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.
Thursday, October 29, 2015
Wednesday, October 28, 2015
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.
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.
Tuesday, October 27, 2015
Hip Decompression
 |
| This is a drill in my left hip. Fortunately, I was unconscious. |
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.
Sunday, October 25, 2015
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.
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.
Saturday, October 24, 2015
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.
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.
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