beginners" gymnastics training class, 2012 my last extreme grade rock climb, September 2014 my last Parkrun. Cycling was the last, thankful, refuge, but that was getting worse: in 2016 I could do an event like the 3 pistes and only fell really bad after about 6 hours in - this year I pulled out because I couldn't face it.

bompington

Mr Ben Clift is the name of the guy in Dundee with the top rep in hip reps, and he suggested that resurfacing was the way to go (as long as it was done by a really good surgeon like himself ;-)).
I did get some sort of verbal assurance that, as a teacher, I could ask to get the op done towards the end of the summer term; in the event that turned out, like most verbal assurances, not to be worth the paper it was written on, and the op was eventually scheduled for the 3rd August - over 10 months since the initial consultant appointment. That's closer to the end than the beginning of the school hols in Scotland.

So I did manage to get in about 600km of riding in during July, but it was getting harder and more painful all the while.

At 7am last Thursday I pitched up at Ninewells Hospital ready for battle.

bompington

I already knew that the advantages of resurfacing over total replacement were not what you would expect: the operation is not quicker, less invasive or less brutal. In fact quite the opposite. In THR, they just hack off the whole head of the femur and put a new one on - resurfacing involves much more precision work fitting the cap to the femur and the socket to the acetabulum (the hole in the pelvis that the hip fits into).

After the usual round of sitting around all morning in a hospital answering the same questions repeatedly to a large numbers of different people, I was wheeled into theatre and given a spinal anaesthetic. No sedative, 'cos that just makes you feel worse in recovery, and no general, 'cos I've got Hypertrophic cardiomyopathy (HCM) and that's a bit of a red flag* for general anaesthetic. I didn't get to watch though, they put up a sheet to stop the blood splatters from getting all over.

* in the exact words of my cardiologist: "yes, it's what they call enlarged heart and it is the thing that young fit people drop dead instantly from - but don't worry, if you were going to do that you'd have done it by now"

bompington

Q. How can you tell the difference between an orthopaedic surgeon and a carpenter?
A. Most carpenters could tell you the names of two different types of antibiotic.

So the cutting, drilling, hammering and bashing started up and went on for a couple of hours or so. Nothing to see but I could smell the burning flesh, feel the hammering, and what was strangely the most disturbing was hearing the schlurping sound of bits of me going up the suction tube.

Once it was all done there was a classic horror movie reveal as they took down the curtain and there were the surgical team all plastered in gore from head to toe. There were quite a few streaks across the ceiling too.

And then I was wheeled back to the ward, all sewn up and deceptively free from pain.

ugo.santalucia

Nice!

Is this just an excuse to post a photo of your ass? :-)

Get well soon

fudgey

I am currently waiting for a hip arthroscopy to have a femoroacetabular impingement removed. I have a cam on the ball joint part of the hip, a labral tear and also the onset of arthritis at 36...

Been on an FAI clinical trial for the last 18 months, the physio didn't work so next step is surgery.

Also waiting for surgery on my knee - bucket handle tear of the lateral meniscus which i did about 10 years ago, funnily enough about the same time i noticed my hip giving me problems but only recently had both diagnosed.

sloppyschleckonds

Fucking hell

bompington

So back on the ward, with its 24-hour pings, beeps and groans. Once the anaesthetic wore off - about 3am - it was pretty painful. Regular doses of oral morphine kept things bearable, I was probably on about 10 a day at first - on top of the twice daily oxycontin, which is the one they call "Hillbilly Heroin," and as much paracetamol as you like.
Oh, and a whole lot of lactulose as well. It may sound like a bit of constipation is the least of your worries but the discomfort got pretty severe.
Learning how to move was not easy - just trying to turn over in bed was likely to send the leg flopping suddenly over with accompanying excruciating pain.
But I did manage to get on my feet the same day: back from theatre at 6pm, standing at 11.

bompington

I was surprised by how hungry I felt, and the hospital meals were never high class but always edible. At least they punctuated the days.
After 24 hours or so I began to get competent at shuffling over to the toilet and even showering.
Physios and OTs were round regularly to put us through our paces, the exercises were (currently still are) always torture at first but you could feel the improvement when you pushed through the pain.

bompington

So a total of exactly 4 days after leaving theatre, I was shuffling into the car with Mrs Bomp and heading home. It had been quite a frustrating day, everything was ready by about 10am except the paperwork and bumper fun-sized bag of drugs, but it took until 6pm to produce that.
Still, very few complaints about the NHS here - I was looked after by people who appeared to be competent, conscientious and caring.

bompington

Before discharge I had drummed into me a stack of exercises to do, and 4 big NO-NOs to avoid.
1. Don't bend the knee beyond 90°
2. Don't lift the knee higher than the hip.
3. Don't twist with any weight on the leg.
4. Don't cross your legs AT ALL

The last one seems a bit surprising - but even if you just cross the legs slightly at the ankles you are putting the hip joint out of line. It's a difficult one to stick with.

bompington

Finding your way around at home is a whole new ball game. Stairs are one problem, of course, but the most frustrating thing so far is trying not to leave essential things behind and have to go back for them later.

I'm dumped in the spare room so I've got a whole bed to myself to groan, wriggle, sweat and snore in - seems reasonable. I sleep quite well at first but by 3am the discomfort is more than anything except the morphine can cope with. Still, I got it down to 2 doses yesterday.

bompington

I still have this most Kardashian-like left buttock:

which is swollen the whole way round to the back - you're looking from the front here, camera perhaps just a bit out to the side of the body.
It's swollen, sore and tight, makes sleeping on my back uncomfortable and any other way impossible. Still a lot of swelling down the leg too but that's starting to go squidgy now so will hopefully be away soon.

The staples (35 or so) are due to come out on Monday - they are another source of discomfort in themselves - touch them and it feels like someone's, well, sticking sharp metal things into you.

bompington

So here it is at dressing change time:

The bruising and swelling are starting to go down - I had to boost the saturation a touch to make the bruising stand out - but the swelling is still pretty tight at the Kardashian bulge.
No infection that I can see, that's a good sign.

Managed to go for a short (1/2 mile) walk last night, just felt really good to be on my feet. Maybe time to think about setting up the turbo soon...

kiwimatt

SloppySchleckonds wrote:

******* hell

This. Compelling stuff though! Good luck with the recovery

keef66

Ouch! That's an impressive scar. Looks more like open-cast mining than elective surgery. Not sure about NSFW but it's certainly NSF lunch. Hope you heal quickly and well!

I know from when I slipped my disc how effective opiates are at shutting down normal gut activity. Had to give up with lactulose; my gut flora developed a liking for it, and became quite efficient at generating noxious gases

Matthewfalle

That's really quite neat and tidy - got any internal piccies?

bompington

Matthewfalle wrote:

That's really quite neat and tidy - got any internal piccies?

'fraid not. Would certainly have liked some souvenirs...

bompington

So we're now one week on from discharge, Day 11 from surgery.

Day 7: got the turbo set up and managed at least long enough to know that it was doable. Walking about with sticks definitely getting easier.
Day 8: maybe walking about was too easy yesterday, bit stiff and sore today. Still, decided I was fit enough to get away for the weekend as planned. Not at all comfortable in the car on the 3½ hour journey - not painful but just not comfortable.
Managed with just one oral morphine dose overnight. Guts starting to get back to something close to normal.
Day 10: back home - again really not comfortable in the car: you know that sort of discomfort when you've been sitting in one position for too long? Well, too long is about 3 seconds right now.
No oral morphine for over 24 hours now.
Day 11: first "proper" session on turbo - meaning 7 minutes going very gently but at full-ish cadence (80 or so). Here's the setup:

Chair to get on (still impossible without), to get the necessary upright position I've just swung the bars up until they're nearly upside down (anyone remember back in the day when that was cool?).

Hopefully get up to meaningful exercise level within a day or two.

bompington

Staples out. Feels better already!
Gash at bottom is where I caught it on a cupboard door. That didn't feel at all better.

kingrollo

Interesting.
Agree your prognosis that hip resurfacing is not a lightweight option (as you would think) - Did you get this on the NHS ? - I have an ex surgeon mate who told me that the problem with any hip surgery is that there is 'no room to get in' - hence its just as brutal as full replacement.

Keep the story coming.

I wan't a photo of you at the top of L'Alpe-d'Huez by christmas ! (with your clothes on !)