Birmingham Hip Resurfacing - Patient Journal

September 25 - November 1, 2006

I have waited for three years for the FDA to approve the hip replacement system known as metal-on-metal resurfacing, which has been in common use in Europe for almost ten years. At my first consultation, Dr. Rogerson gave me information and internet contacts on both conventional and metal-on-metal hip replacements. It was clear to me that there were many benefits to the new metal techniques; I decided to wait for the FDA to approve the new methodology.

About ten years ago, I had injured my right hip while skiing; my right ski tip caught on an unseen stake beneath the snow and, as I passed the stake, my ski wrenched my leg clockwise. I suffered with increasing hip pain for seven years despite therapy and exercise routines. Dr. Rogerson confirmed that I was a candidate for hip replacement, but recommended metal-on-metal resurfacing based on my age and health status. Since my insurance would only pay for FDA approved surgery and prostheses, I postponed the operation until FDA approval was granted. In May, 2006 I was able to schedule hip surgery for September 25, 2006.

At my pre-operation conference in August, I found out that I would have a one bedroom suite available to me and my wife for the week of my surgery. The Meriter Retirement Community which provides the suites is a new and beautiful facility with restaurants, therapy equipment and a pool. My four day post-operative therapy and training would be conducted at this facility. My wife and I found both the suite and the rehab program to be ideal for recuperation.

Additionally, Meriter Retirement Center is located two blocks from Capital Square and in an area with many fine restaurants, shops and coffee houses within easy walking distance. On Saturdays in the summer, there is an extensive farmers' market that surrounds the state capital building. The environment around Meriter Retirement Community is not only very comfortable but it encourages the recuperating patient to get out of the house!

We arrived in Madison on Sunday, September 24th at about 5 PM after about a 3 hour drive from Sturgeon Bay. I was feeling confident, relaxed and hungry. I had no trouble finishing an excellent steak dinner at the Continental Grill, one of the restaurants within walking distance from Meriter.

On Monday morning, September 25....  we arose at 5 AM and arrived at Meriter Hospital (about a 5 minute car ride from the Retirement Community) at 5:45 for admission and pre-op preparation. I was taken to the surgical suite at about 7:15, where Dr. Rogerson and the anesthesiologist were waiting for me.

From this point on, I was often asked to assess my level of pain on scale of 1 to 10, with 10 as highest pain. My level of hip pain before surgery was about a 4-5. As it turns out, my pain level after surgery was no greater than this and perhaps slightly less, although the pain was of a different nature.

After installing an IV, the anesthesiologist placed a mask over my nose and mouth and the hands on the institutional clock slipped from 7:25 to 10:25 in the blink of an eye. It even seemed as though I was staring at the same clock, although that is unlikely. Time in the recovery room seemed to move at a snail's pace. Probably due to pain killers and anesthesia, I felt remote from my environment and from the pain in my hip. At this point the pain felt much like pre-operative hip pain probably because of the trauma to the bone and joint from surgery. A nurse was in attendance full time, taking blood pressure and other measurements.

At about 12:30, I was taken to my hospital room where my wife joined me. I spent the rest of the day of surgery in a detached, surreal state and on a liquid diet (in addition to the IV). I was able to inject a pain killing medication through my IV as needed, but not more often that every 10 minutes. I don't believe I used the pain relief more than every half hour, perhaps less; my pain level was probably about a 5, but I was not bothered by this pain. All the reading material I had brought with me went untouched as I had neither the energy nor the curiosity to open a book. It seemed as though I would sleep for an hour, only to find that two minutes had passed on the clock. The most difficult aspect of the day of surgery and the following night is that I couldn't move or change positions. One reason for this, I found out the following day, was that some adhesive tape on bandages had reversed and literally stuck my leg to the bed sheets. I tried a couple of the supine exercises to use sore muscles.

The day after surgery (Day 2, September 26th).... I awoke fully conscious but still unable to move. My IV was removed and I was placed on oral pain medication as the pain level was still about a 5. Additionally, my drain was removed from the incision. Without these two attachments, I found I could move even the operated leg comfortably (but very slowly).

I enjoyed my first solid food since Sunday's steak dinner. At 10:00 I got out of bed, into a wheel chair and was taken to therapy in the hospital. After some supine exercises, I walked (very slowly) back to my hospital room on crutches. My sedentary pain level by now was about a 2, but my walking pain level was 4; I was surprised by this because this is the pain level I had become used to constantly before the operation. Pain wise, I was no worse off than pre-op. From this point, every therapy session increased my mobility enormously. After my afternoon therapy session on the second day, I could get into and out of bed without help. I even managed a brief but refreshing shower late that afternoon. Pain while resting had dropped to 0 (with the help of pain medication) and pain in motion was 2.

The afternoon of the second day, Dr. Rogerson stopped by to describe the operation. It had gone very well. He encountered many very large bone spurs which were causing me the pain and restricting motion. Without the spurs, my hip was small enough so as to decrease the size of the Birmingham prosthesis I needed from 58 to 56.

Day 3 (September 27th).... brought increased confidence and comfort in moving around. All lethargy from pain treatment and anesthesia were gone. My surgical dressings were removed (pain level 9, but short lived.) The supine pain level was 0, walking was 2 and getting into and out of bed, 4. However, as might be expected, I walked much more slowly and cautiously after surgery, not because of pain, but because the hip still felt fragile and the muscles of my thigh and hip were somewhat sore and weak. At about 1:15 I was discharged from the hospital to return to Meriter Retirement Community (MRC). This was my first opportunity to practice getting into and out of a car. This turned out to be no problem provided I moved slowly and meticulously.

Upon arriving in my suite at MRC, I felt queasy for the first and only time after surgery. My reaction could have been due to becoming overheated (the room was quite warm) or to my last lunch at the hospital, which consisted of a lot of acidic foods. Additionally, I was much more active on day two than I had been previously and this exertion may have tired me too much. I took the rest of the day very easy and had an excellent yet very inexpensive dinner at the MRC.

Day 4 (September 28th).... began with physical therapy on land. I walked two blocks outside the MRC and then practiced supine, sitting and standing therapy exercises. The outdoor walk went well, but was quite tiring. That afternoon I practiced the water exercises in the heated pool at MRC. I found that the Tegaderm occlusive patch (for protecting the incision from pool water) was very difficult to apply properly. After discussing this with the therapist, I decided when I returned to Sturgeon Bay I would wait for my incision to heal before continuing water therapy.

As September 28 was my birthday, we returned to the Continental Grill where we had dined the previous Sunday. I ordered exactly the same meal, but this time I could eat not more than half. I decided this was not a bad thing and resolved to try to extend my lack of appetite when I returned home. A little weight loss would benefit both me and the hip.

On Day 5 (September 29th).... I practiced walking with one crutch during the outdoor walk. The therapist recommended that I continue practicing with one crutch around my suite, but not in public. Not only does the second crutch improve balance, but it warns others in a crowd not to bump me. My wife and I joined a friend for lunch across town and then went to a shopping mall before returning to MRC for water therapy. The activity level was high for the day and I was exhausted. We stayed in the apartment for a meal of leftovers, and I relaxed and napped the rest of the evening.

Day 6 (September 30th).... was Saturday and it brought the farmers' market to capital square. I enjoyed a two hour walk through the market while we purchased some of the superb produce and bakery goods available. A local coffee shop on State Street made excellent cappuccino. I returned to the apartment absolutely exhausted and took a 2 hour nap before my final land therapy session (at which my activities were distinctly low energy.) Clearly my stamina has been reduced by the operation, but it will return with time. For our final meal in Madison, we went to Tournedos where the prime rib and steaks were wonderful. My cholesterol was taking a beating this week, but I didn't care.

During days five and six I had been reducing pain medication to keep the pain level at 3 or less. I found taking one pill at 8 AM and one at 8 PM kept me comfortable and below the preoperative pain level of 4. Surprisingly, there was a fair amount of itching in my lower thigh, knee and upper calf. Also, bruises were evident moving down from the surgical area to the knee; these created hard lumps which would soften when massaged. The whole area from the incision to below the knee was relieved when massaged as suggested by the physical therapist.

Day 7 (October 1st).... brought discharge from MRC and a triumphant return to Sturgeon Bay. The physician's assistant arrived about 9:30 to inspect the incision and remove the staples. The wound was clean and healing well, if somewhat Frankensteinian in appearance. We left Madison around 10:30, stopping each hour along the way for a brief walk and, often, coffee refill. I arrived home about 3 PM and enjoyed a birthday party with the family and an excellent birthday dinner.

At this point I'm mainly using one crutch unless I'm on uneven ground or in a crowd. Weakness in the knee of the operated leg makes stepping uphill and downhill difficult. Walking on uneven ground is much like stairs which I can take only one at a time.

From this point, refer to the attached progressed chart (PDF file) for a summary of progress.

Day 8.... Cut pain medication to 1 in the morning and 1/2 just before bedtime. At this point, pain is almost not a factor in the hip and incision. Stiffness in the joint does occur as I get out of bed or after sitting in a chair for an hour. Stiffness lasts only a few steps. Itching in the knee and calf is now very significant, presumably from healing. I definitely cannot climb stairs yet except one at a time. My right knee (operated leg) is too weak to lift my weight or support the weight on the downward step.

Days 9-11.... Pain is becoming even more manageable. Cut pain pills to once a day in the morning on day 10. Itching continues. I am using one crutch inside and outside. I am walking about a half mile outside every day in addition to land exercises.

Day 12-15.... I stopped using crutches on day 12 when at home. I am moving slowly without crutches primarily to maintain balance and manage weakness in knee, not for pain considerations. Pain medications have been reduced to 1/2 per day in the morning.

Itching in knee, lower thigh and upper calf is declining. However, there is continuing sensitivity and soreness in this area particularly when squeezing or rubbing the lower leg. I am still using the body pillow; I just now am able to sleep comfortably on the operative side of my body. Up to now, I have slept primarily on my back and, more recently, on the non-op side.

Day 16.... A Watershed Day. Pain is no longer a factor even without pain medication. I was forced into a decision to drive to an emergency meeting when a home repair conflict made it impossible for my wife to drive me. Our Suburban is high and comfortable to sit in. Driving was not a problem, but I had to shift my weight several times during the 15 minute drive to town and back to ease the soreness in my right hip. Fortunately, there are only two stoplights and almost no traffic on the 8 mile trip. I still will let my wife drive when we are together.

Days 17-20.... I am continuing and lengthening my walks; land exercises also continue. Except for stiffness after an hour of inactivity, I am perfectly comfortable in daily activities. I am still taking stairs one at a time; I am also avoiding the three forbidden movements/positions of the hip. While I no longer need to use the pincers pick up tool to dress, I still use the shoehorn and sock-aid to put socks on. Other than these restrictions, I feel completely normal; and I am without the pain of hip arthritis. With my wife I hosted a party for about 30 which included a large bonfire (set up before I went in for surgery), grilled chicken, beef and shrimp and a full assortment of beverages. Although all went well, I was so tired I could hardly get out of bed the next day. My stamina has still not completely returned.

Day 21.... No more TEDs. Yea. I have also decided to push myself into climbing steps. The most difficult movement is "up with the bad." I find that, due to weakness in the gluteus, knee and thigh muscles, I have to hop up with my good leg to give some upward momentum and help the operative leg climb the stair. Down with the good is also a little difficult, but less so than climbing up. The weakness in my knee makes it hard for me to support and slow my step down.

Days 22-30.... I am driving as necessary. I have started water therapy exercises at the YMCA, since all hint of scabbing has disappeared from my incision. I am also using our hot tub at home. By day 25, I can now climb stairs with only the slightest weakness in my knee. Pushing myself to strengthen the knee really helped. I am also walking both at home and at the track at the YMCA (35-40 minutes at a time.) I am still avoiding the three forbidden positions; consequently, I still use the shoehorn and sock-aid. While I have not had a really strenuous day recently, I think my stamina is back to normal or nearly so.

On Day 36.... I will have my post-operative x-ray and evaluation. I look forward to the evaluation of my progress and to learning additional exercises, activities and timetables that will complete my therapy and provide me with a healthy, pain free hip for the first time in a decade.

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1/23/2007

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