Clayton Hurd Hip Resurfacing with Dr. Rector 2010

nospam@example.com (Patricia Walter) — Tue, 27 Jul 2010 18:23:30 -0700

In January of 2010, at age 38, I had the difficult decision of what to do about an ailing right hip that had been diagnosed as moving toward advanced osteoarthritis. I first experienced pain in the joint at the age of 26 when my regular doctor told that I should restrict my physical activity (i.e., stop running) and that I would likely need a hip replacement within 6-8 years. That just didn’t really seem like an option for me at that early age. I had been very athletic and active my whole life – starting with basketball, football and track through college and then playing competitive ultimate Frisbee since then, up to 3-4 days a week. Besides, I was still fairly mobile—the rest of my body worked fine—and I was still able to play all the sports I loved. So, despite my family doctor’s advice, I continued my regular activities for the next 12 years, just cutting back when I felt soreness or the stiffness became too painful. Over time, I realized I had to cut basketball out of my activities because it would leave me sore throughout the next day. Then running even a few miles would leave me sore as well. I noticed myself slowly having to cut back on activities I loved because of the pain and stiffness in the hip joint.

I visited a newer family doctor in late 2009 to inquire about what was possible. He told me I "have the hip of a 70 year old," and that I was probably a good candidate for hip replacement. He respected the fact that I was still very active, playing competitive ultimate Frisbee (now at the coed level) and wanted to see that I could continue that. He told me about new developments in hip replacement—namely, hip resurfacing—and referred me to an orthopedic surgeon who he said "wasn’t a surgery nut" and would give me a fairly objective opinion on my options. After I saw him and expressed an interest in hip resurfacing, he referred me to Dr. James Rector in Boulder, CO. I talked with Dr. Rector and he thought I’d be a very good candidate for hip resurfacing. So, after doing a couple weeks of research on the procedure (including quite a bit on the Surface Hippy site, which was a great resource), I decided to go ahead with it, and I scheduled an appointment for late January 2010.

My early post-op recovery was, by all measures, excellent. I was off of all pain meds within 5 days after surgery, I was walking with one crutch at about 9 days, I was walking without crutches by two weeks, and I was driving by 16 days after surgery! In weeks 2 & 3, I would sometimes use a crutch when going on longer walks, because I really wanted to work on maintaining a normal gait, since I didn’t want to normalize any kind of limp which I would still fall into doing sometimes without a crutch. The limp was not so much out of pain as because of the relative stiffness in the joint that was operated on.

I was very committed to making a strong and quick (as possible) recovery. For the first 3 weeks of PT (2 weeks at-home, 1 week outpatient), I worked on the standard exercises they typically give you for post-op strengthening and increasing range of motion. They were great, and I did them religiously every day. When I got to about 3 ½ weeks, I’d pretty much exhausted what they could offer in terms of PT and I got the go-ahead to get onto a stationary bike, and by 5 weeks I was even on the elliptical machine doing 15-20 minute workouts. By about 6 weeks, I decided to get a pool membership and begin working on some water aerobics, which were nice because they allowed me to work on my range of motion without much impact on the joint.

At about 2 months, I felt relatively mobile – I could go on long walks and I was in the gym doing light weights. I’d bike 2 miles to work every day, and I’d go to the pool when I could. It was about that time that I began doing plyometric exercises – the kind that runners and other athletes do to stretch and strengthen muscles—focusing on the ones that did not require any high impact. It was these exercises that made the biggest difference, I think, in speeding my recovery (I would be happy to share those that I did). I focused on ones that strengthened and helped stretch the hip-flexor and quad area muscles, as those seemed to remain the weakest muscles for me (particularly when lifting the knee and extending the leg forward). I continued to do these, along with weights and low impact cardio work, until about 12 weeks post op, when I added beginners’ yoga classes. I didn’t push myself to do everything in the class; just what I could without pain or without breaking the restrictions explained by my surgeon. Between these classes and the plyos, I was able to figure out what muscles seemed to be coming back strong and which remained weaker and needed more attention. Since I still had one fairly strong hip, I was able to use it as a barometer for what "normal" should feel like in terms of strength and flexibility. I made it to the gym 4-5 days a week, for about 1 – 1 ½ hours each time, working on plyos, stretching to increase range of motion, and weights (increasing to moderate by month 3).

When I saw my surgeon for a 3 month appointment, I was doing pretty well. My range of motion – bringing my knee toward my chest—still had a way to go and was limited and somewhat painful if I tried to stretch it too far. Otherwise, the joint strength felt good. He said things looked good, and told me I should keep up with the biking, weights, stretches, and that I could hike as long as I wanted. He told me I should not be doing any running until a full year after the surgery (beyond running to cross the street or something like that). I told him I was doing low impact plyos, and he seemed fine with that. Strangely, he also told me that he thought I could return to playing ultimate Frisbee by about 5-6 months post-op, which made me think: I don’t think he know what ultimate Frisbee is. For those who aren’t familiar, it’s a lot like soccer in terms of sprinting, cutting, jumping, changing direction, etc. So it didn’t make much sense to me, especially when he told me not to run for a year! I tried to explain to him what the sport was, but I’m not sure he ever got the idea of Frisbee golf out of his head – which is a whole different game! He said the fact that it was on a soft surface (grass) – rather than long-distance repetitive motion on something like concrete—made it less taxing on the new joint. He told me ever after the year of no running, I should refrain from playing much basketball. I’ve resigned to doing that for the long term health of the hip joint.

Even though I expected to be in rehab, I committed to be the conditioning coach for the local competitive co-ed ultimate Frisbee team. At about 3 months and one week post-op, I started hosting twice a week, early season track workouts. These included a lot of sprinting exercises, like short recovery sets of 6 x70 yard sprints (1:1 run/rest ratio), with 2 minute recoveries in between, 3 sets total in each workout. Since it was spring, the track infield was very soft, lush grass, so I decided to participate in the workouts on the track infield while they ran on the surfaced track. While I didn’t have full range of motion, my strength was good, and I had enough motion to run relatively normally at the 70-75% speed range. I felt as if the plyometric exercises I‘d been doing prepared my muscles for these types of movements, and I only pushed myself to the point where I felt no real pain at all doing it. I did the "sprints" relatively painlessly, although I was sucking wind because it was the first real cardio work I had done beyond the elliptical machine, which I rarely did at sprinters’ pace because I hated sweating all over the equipment! I was a little sore after the first couple of workouts, mostly in the muscles in the front of my hip, rather than in the joint itself. I’d still be able to bike home, and I was fine by the end of the next day. I never took any pain meds or anti-inflammatory drugs during my early recovery process because I figured if I needed them, I was probably trying to do too much. I kept up the 2 a week (soft) track workouts – largely sprinting, with minimal jogging (less than ½ mile to warm up before stretching) for the next 3 weeks. The reason I did as little jogging as possible was because I was more worried about what the repetitive motion of longer distance jogging would do to my joint than with the sprinting, which was bursts of about 10-15 seconds of running on a soft surface. I’m not saying my logic is medically confirmed, it was just the feeling I had. I also continued to do stretching to increase my range of motion on the days I wasn’t sprinting, as well as some low-impact plyometric stretching and strengthening. If I felt any kind of prolonged pain that could cause me to limp, for example, I would take a day or two off, because while I wanted to come back as fast as I could, I didn’t want to do it too fast. I let pain be my guide.

At about 4 months, I began to add a host of higher impact plyometric exercises to my routine – e.g., high knees, hoping, jumping, bounding, although I had been mixing them in, to some degree, for the previous couple of weeks. I also added some change or direction or "cutting" running drills into the sprinting track workouts – like ladder sprints, where you run 10 yrs and back, then 20 and back, and then 30 and back. I continued these on the soft grass and I changed into cleats so that I wouldn’t slip at all on the turns. I eased into these because I wasn’t sure how my body would respond, but it responded well. The worst part is that the operated hip was still stiffer than the good hip, and I didn’t want to create an imbalance in my stride or muscles by sprinting/cutting too hard one way and not the other. So I only did them at the speed that was within my comfortable flexibility range on both legs, which at that time was about 75% of what I would consider maximum. As it turned out, changing direction did not feel hard on the joint, but changing speed (slow to fast) was a bit difficult because it requires different muscles to slow down and speed up quickly, and I realized I needed some time to get those back.

At 4 ½ months post-op, our team had our first 2-day tournament. I didn’t expect to play, as I really hadn’t done any live-action running and cutting other than very controlled drills. However, I convinced our captain, who called the field lines on our team, to put me in for a few points at a position where I was less likely to have to run or chase people all over the field but would still have to make relatively quick cuts and changes of direction (at the "handler" position, for those who know the sport). I wasn’t super fast or quick, but I was okay! The second day, I took a lot more points, and even played some of the tough, final points in a competitive semi-final game. In that game, I found that having to chase around a quicker opponent was stressing the inside groin muscle on the operated leg, so I wisely benched myself for the final game, not wanting to put my progress back.

My groin was sore for a day or two after the weekend tournament, but I continued to stretch it, and found that all the running I had done had really begun to loosen up the joint and extend the range of motion – still not back to normal but closer to 80-85% - I was finally able to bring my knee to my nose while having one leg on the ground and the operated leg bent on the seat of a chair (that had been my goal for about 2 months. To get this flexibility, I found it helpful to do 5 minute deep stretches, which my PT had recommended. This meant that without pushing too hard at once, I could work on elongating the muscles in the joint over time rather than trying to do anything to force them quickly. It seemed to me to be a safer way to increase range of motion. After 5 minutes of the stretch, my leg would sort of get "stuck" in this position, but after I’d slowly ease my leg back down with my arms and set it straight, it would take just several seconds to return to its regular state. I certainly have a new found respect for the resiliency of human musculature!

At about 5 months post-op, which was the Fourth of July weekend 2010, I attended a 3 day ultimate Frisbee tournament in Seattle Washington. It had been my goal from the day I scheduled the surgery to be able to play in this tournament. It’s much more of a "fun" than competitive tournament, so I wasn’t worried about having to impress or play 100% all of the time. We played 3 - 1 ½ hour games each day, over three days, and I played in each game. I started fairly cautiously on day 1, and I did a lot of standard and plyometric stretching exercises before and after the games. I didn’t entirely feel like my old self – I’m usually the person who doesn’t get tired running and jumping around, but I was definitely tired, both in terms of muscles and lung capacity, but that is typical enough given where I was in my rehab. After day 1 and 2, I was sore, but it was the typical sore – hamstring muscles, a little in the hip flexors on both sides, but nothing that different than before the surgery. If anything, my non-operated hip was a bit sorer than the operated one, and this has generally been the case since I started doing more of the "cutting" types of sprinting activities. My assumption about why this is true is because the operated hip does not have full 100% flexibility—and sometimes I do run at 100%--as a result, the other leg has to compensate a bit. That is why I continue to make it a top priority to get as full a range of motion back in the operated hip as I can, and for me it has taken on-going commitment and work. Anyway, by the end of day 3, I was pretty much feeling like my old self – I was sprinting well, cutting well, and jumping well. I was very pleased to hear my teammate say "welcome back" after the final game, when I played as well as anyone on the field, and played a key role in turning at 6-1 deficit into a 9-6 win for our team!

I just got back from the Seattle tournament last night, and I decided to take time to write this long story. I know that in my own process of deciding on the BHR surgery and undertaking rehab, I depended on, and found strength in, the stories of others who have posted on this site. The stories gave me the confidence to go ahead with the surgery and made me believe a strong recovery was possible.

Even though I was very methodological about my recovery process, I would not suggest that others go against their surgeons orders on how to best assure a successful recovery. Medical doctors know much more about stuff than I do. I only know my body, and I listened to it as best I could, and although I pushed it at times, I always pulled back when pain or discomfort told me I should. And I was very good about heeding the post-op restrictions for the first few months of recovery. In the end, I’m very pleased with my recovery to date. My old real worry is about how long the joint may last, because of course no one knows for sure. But being where I am, 5 months post-op, I couldn’t be happier, and I wanted to share my story.

Hip Resurfacing News - Dr. Rector

Clayton Hurd Hip Resurfacing with Dr. Rector 2010