Standing for the first time (August 23rd)

This was the first time standing after the second hip.  It wasn't nearly as painful as the first one.  There was way less pain in the groin area and moving the leg side to side was so much more painful last time.  When you straighten the leg the first time, the stiffness in the hammy is probably the most notable.   There is really no pain deep down in the joint.  You would think that after all that carving, grinding, and hammering on bone, that there would be some bone pain, but there really isn't.  Also on this event, the catheter removal was much easier and less painful, the gut issues were way better, everything seemed easier. 

Shark Bite No. 2 (August 24th)

I know this is a little gross and sadistic, but I have to show off my wound again.  It's something to be proud of, I guess.

Here is the wound on the right side.  It's about the same as the left was.  I think there is a little more bruising with this one.  Swelling is not too bad though.  It looks worse than it feels.  If I had a straight on butt shot it might look as if a great white chomped on my arse and then quickly spit me out, just enough chomping to scar the cheeks but not enough to actually split me in two.  Lovely, huh?

Day of Surgery No. 2 (August 23rd Right Hip Resurfacing)

Much of the 2 days prior to surgery were spent wandering around Seattle's waterfront stewing about the upcoming surgery.  I knew I had already done it before, but that didn't help all that much.  I had a lot of anxiety the day prior.  Surgery was scheduled for Tuesday morning at 0730, but I was required to be there at 0540.  I don't think I slept much at all the night before.  You know you're anxious when you get up before the alarm clocks go off at 0500.

Once we got into the pre-op area, I took the requisite oxycontin and celebrex and knew there was no going back.  Without anything in my stomach the narcotic made me pretty loopy and that's a good thing.  The IV went in much better this time, maybe because I was not dehydrated.  We met with the surgeon and discussed some of the interesting aspects of HR.  I always like that about my surgeon, he likes to talk about the technical stuff, when he has time.  I then met with the anesthesiologist.  I mentioned that I was numb for longer than expected last time and so he looked at the dosing from before and I suspect made some minor changes.  I was wheeled into the OR and laid on the surgical side while the spinal numbing started.  Gravity got the juice into the surgery area and then I turned over.  Then I think the Versed was put in and I don't remember much after that.

I woke up in the middle when they were hammering in the acetabular cup.  I think there was about 4 solid hits where I recall scooching forward a bit on the operating table with each blow.  I asked the anesthesiologist what was going on and he replied, "that happens sometimes when they start hammering", then I fell asleep again, he probably turned up the juice a little.  I then woke up near the end and tried to lift my head and look over the surgical sheets and someone quickly pushed my head back down and asked that I lay still while finishing up with the sutures.  They probably didn't want me breathing on the wound.  Anyway I stayed awake into the recovery area and actually felt pretty refreshed, like I had a decent 4 hour nap.

In the recovery area, I had the shakes but not as bad as before.  They gave me some Demerol and that settled it down.  Once again, ice chips and warm blankets never felt so good.  I was wheeled into my room much quicker this time and felt more aware and refreshed then last time.  Here it is, for the next 26 hours or so.

Getting Ready for No.2

It's been awhile since I posted here.  Been busy enjoying my summer.  However, I'm on the brink of heading in for the right hip.  We're leaving tomorrow morning to go back to Seattle to see Dr. Pritchett, bright and early at 0540 on Tuesday morn.  We'll spend 2 nights in Seattle on the front end having fun, celebrating our 19th wedding anniversary (bronze).  Fitting since we'll be putting some bronze to work on the oarlocks of a livery boat at the Center for Wooden Boats on Lake Union.  Bronze makes a good bearing, wonder if anyone has ever made a hip prosthesis out of bronze.  I'm hoping to get out of the hospital in 32 hours or less.  A hip buddy of mine just got out of Swedish in 32 hours.  A little competition is good for the soul, but might not be so good for a brand new hip. 

I finished up a new cane for lighter travel. It's totally pimped out.  I found a cool pool cue from Goodwill and thought it would make a good cane.  A few years ago, a friend gave me an LED flashy gearshift knob so that I could "pimp out" my truck, like he planned to do.  I don't usually go for the bling bling, especially on my vehicles.  So the knob sat in the closet for a few years waiting to be used for something cool.  Surprisingly the knob fit nicely on the top of the cue, just had to lightly screw it on.  It threaded on to the nylon end and made a really solid connection. I then measured and cut off the bottom.  The diameter at the bottom was a hair under 7/8".  A couple wraps of electrician's tape and the pharmacy cane tip fit perfectly.  Here's a couple photos.  

Who knew Hip Resurfacing could be so fun!  Bling Bling, BTW - I'm not a Coors fan, I prefer Pacifc NW ale.

I'm no where near as anxious about this surgery.  Although I'm not looking forward to the several weeks of being gimpy, or not being able to roll over in bed for a week or so.  I am looking forward to being able to ride a bike in a month or so, that's going to be pretty awesome. My right leg has been pretty uncomfortable lately, not as bad as the left was, but its obvisou the hip needs to get fixed.  The range of motion is bad and if I overdo it, like step too high, I'll have a painful limp for a day or so.  Today I was happy that my leg hurt, reinforcing why I'm doing this.

Well I've got my medical stuff packed, except for the urinal.  I'll get a freshy at the hospital.  I've got my tunes (Dropkick Murphies, Flogging Molly, Pogues, and Tesla).  Everyone needs a little 80's hair band rock once in awhile, sweet.  Got a full bottle of oxycodone which I'm hoping I won't need.  Maybe I can sell it down in Whiteaker to help pay off the new $500 copay my insurance provider initiated mid plan year because hip resurfacing (HR) is "of questionable medical value".  huh? 

The insurance co-pay increase happened right after the FDA requested more data on HR.  The FDA requested more data on HR because HR, at least metal on metal, has been around since the '70s  before there were rigorous testing protocols, in the US.  Somehow insurance heard that as "questionable medical value" yet data from various national orthopedic registries suggests that hip resurfacing is as successful as total hip replacement.  Oh well, I guess you can't blame insurance for trying to save a little money.  I feel sorry for the poor sap that lives his life not able or willing to pay that extra $500 to get his hip fixed.  What's $500 going to do for a $50,000 procedure, anyway?  It's just a deterrent.

Enough about that.  I'll post after I get back from Seattle.

7 weeks Post op

It's been 7 weeks since I had surgery on the left hip and it feels really good.  Pretty much no pain at all in the hip.  None in the leg like I had previous to surgery.  Problem now is that the right hip is hurting because I'm pushing the range of motion on the left and it works the right over.  I get pain under my knee cap and down the side of the leg.  Weird how I just got used to it in both legs and hobbled around not really knowing I was in pain.  Sucks.

Oh well, I plan to get the right done some time in the next few months before my insurance costs go up next year.  My PT is very happy with my progress and so I am I.  However, I still can't tie my shoe very well.  Some day.

x-ray

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 Paint.net 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. 

 http://www.surfacehippy.info/pdf/bhvsrconserv.pdf

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. 
  
http://www.pritchettorthopedics.com/articles/pritchett_metallosis_of_the_hip.pdf

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.   

             

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.