The controversy regarding adverse wear in metal-metal bearings
Thomas P. Gross , MD 3/5/2010
I have used over 3000 metal bearings in primary total hip and hip resurfacing as
well as revision surgery. I have revised 2 for adverse wear 7 years after
implantation. I know that most other high volume hip resurfacing surgeons have a
similar experience. The revisions were straightforward and the patient enjoyed
the same rapid and complete recovery as if she had a primary hip replacement.
Currently less than 5% of my practice involves revision surgery. However, I have
revised over 100 metal plastic replacements for excess wear. Furthermore
significant wear related damage to the tissues is seen in virtually all metal
plastic hip replacement or knee replacement revised for other causes.
A surgical group that has seen a surprisingly large number of wear‐related
failures of metal bearing implants has coined the term "pseudotumor" when an
inflammatory soft tissue mass is seen around the hip of a metal bearing implant.
However, this inflammatory soft tissue reaction to metal wear debris is not much
different than the inflammatory reaction that we have seen with plastic wear
debris for many years.
All artificial bearing implants give off wear particles. The question is, which
type of wear debris is best tolerated by the body? During the last 20 years of
joint replacement polyethylene osteolysis (bone destruction caused by plastic
wear debris) has been a major problem. But anyone who has revised total joints
is also aware that polyethelene debris also is always associated with large
amounts of soft tissue reaction around the joint. Polyethelene has been
improved, and metal bearings have been developed. Both give off much less wear
debris than the old polyethelene implants. The question is which results in less
wear related damage? At this point we do not yet have the answer. Adverse wear
reaction is a serious problem, but fortunately it is very rare.
Lets put this into perspective. The most common reason resulting in revision of
total hip replacements in the US is hip instability (recurrent dislocation). 20%
of all hip revisions are done for this reason. This is far more common than
adverse wear reaction. Hip instability is a very disabling condition that occurs
in 3‐5 % of hip replacements. The rate of instability for large head metal
bearings is less than 1/2 %. Larger bearings are the solution for this problem.
Large head metal bearings (resurfacing and total hip) are currently the only
ones that allow reconstructing the hip in a biomechanically normal fashion to
avoid instability. Proponents of plastic and ceramic bearings realize this and
have made their bearings thinner recently to allow larger heads to be inserted
(32‐36mm). This has made them more stable, but 32‐36mm does not yet approximate
normal femoral head sizes in the average female (48mm) and average male (52mm)
patients. These larger head (32‐36mm) implants for plastic and ceramic bearings
have only been in use for a few years and it is not yet clear if these bearings
will break at a higher rate because they are thinner. I would not recommend
impact sports on thin plastic and ceramic bearings. Anatomic sizing that matches
the patient's own size is only possible with large metal head designs. These are
stable and can tolerate repetitive full impact without breaking. Wear rates are
not significantly increased by running.
In the last few years we have learned that these rare cases of adverse wear in
metal bearings are related to three factors: steep acetabular inclination
greater than 55 degrees, small component sizes, certain component designs with
an extremely shallow arc of coverage. At this point it is still only a very tiny
percentage of patients with cup inclination angles above 55 degrees that have
had wear problems. If a patient with an inclination angle above 55 degrees
develops symptoms years after surgery, I would first check metal levels and an
MRI. If the levels were high or a soft tissue mass developed I would recommend
revision. So far this has happened twice in my practice.
More important, however, is prevention of this adverse wear complication. Since
this information about cup inclination has become available several years ago we
developed and tested a protocol for measuring the inclination by XR during the
operation. The paper reporting this technique will be published in CORR this
year. Using this technique in every case, I now have had no cups implanted with
inclination greater than 55 degrees since 10/ 2007. We expect that this
technique will completely eliminate this rare cause of failure in metal bearing
hip implants: adverse wear reaction.
Tuesday, March 9. 2010
The controversy regarding adverse wear in metal-metal bearings by Dr. Gross
Tuesday, February 23. 2010
Dr. Gross Discusses Computer Navigation for Hip Resurfacing
One way to conceptualize this is that the experienced surgeon’s brain is a computer with much more sophisticated "software" than a navigation computer. When a computer is programmed, an algorithm must be created which has certain inherent limitations. Furthermore additional significant sources of errors are introduced by the registration of anatomic points for the navigation computer in surgery.
My personal opinion is that navigation that is based on a pre-operative CT scan data, which is being pioneered by Justin Cobb, has tremendous promise in the future to improve the results. At this point, we are still in the early development phase. It will probably add several thousand dollars to the cost of each operation.
In summary, I believe the right kind of navigation surgery based on accurate 3D CT scans holds tremendous promise for the future. It will still require an extensive amount of preliminary development work before it is ready for routine use.
I hope this helps with this very complex issue.
Best regards,
Thomas P. Gross, M.D.
Thursday, January 21. 2010
Wes Byrd Hip Resurfacing Dr. Gross 2009
Would like to first summarize that so far I am completely satisfied and recommend the procedure 100%. Also, I wholeheartedly recommend Dr. Gross and his wonderful practice.
As of today, Aug 15th, 2009, I am almost to the 5 week mark post-op. From
the moment I woke up from the surgery, I have not had any pain in my hip
more than what feels like a muscle stretching or general tightness /
stiffness. There is no trace of arthritic or bone pain. I'm not sure I had
any expectiations either way, as I read lots of stories both ways - people
that had problems and those that sailed through. It is hard to believe that
there could be no pain, not with all the wrenching around that goes on in
there. Dr Gross has videos on his website showing the procedure (ha, I
couldn't bring myself to watch them until AFTER the surgery) - your hip is
sliced through, dislocated, and then subjected to medieval torture devices
and power tools! How can that not hurt later? But, for me, it doesn't.
I have to say, I was feeling very sketchy in the pre-op room where they
start to work on you. Needles and pills everywhere, people coming and going,
doing weird things to me. And then, wheeled into the operating room. Just
like on TV, with everybody in masks, and the overhead light the size of one
of those old satellite dishes. I don't remember much, but even in a sedated
mode, it was scary. Then that's it – I was out. I have heard they ask you to
count or whatever, but as far as I can remember, they snuck up on me.
The first 24 hours after surgery were the hardest, but even that was not too
bad. Even had it been worse, there's not a lot of remembering due to the
pain meds and the lingering sedation. I was told Dr. Gross does five
surgeries a day, twice a week. Mine was on a Monday, at 9 am. That made me
second in line that day. In my mind, that was great - that way he got to
wake up and practice on someone else before hacking on me (ha). Seriously,
though, I wonder about these things. Doctors are people too, I want them to
have their A game when it's me under there. That was really my only question
during my one and only office visit – "hey, Doc, you're not going to go out
and get wasted the night before my surgery, right?" He said he wouldn't,
just for me. Sweet.
Speaking of pain meds, they gave me vicodin that first day and I think I
took my prescription two or two and a half more days after that. As I said,
there never was any real pain from the surgery, but they kept saying "stay
on top of the pain, if you get behind, it's harder to catch up". Well, at
that time, I didn't know if some big pain wave was coming or not, so I took
the meds. I really don't think I needed it. Hard to tell. The only thing
that hurt was when they took the catheter out on the day after surgery. That
was bad. Sort of like a vacuum cleaner hose had been up there all along, and
got removed along with the catheter hose. There was this weird suction
feeling along with the discomfort.
A physical therapist (PT) came and helped me walk that 1st afternoon of my
surgery (a mere few hours after the surgery!). The walk was with crutches,
but the crutches were for balance, not to take weight off the hip. I have
read that they want you to put weight on the hip to help press-fit the
devices into their respective slots. The most difficult part was keeping
balance considering the lingering sedation. Mostly, though, I just laid
there in the bed. The PT also said to keep moving my feet and legs. She gave
some prescribed motions to do.
Providence Northeast Hospital is 1st class. Everyone that I came in contact
with there was super. Also the food was not too bad. The hospital is yet
part of Dr. Gross's well-established system that is wonderful.
I was told to plan for two nights in the hospital, but it ended up only
being one. That first night sucked. The main reason is that it was hard to
sleep with the O2 / heart monitor beeping all the time and the nurse coming
in every two hours. Also, my heart rate kept going down too low, which would
set off an alarm. I don't know what was worse, the alarm, or me wondering
how bad it is to have a heartbeat low enough to set off the alarm. The low
heartbeat was surmised to be me being in relatively good cardiovascular
shape, along with lingering sedation effects. I still hardly slept at all.
At the consultation appointment prior to surgery, they asked (made?) me to
buy this cold pack machine that is basically a little igloo cooler filled
with ice water, attached to a pump, some hoses, and a bandage. I mention
this because had I known it was going to cost so much out of pocket for the
thing, I could have purchased one on eBay, brought it with me, and saved
some $$. But I wasn't aware I would need this prior to the surgery and
therefore didn't know to ask if I could have brought my own. Anyway, cold
water circulates through the bandage. I was told to bring it to the
hospital. After the surgery, they kept it on my hip and leg, circulating
cold water constantly. When I left the hospital, it was sent with me, and I
used it every 2 hours or so, including in the car on the way home. I think
that was a big help to my quick recovery, by minimizing the swelling. I have
read about people with bad swelling problems; I had none.
The next day, Dr. Gross stopped by my hospital room. He asked a few
questions, and advised that I could leave later that day. I was all for
that. Also, a PT came by and explained some of the disabled person tools
like the sock put-on device, followed by another walk. I was able to stand
and take a shower. I got a little dizzy in there, which I believe was due to
the heat and lingering sedation and pain meds. Fearing possible fainting, I
had to get out and sit on the toilet. Later that afternoon, I was discharged
from the hospital. They make you ride a wheel chair out, but I could have
definitely crutched out on my own power.
The second night, which was in a hotel, also sucked. The main problem was
the whole sleeping on your back thing. The main mode of sleeping the first
few nights is on your back with a pillow between your legs. You are allowed
to turn over on either side, as long as the pillow stays between your legs.
Well obviously, I wasn't going to lie on the operated side, and while lying
on the good side, I was not confident in the ability of the operated
side/leg to stay under control. That leaves the back-lying position. There's
only so long you can stay in one position before muscles get tight, and
general discomfort sets in. It was not a good night. In general, the
confidence of sleeping on the good side grew, and by 7-10 days, I was in a
routine of moving from back sleeping to the good side every 1-3 hours, with
good sleep in between. It helped me to sleep in a recliner for a day or two
before moving to my regular bed. One other thing that surprised me was that
I had to pee every 1-3 hours through out the night. I surmise that it was a
side effect of the catheter. That very slowly went away up through the 3
week mark.
Wanted to mention that that 2nd night I had a fever that got up to 101. I
was somewhat nervous about that. It's hard to know in the moment if it's
just temporary (it was), or if it's going to get worse. Make sure you have a
thermometer with you.
On the 3rd day post-op, my wife drove me and our 2 year old daughter on the
6 hour drive back to WV. We have a CR-V, and I sat in the back seat with the
front passenger seat reclined all the way back to give my legs room to
stretch out. Could definitely have made it sitting in the front, it was just
even better back there. The ice pack has a hand pump bulb thing, which I
used to keep the cold circulating on my hip and leg. We stopped 2-3 times so
I could get out and walk.
My walking progressed roughly as follows:
1->4 days - walking with crutches
5->20 days – walking with a cane or one crutch. Towards the end of that
period, walked with a limp when not using the cane.
21 days -> now (34 days). Walking fine with zero assistance. Limp is almost
completely gone.
Again, it seems crazy to me to walk, unassisted, with no limp, so soon. Most
of the time, I have to keep reminding myself that I recently had hip
surgery, lest I do too much too soon and risk damage to it. And really, my
belief is that it would be hard to damage it, but I'm sure not going to
chance it. Like on the stairs. I could walk up the stairs normally with no
problems by 21 days. I catch myself taking two at a time on the way up
(including with the operated leg!), like I used to do before the surgery,
and have to slow down, since, who knows, that might not be good for it.
Definitely one of the best gifts of the procedure is the
"not-thinking-about-my-hip" mindset it allows, in contrast to before, where
the pain when I walked consumed my attention.
Some background on my situation and events leading up to my resurfacing:
I am a former college basketball player, and have enjoyed continually
playing basketball at a fairly high level up until this spring; when my hip
pain finally forced me to stop. It began around 5 years ago as an occasional
snap or click in there, and gradually progressed through tightness and
stiffness to a slight limp in the past 2-3 years (people would ask "why are
you limping?", and I didn't even realize I was). Couldn't pinpoint what it
was, but last spring I knew something was really wrong. An X-ray showed
"severe degenerative changes" (loss of spacing superiorly, osteophytosis),
basically arthritis. There's not much positive in those adjectives "severe"
and "degenerative". Was pretty crushed by that news.
Began my research on problems of the hip. Purchased a couple of books and
eventually found Surface Hippy. Visited a recommended orthopedic surgeon
here in Charleston, WV. He diagnosed arthritis caused by congenital (birth
defect) hip dysplasia in both hips and recommended a total hip replacement
in the really bad one, noting that the other one will require one in the
future. There's another 30-something-year-old guy in my office with one of
those and he's not allowed to run on it. I mentioned hip resurfacing to this
surgeon and he noted that he didn't recommend it due to risk of femoral
fracture and un-proven track record. OK, well, I have to think about this.
Was able to play basketball this past winter. Would basically take my daily
Celebrex and supplement it with two ibuprofen before going out to play. By
March, people were feeling sorry for me and saying I should stop. I would
limp-run up and down the court. The weird thing was though, is that when I
quit for good in April, it REALLY got bad. It went from a manageable limp in
April to a "I can barely walk 2 blocks" severe limp by May. It was like the
running and exercise had been keeping it loose. Got a cane; it was the only
way I could get from my cubicle to the bathroom. Weirdly, though, I could
still play golf. Would ride the cart up to my ball, cane my way the rest of
the way, and then hit the ball. Lost 2-3 clubs worth of distance (due to not
being able to push off with my right hip), but oddly, it didn't hurt my
scoring. I theorize that I was now playing old man golf, where it's hard to
lose any balls if you can't hit it far enough to get into trouble, ha!
Meanwhile, the more I researched re-surfacing, the more it was crystal-clear
obvious that it was the thing for me. Active, young, good-looking (oh, well,
2 out of 3 ain't bad). It seems utterly ridiculous to cut off the top of
your femur when there are other alternatives. There are so many other
benefits, but if you're reading this, you're probably already educated as to
those, so no wasting time re-preaching. How could I find out if there were
any few orthopedic surgeons in this area that would do resurfacing? Call
each and ask? I don't know, I guess I could have done that. Found one that
was on the Birmingham Hip website and visited him. He had only done 8
procedures. I believe it is important to have someone with lots of
experience at this. That's one thing that is so incredibly helpful about
Surfacehippy - the doctor experience data. I cross referenced my insurance
coverage with doctors that had significant experience (at least 100
procedures) within a 2 state radius and that gave me a manageable list to
choose from. Ended up going for the high end of experience, which was Dr.
Gross, and believe that was the very best choice I could have made. Will not
hesitate to return to him when my other hip gives out. Definitely hope it is
later rather than sooner, but I now have no fear what-so-ever about the
procedure.
Wanted to also share some information about the financial end of things.
Below is what I have experienced so far. I have Aetna Open Access (EPO)
insurance.
1. At the doctor's office prior to my surgery, they suggested I buy the
below items, but I am unsure whether I could have refused at the time:
a. Crutches (insurance doesn't pay for all of it) ~$15 copay with my
insurance (you can bring your own if you have them, eliminating the need to
purchase in the office)
b. Disabled person care package (grabber thing, long shoe horn, sock
putter-on thing, and long sponge on a stick) $60
c. Polar ice pack. Mine was a Polar Care 300 model manufacturered by the
Breg Company. It was $250 in the doctor's office. The reason I list it here
is that these are on sale on Ebay for $70-$100. I would have bought mine
there if I would have known.
2. Dr. Gross's office requires a pre-payment of $1,200 which is for having a
Nurse Practitioner present during the surgery; they said most insurance
companies wouldn't cover that. I paid that, and am still not sure if my
insurance will cover that or not. There is also a prepayment of $1,000 for
some people, if their insurance won't cover "minimally invasive technique".
I did not have to pay that one.
3. So far, my insurance website says they've been billed a little over $51K.
Thank goodness for insurance, right?! That is definitely a lot of money, but
to me, it would have been worth paying whatever.
In closing, I am less psyched about getting back on the basketball court
than I was before the surgery. It may have something to do with the thrill
of just walking painfree being plenty of satisfying exercise at the moment;
also it's summertime and golf season. Speaking of golf, I got the OK from Dr
Gross's office to return to the links at about the 5 week mark, so that will
keep me busy until winter. Knowing myself I'll be back on that court,
though. Sweet!
That's all I have as of now, best of luck to you with your decision, and
your surgery. You are on the right path!
Tim Bilateral Dr. Gross 2009
I started having unbearable pain around November of 2008. I called Dr. Gross's office in December after speaking with Mike from this site who had a bilateral with Dr. Gross back in June. When I hung up with Mike I called Dr. Gross's office and on the first call had tentatively scheduled the surgery dates pending me getting the package together.
I got the package put together according to the protocol on Dr. Gross's website and Dr. Gross called me to confirm I was a candidate. I drove to Columbia from Atlanta on a Friday for my pre-op consultation and met with Lee Webb and Dr. Gross (about 3-3.5hr drive). I drove back to Columbia the following Sunday (Super Bowl Sunday '09) and got to the Courtyard Marriott in time to watch the game and get a good nights rest before Monday's surgery.
Monday was very smooth at Providence NE. I went in a bit early and was in pre-op in no time. The whole pre-op team was a lot of fun, the anesthesia team, the nurses... it was a positive environment. The surgery was the blink-of-an-eye kind of thing where I felt like I closed my eyes for a moment and then I am coming to in post-op with the post-op nurses.... to whom I am sure I probably owe an apology for some reason... and then after a while I am being wheeled up to the room for recovery. I was late in the day so the following morning the Physical Therapy team had me doing the exercises, and walking the hall for the first time on crutches. Then the Occupational Therapist showed me how to use the ADL (aid to daily living) kit. Those OT/PT folks were a lot of fun and very helpful to get me started on the way to recovery. The floor nurses were very helpful and good people, one of whom is a fellow Dr. Gross resurfacer!
Wednesday was basically a repeat of Monday. They wheeled me down to pre-op and started with the prep and again it was a very positive experience with the anesthesia team and the nurses and "vampirella" the vampire lady who loved my veins. Then in what seemed like a few moments I was coming to in post-op -- and probably saying things I shouldn't have been -- and then I was wheeled back up to the room. The PT/OT team had me exercising and up and walking on Thursday and then we did a little group PT session and practiced stairs on crutches and walked the hall a couple of times. I was able to shower on Thursday evening, standing up.
Friday after breakfast I did a little PT and then was discharged by 11am. I rode home to Atlanta and got out a couple of times to walk around a rest stop and stretch a bit.
The one thing I would do differently is wear the provided ice packs on the way home. It was cold the week I was in the hospital and some nights that ice felt pretty cold so I was not to fond of the ice. So I didn't use the ice on the way home.
Well I got very swollen. This is probably the one thing I was not prepared for from doing my research. Dr. Gross told me I would probably swell up and I didn't really know I would swell up so bad. I believe it may be normal, maybe not, but the entire length of my legs were enormously swollen starting on that Friday and increased through Sunday. So Saturday, Sunday and part of Monday I spent with legs elevated by a couple of sofa cushions with the ice packs running, laying on my back (for the most of the time) working to get the swelling down. I called Lee Webb on Sunday and she told me to elevate and ice and that the swelling was probably at its worst on that particular day -- she was right. On Monday (5 days post-op) the swelling had already started to decrease rapidly and I was feeling so much better.
Crutches: I was doing my exercises as prescribed and walking on two crutches until 9 days post-op when I felt like the crutches were holding me back at that point. I had shifted to one crutch at 8 days post op and it was a bit awkward so I decided to get a cane.
Cane: I shifted to a cane 9 days post-op and it felt more natural than the crutches. I was glad to be rid of them.
Ten days post-op: Armed with a cane, I went to the Kiwanis Club's pancake breakfast fundraiser and was amazed how well I could stand up in a very long pancake breakfast line inching around an elementary school cafeteria. I am sure most folks with hip pain can relate -- this would not have been possible pre-surgery. I would have had to sit down every two or three minutes to ease the pain. This is when it clicked with me how well the surgery/recovery was going.
Then I walked around Wal-Mart behind a shopping cart and picked up a couple of items. Then we stopped by Lowe's for a few things and I was able to walk fine with the cane. I just had to take it easy and slow getting in and out of the car so as not to break the rules prescribed by the PT team.
Eleven days post-op: Went to church. Walked in with a cane and everyone was wowed that I had bilateral hip surgery and was walking so well. I have to admit I have been pretty wowed by how well everything has gone -- and I thank God for all of it. And I thank Pat and all the helpful people on the surface hippy website and everyone on Dr. Gross's staff that were so welcoming and hospitable, and all of the folks at Providence NE hospital that were part of the process.
Thirteen days post-op: Getting in an out of the car is getting easier. I still have this pain that last about 20 seconds when I stand up after having been seated for a prolonged period of time. I believe this will pass with time and it is so minor compared to the pre-op pain I was having.
I am 34 yrs. old and am in pretty good physical shape. It turns out I had worn a large hole on my right femoral head approximately 3 cubic centimeters. Dr. Gross told me that if I had waited much longer I would have had to go with the THR -- thank God I called in time! He was able to graft the hole and "achieve an excellent press fit."
I hope writing this will help someone else benefit from my experience – since I received so much valuable help from folks on this site. Let me know if I can help with anything.
Thank you,
Tim
Bilateral - Dr. Gross
2-2-09 (R) 2-4-09 (L)
Biomet ReCap/Magnum
June 12, 2009
Today I am 128 days post-op. I have done so well that I have been quite
slack on updating this beloved group where it all started for me. I have no
pain whatsoever in the hips. The "clunking" is very few and far between
nowadays. I have a 5,000 s.f.+ garden that I have been actively working in
every evening without any pain at all. Yesterday I strolled easily up the
middle of a long flight of concrete steps to enter a building (without
touching the rails)! If that sounds like a miracle to you then you are a
surface hippy or a potential surface hippy! I have been back in the gym at a
low to moderate level of activity as I wait for the six months to pass. I
feel wonderful !!! I could go on and on about the things I can do with
ease...
When I read the Wall Street Journal article on last Thursday June 4th, 2009
"Doubts Raised Over New Type of Hip Surgery" by Anne Tergesen, I was a bit
disappointed with the negative tone of the article. Naturally, I fall into
the "perfect" candidate for the resurfacing being young with strong bones,
but I have heard prevailing positive messages from "less-than-perfect"
candidates on this site and other places.
I'm sure you know how these things work in word-of-mouth: the old rule of
thumb in business is "a bad experience gets talked about 11 times where a
good one gets talked about 3 times". I believe it is the same with online
reviews and ratings -- many times we only make the effort to put the bad
ratings and reviews up so as to help prevent anyone else from having a
similar negative experience. With this in mind I believe hip resurfacing's
strengths outweigh the weaknesses or we would have a considerably more
negative feedback on this site and others.
I felt like the article's title and subtitles set a dominant negative tone
and the positives of the article were mediocre in comparison. Oh well...
That article is why I said I better log back in and keep folks updated a
little better.
Please contact me if you have any questions about the surgery or Dr. Gross
or anything else I may be able to help with. In my case it became "no news
is great news!!!" over the last few months, but know that I remain happy to
help wherever possible! Do not hesitate to contact me!!
Tim
Steve's Hip Resurfacing with Dr. Gross 2009
Airline Travel: When booking your flight, talk with a reservations person and tell them about your surgery and need for a bulkhead seat for all legs of your return flight. That will give you the easiest seats to get into and out of with crutches and the most leg room to reduce the flexion of your hip. If you book these seats yourself you can get bumped from them for “priority” passengers who need them, as an online booking will not ID you as a priority person. Be sure to confirm these seats when you arrive at the airport for a return flight. Also, when you check in for your return flight, ask for a voucher for a wheelchair to meet you at your layover and give this to the flight attendant in the plane. Another possibility is to use the “golf cart” transporters, but they may be difficult to get into and out of.
Housing & Transportation: I had my procedure on Wednesday (hospital check in 9:30 am), so with a Tuesday morning (10:30 am) office appointment with Dr. Gross we arrived by plane Monday evening. We stayed at and recommend the Comfort Inn on Bush River Road Phone (#803-798-5101). This is for several reasons: 1) They have free shuttle service from the airport, 2) will take you back to the airport or car rental facility the next morning (if you do not rent a car upon arrival), 3) have very nice comfortable beds, 4) will come pick you up at Providence Northeast Hospital and bring you back to the hotel on your discharge day, 5) have ADA handicap rooms close to the front desk with elevated toilets (so you won't need a raised toilet in Columbia) and walkers in the shower (much safer than crutches), and 6) shuttle you to the airport the following day for your flight home. They also have an accommodative staff, as Vijay and Nick were very helpful, the usual free breakfast and wireless internet service. My wife traveled with me and she slept in a fold out bed in the hospital, so we only needed a hotel before and after the surgery.
Car Rental: We used Enterprise for car rental as their prices were competitive and they had a drop-off location Northeast and Southwest of the hospital where you can leave the car the day of surgery and they will take you to the hospital for check-in. Be sure to clarify this arrangement when you rent the car. That way you really only need to rent a car for one 24 hour period, to get to the doctors office, drive around for the day and get to the hospital the following day. Your doctor office visit and surgery time may require a different schedule.
Office visit with Dr. Gross: Give yourself 2 to 3 hours as it is a slow process. The office is about 15 minutes from the hotel. Be sure to write down all of the questions that you want to ask or you will inevitably forget some. I expected Dr. Gross to be all business with the number of cases he does and rush through the office check. Instead, he was very personable and went out of his way to explain things clearly, showing models of the components and making sure that every question was answered completely. He showed no inclination to leave the room until I was completely satisfied and he demonstrated his concern for his patients in other ways as well. This is a big plus on top of his knowledge and skill.
Pre-Op in the hospital: After checking you in, they will start your IV and draw blood for pre-op testing. They will try to draw blood from the IV so you only receive one stick. If the person starting your IV causes a lot of pain, ask for someone else to make the second attempt. The IV should not hurt that much and some people are just better than others. Request that they do not start the IV in you hand, wrist or bend of your arm as these areas will be painful and troublesome during your stay.
When they use hair clippers on your leg and butt (guys), be sure you brush off all of the hair that is stuck to your body and they change the sheets on the stretcher so you don't take loose hair into the OR room for your surgery. They will also put a blood pressure cuff on your arm, oxygen sensor on your finger and heart monitor patches on your chest.
In the OR: After hooking you up to heart and oxygen monitors they will have you sit forward on the OR table and give you an injection in your back consisting of several medications. This will be the spinal anesthesia that will numb you below your belly button for the surgery and reduce your surgical pain for 24 to 36 hours after the surgery. I feel like this is safer than general anesthesia as is has the potential for fewer serious complications, and is one of the reasons I chose Dr. Gross. This shot will just be mildly uncomfortable. After you lay back down you may feel an odd sensation as they insert the foley catheter into your bladder, but you will be pretty well numb by this time. Shortly afterwards they will give you drugs to put you to sleep, but will allow you to breath on your own. You will not even know the surgery is going on.
In the Recovery Room: When you wake up, they will be watching your vital signs closely for an hour or so until you go to your room. You are going to feel some degree of numbness below the navel which is normal and you will have minimal pain in your hip area. You will have a foley catheter in your bladder, this will be uncomfortable, but will allow you to urinate freely so they can watch your fluid status. You will also have leggings that will inflate and deflate. This is to help prevent blood clots from forming as your muscles are not working normally due to the spinal anesthesia. They are a bit annoying but will be on for the first day and night, then off the next day. From this point forward you have three leg rules- 1) do not move your leg to the midline (centerline) of your body, 2) do not rotate your toes inward, and 3) do not flex your hip more than 90 degrees. These are essential as they help to prevent a dislocation of your new hip joint (very bad).
In your room: All of the rooms are private, have a fold out bed, and have wireless internet access so bring your computer to help pass the time. The low level of pain is from the long acting narcotic in the spinal anesthesia and the oral and injectable drugs given by Dr. Gross. He really does an excellent job here. Saying this, one of the more common side effects is nausea. Just drink water first and give it some time in your stomach. Continue drinking plenty of fluids over the next few days as it will be very important. Start eating slowly and don't chow down your first meal. You may want to ask for an anti-nausea pill to prevent this from developing, or at the first sensations you have of feeling sick to your stomach, ask for one right away.
The staff is good, as they take care of patients with this surgery frequently and you will have a nurse and a nursing assistant working with you. They work two 12 hour shifts going from 7 to 7. You will wake up with the cool pad over your surgical area that you picked up at Dr. Gross's office. This is your best friend and is part of the pain control. Use it regularly for the next 1 – 2 weeks. The ice in the bucket needs to be changed about every 4-5 hours or it melts and the pad warms up. Sometimes the staff forgets to change it, so if the pad feels warm to you, ring the call bell and they will be happy to fill it up. If your surgery is done before 1 o'clock or so you may have Physical Therapy come and begin your exercises and walking the same day as surgery. You will need to follow their directions at home, so follow their instructions carefully as their information is critical to your recovery.
Guys, your legs will be coated with a surgical soap that has glued all of your leg hair to your skin. This will become itchy and uncomfortable, especially during the night. The staff has a white cream that will melt the soap and free up your hair. If you have a significant other staying with you have them use this with a wash cloth on your legs. If you are alone, have the staff do this. Trust me, you will be glad to do this.
You will have the oxygen meter on your finger, this is to monitor your breathing in case the drugs in your spinal injection effect your breathing. If the machine is beeping with every heart beat, ask them to turn the volume off as it is not necessary. This noise will combine with other factors to keep you awake at night. If your oxygen level drops the machine will sound an alarm and this is all that is necessary.
Pain Medications: The staff will regularly offer you Tylenol for you pain, take them. They have basically no side effects and will be helpful. There will be stronger pain medications for you as well that are related to morphine. You want to take these stronger pain medications before the level of pain increases, or it will be difficult to reduce the pain. Balance this out with not taking them when they are not necessary, as there are side effects that you do not want. One of these is a slowing down of the bowels which are already affected by the spinal anesthesia.
First Night: We were awoken almost hourly after 1 am the first night, and I hope these steps will help minimize your sleep disruptions. The staff will say that their job is to keep an eye on you and not necessarily let you get rest. However, with some coaching you may be able to get them to minimize the wakeups and improve your care. I strongly encourage you to ask your nurse to do the following: at 10:00 pm when you have medications and vital signs due, have them refill your ice bucket at that time. While taking your medications, firmly request that your nurse comes in to check you at the same time as the assistant gets your vital signs at 2:00 am and refills your ice. Ask them to come in for the 6:00 am vital signs and ice refill when the phlebotomist comes in to take the early morning blood samples. It was extremely annoying and unrestfull when their visits were staggered. Their excuse is that they need to check on you, but they can do this in a coordinated manner that provides better patient care.
1st Post-Op Day: First thing in the morning they will take out your foley catheter. It will hurt but only for a few moments. Afterwards, you are going to feel like you need to urinate but it will just be a false sensation. When you do pee, it will hurt again and feel difficult to get started. You may also have some air burp out with the urine, which will resolve after a day or two. This pain will decrease after a few more urinations and it will be normal in a few days. Measure your urine (urinal for guys and hat for gals) for the staff who will be keeping track of this today. I suggest you get up and go to the bathroom whenever you need to urinate as this movement is good for the body. Get up only with help, as there is an increased potential for falling and serious injury this soon after surgery.
Your hip and leg will still feel pretty good, I was amazed at how little it hurt. Stay up in the chair as much as possible and follow the OT and PT instructions for your activity. If you have work to do this is the day to get it done because the next couple of days will be more uncomfortable.
Your digestive system and bowels are going to be messed up with the drugs you have received and this will be a problem for you over the next few days. I did not follow everything here and my abdominal pain was much worse than my hip pain. Don't minimize this complication. Here are a number of suggestions that will help
(http://www.spine-health.com/treatment/back-surgery/preventing-constipation-after-back-surgery):
·
Increase
activity as soon as possible after surgery. Walking is an excellent way to
help bodily functions return to normal, and also helps with healing from the
surgery.
·
Limit use of
narcotic medications (e.g. Vicodin, Tylenol #3, Darvocet, Percocet,
Oxycontin) to just what is necessary for adequate pain control. Narcotics
slow down bowel motility, leading to constipation. Consider switching to a
non-narcotic pain reliever (such as regular Tylenol or extra strength
Tylenol) for pain control shortly after surgery to reduce the risk of
constipation.
·
Begin using a
fiber laxative, stool softener, or combination product after surgery to
reduce the risk of constipation, particularly if one has experienced
constipation in the past.
·
Drink plenty
of water and other non-caffeinated fluids (at least 40 oz per day), provided
that the physician has not restricted fluid intake for another reason. Prune
juice and apple cider (not apple juice) are also excellent natural
laxatives.
·
Eat foods
that are naturally high in fiber to stimulate the intestines. High-fiber
foods include beans, whole grains and bran cereals, fresh fruits (such as
watermelon, grapes), and vegetables (such as lettuce, carrots). Limiting
foods that contribute to constipation is also a good idea, such as cheese,
meat, and processed foods.
·
Eat small,
frequent meals throughout the day, rather than large meals to aid in the
digestive process. (Save some fruit for between the meals snacks)
Even with
doing these things it may be until your 3rd Post-OP day before
you have a bowel movement.
2nd Post-OP day: Your hip is going
to be more sore today, so utilize the stronger pain pills but only as
needed. Be up as much as you can in the chair, take a walk as often as you
can, continue eating as before and drinking lots of water. This was my most
uncomfortable night, from abdominal cramping and pain, not the hip pain. I
did not follow all of the recommendations above and paid the price. If you
sleep on you back, put a couple of pillows under your legs to give you a
little hip flexion to make it more comfortable. If you sleep on your side,
be sure to place a couple of pillows under your operative leg to elevate it
and not allow this leg to approach the centerline of your body.
3rd Post-OP day: Your hip is going
to feel stiff today, but don't let that slow down your exercises and
walking. These activities will loosen it up and help. Other writers on
this website have inferred about the difficulty of their first bowel
movement and this is not to be underestimated. Here are a couple of
suggestions. Sliding your underwear down to your thighs will keep your legs
fairly close together and create more pain in the hip as you sit on the
toilet. For a more comfortable position, and to make it easier to lower
yourself safely onto the seat, drop your underwear off of one leg completely
so you can move your feet and knees further apart. Find a comfortable
position and try to relax, try not to strain, it will take some time and
won't be pleasant. If you feel light-headed lean back and let whoever is
with you know so they can come into the bathroom with you at this point.
People have passed out and hurt themselves.
Flight Home: When checking in to return home,
confirm your bulkhead seats. Allow plenty of time for wheelchair travel and
a full body search by the TSA people. It is going to happen, so just
accept it. Some of the airplanes leaving Columbia will arrive at their
destinations and park away from the terminals and lower the plains steps to
the tarmac. To prevent this, let the flight attendant know that you will
need a ramp upon arrival, and they can make that arrangement. They will not
automatically put together a slow moving person on crutches with the need
for a ramp.
Home: Pretty much continue what you have been
doing. If you start feeling like things are difficult, think of all of the
young men and women that are returning from fighting in the middle east
without legs. Again, this information is from my personal experience (and
hospital experience) and yours may be different. I hope it will be of some
help.
Rob Baum Bilateral Dr. Gross 2009
I am here in South Carolina with Dr. Gross at the hospital. It is Tuesday today. I had the right hip resurfaced at 9am yesterday. Tomorrow, I will have the left leg resurfaced at 3pm. Thanks to all the folks who have published comments and given feedback on this site. It is incredibly useful for setting expectations and getting a feel for what is going to happen next. My thanks to all you great posters!
I am 44 years old, and am in good to great physical shape (except for the hip area!). I learned about Hip Resurfacing and Dr. Gross by doing a Google search when I was frustrated about "hip replacement and snowmobiling". Somehow I came across an individual who was a year out and bragging about being able to snowmobile again with no pain. What a funny way to hook into this site!
I learned about Dr. Gross from this site as well a ton of independent research. I called and talked to their staff and was impressed with how caring they seemed. In reading the blogs, I felt that Dr. Gross and his staff went the extra mile to make their patients recover well.
So I decided to sign up and go through the process. For me, my life felt like I hit a brick wall sometime back in October. I was limping for the past 8 years or so, but there was no affect on my sports, ROM, or anything else. I had pain, but medicine seemed to be the way to treat it. What was interesting to me
What was interesting to me was how the pain medicine doses became part of my life. Two alleves in the morning to get me started, maybe one before playing hockey, or maybe throw down a couple of Anvils. I was popping these pain killers every day. I do not think that was so good!
Then, in October, for the first time in my life, I felt that my ROM and strength in my legs was to push off, or stand up from the back of the skies, or do something I always had been able to do, was GONE! I finally decided to do something about it.
I met Dr. Gross and his staff in their office on Friday. I was impressed with how friendly, nice and caring his staff was. It might be something to do with the South as well… you all are a caring and wonderful group! I hail from Northern Michigan, and live now over in Northern Sweden!
Dr. Gross and I discussed in detail the results of my DEXA scan, which is a bone density scan. Because of my arthritis, I was a little low. If not for my physique, desire to do both, and commitment to take it easy, I think Dr. Gross would not have gone forward. Being a male 44 years old helped as well, but the bone density was a big deal. I was a -2.1 on the left and -2.3 on the right. Osteo something arthritis is -2.5. So I am not so good! But I am on a course to strengthen my bones (good tip for people to look at prior to surgery, have the DEXA done early). I take calcium and vitamin D daily as well as a bone strengthening prescription (forgot the name) once a week. So we decided to move forward!
My right side feels pretty good. I have been up and down the hall 3 times practicing a gated walk with the crutches. It is definitely stiff@! And it is definitely hard to maneuver out of bed turning the right leg to get into a standing position. Because of my Dexa, Dr. Gross has me on the slow progression PT. I am not to weight bear much (and little as I can) for 6 weeks. But… I willing to do that because I really want to get my life back and both sides were killing me pre Bilateral!
So…things are going well. The staff here is excellent at the hospital. I have felt very welcome and very cared for. Everyone has been great. This is truly a first class place. Tomorrow, I have to stop eating and drinking tonight at midnight, I will get stage 2 – the left side done! I will keep everyone posted. I am excited and nervous. After reading all the posts, I know the first 10 days are going to be tough! But I am ready, here, and willing to endure! We fly back up north on Saturday.
July 15, 2009
Well... I am now post op 2 weeks. I agree with previous
post that the first week is tough. I would refer to it as more than tough.
At least it was for me... wow! I will do a little memory recital here and get
caught up to where we are today.
I had the second hip done on Wed late - I was the last surgery of the day. I
had the good fortune to be very easy. The surgery according to Dr. Gross was
straight forward and easy. As you may recall, I was a little low on my bone
density - a negative 2.1 on the right and a negative 2.3 on the left. Dr.
Gross had originally suggested I not do a bilateral. Upon our meeting, and
discussion, we decided together to proceed with the bilateral surgery
knowing my recovery would be under his slow program. More on this later!
On Friday, we were discharged from the hospital. The pain meds, coupled with
what I assume was some device to dislocate my leg from the socket prior to
surgery, made the bathroom a big nightmare. We stayed at the Courtyard on
Friday night. My butt was so uncomfortable. Trying to go the bathroom was
terrible. It does get better, but that first ten days are tough for men. Of
course, I am a big baby, but that was no fun!
Courtyard was great. We had the handicap double room. My father had been
with me all week. Having him to help was indispensable. You need someone to
help you out for a couple of weeks.
On Saturday, we packed up and headed to go out of town from Columbia airport.
I had to take two small flights to get home. One jump from Columbia to
Detroit, and then from Detroit to Traverse City, Michigan. Having read the
forums, I knew to take my medicines – the pain meds. In addition to Vicodin,
I had something Dr. Gross gave me that was a 12 hour. I took that as well as
brought the vicodins with me to use ,as well as the next 12 hour pill for
when we were in Detroit. I also packed empty head ice packs. Those ice packs
you can buy at the store that have a big screw off top, are meant for your
head, and you can put ice in them with water. We carried these empty through
security and had a vendor fill them with ice in Columbia. They were a HOT
TICKET! And very recommended. Having one for each side during the flight,
really helped me a lot. We refilled with ice in Detroit for the next
segment. They were perfect because you can take empty through security.
Upon arrival home, I was a little swelled and took it easy. The hardest part
was the bathroom. The pain killers act like a plug, and your butt feels like
(and is) very bruised. Sitting on the toilet seat for 5-7 days was not
pleasant. Cover your one eyed snake with a towel, and grip those side bars
on one of those raised toilet seats your grandpa would use. You need both
hands to hold your butt off the seat, since it hurts, which is why your
one-eyed snake needs a blanket! Nuff said… And...Get ready to pass the
football....
Once home, my father was diligent about filling the polar ice machines and
wrapping my hips with those cool packs. They really helped with bruising and
the swelling. They are like having a loud fish tank (as a bilateral you get
TWO!) in your room, but they are worth it. By day 5 or 6 post op, after
sleeping with ear plugs (trying anyway!) I pulled the plug on those babies
and put them away! I needed some sleep.
Sleep has been tough. I am a roller. You cannot roll with a baseball in each
hip! It is difficult, and just now possible, to sleep on the stomach. But
still… it does not work like it should! Just takes time!
I have been really good about taking long walks. I am now post op almost 2
weeks, and enjoy going around the block on my crutches for a good 40-50
minutes. I also walk on my crutches everywhere when we go shopping and
stuff. Because of my bad bone density, I am forced to keep the crutches for
6 weeks (doctor’s orders). That will be the toughest thing for me moving
forward, as I am already able to walk around without them. Only good part is
that you get lots of sympathy from people – everyone has been so nice and
helpful. Bad part… for a guy that is single… not like having a cute puppy…!
My spirits are high. I feel good and the bones are getting stronger. I did
push one day and took some family (day 12 post op) out on my boat. It is a
big boat, so the wave impact was minimal, but still, because I was doing the
driving, and standing a bit of time, my legs told me the next day I over did
it! It completely wiped me out. I passed out and slept a day away the next
day. Moral of the story… you just had major surgery dummy… take it easy!!!
Today, I feel great again. I am going to go out now and go for a long walk.
I really like having done this in the summer. I don’t put on anything but
shorts and I never have to worry about ice. I can walk every day and I am
never too hot (that might be a living in northern Michigan summer thing!).
If I can help anyone else, please hit me with questions. This has been a
wonderful process for me. I have NO arthritis pain. My wounds on my leg
where the incision was made are healing great. I feel them but the feeling
is like a cut healing on your leg, not arthritis deep pain. I don’t feel the
new resurfaced components like I thought I would at all.
Looking back, and concluding this long rant(!), that first week is tough
TOUGH TOUGH! It just gets stronger, easier, and better. I am so GLAD and so
HAPPY I went and saw Dr. Gross. I owe it all to this website and the people
who have contributed before me. I am really excited to keep improving, and
in 6 months, be back to normal!
Max Bilateral Hip Resurfacing Dr. Gross 2009
I am just over 2 weeks post op from second half of
Bilateral. The first week was definitely a challenge. I took the pain pills
before I felt I needed them and that worked great, not much pain to deal
with. I was a little unprepared for how useless my legs would be, a good
deal of swelling even with the ice machine. I guess the big downside from
Bilateral is not having a good leg to help out. I definitely questioned the
wisdom at first but now I'm sure it was the right way to go.
When I first arrived home from Columbia it was all I could do to walk from
the car to the house, but each day was noticeably better. After the first
week at home I made it around the block, roughly a mile, and I have
continued to do that walk daily, getting faster each day. I hope to lose the
crutches soon. there is still a measureable difference in the recovery
between the first and second leg that I find interesting.
So far so good, hope to head back to work next Monday
4/23 ( 3 weeks post op)- Back at work, no real issues just need to prop my
feet up as often as I can to minimize any swelling. Using one crutch, mostly
just carrying it around for balance. I also went to the health club and rode
the stationary bike for half an hour, pretty stiff but no real pain. I can't
wait until I can finally tie my own shoes...
4/30 Walking without a cane, riding the stationary bike for about 30 minutes
a day, I even cut the grass a couple of days ago. Stairs are still a little
dicey. I have to remember all the things I'm not supposed to be doing as I
am definitely tempted to push it a little bit.
Additional Comments about Max's Bilateral Surgery
I had bilateral with Dr Gross back in May and my dominant leg actually healed a little slower. I think it really has to do with the details of the surgery, each one is slightly different.
I had some cramping after my bilateral most likely due to the increased fluids causing the swelling, it will go away but it takes a while. Even at my 6 weeks check Dr. Gross told me it is normal to still have excess fluid in the joints. As for tying shoes I did not even attempt until after 6 weeks and it took a while to get flexibility back.
I had lots of discoloration on the back of my legs for 4-6 weeks afterwards. It takes long time for the bruising in the muscles to go away, there is a good deal of excess fluid as you know. Both my legs were swollen to twice their normal size and felt like chunks of dead wood. Ice machine helps a lot, walk when you can and when you are not on your feet elevate you legs. I slept with pillows under my knees ad calves help drain excess fluids.
Joseph P. Tierney Hip Resurfacing Dr. Gross 2009
At the age of 29 I was diagnosed with severe OA in my left hip, likely due to a slight malformation of my femoral head which caused uneven pressure and eventual breakdown of cartilage. The news was very unexpected and I was absolutely crushed. The tears started coming once I got back to my car. It wasn't that I was thinking "why me" or anything like that but that I felt a huge sense of loss. Everything about my life was active - a normal week might consist of 50 miles of single track mountain biking, soccer, softball, yoga, and the gym. Being active was how I relaxed - it was my only real hobby besides reading. My journey to the diagnosis was a long one and started with groin pain as a college soccer player - trainers and myself would assume the pain was due to a strain or pull and I would rest. Several weeks and I would always be fine. A blown knee and approaching graduation took the focus off soccer and on to academics. Once I stopped competing at a high level I paid little attention to a progressive loss of speed and agility. I was athletic enough to compete just fine in recreational sports and the years passed while I immersed myself in my professional life. I naturally transitioned to sports that better fit my changing abilities - yoga and mountain biking. I though I had just been slacking and yoga would bring back my flexibility. It didn't. I continued to loose flexibility, was unable to run at speed, and groin pain had become a constant part of my life. Eventually I realized I could not remember not using my hand on my knee to pull my left leg into my car or picking something up without lifting my left leg in the air behind me. Putting on socks and shoes was one of the hardest aspects of my day. "Are you limping?" questions came from all directions. It hurt to exist - awake, asleep, sitting, standing - chronic hip pain now defined who I was.
Before I found the Hippy Surface website two themes defined the messaging I received from medical professionals. The first was that I was too young for this to be happening and that my situation was weird (fascinating insight). The second was that this was a big shame, none of my options were ideal and I should wait as long as possible to consider surgery because of my age. I have enough experience in healthcare to know doctors are constantly wrong, information disseminates at a snails pace in medicine, and there were other people like me and I needed to find them ASAP. Finding the Surface Hippy website was one of the best days of my life.
At my age I never considered traditional THR - if you're reading this neither should you! There are situations when THR is the only option but they are rare. It is important to note that THR is a massive industry - there are billions of dollars and lifetimes invested in this procedure. If you think most physicians who have built their entire practice, professional career, and sent kids to college by performing THR's are going to be impartial regarding resurfacing you're nuts. I asked a physician at Washington University why anyone in their right mind would ever consider THR if resurfacing was an option. He seemed almost offended, stated it was a perfectly good procedure (for him maybe) and I should consider it as a very viable option. Doctors are people - its your hip, you're the expert and must take on the responsibility of the role. Ask questions and know the answers you're looking for.
In choosing my surgeon I met with teams at Washington University in St. Louis, Dr. Su at the Hospital for Special Surgery in New York, and Dr. Gross at Midlands Orthopaedics in South Carolina. The surgeon at Wash U was primarily a THR surgeon who basically does resurfacing on the side. He had completed about 60 cases in 3 years. I wanted someone with more experience. I met with Dr.Su in New York. I left the meeting feeling very confident he would do a great job and enjoyed our meeting. However I passed on Dr.Su for several reasons. I wanted to go with an uncemented femoral component and Dr. Su only does cemented. The Hospital for Special Surgery is an extremely difficult facility to navigate (one appt. had me visiting 3 completely different buildings) as is Manhattan (awesome town, unless you can't walk) - this seemed like a nightmare scenario after surgery. Some of the staff at the Hospital for Special Surgery were also extremely unprofessional - staff members making fun of and arguing with patients definitely had an impact on my perception of the facility.
I choose to have my surgery with Dr. Thomas Gross in South Carolina for several key reasons. Key factors included: surgeon's experience specifically with resurfacing; uncemented femoral component option; an incredibly friendly staff throughout the facility; and easy access to facilities.
THR and resurfacing are two completely different surgeries - skill at one DOES NOT necessitate skill at the other NO MATTER what any doctor might say - the entire process, tool set, prosthetic components, etc. is completely different. Resurfacing is going to continue to gain in popularity which means more and more inexperienced surgeons are going to start doing the procedure - I personally wouldn't want to be someone's practice. Ask your surgeon how many times they have performed the specific procedure with the specific components. The experience and skill of your surgeon is the single most important factor in your success. It is only day 7 and the only pain medication I took today was two Tylenol 7 hours ago and I'm sitting on my couch with ZERO pain. I have almost ZERO bruising. I walked one mile today without crutches or a cane and didn't have any pain - I could have walked another one, the last step didn't feel any different than the first. I have not heard any popping, clicking or other unnatural noises coming from the joint. The OA pain is GONE! I know my joint and recovery still have a very, very long way to go and I'm far from out of the woods - anything could still happen - but I could not be happier with how things have gone thus far. These results are all due to the skill of Dr. Gross.
While the contemporary uncemented femoral component option is so new data is not yet available on outcomes it was an easy choice for me. I believe it will become the standard. While a 20 year lifespan for a cemented component is a great outcome it would still have me moving to a THR relatively early. I need both components to become parts of my body - I need the connection between the components and my body to be alive - I need the connection to be bone. I personally saw cement as one more point of failure which added variables to the overall system. Cement is not alive and cannot regenerate itself.
Everyone at Midlands Orthopaedics was extremely professional - from the front office, to x-ray, Nurse Nancy Smith, Nurse Practitioner Lee Webb, and Dr. Gross himself. After having visited Wash U and the Hospital for Special Surgery this professionalism was a giant relief. I finally knew I found the team I wanted to work with. Dr. Gross was the first surgeon who seemed genuinely excited about the components he used for the surgery. I asked other surgeons, "What components do you use and why?" The general answer before Dr. Gross was "I use 'x' mostly and it seems to work OK" - I absolutely hated that answer! These guys should be experts on the options and choose their tools of the trade with passion! I wanted to hear extremely specific reasons why, of all the options, this doctor thought I should have a particular piece of hardware in my body, potentially for the rest of my life. No doubt they're getting paid by the component vendors but I wanted to figure out what other specifics they used to pick their horse.
I'll share some of my advice for anyone facing the difficult situation of needing a new hip(s).
-
Find ways to get into or stay in shape. Your body is a system - the stronger the overall system the better you will be able to cope physically and mentally with the challenges before and after your surgery and recovery. Find exercises you can do - swim without kicking, use adjustable elliptical machines to find a bearable setting, do upper body exercises, walk as much as possible. Rehabbing a hip is a difficult task - you don't want to have to rehab a quad, hamstring, calf, etc. all at the same time too. My left leg was still very strong at the time of my surgery - I can already tell this is an excellent help in my recovery. You also want to get into the habit of a daily exercise routine before surgery so you will have one less change you have to make after - you'll already feel comfortable with the daily routine of rehab.
-
You are the foremost expert on this planet regarding your hip. Nobody else. Embrace this role and become an expert on every aspect of your situation. Don't let doctors intimidate you or pressure you into any procedure or timeline. Ask specific questions and demand specific answers, "how many hip resurfacings have you done?" - I had a doc answer this question by lumping THR's and resurfacings together 3 times and would not tell me the specific number eventually stating the surgeries are basically the same which we all know is nonsense. If you've studied the Surface Hippy site carefully, you have expert knowledge and know more than a vast majority of doctors.
-
Take your time in choosing your surgical team. I remember just wanting to get the decision over with and move on with my life. If not for my very supportive family challenging me to make sure I felt comfortable with my surgeon I probably would have gone with the easiest option which upon further reflection would have been the wrong choice.
-
Remember THR is a multibillion dollar institution - there are vested interests and a great deal of economic momentum working to keep THR procedures as the standard. Just because your local doctor isn't up to date on modern resurfacing doesn't mean it's not the better option in many cases. Personally I do not see any reason why someone who has the option of resurfacing would ever choose THR.
-
Keep a positive attitude. Life is difficult. Always has been, always will be. I'm in a good place right now with my outcome but a fall on ice, an infection, or some random car accident and the game changes. Before I had my surgery I had reserved myself to accept the worst possible outcome (well death is the worst but that would be easy on me) which I saw as a long fight with infection, zero weight bearing, and ending up with a THR . This situation would suck but I'd need all my mental strength at hand to fight to get my health back. I entered the hospital ready to battle. My right hip isn't too far behind my left so I'll be on this journey for a while.
If you've found this site consider yourself lucky. Take your time, get prepared, and take your
life back from pain. I am so very thankful for my supportive family and my
beautiful girlfriend Meghan who traveled with me to South Carolina. I am
eternally grateful for and humbled by all the love and support I received
from Meghan, my family, and our friends.
Best wishes on your journey!
Sincerely,
Joseph P. Tierney
Surface Hippy Newbie
Alan Bilateral Dr. Gross 2009 Hip Story
I just turned 56 years old and am by no means a fitness
model (and probably somewhat embarrassed about how little I have to show for
how much I have worked out , but I have been physically active most of my
life with running, biking, swimming, skiing, hiking, yoga and weight
lifting. Well up until about a year ago, when my left hip suddenly became as
sore as my right hip, which had become sore and stiff about seven years ago.
I was able to compensate and refused to let it slow me down, but now every
form of physical activity now hurts. I have become increasing less
physically active with each passing month. I have delayed getting treatment
this past year while relocating our household from the Washington D.C. area
to Colorado. Maybe this delay has played in my favor.
Last February with my rapidly deteriorating hips, I went to an orthopedic
surgeon and he diagnosed moderate OA in my right hip and slight OA in my
left. He advised that someday when the pay became intolerable I would need
an THR, but I should put that off as long as possible. I had heard something
about "resurfacing" and ask him about it. He said it was pretty knew and he
saw no benefits over the THR.
By October, we were living in temporary quarters waiting for our new house
to be finished and the pain had continued to get worse. I made an
appointment with a Denver OS and his conclusion was I had severe OA in the
right hip and moderate in the left. He had done resurfacing but told me I
was a poor candidate for the procedure and he was only 50% confident that he
could do the resurfacing and would know until the surgery was begun. He also
wanted to wait at least three months between hips. I went ahead a rather
hesitantly scheduled surgery for the middle of December.
The more I thought about it the more I didn't like those odds. This web site
lead me to send my xrays to Dr. Gross and within a couple of days Lee Webb
emailed me saying I was an excellent candidate for resurfacing. Dr. Gross
called me on the phone and spent about 40 minutes discussing the operation.
He suspected there was more bone on bone contact happening in my left hip
than the X-rays indicated and said he could take care of both hips on the
same trip to Columbia, SC. My recovery might be slightly longer, but once
done I'd be pain free and not facing another operation and recovery. The
pace and responsibilities of my project manager's job make it very difficult
to be away from work and extended period, and my wife is a school teacher
and it is hard for her to be gone, so doing both hips during one trip was
very appealing.
I scheduled the operation for the middle of March the week before my wife's
spring break, so she could be with me for the operations in SC and then have
the next week to be my nurse at home. Dr Gross operated on my right hip on
Monday (3/16/09) and my left hip on Thursday (3/19/09). I was discharged
from the hospital on Saturday (3/21/09) and we flew home to Denver on Sunday
(3/22/09).
March 23, 2009: Post Op Day 7 (right) Day 4 (Left)
My first full day home and my worst day of this experience so far! Swelling
and pain and questioning my own intelligence. I did my twice per day PT
exercises and walked on crutches about 400' each time. My right leg is sorer
than my left and is noticeably the more swollen of the two. Seems to be to
types of pain happening. The first is an incredibly tight/twisted knot of
muscles, almost like a constant muscle cramp. The underlying muscles are
sore to the touch. My intuition tells me this tightness will get better with
time. Funny thing is in different spots on the two legs: on the outside of
my leg above my right knee, but on the left about mid thigh.
The other type of pain is far more frightening. It is a sharp stabbing pain
from deep in the groin and hip joint itself. When it happens, I immediately
panic, fearing that I just fractured the neck of the femur. Fortunately it
does last long. I guess I adjust to it when it happens.
Chuck is entitled to an "I told you so!," but part of my discomfort may have
been trying to be a "hero" and avoid the heavy duty pain killers. I have
read several post from other of Dr. Gross patients stating they didn't need
anything but Tylenol after leaving the hospital. I didn't think I needed the
vicodin. I decided I would not play "hero" tomorrow, use the drugs before
the PT and hope things improve.
March 24, 2009: Post Op Day 8 (right) Day 5 (Left)
Today was much better than yesterday, despite a fitful night full of self
doubt. I arose feeling better than the day before. I took a long hot shower
and worked on all the areas of residual adhesive tape from the hospital. The
shower was wonderful. I felt good enough to sit a couple of hours in front
of my desktop computer catching up on email. Before the morning PT exercise,
I took a Vicodin and my morning walk was slow and probably about 600'. The
air was crisp and the view of the fresh snow covered Front Range was
inspiring. No comparison to how bad I felt on Monday. The swelling in the
right leg is decreasing and the muscle pain doesn't seem as intense. I did
put on the polar packs and took a little nap courtesy of the drugs.
Afternoon PT exercise seemed easier than this morning and some of the muscle
stiffness seems to be easing. I increased my distance to about 800' with
some of it being up hill. I had a couple of those "joint jolts" during the
walk, but decided I probably haven't really fractured anything and perhaps
they were part of the healing process.
Overall a much better day and a much better attitude.
March 25, 2009: Post Op Day 9 (right) Day 6 (Left)
Today was a break through day!
I discovered I could "walk" using my crutches (i.e. Right crutch forward
with left leg forward alternating with left crutch with right leg forward).
This was so much easier than moving both crutches forward simultaneously.
This feels so natural and my wife commented that I was "walking" with no
detectable limp.
It was also a very mild and beautiful day in Colorado and I was so pumped
that I went double the distance from the day before (probably about a 1/4
mile) with this new form of walking. I went again that afternoon and
increased the distance by another block or so. That evening, I even had
enough energy left to attend as small group meeting in our neighborhood,
where I sat for a couple of hours in a straight back chair.
Assessment: I am clearly on the road to recovery!
March 25, 2009: Post Op Day 10 (Right) Day 7 (Left)
Blizzard day in Colorado and my bodies tells me I have over done it! I awoke
with a different feeling in my legs. The "monkey's fist" was still there and
painful, but my legs felt dead. Overall, I felt hung-over and out of sorts.
Just moving about the house caused my legs to tire quickly. I had felt this
way years before when I was a runner on the day after a road race. So with
the blizzard raging outside, I decided to take the day off and didn't even
make it to the computer to post. I need to learn to pace my recovery.
We did pull the "super seal" bandage off the right hip incision. My scar is
about 4" long and it is not very pretty. Dr. Gross uses cement to seal the
wound instead on stitches or staples. It will be interesting to see how it
"cures out."
Assessment: It is easy to over do it on the road to recovery!
March 28, 2009: Post Op Day 12 (right) Day 9 (Left)
Yesterday's swelling has reduced significantly and the snow has melted
enough to go for a walk. I walk about 1/4 mile on crutches with only minor
discomfort toward the end of my circular path, which is up hill. I began
consciously trying to reduce the weight I putting on the crutches.
For the first time, I feel stable enough to shuffle around without the
crutches in the house. One amazing discovery is while sitting I can spread
my knees further apart than I could pre-surgery and when I bring them back
together. My in-laws arrive to stay with me next week while my wife returns
from work. They are amazed that I answer the door without crutches and
question.
I apply the Polar 300's and take a Vicodin during the afternoon when I feel
some discomfort and a little swelling in the ankles.
I sleep the entire night in bed with my wife and briefly try rolling over on
to my right side. Too much discomfort lying on my side for more than just a
few minutes. I make a mental note to ask Dr. Gross if he and Lee were
playing pool during my operation and lost the Q BALL. I have perfected my
technique somewhat in getting in and out of bed without making too much
noise.
March 29, 2009: Post Op Day 13 (right) Day 10 (Left)
This is the magical tenth day after the last surgery where so many patients
report feeling a net gain in their recovery. I am feeling very good and my
morning walk with my father-in-law is about 300' further than yesterday.
During the walk I pass a neighbor who was speaking to some friends sitting
in a car in her drive way and she asks, "What happened to you?" I start
explaining and suddenly a man jumps out of the car and runs over to me. He
smiles and said "This is what you can look forward to being able to do in
about three months." He had a THR three months ago and I was impressed with
his spryness. I tried to explain that I had had resurfacing instead of a THR
and he said he had never heard of resurfacing.
I still have pain and discomfort when I first stand up after sitting for any
length of time. I definitely feel my right leg is ahead of my left in
recovery. I plan to do a second walk to equal length before supper.
It will be nice when the snow completely melts and I can have access to the
numerous cross country paved trails in our neighborhood, but alas another
snow storm is forecast for this evening and Monday for the Front Range.
March 30, 2009: Post Op Day 14 (right) Day 11 (Left)
Hard for me to believe it was only two weeks ago that I had my first
surgery. My wife returned to her teaching job today and left me in the
company of her parents. I have adapted to life under Dr. Gross's three
restrictions: (1) Don't bend greater than 90 degrees, (2) Don't cross my
ankles and (3) Don't turn my toes inward, by mastering the tools in the
assisted living kit. I can even use the sock installer. I feel pretty self
sufficient, but it nice to have their some company on the walks, knowing if
I hurt something and can't make it back to the house, someone can go back
and bring the car to rescue me.
This morning's walk was nearly 1/2 mile and I felt really good. I focused on
stand tall and reducing the pressure on the crutches. I am still amazed how
after walking it is so easy to take a nap.
This afternoon the wind made walking outside brutal, so my father-in-law and
I went over to Sears Grand to walk in doors and oogle the tools. It is hard
to tell how far we walked but my left hip began protesting, so I called it
good. This evening the pain continued so took a Vicodin.
All in all a good day.
March 31, 2009: Post Op Day 15 (right) Day 12 (Left)
Weather today was nice and I took two long walks on crutches. I am
concentrating on reducing the downward pressure on the crutches. I am still
suffering what others are calling "start-up pain" after sitting for any
length of time. It is not from the joint, but from tight knotted muscles.
On the second walk of the day, I am feeling pretty frisky and push the
distance by walking to the tennis courts before turning back. This is
probably 3/4 mile. The last quarter of the way back is slightly uphill and I
am feeling in both legs. I fell some joint pain in my left groin. I think I
may have once again over-done it.
April 1, 2009: Post Op Day 16 (right) Day 13 (Left)
April Fool's Day, which is appropriate for me. I had a pretty rough night
and took some Vicodin due to pain in the left hip. I obviously had over done
it the day before. When will I learn? I decide to shorten my distance on the
walks today.
April 2, 2009: Post Op Day 17 (right) Day 14 (Left)
I had a better night and took things easy during the morning. Last night's
snow melted by early afternoon and my wife accompanied me on a late
afternoon walk. We took one of the new paths that had just been opened. Bad
decision the path ended in a muddy spot about 20' wide. In retrospect, we
should have turned around, but I thought I could negotiate the mud and
uneven ground on the crutches. It was not a pleasant experience, it would
have been very easy to slip and hurt something. However, I had to be
extremely careful and take very small measured steps to get across the muddy
spot without the incident, but afterward I felt exhausted.
April 3, 2009: Post Op Day 18 (right) Day 15 (Left)
I spent most of the morning on the phone with our IT support folks trying to
make the VPN into the corporate network work. My plan is to start trying to
do some work from home next week. Sitting for nearly four hours at the
computer, I noticed my legs had become quite sore and stiff.
In afternoon the weather was beautiful, but another snow storm was expected
in the evening. I took a long walk around the lake with my wife and in-laws.
My legs felt significantly stronger and I for several long flat stretches, I
carried my crutches. What a miracle! Two weeks ago I was having trouble walk
a couple hundred feet in the hospital.
Whether it was walking without crutches or sitting at the computer for
nearly four hours, I noticed my calves and ankles had became very swollen.
So it is another intimate evening with the Polar 300's wrapped around each
hip/thigh and keeping the "toes above the nose."
April 30,2009 Post Op Day 45 (right) Day 42 (Left)
Hard to believe it has been six weeks ago today that Dr. Gross and Lee Webb
performed the hip resurfacing on my left hip. I actually flew back to
Columbia, SC today and have my six week post op exam tomorrow.
I have had a great recovery with really only one bump in the road. A couple
of weeks ago (4/13) I was feeling so good and the weather was just excellent
that day, I went for a walk with my wife and way over did the distance,
probably walking close to 3 miles that day. By evening my left hip had
become tremendously sore and I was having some pretty intense deep stabling
pains.
This was the most severe pain I have experienced during or after the
surgery. I was somewhat alarmed and feared I had messed up the hip joint or
even fractured the femur, so I called Dr. Gross' office. Lee had me go to a
local hospital for x-rays, which I emailed to her. The x-rays looked fine,
the hip mechanics were in good condition and there was no sign of a
fracture. Lee had me ice and elevate the left hip and take it easy for a few
days and then to slowly begin back with the PT.
My left hip is better but still sore. If I walk too far, I feel a pain under
my incision that feels like something (i.e. ligament or muscle) is being
stretched at a certain point in my stride. It responds well to icing, so I
assume some of the soft tissues are still inflamed.
Other than that, my recovery has gone well. The bone-on-bone pain from the
arthritis that has been my constant companion for the last couple of years
is gone and so is the severe limp. Even with the soreness in my left hip, I
am much better off than before the surgery and I know I will only will
improve.
I will post a summary of my 6 week post op exam tomorrow.
Alan
May 1, 2009 Post Op Day 46 (right) Day 43 (Left)
I showed up at Dr. Gross' office ten minutes early for my 09:50 AM
appointment. They called me on the dot and took me back for two sets of
x-rays. The first was from an overhead machine and the second was from a
sideways machine that shot from the inner thigh outward. They had me fill
out the patient hip survey. For normal and "at its worst" pain levels I
answered 0 and 2 for my right and 1 and 4 for my left.
Lee Webb tested my range of motion and was very surprised and pleased with
the increase over the ROM before surgery. She also tested the strength of my
legs by having me resist as she pushed and pulled on my legs. Again she was
surprised and pleased with my strength. I assumed my left side would be much
weaker than my right, but she said they were essentially the same.
She then went over the phase two restrictions, which last until six months
post op. Basically, I am not to cross my legs at the knees or above, avoid
extreme stretching or bending until 6 months, no impact exercises like
running, no bike riding due to the risk of falling and fracturing the femur
(but an indoor bike is fine) and no contact sports. (I'll have to postpone
my post-op mixed marshal arts match for awhile.) But anythings else that is
not prohibited is a okay as long as I ramp up with moderation.
Next Dr. Gross came in and reviewed my x-rays. He said everything looked
perfect. There was perfect symmetry between the left and right and the
critical angle on each side was exactly 38 degrees. I told Dr. Gross, "You
do very good work."
We talked about the soreness in my left hip and he said that I shouldn't be
alarmed that one side was healing different than the other. The mechanical
parts are perfectly positioned and the bones show no fractures and with that
the soft tissues will heal - eventually. I asked him if I might have pulled
the internal sutures loose by overdoing the walking and he admitted it was
possible, but even so the tissues would grow back together. At this stage,
there is nothing to really do about the pain in the left hip, except just
wait and see if the soreness goes away. He said to call the office if it
doesn't improve in the next few weeks. He said that if possible they would
like to see me 1 yr post-op and if I couldn't travel to SC, I could have
x-rays and ROM exams done locally
I thanked both Lee and Dr. Gross for the wonderful job they had done and
told them how thankful I was that my life had been given back to me. I left
their office about 12:15 PM feeling very happy with my decision to travel
out of state to a doctor that I had found out about on a web site with a
strange name about surface hippies. I was also glad I traveled back to SC
for the six week post-op exam in person given the concern I had developed
over the soreness in my left side.
I had lunch and then drove the Charlotte airport arriving at around 02:30
for my 06:10 PM flight. I had a couple of hours to kill so visited the
Carolina Air Museum that is located at the airport. I wondered about the
exhibits and even crawled up into the cockpit of the DC-3 that is the museum
show piece. I left when the museum closed at 4:00 PM and then realized an
amazing thing. I had been on my feet walking around and climbing into the
aircraft for an hour and half without having to sit and rest because of the
OA pain and weakness!!!!
May 2, 2009 Post Op Day 47 (right) Day 44 (Left)
Saturday I began the new phase 2 exercises and could really tell they were
doing something by the end of the day. I worked on doing the stairs foot
over foot and then my wife and I installed two ceiling fans. She did most of
the work on the ladder, but I made numerous trips up and down the stairs to
my tools in the basement. Surprisingly on the afternoon walk I found that my
left hip was not nearly as sore . Maybe it is healing after all.
May 3, 2009 Post Op Day 48 (right) Day 45 (Left)
The Sunday was the most amazing day. After waking up, I did the Phase II
exercises, went to Church and had to park a good distance from the entrance
and I walked in with no pain or soreness from the left hip. After church my
wife and I went out eat lunch and then I did something with her I hadn't
done in ages, (no not THAT) but we went shopping. We spent an hour and a
half walking through Sam's and then spent another hour buying grocery store,
walking each isle. All of this was on my feet and without sitting down.
Before my surgery, I would just wait in the car while she shopped.
Then we returned home and I mowed the front and back yard for the first time
since May. We then decided to go buy a leaf blower and discovered Sears was
having "Friends and Family" Sale from 6 PM to 9 PM. We went to buy the leaf
blower and spent another 90 minutes walking around the store and also bought
some patio furniture. When we returned home, I assembled the leaf blower and
used it to clean off the grass clippings from the drive way and sidewalk.
When I finished that and still had plenty of energy to get on the computer
and make these posts.
This has been the most amazing day. I feel like I have my life back and can
do normal everyday activities that most healthy people take for granted. I
don't think I will ever take doing these normal everyday activities for
granted. I have had no pain today. Seven weeks ago before my surgery, I
would not have been able to do a fifth of what I did today.
Miracles do happen to ordinary people like me.
May 4, 2009 Post Op Day 49 (right) Day 46 (Left)
Today I returned to work after being gone starting 3/13. I took the crutches
with me just in case, but kept them in the car, (they are kind of becoming a
crutch to me if you know what I mean.) My coworkers were glad to see me. At
the staff meeting they even gave me my own bullet point on the week's
significant events.
Alan (The Terminator) Uber returns to work:
Some of my other coworker accused me of faking the
surgery, just to be able to have a six week vacation. They said I showed no
signs of having such major surgery just six weeks ago. I was so tempted to
show'em my other "cheeks", but now my scars don't look all that bad and they
are only 4" long. I didn't want a bullet point next week saying "Alan (The
Terminator) Uber moons coworkers."
Even though I had been teleworking from home, we have another email system
that is only available in the office and I had over 1,100 unread emails
waiting for me. Oh the joys of a "paperless society."
In the afternoon, I had to give a briefing to a visiting VIP at one of our
other facilities that is so large you literally have to walk nearly a mile
from the available parking spaces to the entrance. I had intended to see
about getting a short-term handicapped parking sticker, but forgot about it
until Monday morning. Anyway I negotiated the distance just fine, gave the
briefing and walked back to the car. Probably close to two miles.
Although I had intended to may be leave early, I wound up working an 11 hour
day. I was tired when I returned home, but I was delighted that the hips had
carried me through my first day at work without pain or problems.
Alan Bilateral Dr. Gross 2009 Hip Story
I just turned 56 years old and am by no means a fitness
model (and probably somewhat embarrassed about how little I have to show for
how much I have worked out , but I have been physically active most of my
life with running, biking, swimming, skiing, hiking, yoga and weight
lifting. Well up until about a year ago, when my left hip suddenly became as
sore as my right hip, which had become sore and stiff about seven years ago.
I was able to compensate and refused to let it slow me down, but now every
form of physical activity now hurts. I have become increasing less
physically active with each passing month. I have delayed getting treatment
this past year while relocating our household from the Washington D.C. area
to Colorado. Maybe this delay has played in my favor.
Last February with my rapidly deteriorating hips, I went to an orthopedic
surgeon and he diagnosed moderate OA in my right hip and slight OA in my
left. He advised that someday when the pay became intolerable I would need
an THR, but I should put that off as long as possible. I had heard something
about "resurfacing" and ask him about it. He said it was pretty knew and he
saw no benefits over the THR.
By October, we were living in temporary quarters waiting for our new house
to be finished and the pain had continued to get worse. I made an
appointment with a Denver OS and his conclusion was I had severe OA in the
right hip and moderate in the left. He had done resurfacing but told me I
was a poor candidate for the procedure and he was only 50% confident that he
could do the resurfacing and would know until the surgery was begun. He also
wanted to wait at least three months between hips. I went ahead a rather
hesitantly scheduled surgery for the middle of December.
The more I thought about it the more I didn't like those odds. This web site
lead me to send my xrays to Dr. Gross and within a couple of days Lee Webb
emailed me saying I was an excellent candidate for resurfacing. Dr. Gross
called me on the phone and spent about 40 minutes discussing the operation.
He suspected there was more bone on bone contact happening in my left hip
than the X-rays indicated and said he could take care of both hips on the
same trip to Columbia, SC. My recovery might be slightly longer, but once
done I'd be pain free and not facing another operation and recovery. The
pace and responsibilities of my project manager's job make it very difficult
to be away from work and extended period, and my wife is a school teacher
and it is hard for her to be gone, so doing both hips during one trip was
very appealing.
I scheduled the operation for the middle of March the week before my wife's
spring break, so she could be with me for the operations in SC and then have
the next week to be my nurse at home. Dr Gross operated on my right hip on
Monday (3/16/09) and my left hip on Thursday (3/19/09). I was discharged
from the hospital on Saturday (3/21/09) and we flew home to Denver on Sunday
(3/22/09).
March 23, 2009: Post Op Day 7 (right) Day 4 (Left)
My first full day home and my worst day of this experience so far! Swelling
and pain and questioning my own intelligence. I did my twice per day PT
exercises and walked on crutches about 400' each time. My right leg is sorer
than my left and is noticeably the more swollen of the two. Seems to be to
types of pain happening. The first is an incredibly tight/twisted knot of
muscles, almost like a constant muscle cramp. The underlying muscles are
sore to the touch. My intuition tells me this tightness will get better with
time. Funny thing is in different spots on the two legs: on the outside of
my leg above my right knee, but on the left about mid thigh.
The other type of pain is far more frightening. It is a sharp stabbing pain
from deep in the groin and hip joint itself. When it happens, I immediately
panic, fearing that I just fractured the neck of the femur. Fortunately it
does last long. I guess I adjust to it when it happens.
Chuck is entitled to an "I told you so!," but part of my discomfort may have
been trying to be a "hero" and avoid the heavy duty pain killers. I have
read several post from other of Dr. Gross patients stating they didn't need
anything but Tylenol after leaving the hospital. I didn't think I needed the
vicodin. I decided I would not play "hero" tomorrow, use the drugs before
the PT and hope things improve.
March 24, 2009: Post Op Day 8 (right) Day 5 (Left)
Today was much better than yesterday, despite a fitful night full of self
doubt. I arose feeling better than the day before. I took a long hot shower
and worked on all the areas of residual adhesive tape from the hospital. The
shower was wonderful. I felt good enough to sit a couple of hours in front
of my desktop computer catching up on email. Before the morning PT exercise,
I took a Vicodin and my morning walk was slow and probably about 600'. The
air was crisp and the view of the fresh snow covered Front Range was
inspiring. No comparison to how bad I felt on Monday. The swelling in the
right leg is decreasing and the muscle pain doesn't seem as intense. I did
put on the polar packs and took a little nap courtesy of the drugs.
Afternoon PT exercise seemed easier than this morning and some of the muscle
stiffness seems to be easing. I increased my distance to about 800' with
some of it being up hill. I had a couple of those "joint jolts" during the
walk, but decided I probably haven't really fractured anything and perhaps
they were part of the healing process.
Overall a much better day and a much better attitude.
March 25, 2009: Post Op Day 9 (right) Day 6 (Left)
Today was a break through day!
I discovered I could "walk" using my crutches (i.e. Right crutch forward
with left leg forward alternating with left crutch with right leg forward).
This was so much easier than moving both crutches forward simultaneously.
This feels so natural and my wife commented that I was "walking" with no
detectable limp.
It was also a very mild and beautiful day in Colorado and I was so pumped
that I went double the distance from the day before (probably about a 1/4
mile) with this new form of walking. I went again that afternoon and
increased the distance by another block or so. That evening, I even had
enough energy left to attend as small group meeting in our neighborhood,
where I sat for a couple of hours in a straight back chair.
Assessment: I am clearly on the road to recovery!
March 25, 2009: Post Op Day 10 (Right) Day 7 (Left)
Blizzard day in Colorado and my bodies tells me I have over done it! I awoke
with a different feeling in my legs. The "monkey's fist" was still there and
painful, but my legs felt dead. Overall, I felt hung-over and out of sorts.
Just moving about the house caused my legs to tire quickly. I had felt this
way years before when I was a runner on the day after a road race. So with
the blizzard raging outside, I decided to take the day off and didn't even
make it to the computer to post. I need to learn to pace my recovery.
We did pull the "super seal" bandage off the right hip incision. My scar is
about 4" long and it is not very pretty. Dr. Gross uses cement to seal the
wound instead on stitches or staples. It will be interesting to see how it
"cures out."
Assessment: It is easy to over do it on the road to recovery!
March 28, 2009: Post Op Day 12 (right) Day 9 (Left)
Yesterday's swelling has reduced significantly and the snow has melted
enough to go for a walk. I walk about 1/4 mile on crutches with only minor
discomfort toward the end of my circular path, which is up hill. I began
consciously trying to reduce the weight I putting on the crutches.
For the first time, I feel stable enough to shuffle around without the
crutches in the house. One amazing discovery is while sitting I can spread
my knees further apart than I could pre-surgery and when I bring them back
together. My in-laws arrive to stay with me next week while my wife returns
from work. They are amazed that I answer the door without crutches and
question.
I apply the Polar 300's and take a Vicodin during the afternoon when I feel
some discomfort and a little swelling in the ankles.
I sleep the entire night in bed with my wife and briefly try rolling over on
to my right side. Too much discomfort lying on my side for more than just a
few minutes. I make a mental note to ask Dr. Gross if he and Lee were
playing pool during my operation and lost the Q BALL. I have perfected my
technique somewhat in getting in and out of bed without making too much
noise.
March 29, 2009: Post Op Day 13 (right) Day 10 (Left)
This is the magical tenth day after the last surgery where so many patients
report feeling a net gain in their recovery. I am feeling very good and my
morning walk with my father-in-law is about 300' further than yesterday.
During the walk I pass a neighbor who was speaking to some friends sitting
in a car in her drive way and she asks, "What happened to you?" I start
explaining and suddenly a man jumps out of the car and runs over to me. He
smiles and said "This is what you can look forward to being able to do in
about three months." He had a THR three months ago and I was impressed with
his spryness. I tried to explain that I had had resurfacing instead of a THR
and he said he had never heard of resurfacing.
I still have pain and discomfort when I first stand up after sitting for any
length of time. I definitely feel my right leg is ahead of my left in
recovery. I plan to do a second walk to equal length before supper.
It will be nice when the snow completely melts and I can have access to the
numerous cross country paved trails in our neighborhood, but alas another
snow storm is forecast for this evening and Monday for the Front Range.
March 30, 2009: Post Op Day 14 (right) Day 11 (Left)
Hard for me to believe it was only two weeks ago that I had my first
surgery. My wife returned to her teaching job today and left me in the
company of her parents. I have adapted to life under Dr. Gross's three
restrictions: (1) Don't bend greater than 90 degrees, (2) Don't cross my
ankles and (3) Don't turn my toes inward, by mastering the tools in the
assisted living kit. I can even use the sock installer. I feel pretty self
sufficient, but it nice to have their some company on the walks, knowing if
I hurt something and can't make it back to the house, someone can go back
and bring the car to rescue me.
This morning's walk was nearly 1/2 mile and I felt really good. I focused on
stand tall and reducing the pressure on the crutches. I am still amazed how
after walking it is so easy to take a nap.
This afternoon the wind made walking outside brutal, so my father-in-law and
I went over to Sears Grand to walk in doors and oogle the tools. It is hard
to tell how far we walked but my left hip began protesting, so I called it
good. This evening the pain continued so took a Vicodin.
All in all a good day.
March 31, 2009: Post Op Day 15 (right) Day 12 (Left)
Weather today was nice and I took two long walks on crutches. I am
concentrating on reducing the downward pressure on the crutches. I am still
suffering what others are calling "start-up pain" after sitting for any
length of time. It is not from the joint, but from tight knotted muscles.
On the second walk of the day, I am feeling pretty frisky and push the
distance by walking to the tennis courts before turning back. This is
probably 3/4 mile. The last quarter of the way back is slightly uphill and I
am feeling in both legs. I fell some joint pain in my left groin. I think I
may have once again over-done it.
April 1, 2009: Post Op Day 16 (right) Day 13 (Left)
April Fool's Day, which is appropriate for me. I had a pretty rough night
and took some Vicodin due to pain in the left hip. I obviously had over done
it the day before. When will I learn? I decide to shorten my distance on the
walks today.
April 2, 2009: Post Op Day 17 (right) Day 14 (Left)
I had a better night and took things easy during the morning. Last night's
snow melted by early afternoon and my wife accompanied me on a late
afternoon walk. We took one of the new paths that had just been opened. Bad
decision the path ended in a muddy spot about 20' wide. In retrospect, we
should have turned around, but I thought I could negotiate the mud and
uneven ground on the crutches. It was not a pleasant experience, it would
have been very easy to slip and hurt something. However, I had to be
extremely careful and take very small measured steps to get across the muddy
spot without the incident, but afterward I felt exhausted.
April 3, 2009: Post Op Day 18 (right) Day 15 (Left)
I spent most of the morning on the phone with our IT support folks trying to
make the VPN into the corporate network work. My plan is to start trying to
do some work from home next week. Sitting for nearly four hours at the
computer, I noticed my legs had become quite sore and stiff.
In afternoon the weather was beautiful, but another snow storm was expected
in the evening. I took a long walk around the lake with my wife and in-laws.
My legs felt significantly stronger and I for several long flat stretches, I
carried my crutches. What a miracle! Two weeks ago I was having trouble walk
a couple hundred feet in the hospital.
Whether it was walking without crutches or sitting at the computer for
nearly four hours, I noticed my calves and ankles had became very swollen.
So it is another intimate evening with the Polar 300's wrapped around each
hip/thigh and keeping the "toes above the nose."
April 30,2009 Post Op Day 45 (right) Day 42 (Left)
Hard to believe it has been six weeks ago today that Dr. Gross and Lee Webb
performed the hip resurfacing on my left hip. I actually flew back to
Columbia, SC today and have my six week post op exam tomorrow.
I have had a great recovery with really only one bump in the road. A couple
of weeks ago (4/13) I was feeling so good and the weather was just excellent
that day, I went for a walk with my wife and way over did the distance,
probably walking close to 3 miles that day. By evening my left hip had
become tremendously sore and I was having some pretty intense deep stabling
pains.
This was the most severe pain I have experienced during or after the
surgery. I was somewhat alarmed and feared I had messed up the hip joint or
even fractured the femur, so I called Dr. Gross' office. Lee had me go to a
local hospital for x-rays, which I emailed to her. The x-rays looked fine,
the hip mechanics were in good condition and there was no sign of a
fracture. Lee had me ice and elevate the left hip and take it easy for a few
days and then to slowly begin back with the PT.
My left hip is better but still sore. If I walk too far, I feel a pain under
my incision that feels like something (i.e. ligament or muscle) is being
stretched at a certain point in my stride. It responds well to icing, so I
assume some of the soft tissues are still inflamed.
Other than that, my recovery has gone well. The bone-on-bone pain from the
arthritis that has been my constant companion for the last couple of years
is gone and so is the severe limp. Even with the soreness in my left hip, I
am much better off than before the surgery and I know I will only will
improve.
I will post a summary of my 6 week post op exam tomorrow.
Alan
May 1, 2009 Post Op Day 46 (right) Day 43 (Left)
I showed up at Dr. Gross' office ten minutes early for my 09:50 AM
appointment. They called me on the dot and took me back for two sets of
x-rays. The first was from an overhead machine and the second was from a
sideways machine that shot from the inner thigh outward. They had me fill
out the patient hip survey. For normal and "at its worst" pain levels I
answered 0 and 2 for my right and 1 and 4 for my left.
Lee Webb tested my range of motion and was very surprised and pleased with
the increase over the ROM before surgery. She also tested the strength of my
legs by having me resist as she pushed and pulled on my legs. Again she was
surprised and pleased with my strength. I assumed my left side would be much
weaker than my right, but she said they were essentially the same.
She then went over the phase two restrictions, which last until six months
post op. Basically, I am not to cross my legs at the knees or above, avoid
extreme stretching or bending until 6 months, no impact exercises like
running, no bike riding due to the risk of falling and fracturing the femur
(but an indoor bike is fine) and no contact sports. (I'll have to postpone
my post-op mixed marshal arts match for awhile.) But anythings else that is
not prohibited is a okay as long as I ramp up with moderation.
Next Dr. Gross came in and reviewed my x-rays. He said everything looked
perfect. There was perfect symmetry between the left and right and the
critical angle on each side was exactly 38 degrees. I told Dr. Gross, "You
do very good work."
We talked about the soreness in my left hip and he said that I shouldn't be
alarmed that one side was healing different than the other. The mechanical
parts are perfectly positioned and the bones show no fractures and with that
the soft tissues will heal - eventually. I asked him if I might have pulled
the internal sutures loose by overdoing the walking and he admitted it was
possible, but even so the tissues would grow back together. At this stage,
there is nothing to really do about the pain in the left hip, except just
wait and see if the soreness goes away. He said to call the office if it
doesn't improve in the next few weeks. He said that if possible they would
like to see me 1 yr post-op and if I couldn't travel to SC, I could have
x-rays and ROM exams done locally
I thanked both Lee and Dr. Gross for the wonderful job they had done and
told them how thankful I was that my life had been given back to me. I left
their office about 12:15 PM feeling very happy with my decision to travel
out of state to a doctor that I had found out about on a web site with a
strange name about surface hippies. I was also glad I traveled back to SC
for the six week post-op exam in person given the concern I had developed
over the soreness in my left side.
I had lunch and then drove the Charlotte airport arriving at around 02:30
for my 06:10 PM flight. I had a couple of hours to kill so visited the
Carolina Air Museum that is located at the airport. I wondered about the
exhibits and even crawled up into the cockpit of the DC-3 that is the museum
show piece. I left when the museum closed at 4:00 PM and then realized an
amazing thing. I had been on my feet walking around and climbing into the
aircraft for an hour and half without having to sit and rest because of the
OA pain and weakness!!!!
May 2, 2009 Post Op Day 47 (right) Day 44 (Left)
Saturday I began the new phase 2 exercises and could really tell they were
doing something by the end of the day. I worked on doing the stairs foot
over foot and then my wife and I installed two ceiling fans. She did most of
the work on the ladder, but I made numerous trips up and down the stairs to
my tools in the basement. Surprisingly on the afternoon walk I found that my
left hip was not nearly as sore . Maybe it is healing after all.
May 3, 2009 Post Op Day 48 (right) Day 45 (Left)
The Sunday was the most amazing day. After waking up, I did the Phase II
exercises, went to Church and had to park a good distance from the entrance
and I walked in with no pain or soreness from the left hip. After church my
wife and I went out eat lunch and then I did something with her I hadn't
done in ages, (no not THAT) but we went shopping. We spent an hour and a
half walking through Sam's and then spent another hour buying grocery store,
walking each isle. All of this was on my feet and without sitting down.
Before my surgery, I would just wait in the car while she shopped.
Then we returned home and I mowed the front and back yard for the first time
since May. We then decided to go buy a leaf blower and discovered Sears was
having "Friends and Family" Sale from 6 PM to 9 PM. We went to buy the leaf
blower and spent another 90 minutes walking around the store and also bought
some patio furniture. When we returned home, I assembled the leaf blower and
used it to clean off the grass clippings from the drive way and sidewalk.
When I finished that and still had plenty of energy to get on the computer
and make these posts.
This has been the most amazing day. I feel like I have my life back and can
do normal everyday activities that most healthy people take for granted. I
don't think I will ever take doing these normal everyday activities for
granted. I have had no pain today. Seven weeks ago before my surgery, I
would not have been able to do a fifth of what I did today.
Miracles do happen to ordinary people like me.
May 4, 2009 Post Op Day 49 (right) Day 46 (Left)
Today I returned to work after being gone starting 3/13. I took the crutches
with me just in case, but kept them in the car, (they are kind of becoming a
crutch to me if you know what I mean.) My coworkers were glad to see me. At
the staff meeting they even gave me my own bullet point on the week's
significant events.
Alan (The Terminator) Uber returns to work:
Some of my other coworker accused me of faking the
surgery, just to be able to have a six week vacation. They said I showed no
signs of having such major surgery just six weeks ago. I was so tempted to
show'em my other "cheeks", but now my scars don't look all that bad and they
are only 4" long. I didn't want a bullet point next week saying "Alan (The
Terminator) Uber moons coworkers."
Even though I had been teleworking from home, we have another email system
that is only available in the office and I had over 1,100 unread emails
waiting for me. Oh the joys of a "paperless society."
In the afternoon, I had to give a briefing to a visiting VIP at one of our
other facilities that is so large you literally have to walk nearly a mile
from the available parking spaces to the entrance. I had intended to see
about getting a short-term handicapped parking sticker, but forgot about it
until Monday morning. Anyway I negotiated the distance just fine, gave the
briefing and walked back to the car. Probably close to two miles.
Although I had intended to may be leave early, I wound up working an 11 hour
day. I was tired when I returned home, but I was delighted that the hips had
carried me through my first day at work without pain or problems.
