This then was my real first day post operation. The physiotherapists are keen to get patients moving as quickly as possible for various reasons, and muscle tone deteriorates quite quickly.
Today the physio visited me and helped me to my feet. Zimmer frames I have always associated with people who are far less ambulant than myself, but here I was using one to move around my bed area and the ward. This gave me even more client empathy - as I have previously said I am a stairlift and domestic mobility lift surveyor in my professional life!!!
I soon progressed onto crutches and was determined to demonstrate to the staff that I was safe, confident and more than ready to go home. The physio's were happy with my efforts and gave me other flexion exercises to carry out, but I had to stay in for another night and because I live in a house with stairs (and kids, dogs and all other family paraphernalia) I would have to manage a flight of stairs tomorrow morning.
The bit was firmly between my teeth to pass this test...which I thankfully did without any problem.
Friday, 8 August 2008
Alignment Pin Removal Surgery
The weekend passed and early Monday morning I was prepped for theatre.
This time unlike the actual resurfacing operation I had no option for anything other than a general anaesthetic. I don't like generals! but hey, all I wanted at this point was to have the pin which was causing me pain and physically restricting my movement to be removed (see photo) and to get up on my feet so I could catch up with the other patients who had surgery and were now mobile unlike myself, and I had a typically 25 year age advantage...just to rub salt into my metaphorical wound my neighbour in the ward, an 82 year old very independent man had recovered so much that he had been discharged on the Saturday which was less than 72 hours post operation.
I had serious concerns about infection, my original wound was still very fresh and it would mean further exposure to atmosphere, had the procedure been carried out correctly in the first instance this would not have been necessary and infection less of a worry. I felt aggrieved but maintained my outwardly positive attitude so I could move past my now delayed personal RESET POINT as previously mentioned.
The operation lasted less than an hour. I understand that the procedure involved cutting through the skin and muscle to expose the pin that was firmly set in my femur, extracting it then closing the wound. I came round in the recovery room and was to say the least very sore!
The consultants registrar had explained prior to the surgery that this would require a further incision, sure enough I have a smaller scar healing on my leg next to the main one, unlike the main incision which was stapled this one simply had sutures holding it together.
The nurse in the recovery ward administered morphine and tramadol for pain relief but this didn't ease the soreness. I was returned to the ward to recover.
This time unlike the actual resurfacing operation I had no option for anything other than a general anaesthetic. I don't like generals! but hey, all I wanted at this point was to have the pin which was causing me pain and physically restricting my movement to be removed (see photo) and to get up on my feet so I could catch up with the other patients who had surgery and were now mobile unlike myself, and I had a typically 25 year age advantage...just to rub salt into my metaphorical wound my neighbour in the ward, an 82 year old very independent man had recovered so much that he had been discharged on the Saturday which was less than 72 hours post operation.
I had serious concerns about infection, my original wound was still very fresh and it would mean further exposure to atmosphere, had the procedure been carried out correctly in the first instance this would not have been necessary and infection less of a worry. I felt aggrieved but maintained my outwardly positive attitude so I could move past my now delayed personal RESET POINT as previously mentioned.
The operation lasted less than an hour. I understand that the procedure involved cutting through the skin and muscle to expose the pin that was firmly set in my femur, extracting it then closing the wound. I came round in the recovery room and was to say the least very sore!
The consultants registrar had explained prior to the surgery that this would require a further incision, sure enough I have a smaller scar healing on my leg next to the main one, unlike the main incision which was stapled this one simply had sutures holding it together.
The nurse in the recovery ward administered morphine and tramadol for pain relief but this didn't ease the soreness. I was returned to the ward to recover.
Thursday, 7 August 2008
Day 1 Post Op - Confirmation of Alignment Pin
I was visited by the consultant who didn't waste any time in confirming to me that there was a problem.When the operation is carried out the consultant fixes an alignment pin in the thighbone which is used during the operation and removed prior to closing the site. In my case somehow it was overlooked and the alignment pin (also known as a guide wire) remained in my femur and quadriceps muscle (see photo).
Unfortunately for me this was discovered on a Friday afternoon, a further operation was scheduled for me to have the pin removed first thing Monday morning.
It soon became apparent to me that I could feel a specific pain in the approximate position of the pin, and I was told that I would be unable to carry out and physio over the weekend, this really was my lowest point as I had hoped to be discharged on Sunday, but now had an extended stay and an additional operation to face.
Day 1 Post Op - pt1
Day one of the rest of my life.
This is possibly the sorest I felt, the patient administered painkiller was removed yesterday and the only pain control required was paracetamol. My legs have been covered in delightful anti embolism tights since before the operation yesterday (these stay on for two weeks) and I have spent the first night's sleep on my back (this has to be maintained for six weeks). There were two distinctly different types of pain in my leg, a dull muscular pain - like a heavy dead leg and a sharp pain at the surface where the incision was carried out. I couldn't identify any specific pain at this time - more to follow.
I enjoyed my Weetabix and cup of tea for breakfast and was glad that my waterworks were functioning as normal, 'cos I really didn't want to be catheterised.
Day one post op the physios plan is for patients to get out of bed and do some very basic physiotherapy, i.e. transferring into their bedside chair, this I did, but gosh it was an effort, and if I'm honest quite painful.
The next thing that happened was that the porters came to take me down to X-ray, this is carried out to check the post operative alignment of the cup and cap. So off I went and when I arrived at X-ray was transferred to the table, this I found to be very painful, the X-ray was carried out. Immediately I realised that something wasn't quite right because the staff all huddled round the monitor in conversation. It transpired that there was something showing up on the X-ray that shouldn't have been there, I was taken back to the ward gathering as much information as I could along the way.
Once back on the ward a nurse removed my dressing to see if any item had been left under the dressing - it hadn't.
This is possibly the sorest I felt, the patient administered painkiller was removed yesterday and the only pain control required was paracetamol. My legs have been covered in delightful anti embolism tights since before the operation yesterday (these stay on for two weeks) and I have spent the first night's sleep on my back (this has to be maintained for six weeks). There were two distinctly different types of pain in my leg, a dull muscular pain - like a heavy dead leg and a sharp pain at the surface where the incision was carried out. I couldn't identify any specific pain at this time - more to follow.
I enjoyed my Weetabix and cup of tea for breakfast and was glad that my waterworks were functioning as normal, 'cos I really didn't want to be catheterised.
Day one post op the physios plan is for patients to get out of bed and do some very basic physiotherapy, i.e. transferring into their bedside chair, this I did, but gosh it was an effort, and if I'm honest quite painful.
The next thing that happened was that the porters came to take me down to X-ray, this is carried out to check the post operative alignment of the cup and cap. So off I went and when I arrived at X-ray was transferred to the table, this I found to be very painful, the X-ray was carried out. Immediately I realised that something wasn't quite right because the staff all huddled round the monitor in conversation. It transpired that there was something showing up on the X-ray that shouldn't have been there, I was taken back to the ward gathering as much information as I could along the way.
Once back on the ward a nurse removed my dressing to see if any item had been left under the dressing - it hadn't.
Wednesday, 6 August 2008
Operation Day!!!
It's the 17th July 2008 - Operation Day...
I have adopted a positive view of having the operation since day one. The way I view it is that this is a RESET POINT in my life, so that I can regain the normality I had prior to the arthritis limiting my abilities. This is simply one day out of my life which might cause me pain for a few hours, I don't think that's enough of a reason to get anxious or stressed.
My instruction was to report to the hospital ward for 7am, as per usual I was early and prepared. The Staff Nurse showed me to my bed, I was on a clean small ward made up of only 6 patients. I was one of three new intakes (all hips: one traditional, one revision, and my BHR). My operation was scheduled for 4pm, but due to the consultant wanting to meet and greet his patients I had to be in early. Early on the consultant and his registrar visited and explained the procedure; they were going to make a traditional incision, from the rear. They marked my leg, asked If I had any questions, I signed the consent form, and I might then see them later. It was very welcoming.
I was unprepared when at 12pm the porters came to get me! there had been a change of plan, it was my turn. Quickly, I undressed and put on the slightly bizarre open backed gown that I would get used to.
When I arrived at theatre the anaesthetist greeted me and explained the options available to me; they were:
I have adopted a positive view of having the operation since day one. The way I view it is that this is a RESET POINT in my life, so that I can regain the normality I had prior to the arthritis limiting my abilities. This is simply one day out of my life which might cause me pain for a few hours, I don't think that's enough of a reason to get anxious or stressed.
My instruction was to report to the hospital ward for 7am, as per usual I was early and prepared. The Staff Nurse showed me to my bed, I was on a clean small ward made up of only 6 patients. I was one of three new intakes (all hips: one traditional, one revision, and my BHR). My operation was scheduled for 4pm, but due to the consultant wanting to meet and greet his patients I had to be in early. Early on the consultant and his registrar visited and explained the procedure; they were going to make a traditional incision, from the rear. They marked my leg, asked If I had any questions, I signed the consent form, and I might then see them later. It was very welcoming.
I was unprepared when at 12pm the porters came to get me! there had been a change of plan, it was my turn. Quickly, I undressed and put on the slightly bizarre open backed gown that I would get used to.
When I arrived at theatre the anaesthetist greeted me and explained the options available to me; they were:
- General anaesthetic
- Spinal sedation from the waist down
I elected to have the latter and there was then a further question, did I, or did I not want to be conscious for the operation? It didn't take long for me to elect to stay conscious! I have always been curious and I figured that if I didn't like what was going on they could top up the anaesthetic and I would be no worse off.
The spinal injection didn't hurt a bit, and then I was wheeled into theatre. The team rolled me onto my side, and fitted pommels to secure my position. The sheets went up and I could see no more, and it happened really quickly.
At that point I think I dozed for a bit. I remember later talking to the anesthetist, and the consultant then started asking me some questions, he then explained the part of the procedure he was carrying out, for those interested he was coring the head of my femur to accept the new cap, he then "tapped" the new cap into place and fitted the acetabular component "cup". It wasn't unsettling or scary in the slightest.
Soon after they closed the wound using removable staples and I was wheeled through to the recovery room.
Because I had generally stayed awake I was offered water, I also was hooked up to a patient operated painkiller machine and oxygen. Feeling came back to my feet while I was in the recovery room and it was really exciting! I could wiggle my toes and the operation was over.
I was really keen to get back to the ward so I could ring Lynda and let her and my family know I was OK, this I did fairly soon afterwards.
The anaesthetist uses a nerve blocker there really isn't too much pain on the operation day, and because I had my own means of administering painkiller it really didn't seem to be obvious.
That night however is likely to be a long night, the nurses come round on hourly/ 2 hourly observation intervals, so if you get any sleep well done!
Reality Dawns!!!
The date was confirmed, 17th July 2008. I was instructed to attend the orthopaedic pre-assessment unit earlier in the week to ensure that I would be fit enough to have the operation.
This would be my first needle experience and oh boy was I not looking forward to it! I have to admit that my fears were allayed really quickly, the nurse was great, she took my blood pressure and while my veins were up, she took some blood and I didn't even realise...wow. At this point I felt relieved that I could face the operation minus my hangup over needles, which was just as well.
At the pre-op assessment I was given a dossier of paperwork to read and to give me an insight of what to expect. As I have previously said I am a surveyor for a stairlift company, yeah irony he he etc! but my job is great and I am always very aware of people far worse off than myself, people who have long term mobility issues and worse, but in the course of my job I spend much of my time carrying out joint visits to clients with Occupational Therapists, now O.T's provide a service to people who have problems to overcome the problem and lead an easier life, they will be involved with you in hospital and provide equipment for you when you are sent home.
Some of the O.T's I have the privilege to work with are axperienced in orthopaedics so they were able to give me an insight in to what I should expect.
The last thing I had to do was to ring the hospital at 3pm the day before the operation to ensure that there was a bed for me!
This would be my first needle experience and oh boy was I not looking forward to it! I have to admit that my fears were allayed really quickly, the nurse was great, she took my blood pressure and while my veins were up, she took some blood and I didn't even realise...wow. At this point I felt relieved that I could face the operation minus my hangup over needles, which was just as well.
At the pre-op assessment I was given a dossier of paperwork to read and to give me an insight of what to expect. As I have previously said I am a surveyor for a stairlift company, yeah irony he he etc! but my job is great and I am always very aware of people far worse off than myself, people who have long term mobility issues and worse, but in the course of my job I spend much of my time carrying out joint visits to clients with Occupational Therapists, now O.T's provide a service to people who have problems to overcome the problem and lead an easier life, they will be involved with you in hospital and provide equipment for you when you are sent home.
Some of the O.T's I have the privilege to work with are axperienced in orthopaedics so they were able to give me an insight in to what I should expect.
The last thing I had to do was to ring the hospital at 3pm the day before the operation to ensure that there was a bed for me!
Birmingham Hip Resurfacing, what is it?
OK, I'm not medically trained but there are some fantastic sites on the Internet that can provide you with great information on various surgical techniques.
BIRMINGHAM HIP RESURFACING is a relatively new surgery, having been around in its current form since the late 90's. It's a preferred technique for younger, more active males. It is a metal-on-metal replacement joint comprising of two components a cap and a cup, I was told that there is some concern over carrying out this procedure on older people as there is an increased risk of suffering a femoral fracture, furthermore due to the metal-on-metal wear issue there is insufficient evidence to determine whether there may be a risk of the ions changing the recipients DNA long term, for this reason I learned that it is not the preferred choice of hip replacement for females of child bearing age.
Simply put the surgeon will replace the nice shiny round head of your femur and fit a new even shinier metal cap, they will then push fit a matching shiny metal cup into your pelvis and you have a new hip, mine was done in under an hour and half, and I stayed awake...however you don't have to.
BIRMINGHAM HIP RESURFACING is a relatively new surgery, having been around in its current form since the late 90's. It's a preferred technique for younger, more active males. It is a metal-on-metal replacement joint comprising of two components a cap and a cup, I was told that there is some concern over carrying out this procedure on older people as there is an increased risk of suffering a femoral fracture, furthermore due to the metal-on-metal wear issue there is insufficient evidence to determine whether there may be a risk of the ions changing the recipients DNA long term, for this reason I learned that it is not the preferred choice of hip replacement for females of child bearing age.
Simply put the surgeon will replace the nice shiny round head of your femur and fit a new even shinier metal cap, they will then push fit a matching shiny metal cup into your pelvis and you have a new hip, mine was done in under an hour and half, and I stayed awake...however you don't have to.
What are my options?
The consultant continued to explain various things to us.
Now I think I am man enough to tell you that I am a self confessed coward, i.e. I really don't like needles. I was preoccupied that I might need a steroid injection into my hip to manage the pain, and I had heard the urban rumours of a needle the size of a pool cue, no pain relief , etc.
This wasn't an option as the arthritis was too advanced for that.
The consultant informed me that there was a technique known as HIP RESURFACING this was the preferred surgery for young active males, it may be chosen because your life expectancy exceeds that of the hip replacement, and a revision is needed. Having this proceedure first preserves more of the thighbone so if a conventional proceedure is required later then it can be carried out without additional complications. I was given the following treatment options:
Now I think I am man enough to tell you that I am a self confessed coward, i.e. I really don't like needles. I was preoccupied that I might need a steroid injection into my hip to manage the pain, and I had heard the urban rumours of a needle the size of a pool cue, no pain relief , etc.
This wasn't an option as the arthritis was too advanced for that.
The consultant informed me that there was a technique known as HIP RESURFACING this was the preferred surgery for young active males, it may be chosen because your life expectancy exceeds that of the hip replacement, and a revision is needed. Having this proceedure first preserves more of the thighbone so if a conventional proceedure is required later then it can be carried out without additional complications. I was given the following treatment options:
- I could wait until the pain was insufferable
- I could have a follow up appointment in 6 months
- I could be put on the waiting list of approx 18 weeks from initial consultation
Now I suggest if you find yourself in this situation opt for the operation, I didn't immediately but as soon as we left the consultation it dawned on me that his opinion was for me to get the op out of the way sooner rather than later, as I was fitter, my muscle tone was better and there was less chance of having any additional pains across my lower back or placing further strain/stress on my not so poor hip.
It was only a matter of days before I made that call and got onto the waiting list.
What's up Doc? - Appointment 2
Understandably, when I told my family and friends they thought this was a variation of the legendary Man Flu, how on earth could I have arthritis? me need a hip replacement, yeah right. It was clear that they thought I was exaggerating (it has been known). I mentioned it to my boss that I might need some time off within 5 years so I could have a hip replacement, this was a bloody great joke because I work for a stairlift company!!! - my choice of employment sector was really useful later on!
So the follow up appointment came, this time my good lady (Lynda) came too, I think as much as anything else she wanted to disbelieve my apparently far fetched claim. Again, this more senior consultant put me through a range of movement check and then invited us into his consultation room.
On the computer screen was my X-ray, showing my whole pelvic region (be prepared and only invite close people into this appointment with you, unless your happy being an exhibitionist, even more relevant if you are male - everything is outlined and its explicit!).
The consultant pointed to my right hip, yes my right hip and showed us the problem. At this point I was confused, my painful hip was my left hip, so I said "this is my good hip"
his reply was along the lines of "the problem is that the top of your femur isn't angled enough and is shaped incorrectly, this is causing the cap of the femur to be pushed out of alignment and putting additional stress on the opposing side of the socket, causing wear and arthritic cysts"
I again said " this is my good hip"
He clarified, this wasn't in fact my good hip as both hips had problems!
Lynda at this point calmly suggested I should be quiet and listen more carefully, as only a loved one can suggest.
I listened, he informed me that the problem may have been there since very early years, and could be caused by too much strenuous sport before my bones had fully formed, or maybe not, as it was unclear.
I was now beginning to understand that my hips were "special" could this be the reason I had never had the slightest rhythm? or awful co-ordination? probably not, but its amazing what goes through your head when you learn somethings not quite right!
So the follow up appointment came, this time my good lady (Lynda) came too, I think as much as anything else she wanted to disbelieve my apparently far fetched claim. Again, this more senior consultant put me through a range of movement check and then invited us into his consultation room.
On the computer screen was my X-ray, showing my whole pelvic region (be prepared and only invite close people into this appointment with you, unless your happy being an exhibitionist, even more relevant if you are male - everything is outlined and its explicit!).
The consultant pointed to my right hip, yes my right hip and showed us the problem. At this point I was confused, my painful hip was my left hip, so I said "this is my good hip"
his reply was along the lines of "the problem is that the top of your femur isn't angled enough and is shaped incorrectly, this is causing the cap of the femur to be pushed out of alignment and putting additional stress on the opposing side of the socket, causing wear and arthritic cysts"
I again said " this is my good hip"
He clarified, this wasn't in fact my good hip as both hips had problems!
Lynda at this point calmly suggested I should be quiet and listen more carefully, as only a loved one can suggest.
I listened, he informed me that the problem may have been there since very early years, and could be caused by too much strenuous sport before my bones had fully formed, or maybe not, as it was unclear.
I was now beginning to understand that my hips were "special" could this be the reason I had never had the slightest rhythm? or awful co-ordination? probably not, but its amazing what goes through your head when you learn somethings not quite right!
Problem hips....not me I'm only 38
OK, so where do I begin? I'm pretty average really, Im a family man, I play a little sport, mostly golf and a bit of cycling and walk my two dogs regularly. My weight is only slightly more than it should be for my height (175cm).
I visited my GP last year after playing golf and feeling a sharp pain right down my left leg that was severe enough for me to abandon my game! My GP diagnosed a trochanteric bursitis and prescribed anti inflammatory medication. I carried on with the medication for about a year but I decided that although there were good times the drugs hadn't addressed the problem.
Upon revisiting my GP in January 2008 I re-explained the symptoms I had been experiencing; which had become more regular and painful these included:
I visited my GP last year after playing golf and feeling a sharp pain right down my left leg that was severe enough for me to abandon my game! My GP diagnosed a trochanteric bursitis and prescribed anti inflammatory medication. I carried on with the medication for about a year but I decided that although there were good times the drugs hadn't addressed the problem.
Upon revisiting my GP in January 2008 I re-explained the symptoms I had been experiencing; which had become more regular and painful these included:
- Sudden loss of strength in my leg
- General and shooting pains
- Inability to walk any real distance
- Driving pain (my car is manual)
- Prolonged aching and restricted movement
This resulted in me being a real grouch!!! my poor family went through it.
Fortunately I saw a different GP who pulled me about a bit and suggested he refer me to our local hospital to see an orthopaedic specialist.
March 2008 my hospital appointment came through, it was a two part appointment with a visit to X-ray first, followed by the consultants appointment a week later.
The consultant laid me down and checked ranges of movement in both my legs, this took minutes and then showed me the X-ray, it was conclusive that there was arthritis in my left hip. Now being 38 - an ex serviceman and physically fit, this was unbelievable to me, I couldn't really take it in, what did it mean? I was assured by the consultant that within about 5 years he would see me again for a hip replacement, and in the meantime he would make me an appointment to see his colleague regarding pain management.
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