Dr. Brooks

Here is my story about my hip resurfacing. It starts in October of 2006 when I went to a local doctor in southwest Michigan and had my right hip X-rayed. I wanted to make sure it was arthritis and not something else. He said it was indeed arthritis in my hip and I would have to have it replaced in three to five years. I laughed and said fat chance. After my visit I started taking glucosamine/chondroitin regularly and ibuprofen if I had pain. I am quite active and started to ballroom dance which put more stress on my right hip. The activity that hurt the most was driving. I could not drive for more that 30 minutes without pain going right down to my knee. The same pain was involved when I rode horses. During the week, while I was at work the pain was not too bad but on the weekend when I would walk extensively at the farm or do more manual labor my hip would hurt. As my hip continued to deteriorate I could not ride my horse and dance in the same day. When my leg started giving out while I was dancing I knew something had to be done.

I went to the Cleveland Clinic in August of 2009 and asked the surgeon if there was anything else I could do besides replacement. He was a replacement surgeon and strongly recommended replacement. He mentioned resurfacing but told me there were a lot of issues with it. I scheduled replacement surgery for April 29th. I had a lot of time before the surgery, so I started doing some research. I was disturbed about the restrictions that are involved with hip replacement. I read more about resurfacing and decided I needed to see Dr. Brooks at the Cleveland Clinic about this procedure. My appointment was February 24, 2010 and he said I was a candidate for resurfacing and it was scheduled for May 5, 2010, Cinco de Mayo.

Because I am from out of town Phil, Dr. Brooks' Physician's Assistant scheduled my preop examination on Tuesday May 4 to save me an extra trip to Cleveland. I traveled to Cleveland with my wife and we got a hotel room for the week. My daughter is a nurse at the Cleveland Clinic so she was with me as well. I was getting rather apprehensive and thought about going back to Michigan but decided that was a foolish thought and continued. My surgery was scheduled for 8:30 AM on Wednesday morning so I had to check in the hospital at 6:00 AM. I was taken to the pre-surgery suite at about 7:15 AM and wheeled in the operating room at 8:23 AM. I was back in my room before Noon just in time for lunch. I felt great. I of course had no pain with the spinal and was in a very positive and upbeat mood. Dr. Brooks came to see me in the afternoon and saw how well I was able to move my right leg with my "dog leash" and said as soon as the spinal wore off I could get out of bed and walk.

After I ate dinner I got out of bed, got rid of the hospital gown, and started walking with my walker. It felt great. My wife and daughter did not want me to walk too far so I spent the rest of the evening in my chair before I went back to bed. On Thursday morning I got up, got dressed and walked with my walker as much as I could. On Friday they taught me how to use crutches, made sure I could go up and down stairs and released me from the hospital at about 2:00 PM. That night we all went out to dinner at a nice restaurant in Cleveland. My wife and I spent the night in the hotel and drove back to Michigan on Saturday morning. It was a four hour drive and I really had very little pain in my leg. Saturday May, 8th happened to be my birthday and I dearly wanted to be home on my birthday so that worked out well. Oh, I should probably mention that on May 8, 2010 I turned 63.

I can't say enough about the care I received at the hospital. Cleveland Clinic took over the Euclid Hospital several years ago. The whole staff was excellent and took very good care of me. I owe a lot of my speedy recovery to Dr. Brooks who is a magician when it comes to this surgery. He did an excellent job. Unfortunately I will have to have my left hip resurfaced soon and you better believe I will be right back at Euclid Hospital with Dr. Brooks doing the resurfacing.


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July 2010

James Laveglia - Hip Resurfacing Part II

I forgot to mention that the picture is of me and my daughter 10 hours after surgery. After my stroll down the hall with my walker after dinner on Wednesday, May 5th I came back to the room and took this picture with my daughter.

I went back to work on Tuesday, May 11 for half a day. I have a desk job so that was a fairly easy task. I did half days for the rest of the week. I have to admit I was tired after being at work for just half days that week. I was not prepared for the swelling that occurred in my thigh, lower leg and foot. By the end of the day it was fairly painful and I would go home and raise my foot up. I had to wear a sneaker on my right foot for several days. The swelling lasted less than a week and although there may be a very slight amount of swelling in my ankle and foot today (8 weeks post surgery) for all practical purposes it was pretty much gone at three weeks post surgery.

I travel quite a bit and I had a trip scheduled for Japan on June 14th (5 weeks and 5 days after surgery). My 6 week check up was scheduled for June 16th so I contacted Phil and asked if I could come in for my check up on June 10th (5 weeks and 1 day after surgery). He said that was fine. They took X-rays and Phil had me walk without my crutches and told me I could go to Japan but to continue taking my aspirin until I got back. It is a 13 hour flight from Detroit to Tokyo and this was a preventative measure. Phil noticed I had a slight limp when I walked and he gave me an additional exercise to do. He told me to lay on my left side and raise my right leg as high as I could and to do this exercise 90 times a day. This was difficult in the beginning but it has really strengthened my muscles and my limp is gone.

I have been inspired by the post surgery video’s on Surface Hippy especially the video of the young lady dancing 4 weeks after surgery. I dearly wanted to make a dancing video 4 weeks after my surgery but I just could not dance very well. I continued to work on it and I did make a video of me waltzing 5 weeks after my resurfacing surgery. I will send that video to Surface Hippy. At that time I could actually dance better than I could walk. I went for my check up in Cleveland the next day and with the exercise that Phil gave me it has really improved my dancing and walking.

It has been 8 weeks since my resurfacing surgery and I can honestly say I am very happy I did this procedure and I have been very pleased with my recovery. Dancing has become a big part of my life and before my hip resurfacing I was unable to perform the Viennese Waltz as my hip would not hold up to all the movement and pressure that is required to perform this dance. I am learning that dance now and with my new resurfaced hip I am able to do the dance with no pain and my hip does not give out. We are putting together a Viennese Waltz routine for our dance competition in September and once we have the routine down I will take a video and submit it to Surface Hippy. I recommend this procedure to anybody that is thinking about hip surgery. It is truly a phenomenal procedure.

Computerized navigation has been around for a long time, in total hips, total knees, and now hip resurfacing. A lot of surgeons, including me, have tried it out and not seen an advantage in all but very exceptional cases. Yet other surgeons use it on every case.
 
This is what I think about computerized navigation: It is a tool which can narrow the "bell-curve" of component position, but the curve still has some spread. That helps a surgeon avoid "outliers", or badly misplaced components. Navigation does not make component position the exact same every time, but it helps avoid those outliers. (If it was the exact same every time there would be no bell-curve at all.)
 
So, if a surgeon has no outliers, in other words if he is doing a good job of keeping his personal bell-curve narrow, there is no advantage to using computer navigation. Alternatively, if a surgeon thinks he might accidentally misalign a component so much that it would be considered an outlier, the computer may prevent that.
 
Like any computer, what comes out depends on what went in. Registering the anatomy (which tells the computer where everything is) at the beginning of a computer-navigated operation is not at all an exact science, but depends upon knowledge and experience. It's the same with mechanical alignment jigs. With either method, one should hope that the surgeon is ready to adjust the verdict of the computer or the jig to place the component accurately in the bones which are clearly visible.
 
Are there any downsides to using a computer? Well, there is the extra time involved, which prolongs the surgery (think infections, blood clots). There is extra expense. There is often one more person in the OR, and more traffic in the OR can lead to infection. There is the possibility of surgical complacency if the doctor believes in the infallibility of computers.
 
I have heard this discussed at resurfacing meetings, and people whom I respect more than any others in this field have tried navigation and declared it "useless", and a "waste of time". While unwilling to go quite that far, it does make me think I am fine in continuing with mechanical jigs.
 
Your question about doctors not having 100% "retention" due to component malposition requires a reply. Personally, I have not had any failures in almost 600 resurfacings due to component malposition. I have 1 femoral neck fracture due to leg presses 8 weeks after surgery, and one pelvis fracture resulting from trauma 2 years after resurfacing. That's it. But malposition is an important cause of fracture, wear-related failure, and possibly pseudotumors as well, so should be avoided.
 
Any surgeon "young" enough to learn hip resurfacing is certainly young enough to learn the much easier task of computer navigation, so people who consider someone too "old" to learn navigation are being silly.
 
Similarly, a patient who would choose his surgeon based upon their use of computer navigation is badly misguided. There are many much more important issues to consider.
 
Having said all this, I wouldn't be surprised if at some point in the future surgical navigation becomes more accurate, easier, cheaper, and quicker. Robots will substitute for doctors. Surgeons will look back on the old days and shake their heads in amazement that we used to do all this by hand.
 
Peter Brooks MD, FRCS(C)
Cleveland Clinic

I had a RBHR by Dr. Brooks on February 25, 2009 at Euclid Hospital-Cleveland Clinic. It has been about 8 months since my surgery and I divided my experience into categories of chronological order. Before sharing my experience, I would like you to know that I am completely satisfied with the procedure and would recommend Dr. Brooks for anyone considering a hip resurfacing.

Background
I was diagnosed with arthritis in my right hip about 5 years before having surgery. At that time I was 46 years old, and was told that I need a hip replacement. I tried to maintain a high level of activity and control the pain with over the counter pain medicines. However, as the joint degenerated I modified my activities because of the hip pain and stiffness that would result. The degeneration of the joint was slow. People would ask why I was limping. I did not realize it because the slight limp became my normal gait. The limp and stiffness got worse overtime. About a year before my surgery, I could not walk more than a block or two before severely limping. My recreational activities were reduced and centered around weight lifting, golf, and the use of an elliptical trainer.

About a year before my surgery, a friend of mine was told he needed both hips replaced. I told him about Pat’s hip resurfacing website and we worked together to figure out the best approach. His hip pain was more severe than mine, and he beat me by about three months to getting an appointment with Dr. Brooks and having the surgery. I was able to observe his recovery before my surgery and that reduced some of my questions and anxiety.

I decided on a hip resurfacing because of my age and the level of activity that was possible after surgery. Once I felt comfortable in selecting hip resurfacing over a total hip replacement, the most important factor for me was to find a surgeon. I wanted a surgeon who has “seen it all” and did resurfacings on a regular basis. This website helped educate me (and my friend) and narrow down the search.

Initial Consult
I traveled about 180 miles from my home in Belle Vernon, PA to see Dr. Brooks. My initial consult was quite memorable. I drove 6 hours through lake-effect snow storm to get to the Cleveland Clinic Main Campus the night before my appointment. It is normally a 3-hour drive to Cleveland from Belle Vernon, PA.

Dr. Brooks took the time to answer all my questions and to explain the risks that were involved. As an engineer, I really liked Dr. Brooks’ knowledge of the biomechanics of the resurfaced joint. He was able to answer all of my “why” questions about the implant and resurfaced joint. At the initial consult, I met Phil Golnick, Dr. Brook’s Physicians Assistant. Phil was great – he patiently answered all my questions between the initial consult and my surgery, and the questions I had weeks after the surgery.

Surgery – 1st Day
The morning of my surgery, I was instructed to wash the right hip area with a scrub – something like a Phisohex. I liked the fact I was told to write NO on the left hip. I think that was for my own piece of mind – but some of the simplest things can be the most effective.

I don’t remember much of the operating room. When I transferred from the gurney to the operating table, I was asked to sit up and dangle my legs over the edge of the table. Looking around, the operating room reminded me of the PBS series Olde Yankee Workshop. Phil came up to me and held my shoulders and told me they were ready to start with the anesthetic. I looked down at the IV tube and saw a milky white fluid. I asked what it was, and was out before I heard the answer.

I was given a general anesthetic and epidural. When I woke from surgery, I was numb from the belly button on down. It took several hours to regain all the feeling in my legs.

The first day was the hardest, but it was not too bad. I was immobile with ankle cuffs that would inflate to move blood around my legs, my operative leg was slightly elevated, and the incision was iced. I had an IV, heart and O2 monitors attached to me. I drank a lot of water the first night thinking it would help flush the anesthesia out of my system - not sure if that is true but it seemed to make sense at the time. The ice helped to dull the pain and help reduce swelling.

I was not in any significant pain, probably because of the lingering effect of the epidural. Also, the nursing staff told me to take pain medications to stay ahead of any pain. So I asked for the pain meds that were prescribed and was given a pill every six hours. Unfortunately, I was not very groggy and did not sleep much after surgery – it was hard to fall asleep with all the equipment strapped to me.

Surgery – 2nd Day
The nursing staff wanted me to get out of bed and sit in a chair. I could put 75 percent of my weight on the operative leg. It was good to have someone around when getting out of bed for the first few times so you don’t fall. I was able to use a walker to get to the bathroom. There was brief, but sharp, pain in the operative leg muscles when I got up the first few times. I think it was due to stretching the muscles that occurred during the surgery. I started eating solid foods later the second day.

Surgery – 3rd and 4th Days
I begin moving around on crutches on the 3rd day after surgery. The physical therapy staff gave me several exercises to do while laying in bed to keep the blood moving.

The hospital staff also showed me how to administer the Lovonox injections. I took self administered blood thinners the same time each day for the first 11 days after being discharged. Injecting myself with a needle was not too bad because the needles are very fine. After I completed the series of Lovonox injections, I had to take one 365 mg aspirin about every 12 hours for the next month.

Dr. Brooks showed me that I did not have to be afraid of bending my operative leg. I was able to lay in bed with my back elevated, and move my operative leg almost to my chest.

The night before I was released, I got an ultra sound on my legs to check for any blood clots. Before I left the hospital, I received a prescription to get another ultra sound about 10 days after being released.

The day I was released from the hospital, the epidural had a delayed side effect. I began getting headaches after I sat up for about 10 minutes. Lying down or standing did not seem to bother me. Apparently, everyone does not experience side effects from the epidural and there are several ways to curb them should they occur. Since I was going home, I was instructed to drink caffeinated beverages – not tea – but something like double shot espressos for a few days. The headaches lasted about 4 or 5 days after going home. The caffeine helped reduce the headache pressure.

Since I had to be driven 180 miles, I asked for pain medications for the trip home. The PA turnpike can be a little bumpy in sections. Fortunately, I was in a SUV and brought several pillows to provide cushion for the drive home. I could also stretch out over the entire back seat which made the ride home comfortable. Also, I brought easy slip-on shoes and basketball tear away pants so I did not have any tight fitting clothing for the trip home.

The staff at the Euclid Hospital was great during my stay. They were always there when I needed assistance.

Post Surgery Recovery Up To 6 weeks
Dr. Brooks requires you stay on two crutches for 6 weeks. For about the first two weeks, I went for short walks. I increased the distance a modest amount each day, at first starting with a few hundred yards and increasing the total distance to about 1 mile at about 5 weeks post surgery. I was fortunate that I could take off work for 6 weeks on medical leave.

I continued to take the prescribed pain medications as I did in the hospital for about three days after leaving Euclid. I was not in any pain, but did not want to experience any either. I just stopped taking them and I was fine. After that, I took one prescribed pain med about a week after being home when I went to sleep. This reduced the discomfort from the 32 staples holding the incision.

I continued to take the Lovonox injections as prescribed. I also was instructed to take my temperature each day – I assume it was to help alert me if an infection started.

I could easily get dressed and put my sock on the operative leg without the aid of any device - it was a little tough at first. I was able to do most simple things (like cook and cleanup after myself) but it took about 3 times longer than pre–surgery. I bought an extended gripper to help pick up items, but never used it.

I did not opt for a surgical dressing to cover the incision so I could take a shower. I did the “bird bath” cleaning every day. I did not want to take a chance of getting the incision wet. It was a good feeling to take a shower a few days after the staples came out. While the incision was healing, I used an 8-inch abdominal bandage to cover it and change the dressing two times a day. Those bandages were not available at the local drug store. My friend ordered them in advance of his surgery and he had many left over. I used medical paper tape that can be bought at the drug store to secure my bandage to the skin. The medical paper tape did not irate my skin. I had the bandages so I used them.

My leg was bruised, probably because of the very strange positions it was placed during surgery and putting the implants into my bones. The bruising peaked about 7 to 10 days after surgery. It was looked much worse than it felt – although it was sore, it was easily tolerable. Taking the blood thinners probably made the bruising worse. I was never in much pain, but my friend prepared me for the bruising that would occur.

After being discharged from the hospital, I did not have any trouble sleeping. When I woke up in the morning, I would do some stretching exercises before trying to stand. I would take my time getting out of bed and did not rush since I had no where to go. I could not drive until getting off crutches.

6-Week Check-Up
My 6-week check-up with Dr. Brooks was in early April 2009. Dr. Brooks watched me walk without crutches, and I had a slight limp. Dr. Brooks suggested one more exercise for the leg. It was to lay on my non-operative side and raise my operative leg, 3 sets at 30 reps per set, three times a day. Initially I was too weak to lift my leg an inch, so I got the remedial version. That was to stand, balancing myself, and move the operative leg laterally. I did the standing version for about a week before attempting the lying version.

Dr. Brooks showed me the X-rays of my operative leg – about 3 or 4 were taken that day. Although I have no medical training, the hip joint looked like a perfect fit from every angle. Since hip resurfacing is elective surgery, it is so important to do your homework and find a surgeon that can make the implant fit just right.

Dr. Brooks indicated that for one year I could not run, jump, or lift any weight over 30 lbs. Basically, do not over exert myself. I had to wait another 6 weeks before playing golf, and had to take a cart for the first year. After one year, Dr. Brooks indicated he will re-evaluate my BHR and determine if all restrictions could be lifted.

Post 6-Week Check-up To 8 Months Post Surgery
About 4 days after being off crutches, I was walking up a flight of steps and pulled the quadricep muscles in the operative leg. It took about 6 weeks for that to completely heal. I continued to do the leg exercises and strengthen the hip muscles.

I had access to a heated therapy arthritis pool and found some water exercises on Pat’s web page. I did those exercises and walked around the therapy pool for about 3 weeks after getting off crutches. I did not ride a bike or do an elliptical trainer – I just walked everyday, rain or shine, trying to increase the distance. I bought a pedometer to monitor my walking distance and to make sure I did not over do it, take it too easy, or plateau.

For the first few weeks after getting off crutches and doing the leg raises, I did not feel there was any improvement since I continued to limp. At the time, it was a little frustrating. I visited Pat’s web page many times and called my friend often to compare my progress, and to find any morsel of information about recovery. I continued to do the lateral leg raises and it was very hard, straining to raise the leg and breaking into sweats for such a simple exercise that I now take for granted.

After about 5 weeks of being off crutches, I began to notice the leg was getting stronger and the limp starting to slowly resolve. I continued to walk every day as a strengthening exercise. There was some muscle soreness – in the buttocks and top part of the back of the thigh – but I continued to work the muscles – keeping in mind not to over do it. Throughout this time, the operative hip joint felt fine, just like my non-operative hip.

The slight limp began to diminish each day as the leg got stronger. It was not a step change, but a very gradual process that completely faded after about 4 months of my surgery. Throughout the recovery, I remembered that slow and steady wins the race and I made sure not miss an exercise set. I hoped that I would recover like one of those people that boast about extraordinary activities only a few weeks post surgery – but I did not. My friend and I recovered at about the same pace so I assume that my recovery must have been average.

I steadily increased my walking distance. July 4th was about 4-1/2 months post surgery and I went for a 5-mile walk. Over the next few weeks, I increased the walking distance to over 6 miles. Today, I don’t think about my hip surgery and I feel that I could do just about anything. But I’ll wait until February to see Dr. Brooks in hopes there will be no restrictions associated with my new hip.