Sunday, March 27, 2011


Here is my x-ray from my 2 week post op visit to my surgeon.  I made it extra large for detail.  The dense implant (metal) on the right is quite obvious.  In addition, you can see that the right hip (on the left) has a lot of degeneration (lumpy femoral head, tight spacing at acetabular rim, huge osteophyte on femoral neck).  This is why most surgeon's who saw my pre-op x-rays thought I would be in more pain on the right.  The right looked worse than the left. 

I tried to show the abduction angle measurement that I made myself which is identified by the yellow lines.  The surgeon will do that on his own also.  The target angle for all hip resurfacings is generally 40 degrees. That's the angle identifed as alpha on this image.  It represents the outward tilt of the acetabular cup and is measured between a straight line across the pelvis and a straight line along the face of the acetabular cup.  You can see the small indentations on the implant which designates the edge of the cup.  The cup wall is about 3 mm thick and is bevelled at the face, so the "ledge" is soft and not abrupt.  However, it still shows up on the image.  Keep in mind that the both pieces of the implant are essentially touching and the x-ray makes it look like one piece.  See the Birmingham ad in another post here to get a better understanding of how the 2 components go together.       

The software that my surgeon's radiologist uses is OmniVue and the images the radiologist gave me had a free viewer version of OmniVue.  It's not very robust, but it's free so I shouldn't expect much.  I pulled the image up using the free viewer then drew on the lines for measuring.  The software measures the angle, but it uses the edges of the image as the reference, not the line through the pelvis.  The number "31.8" can be seen on the image.  That's the angle provided by the software.  I was not square on the x-ray table, mostly because at 2 weeks post-op I was still a little tender and getting straight on the x-ray table was not a priority.  I could not export the image, so I used Faststone Capture to do a screen capture at high resolution and generated a tiff, brought it up in and fuzzed out the personal info and personal area.  BTW - The radiologist did not throw a lead codpiece on me, I suspect because of my age.

I then measured the angle between the lines, on the screen, using a protractor.  The angle is about 38 degrees.

There is much talk about abduction angle of the acetabular cup in the hip resurfacing community.  The reason is because the steeper angles (near 55 degrees or more) may cause increased wear on the components and metallosis (high metals ions in the fluid around the joint).  There is a general belief within the community that you are more likely to have metallosis and problems with steeper angles.  The well-known Belgian surgeon (De Smet) supports the argument that steeper angles cause more wear and higher metals concentrations, in his study comparing the BHR to the Conserve.

On the other hand, Pritchett does not suggest that steeper angles are directly responsible for metallosis.  Pritchett suggests that there are other factors that are in play and provides details in his paper on metallosis. He also suggests that metallosis occurs in about 4% of resurfacings.

Also, there is talk that a larger component will have less wear, due to the increased surface area which spreads out the weight and thus the wear.  This is why some surgeons suggest that smaller framed people are not good candidates for resurfacing.  However, most of the top surgeons will do resurfacing on smaller framed people.

In summary, I'm happy with my angle and I'm not too concerned about excessive wear or metallosis.   


Monday, March 14, 2011

3 Weeks Post-Op

Tomorrow will be 3 weeks since surgery and I am doing about as well as should be expected.  Sitting in a hard chair is still a little tiresome for the left flank.  Probably due to residual swelling.  I'm walking with a cane, but not using it much, or at least trying to not put much weight on it.  When I walk without it I have a swagger, which I think is more fear than much else.  My PT thinks its more of a subconscious disconnection due to capping the surfaces with something that isn't bone.  There really isn't any pain with rest.  I do get some discomfort if I walk too long, or put too much energy into my exercises.  

I went to my kid's soccer practice tonight where they practiced with the North Eugene High Team and it was great for me since I didn't have to coach.  Also the kids are beginning to connect with the high schoolers where they will be next fall, so it was good all around.  I wanted so badly to get out there and play, but stood on the side with my cane and did my simple dance steps to work the new hip.  With time I might be out there again, but I might not and that's just the way it goes.  Even if I do no. 2 this fall, I will have a solid 1.5 years from now before playing an impact sport like soccer.  With the 1.5 years since I've played, that will be 3 years without playing.  A lot changes in 3 years and I've lost any drive to play soccer with people who are super aggressive and rough. It's sad because a lot of those people are 50 years old, 10 years older than me and they still don't understand what's important in life. 

Tuesday, March 8, 2011


I went to my first PT session today.  I walked with one crutch for a bit in front of the PT and he recommended sticking with the crutch for a bit.  He then rubbed my butt for awhile (the suture zone).  I was expecting some serious bending and stretching.  In time, I guess.

I finished my weekend project, making my own cane.  I think I spent too much time standing at the workbench this weekend and not enough time doing my PT exercises.  Back got sore.

The cane has a steel top that is shaped like the top of a human femur.  I used a hollow blacksmithy 2" ball for the head, welded on some thin-walled tubing for the neck and then added a piece of elliptical tubing from a crappy kid's donor bike for the main femur, then I had to go free-form on the top and add various 3/8" wire and 1/8" strap to make the greater trochanter and the lesser tochanter on the inside. I made kerf cuts in the bike tubing to bring it's diameter down consistantly as you move down the shaft.  I did a lot of welding and grinding, then some sanding and then some wire brushing.  The finish on the steel is simply olive oil burned in at high temp, like seasoning a cast iron pan.

I found a piece of hardwood in the shop for the "stick" of the cane. Rounded it down with a plane and sanded it.  It smelled like black locust but appeared more reddish, maybe osage orange.  It took danish oil well and just has a really nice smooth finish to it.  I completed it with a homemade steel ferrule, like the top.  Then I put one of the rubber crutch tips on the bottome  That doesn't go well with it, though, it's too medical-looking.  I'll try to find a thinner black rubber stopper.

It's a little heavy, but it reminds me of walking with my old-school Chounard laminated wood ice axe, or with my handy mini mattock that I used a bunch for soil sampling several years ago.  Plus, the kids reminded me, it can be used as a weapon.  Lovely.  Also, the piriformis (small top knot on the greater trochanter) adds a little massage to the hand if you want to mix it up a little. 

It looks pretty cool, but it's not exactly anatomically correct and hopefully Mr. PT won't tell me I can't use it. 

Monday, March 7, 2011

2 week post-op appointment

Sorry, no photos.  I saw my surgeon on Friday March 4th to get my sutures out, have an x-ray, and to talk to the doc.  The sutures were a little stubborn and had to be wiggled a little before pulling them out.  I was picturing grilled chicken on a skewer, with the sutures being the skewer, but no meat getting stuck to the suture.  It felt good, but a little painful here and there.  It was the most glamorous part of the surgeon's assistant's job.  When she wasn't setting up appointments and answering thousands of questions from prospective patients, doing insurance pre-authorizations, transferring lab results to the hospital, and all that other lovely office stuff, she was busy looking at people's butts and removing their sutures. 

I got an x-ray, which the surgeon will put a protractor on and measure the angle of the acetabular cup with relationship to the pelvis (I think).  The goal is 40 degrees.  There appears to be some debate in the hip resurfacing community about the steep angles (ie 50 and 55 degrees) causing higher wear and thus elevated metals ions (Cr, and Co) in the blood.  Then there's a lot of debate simply around elevated Cr and Co in the blood.  I could go on, but I won't.

Then I chatted with the surgeon.  I had about 25 questions for him which I wrote down while riding the train to Seattle.  It was a good visit and I sort of thought maybe I should become an orthopaedic surgeon.  He mentioned some of his research on different types of bearing materials for resurfacing.  Give me another 15 years and maybe I'd be there.  Doubtful, oh well, I think that ship has sailed.

I took the train up to Seattle and back in the same day.  When I got back into to Eugene at about 8:45 pm, my wife and a friend were waiting at the station.  Right next door to the station is the Jackaloupe Lounge, a well known Eugene establishment.  It was nice to have a beer before heading home and going to bed.  It was a great feeling to be nearly 2 weeks post op.  The wound has healed well, not much pain, and my surgeon indicated that I was right on schedule with recovery.  I was so stoked that I figured I could drink a whole pitcher of HUB IPA.  Not such a good idea when you're not in shape.

The next day I began a metal and wood working project.  I decided I was getting close to using a cane and wanted to do away with the crutches, so I built a cane.  I'm close to being finished with it and when done, I'll post a photo.

Also, today, I went back to work.  Walked around the office with one crutch and sounded like a peg leg pirate coming the corner.  It was a pretty easy when you're sitting at a desk most of the day.  

Wednesday, March 2, 2011

Swelling no. 2

Sorry that these photos aren't quite as exciting as the suture photo.  When you sit around the house all day, you get a little bored.  This is a photo of my feet at day 8 post-op.  It's not horribly obvious, but the left side of my left foot has now received some swelling.  I guess it takes a few days for stuff to sink down to the foot.

A general update - I'm down to about 6 x 500 mg of acetaminophen per day.  Yesterday I had a major charlie horse in my lower quad for about a day which reduced my motivation on the exercises.  I should have massaged the quad and really iced it up, maybe even stayed a little heavier on the meds.  At about day 6 post-op I was able to sleep on my side with pillows between my legs.  I'm up to about 8 hours of sleep a night broken into 2 hour to 3 hour segments.   Very nice.

A couple days ago, I made the mistake of falling asleep while laying on my stomach.  My wife had just changed the dressing.  I generally sleep on my stomach and since it had been over a week since I laid in that position, I fell asleep.  It was very comfortable.  The problem came when I woke 3 hours later and could not roll over on my own.  I was like a turtle, but the opposite.  For those of you planning to do a bi-lateral surgery, you might think twice about it.

A tool of the trade

No, not a bone saw, or scalpel,...a raised toilet seat!  This is the best invention ever.  I never thought I would ever need one of these and even when the pre-op nurse discussed prepping the house, I sort of ignored it.  I was thinking I could get away with sitting at the regular level.  Doctor's orders - "Do not bend more than 90 degrees at the hip!"  They scare they hell out you, as if you might dislocate the new hip and botch the whole deal in one minor mistake.   I wasn't going to push it, best not to go acute, stay obtuse. 

The toilet is light and can be used as a walker to get around in the bathroom.  You can put it in the tub and take a cat bath and the toilet gets cleaned at the same time.  See what I mean, a sweet invention.