Five Weeks and a Day

Having passed the five-week mark since my surgery yesterday, I can confidently say that I am back to 100%. In fact, I'm at 110%; I am much, much more pain-free than I was before surgery, and find that I am able to do things that I hadn't been able to for years.

I've been going to the gym and using the elliptical machine for up to an hour at a time! Before my hip replacement, anything more than 20 minutes or so would cause soreness and stiffness in the joint that I would start to feel immediately but would become progressively worse over 12-24 hours. I now have absolutely no stiffness or soreness whatsoever.

I've still been going to physical therapy to work primarily on increasing my range of motion and strength, but after my sessions next week, I'm done with PT. I'll still have some exercises to do at home to continue to strengthen my new hip.

Beyond that, I'm still following my hip precautions (no crossing the legs, no bending the hip past 90 degrees, no angling the feet), but find I have to remind myself not to break the precautions all the time because I don't remember that I've had surgery. I'd say that's pretty successful.

If you would have told me how quickly my recovery was going to be, I wouldn't have believed you. Looking forward to continued recovery in the weeks to come!

Three and a Half Weeks Later

I am fast approaching four weeks post op and am happy to report that I feel almost fully recovered. 

I have been walking around, going to work, and doing most everything normally with no pain whatsoever. And I write this post at the gate of an airport in Florida as I prepare to head home from a family wedding. Airplane travel was no issue whatsoever, and my new hip didn't even set off the metal detectors (though it has previously at other security checkpoints).

I continue my physical therapy twice a week, which focuses on both expanding my range of motion and building strength in the muscles around the hip. I'm still walking with a slight limp -- it gets worse when I'm tired -- but I attribute that to years of compensating for a bad hip rather than any pain or discomfort from the hip replacement. 

I've also been able to sleep on my side -- finally. I keep a pillow between my legs to make sure I don't break any of my precautions, and even with a pillow it is fantastic to not have to be stuck on my back all night. 

All told, my recovery has been much, much faster than I anticipated it would be in the lead up to surgery. It's been fantastic, and I am so glad I did it. 

(Almost) Two Week Update

Tomorrow will be two weeks since my total left hip replacement. I am now walking unassisted, have gone back to work full time, and, other than some soreness, am generally getting around easier than I was pre-surgery. 

I had my post-op checkup this past Monday. My surgeon told me that more than one-third of my old hip ball was rubbing against my hip socket every time I put weight on my left leg. That would explain the pain. He also told me that my new hip fit in very snugly during the surgery, and that he had trouble trying to force it to dislocate as he was testing out the fit. All very good news. Plus, I got my staples out. Oh sweet, sweet relief. It's been a huge improvement in my quality of life. Sitting and standing no longer pinch. 

I've also started outpatient physical therapy. I'm finding that my range of motion is coming back pretty quickly, but my strength is understandably lacking. I've also got a pretty tight IT band on my left leg from not being able to stretch the tissue and muscle in that leg properly. PT thus far has involved several different stretching and strengthening exercises as well as some tissue massage to discourage scar tissue from forming. Some of it is painful, but nowhere near as painful as it was trying to exercise with my old hip. 

Happy Thanksgiving. 

8 Days Later

Hard to believe I'm on post-op day 7 and that it's been more than a week since I had my new hip installed.

Today marked my last in-home physical therapy session. I will miss Roger - my physical therapist - whose special blend of humor and drill sergeant-like motivation helped me progress farther than I thought possible in such a short period of time.

I'm cleared to walk around my house without any assistance. No crutches, no cane, no nada. It's not pretty -- I limp quite a bit -- but I can certainly make my way around. Outside my house, I'm down to one crutch, which helps the limp noticeably. I'd like to be done with the one crutch -- and any limp -- in the next week or two.

I'm still following all of my precautions, and still have some pain from time to time, namely right after physical therapy. My post-op appointment with my surgeon is on Monday, and I'm hoping he'll remove the staples on my incision then. Every time I sit down or stand up I have a sharp pain right at the incision site; I'm hoping that's the staples, and that it will go away as soon as they're removed.

Here's something they don't tell you in your pre-hip replacement class: sneezing hurts like a sonovabitch after surgery. I dread the telltale tickle in my nose that tells me a sneeze is inevitable. Regardless of how much I try to brace myself, with every sneeze I feel a stabbing, hot pain right in my new hip. It's close to some of the worst pain I've ever felt. It only lasts a fraction of a second, but it's pretty dreadful.

Sleeping is still a challenge. After laying uncomfortably on my back for three hours last night without falling asleep, I got up and sat/laid down on our recliner. It was the best sleep I've had since I had the operation. Though I'm not enamored with the idea of sleeping on the couch for the foreseeable future, I need sleep badly, and I'm willing to do (almost) whatever it takes to get it.

Still not taking any painkillers stronger than Tylenol.

My next check in will be on Monday following my post-op appointment. I also have my first outpatient physical therapy appointment on Monday, as well. Exciting stuff!

Day 6

My recovery continues to proceed quicker than I expected. Tomorrow will mark one week since my left hip replacement. Though I've not yet returned to work, I have been able to get out of the house for short jaunts, and am able to drive since I haven't needed to take a painkiller for three days now. I'm planning to start transitioning back to work tomorrow -- a few hours tomorrow and Friday, and then, hopefully, a normal work schedule beginning next week.

The pain has been surprisingly manageable without any prescription painkillers. I've been doing just fine using only Tylenol for the last several days. I'm also able to walk without any support, though it isn't pretty to watch. So I'm still relying on crutches to assist me. 

I've enjoyed physical therapy thus far. It's pretty amazing to see the progress I'm able to make with my new hip from appointment to appointment. Whereas I was barely able to move the joint last week, I'm now able to move my hip in most directions with some effort. There are of course still some movements that I'm unable to do, or that are particularly painful.

The biggest challenge thus far has been sleeping. Because I'm not allowed to sleep on my sides or stomach, I sleep on my back every night (or try to), which isn't a natural sleeping position for me. I wake up in the middle of the night with the joint feeling sore and slightly painful, and try to move a little bit to ease the stiffness. Sometimes it works, other times it doesn't. I therefore haven't been able to get a good, solid night of sleep since before the surgery. I have been trying to nap during the day whenever possible.

Almost one week down...seven more to go until I don't have to worry about my precautions (no bending past 90 degrees, no twisting my feet, no crossing my legs).

2 Days at Home

I've been home for the last two and a half days, having been discharged from the hospital on postoperative day 1. I'm finding that the stairs in my house are no big deal, but I am having trouble getting into and out of bed or cars.

I also came very close to fainting yesterday morning when I first woke up. I got out of bed, crutched to the bathroom, and was in the middle of taking my medications when I suddenly felt woozy and very warm. I sat down and called my wife in. She had to support me while I was sitting so I wouldn't fall over. (Did she win the lottery when she married me or what?) The feeling eventually passed and I went back to bed.

I had my first at-home physical therapy session yesterday, as well. Lots of simple exercises to loosen up the new joint, both standing up and laying down. And I was encouraged again to walk as much as I'm able to.

Finally, I also had a nurse come to the house to check on me yesterday. Everything looks good, except I have a low grade fever just under 100 degrees. That's not terribly uncommon right after surgery and nothing to worry about unless it gets closer to 101 degrees. So I am to keep an eye on it.

Very little on the agenda for today -- maybe a short walk outside -- and then in-home physical therapy again tomorrow.

24 Hours Later

I am 24 hours post total left hip arthroplasty. Since my last update yesterday evening, the numbing agent in the hip joint has begun to wear off. Around 9 pm last night, I began to experience searing pain in the hip and groin. The very nice nursing staff quickly administered pain killers, but it took about an hour or an hour and a half for them to start working well. Between the pain and the multiple rounds and check ins by the nurses and the medical staff, I only slept in fits and starts throughout the night. After being woken up at 6 am so that I could take medication (antibiotics, blood thinners and a long-lasting painkiller), I decided to cut my losses and stay awake.

My second physical therapy session is scheduled for 11:45 this morning and I'm told I'll be focusing on stairs, getting around with crutches, and some occupational therapy. Assuming all goes well, I should be discharged shortly thereafter.

I also got my first good look at the area where my surgeon made his incision for the surgery. It's still covered by dressing, mind you, but I can kind of see through it. It's bigger than I was expecting it to be -- somewhere on the order of 8 or 10 inches long -- running along the back side of my hip. I'm sure it will heal well and become barely noticeable, but the size of the impending scar definitely surprised me.

I've been doing some of the post op exercises, as well. I find many relatively easy, particularly those involving ankle movements, but am struggling a bit with knee bends and exercises more focused specifically on the hip area. But I'm sure those will get easier over time.

Post-surgery Update

It's been just less than 12 hours since my hip replacement surgery began this morning. I'll be staying in the hospital overnight but expect to be discharged tomorrow morning, which is pretty incredible. I've had my first physical therapy appointment, which covered how to get out of bed and sit down, and also involved me taking my new hip for a test walk down the hospital corridor. I was able to put full weight on the operated let, and though my hip area feels stiff, I've had absolutely no pain whatsoever. This will likely change as the long-lasting numbing medication wears off in 24-36 hours.

My surgeon stopped by on his way home to see how I was doing. From his perspective, the surgery went perfectly. The artificial pieces fit perfectly and he didn't need to make my leg any longer. He told me I could go home tonight if I want to! Unfortunately, the head nurse for the floor had to leave early and she would have to sign off on my discharge, so I'm staying the night. Not a problem, though -- I had planned to anyway. And everyone here is exceptionally kind and helpful.

Surgery

The surgery this morning went on without a hitch. I'm currently in my hospital room with inflatable cuffs around my legs to ward off blood clots. I'm also on a ton of pain killers and nerve blockers.

I'm very happy to report that I have no memory whatsoever of the surgery or of even receiving the spinal anesthesia injection. Just before the spinal, I was given some sedatives to help me relax. The next thing I remember is becoming alert in the recovery room, having oxygen tubes in my nose, and being offered ice chips and apple juice.

I'm currently completely pain free, but that's due to the painkillers and some long-lasting numbing medication my surgeon injected into my new hip during the procedure. I start physical therapy at the hospital sometime this afternoon, and have to demonstrate to the nurses that I can urinate within the next 90 minutes. Otherwise, I'm afraid they'll need to insert a catheter, which I'd very much prefer to avoid.

So -- surgery done, onto recovery!

24 Hours Away

If all goes according to schedule, I should be waking up in the recovery room at the hospital around this time tomorrow with a new left hip.

I'm a little bit nervous about the spinal anesthesia and worried about how aware I'll be of what's going on during the surgery. I've read on various joint replacement-related boards that the anesthesiologist is able to heavily sedate joint replacement patients even if they elect to go for spinal anesthesia. I'm hoping my team will give me this option -- I don't want to be aware of anything until after the operation is over.

I'll try to post to this blog as I'm able to over the next few days. See you on the other side!

Preop at the Hospital and More About the Replacement

I was scheduled this afternoon for my preop appointment at the hospital. The utility of this appointment was to allow me to preregister for my surgery on Thursday -- allowing me to go straight to the surgical suite -- and to draw additional blood and give me last-minute preop instructions. These instructions include my having to wipe myself down with antibacterial wipes the night before surgery. I'll evidently have to repeat the process at the hospital on Thursday morning as well. Other than that, a pretty straightforward process and I already have my hospital wrist band. I'm really, finally, getting a new hip!

Speaking of the hip, while I was researching hip replacements over the last several months, I read quite a bit about the relative merits of the posterior and anterior approaches -- the place on your body through which the surgical team reaches and replaces your hip. Generally speaking, the posterior approach is a bit more old school, whereas the anterior approach is newer and marketed as less invasive and easier to recover from. This is because the surgeon must cut through muscle in the posterior approach but not in the anterior.

My surgeon is not a fan of the anterior approach and only does posterior approach replacements. In his experience, he finds it more difficult to see the hip joint using the anterior approach and is generally more confident of the fit of the artificial joint when using the posterior approach. He also has explained to me that the femoral nerve runs down the front of the leg near where the incision is made on an anterior approach patient, meaning there is a risk (albeit a small one) of the nerve being severred.

So I am having a posterior approach replacement. My doctor tells me this might slow my recovery in the first week or two as compared to an anterior approach patient, but the odds of long-term success are higher.

Just a few more days to go.

Pre-op Interview and Clearance

I had my preoperative interview this afternoon with one of the nurses in the joint replacement center at the hospital where I will be having my surgery next week. It was a relatively straightforward 30-minute conversation about my health history and what to expect during and after surgery. I learned that the joint replacement center at this hospital gives each patient their own private room for the duration of their inpatient stay. That is excellent news. It's embarrassing enough to be this young and need a hip replacement. Being confronted by roommates twice my age would be rubbing salt in the wound.

I also learned from my primary care doc that one of my presurgical tests came back semi-positive, which initially caused a bit of a scare. I had a MRSA swab done to check for mediation-resistant staph infection. The good news is that I don't have MRSA. The bad news is that I do evidently have staph bacteria living in my nose. I spoke to my surgeon's office and they told me there was no need for concern: more than one-third of the population lives with staph somewhere on their body and are asymptomatic.

The other exciting news to report is that I've ordered my hip kit. This a 20-something dollar package that includes a reacher, an extended shoe horn, and a bunch of other items that will be useful for someone who won't be able to lean forward for the foreseeable future. Thanks to Amazon, I should have it in hand tomorrow to start practicing.

Less than 10 days to go. I have a bit of a cold and am hoping that it abates before next Thursday. I'm not sure whether I'd be allowed to have the replacement done if I'm congested. No use worrying about it now, though: there's still plenty of time.

The Pain Returns

About eight weeks or ten weeks after my core decompression, I once again could put almost no weight on my left leg. My hip hurt that much. Back to the surgeon I went for a new set of x-rays. The x-rays showed that my osteoarthritis had advanced very quickly, to the point where my femur and hip socket were rubbing against one another. My doctor advised me I could try to continue to put off a replacement by getting cortisone injections, so that's what I did.

And so I had my third injection directly into my hip joint. This time it was cortisone (a long-lasting steroid that decreases inflammation and provides pain relief) and lidocaine (a short-lasting pain reliever that is absorbed and eliminated after about a day). The lidocaine relief was glorious. The cortisone helped -- I could put weight on my left leg -- but I was still limping and I wasn't pain free.

Which is why I decided that it was time for a total left hip replacement. I've scheduled the surgery for November 12 at 7:30 am and plan to be in the hospital for just one night. I've already had my pre-surgical clearance checkup (I'm fit for surgery) and will be speaking by phone with the nurses at the hospital tomorrow, and then going into the hospital for one last blood draw and a blood donation (in case I need a transfusion) a couple of days before the surgery.

I have my first inpatient physical therapy session scheduled for the afternoon of my surgery. They want me up and using the new joint as soon as possible. To help encourage this, I'll be given spinal anesthesia this time around rather than general. This is very similar to an epidural -- it's an injection into the base of the spine -- but it will totally paralyze me for a couple of hours from the waist down. I'll also be given some sedatives during the surgery so that I won't be aware of what's happening, but at no point will I be unconscious to the point of requiring a respirator, as I would be if I were to go under general anesthesia. My biggest fear with spinal anesthesia is that the doctors don't sedate me enough and that I'll have some awareness of sounds, smells, etc. of my hip replacement. I plan to tell the anesthesiologist to make sure I'm good and knocked out.

My doctor tells me I'll only need about 6 weeks of physical therapy. One of those weeks will include daily visits at my house for a week right after I get home from the hospital, and the rest I've already booked outpatient. All I need to do -- other than the phone interview and blood work -- is to buy a "hip kit" with a grabber, a shoe horn extender, and some other fun things that no 30-something-year-old should be without, as well as an elevated toilet seat.

Following surgery, I am not to bend my left hip more than 90 degrees for risk of dislocation. Toilets are generally low to the ground and involve a higher degree hip bend. Even if you don't dislocate your hip bending so much (and from what I've gathered, it is pretty rare), it's still evidently pretty hard to get yourself up from such a low position with a new hip. An elevated toilet seat helps on both counts.

I also already have my prescriptions for after surgery: painkillers, blood thinners, anti-nausea medication (to take with the painkillers), and iron supplements. I'll be given some compression socks when I'm discharged from the hospital to further combat blood clots in the my legs.

So that's where we are, and now you're fully caught up. Beginning with tomorrow's phone interview with nurses at the hospital, this blog should be fully real-time.

Decompression Recovery

I'll be blunt: recovery from the core decompression surgery sucked pretty hard.

I wasn't allowed to put any weight whatsoever on my left leg for six weeks. The rationale here is that, just as it sounds, the core of the bone in my left femur had been drilled and the bone wasn't stable enough to support my weight. That was fine for the first few days since I was in a drug-induced stupor and mostly stayed in bed or on the couch. But the next five-and-a-half weeks wasn't fun. I had to work, play, and live on crutches for a month and half, always being careful not to put any weight on my left leg.

I had an unfortunate occurrence about a week into my recovery. My wife and I decided to venture out for a night out for the first time since my surgery. As I was crutching along into a movie theater, I stumbled and accidentally put all of my weight on my left leg for about a second. The pain was pretty intense, and I was concerned I'd caused additional harm to my femur. We went home, I took a Percocet, and all was right with the world for 4-6 hours. I had some additional pain for another few days from that accident.

I wasn't prescribed physical therapy after my core decompression, so really all I had to do was avoid putting weight on my left leg. After six weeks, I was back to walking normally, ellipting, etc. My surgeon and I were cautiously optimistic that the surgery had successfully stemmed the advancement of the avascular necrosis. And, (spoiler alert), it had. But, lucky me, you'll recall that I had two issues in my hip: avascular necrosis and osteoarthritis. And the the osteoarthritis in the joint was about to come on hard.

Hip Decompression

This is a drill in my left hip. Fortunately, I was unconscious.

And so it was that one very, very early morning in mid-June of this year I found myself in a car with my wife driving to an outpatient surgery facility in the middle of shopping center. It felt odd walking in, knowing that I would soon be under general anesthesia about 100 yards across from a huge grocery store. 

I was scheduled to have the surgery at 8am, but had to report in at 6:30 in the morning. As soon as I arrived, I was checked in, asked to change into a gown, and had an IV started. Several nurses came by to verify a bunch of information, and my left hip was clearly marked to ensure that the correct joint was being operated on. My surgeon came by to say hello, to sign the left hip to further make sure he drilled the correct one, and to answer any last-minute questions. 

Then the anesthesiologist came into the room to talk me through the general anesthesia. I told her I'd had general once before for a completely different issue and had been sick and felt generally awful for a day afterwards. She told me she'd give me a cocktail of anti-nausea medication that should avert that outcome this time around.

Then it was time. They had already started giving me some very nice sedatives through my IV, so as I said goodbye to my wife, I evidently told her she was "a good American" quite a few times (I have a vague memory of this). I was wheeled into the operating room. I remember entering the room, feeling very cold, seeing my surgeon scrubbing up, and transferring myself from the gurney to the operating table. The next thing I remember is sitting in a chair in the recovery room and having a completely normal conversation with one of the nurses while she gave me apple juice and some cookies. I was fully dressed but, embarrassingly, have no recollection of how I came to be so.

The whole procedure had taken just about 30 minutes. I felt absolutely no pain and had no nausea or sickness whatsoever. Within 20 minutes of being woken up, I was transferred to the car and was on my way home. I felt so good that I asked my wife if we could stop for breakfast somewhere. But because I was still calling her "a good American" throughout the car ride home (I have no memory of this), she wisely decided that heading straight home was a better course of action. 

My first hip surgery was behind me, and now it was onto recovery.

Ignoring the Problem Didn't Make it Go Away

The pain and limited range of motion in my left hip became too much to bear earlier this year. So I went back to my orthopaedic surgeon, fully intending to go in for arthroscopic surgery to repair my torn labrum, shave down the bone spur, and be on my way. Of course, because I had waited a couple of years, I needed new MRI images. Back to the lab to have dye injected in my hip again, which was worse the second time because I knew exactly how uncomfortable it was going to feel.

Armed with my new MRI images, I went back to my surgeon, who had some bad news: the new MRI had shown that my real pain wasn't from a torn labrum. Rather, it was from a combination of avascular necrosis and osteoarthritis -- a double whammy.

Let's take osteoarthritis first, as it's more common. Generally speaking, osteoarthritis of the hip refers to the narrowing of the space between the ball of the femur and the hip socket. Left untreated, the two bones ultimately could end up rubbing against one another every time the affected person puts weight on their leg. At this point, though, the osteoarthritis in my hip wasn't my surgeon's main concern.

My MRI also showed evidence of stage 2 avascular necrosis. Simply put, avascular necrosis is a condition in which the bone tissue begins to die due to a lack of proper blood flow. In hips, there are four stages, with stage 1 referring to the beginning indications of the disease and stage 4 referring to a hip that has essentially collapses due to bone death.

My surgeon was pretty blunt with me that day in May: you're going to need a hip replacement at some point in the next ten years, in all likelihood. But he was much more concerned with the necrosis than he was with the arthritis, which he thought wouldn't progress nearly as quickly.

So we agreed that I would have an outpatient surgical procedure called a "core decompression" done on my hip to try to slow the advancement of the avascular necrosis. While it sounds fancy, all it really entails is having a drill inserted through your outer thigh and into the top of your femur to: 1) drill out as much dead bone as possible and 2) create scar tissue, which creates new blood vessels, which, hopefully improves blood flow to the affected part of the bone for some time.

My doctor advised me going into the procedure that the odds were only about 60% that the core decompression would work well enough to put off a hip replacement for ten years. But he argued it was low risk, fairly easy recovery, and was strongly of the view that somebody my age should put off a total replacement for as long as possible.

And so I signed off on a core decompression on my left hip this past June.

The Beginning

In retrospect, I knew something was wrong with my left hip more than five years ago.

I'd been on a running kick for a few years, running somewhere between 15 and 25 miles a week, mostly on treadmills. But lately I'd been noticing that my left hip was getting sore as my runs went on, and would be pretty stiff for a day or so after a longer run. I was in my late twenties at the time, and chalked it up to not stretching properly.

Since you're reading a hip replacement blog, you can see where this is going.

Fast forward to three years ago. I was at a professional conference in a windowless conference room at some nondescript hotel -- I don't even remember what city I was in now -- minding my own business. When I stood up at the end of the last session to make my way home, I felt an incredible, sharp pain in my left hip and then the entire leg went numb. I could put almost no weight on my left leg. I literally hobbled home.

The pain became worse over the next 24 hours and I ended up going to an emergency clinic, where they took x-rays and a CAT scan. The facility didn't have an MRI machine, unfortunately. The x-rays showed that I had developed a bone spur that had likely torn some of my labrum. I was given some painkillers and a referral to an orthopaedic surgeon.

The orthopaedic surgeon ordered an MRI with contrast. This involves injecting dye directly into the affected hip joint (not pleasant) using an x-ray machine and then using the MRI to see what's going on inside and around the hip joint. The whole process lasted about an hour.

The MRI showed labral tears and my surgeon recommended arthroscopic surgery to repair them. I wasn't keen on a surgical outcome at this point and therefore sought alternative solutions. These included physical therapy, transitioning to aerobic exercise that caused less stress on my hip, like elliptical machines, and, most notably, ignoring the problem for a couple more years.

And that brings me to this summer.