Wednesday, April 15, 2009

Proof of two-hip status

Here's what things are looking like in x-ray:


More metal for the metal detectors. But still not quite a Terminator.

Where hip #2 is at.

Having two surgeries for one hip, along with the associated ups and downs, has been draining. It knocked hell out of my master plan for dealing with the work I do at the university. My entire psychology is different: whereas for my left hip, everything was great, improving, progress, this time I've ended up more negative and really cautious and worried and tentative (hence the long delay in posting anything about this surgery). 

At this point, I think I've turned the corner, and within the noise, I'm at the point where many patients would normally be. Whether by chance or due to the extra trauma, I've been experiencing a syndrome that many but not all hip patients face (whether they are conventional or Birmingham); it's the get-up-and-go problem, where you experience sharp groin pain when you stand and try and take your first step; this clears up within a moment or two, but is an annoyance in terms of mobility. I also experience more of this pain after therapy, and I am way behind on the ability to do straight leg raises: it's still hard to get the leg started at all, let alone without pain, though once I start doing the raises, it's no problem to keep doing them or even restart the exercise. But, I am just about walking pretty well without a cane and can do a mile or more with really no pain or fatigue. I'm spinning up my speeds on the bike trainer towards 17 mph, and I've gone as long as 50 minutes. 

Here's a summary of the events and sequence since surgery.

Day 1: Initial right-hip resurfacing surgery on 23 February.
Day 4: back home
Days 7-9: lots of discomfort, sense that something is wrong with joint
Day 12: Visit surgeon; get news that another surgery is needed to replace slipped cup
Day 13 (Day 1): Second surgery, 7 March. New cup with screws inserted.
Day 22 (Day 10): Hold graduate seminar home; using crutches to get around
Day 25 (Day 13): staples out, no infection, implant looks good
Day 27 (Day 15): Use cane for some walking, mix with crutches
Day 29 (Day 17): Back to work full time, lots of stair climbing descending
Day 31 (Day (19): First outpatient therapy
Day 34 (Day 22): First ride on indoor trainer: ~20 minutes, 5 miles (15.1 mph)
Day 48 (Day 36): Indoor trainer, 12 miles, 45 minutes, 16 mph
Day 50 (Day 38): Walking longer distances, basically not needing cane; still need cane a bit after therapy or after sitting for longer periods. Can sleep in any position without any real discomfort. Stretching at therapy starting to feel good rather than painful.

What's the deal with two surgeries in succession?

You might wonder what the outcome was to have two surgeries in such quick succession. Well, remembering the fundamental equation, that hip surgery = ass surgery, it is an insult to your ass, because the incision is re-used, and partly healed muscle and tissue is cut... Ouch. Dr. Ferrante closed this new incision with staples, rather than sutures and steri-strips (which he had used for the initial one).

The biggest concern is infection, with rates apparently reaching 10%, because of the greater difficulty of sterilizing the area plus the plain reality of re-exposing traumatized tissue to the environment. I did have a bit more tenderness, and a day or two extra of mild evening temperatures, but so far it looks like I'm ok. 

Other than that, the two surgeries have left me in a slightly curious hybrid state, as there was some healing from the first surgery that I retained and that wasn't reset by the second operation. So for that reason and because each hip and each surgery can be different anyway, it's a little hard to index my progress this time against progress after the surgery I had two years ago on my left hip. All in all, the net is that I'm a little more sore and weak this time, probably reflecting the additional trauma. 

Surgery 2b: groundhog day

The second surgery got off to a wobbly start in that I was told to report too early, to the wrong place, in a hospital that does not do or handle surgeries like this on the weekend. But we found a helpful person who connected us with people who were in fact looking for me. I was back in the same room that I had just left 10 days before ( it is not good when the staff remembers you!).

The surgery was short and sweet (I had a general this time, no stinking spinal (see earlier post)). The original cup was hand-loose, and although some extra cutting was needed to insure that the replacement with screws went in for sure, things went well and I was out in about 40 minutes. I woke up feeling great, and relieved that I was back in one piece with the Birmingham hip intact. I was able to head home after two days, given that this surgery was not quite as major.

We never really had an explanation for how the cup could have popped out so quickly. There was no recorded fall or incident that I had. True, my leg was numb for too long after surgery, but I didn't try walking on it or anything. Dr. Ferrante said that is went in well and firm. ALl I can figure is that the press fit was just barely ok, and it popped out under a fairly minor nudge in normal use. There's no point in blame for anyone because there is no evidence of anything particular happening, and the repair worked out. 

But... if you feel lots of sudden shifts and motion in the days post surgery, don't wait: see you surgeon. I would have saved myself a bunch of wasted recovery days if I had reported the systems and asked for an examination and x-ray.

Things go south

Once I got home, I felt like I was improving for a few days but then this stopped. My hip felt sore, and the shifting or offset thing was happening more often. Getting onto a toilet seat was horrible, just the worst, because as my femur hit the seat, I'd feel this terrible sudden motion. Not really painful, but REALLY REALLY CREEPY. 

I as scheduled to see my doctor for a followup on Friday March 6, about 12 days after surgery. By the Wednesday before that I was about to call for an early visit, but then I just thought I'd give it two more days. 

The day of the appointment, the discomfort was so great that I couldn't sit in the front, mildy shaped seats of our Prius -- I had to use the bench seats in the back. We got to the doctor's office, and about 10 minutes after getting X-rayed Dr. Ferrante came in to the examining room, and to his credit, did not beat around the bush to tell me that the cup had slipped and I would need another surgery.

This was bad news, but frankly, given how I felt, I knew something was up, and bummer that more surgery was, anything to fix the creepy motions and clunks and growing pain were fine with me. Dr. Ferrante apologized for the 10 days of lost recuperation, but said that most likely he could get me back on track fairly quickly, using a dysplasia cup that could be help in place with screws (nothing would have to be done with the femoral component, which was fine). His one concern was that there might have been some acetabular fracture or issue that had caused the cup to loosen, in which case I would need revision to a conventional hip and work to stabilize the acetabulum. But he considered this unlikely.

Chris actually asked if I had breakfast -- i.e., he was willing to operate that day! I just wasn't ready for that, so I choose to go in the next morning, a Saturday, to get the cup replaced.

Long story short: a different experience this time.

Ok, a bit of a gap there. Things turned out very differently for me this time, and I've held off from recording events until I had confidence in the outcome (translation: superstitiously, I didn't want to jinx my recovery). As you might suspect, things didn't turn out so well this time at least at first.

Lots of details that I reported about my first surgery, for the run-up and hospital stay, still apply, so I will omit those. I'll focus on what was new... and different.

My surgery on 23 February went well. I made the dumb mistake of choosing a spinal block at the last minute and it was a miserable experience. For me, never again. But if you like writhing like a pithed frog, I recommend it (and keep reading).

My first trauma was that the block did not wear off in anything like the 12-18 hours I was assured was normal. By bedtime of Day One in the hospital (12 hours after surgery), there was no feeling below my knee. Nothing at all. All night long, as the anti-clotting foot-squeezers alternated their caress, it was like "these little piggies have feeling".... "and these little piggies have none." So, no, I did not sleep, at all. By 6 am, still nothing. After 8 am and breakfast, nothing. The anesthesiologist came by, and when he heard, he said "Really!?!? That's not good! We'll get a neurologist in later." Great. Damaged nerve. Severed nerve? Have I traded a sore hip for paralysis?

Fortunately, Chris Ferrante, my surgeon, was comforting and told me to wait just a bit more before we took action. Son of gun, 15 minutes after he left, and about 26 hours after surgery, my little toe wiggled! I was healed! Within an hour, my leg was back. Still, that did not make for gentle first day. 

Everything proceeded fairly smoothly after that, but I noticed increasingly that there was an odd clunk or shifting feeling in my operated leg. My doctors thought this was just soft tissue moving, based on my description. I went home on schedule, on the Thursday following the Monday surgery.