Middle-Aged Hip

Late-2011 Update

2011-12-03T22:34:00.002-05:00

Time flies. While I still at times am aware of having two mended hips (hey, I fly at least every few months), lots of days go by where I don't even think about it. In 2010 I rode the most miles ever on my road bike (4750), and I rode two centuries with my son; 2011 will be similar. I also have done some pretty strenuous fieldwork, camping, and hiking in Yosemite and Mongolia. I do get phantom twinges every so often that can be briefly worrying but they always disappear quickly; kind of a scar-tissue feel in most cases. Really my biggest issue at the moment is re-discovering that my knees aren't so hot either. I follow the news about metal ions and resurfacing, and I'm just glad to have Birmingham implants (the full Australian report is pretty reassuring in that regard).

Moving on to too-much information territory, the surgical scar from 2007 is really faint, and the 2009 double scar is getting better, although I'm not planning on a retirement that involves modeling thongs (for which the world is grateful). So, so far, so good. Even if the implants fall out tomorrow, I already feel like it's been worth it.

On surgeon error and slipped cups

2009-05-21T20:20:00.003-04:00

On the very useful and comprehensive Surface Hippy web site, there have been recent posts about slipped cups becoming a more common problem in hip resurfacing, with this problem being strictly surgeon error. Since in my academic research analysis of error is something I think about a lot, I feel the need to add a comment because of the way technical and everyday uses of the word "error" can cause confusion.

Nothing is definite and exact: all measurements and procedures will have error. Good engineering is about using the latest technology to construct something such that the error tolerances are way outside our day-to-day experience. So error is part of life in this world. Used in this way, 'error' is a value-neutral term.

If you think about all that's involved in a process like setting an acetabular cup (drilling, shaping, pounding, testing, bone quality....), some "error" is quite possible and can be expected. Experienced people will have lower error rates, but the complexity of the process and of the human body means that this rate can never be completely zero. To say it again: this rate can never be zero.

If I gave you 100 nails, and I just told you to pound them into a board, I bet you would get most of them into place, but I also bet you'd blow a few of your attempts at this very simple procedure: you'd make a few errors. A skilled person would make fewer mistakes. Anyone would in general make more mistakes if they were tired, rushed, or momentarily distracted, and fewer mistakes if they were really focused and practiced. All these are shades of gray between degrees of error.

My concern is that when people hear "surgeon error" they will tend to make the leap towards thinking "malpractice" or "incompetence" or "neglect" when they should just be hearing the value-neutral word, error. Clearly, if a surgeon has a complication rate way outside the norm, something might be up (assuming that the issue is in the operating room and not in patient selection, and that the numbers are high enough to be statistically valid). You really have to watch out for the latter - low to moderate-n statistics involving random error are really prone to runs and streaks: look at baseball as an example: with enough players randomly batting 250, a few players are always going to have a hitting streak going.

All surgeons go through training, and if hip resurfacing is to spread and help lots of people live better lives, lots of those people will be seeing surgeons who have done relatively fewer procedures. Instead, should they all, every one of them, go visit the handful of superstars who have done many hundreds of operations?

The tough thing for the prospective resurfacing patient is that you can't easily tell if you're surgeon is just riding an unlucky or a lucky streak, or if they are truly inept (or gifted). That is where high numbers do tend to help out. But you have to keep things in perspective, and beware of the human tendency to seek out zero risk - I'm sorry: but you cannot have that, because it does not exist. I think some realism and perspective is important, and at a time when you are already under stress and making lots of decisions, feeling pressed to hook up with a superstar might not be the most helpful thing, all other things considered.

I'm sure others might disagree.

Mending and on track...

2009-05-21T20:02:00.002-04:00

Finding myself superstitious after the travails this hip has given me, I've been laying low, not wanting to jinx my recovery. But at this point, I've decided to emerge from my hideaway to give this report.

My doctor has cleared me for full activity, provided I listen to my body and avoid extremes. I've ridden my road bike four times over the past 10 days, discovering mostly that I am now fat, slow, and out of shape. I also hiked up Mt. Cardigan in New Hampshire, about a 3 mile roundtrip hike with about 1000 feet of climbing on a moderately rough trial. Given all that and how I felt, I also stopped outpatient physical therapy this week, figuring that activity like I was doing plus some exercises at home would be fine, and save me some time and the healthcare system some money.

So, 75 days after the revision surgery to fix the slipped cup, things look good. I still get a little sore if I push it on the bike, or briskly mow the lawn (it's about 3.5 miles of walking on uneven terrain behind our wee little Neuton electric mower). But flexibility is good for the new hip and mostly there are lingering tugs and pains in me butt.

One tip - About two weeks ago, feeling sore after a session with the lawn, I popped one of my diclofenac anti-inflammatories that I had been using before surgery. Just one long-release pill. Wow! It just took away the soreness, and I felt great. I asked my doctor and he said it would be fine to do this on occasion, understanding that by the six-month point pain relief should not be necessary. So, if for some reason like me you have been going cold turkey on meds but you're feeling sore, try an Aleve or something like that. You might be surprised at the improvement.

I guess the only other thing to report is my blimping up by a few pounds. The scale provides the undeniable evidence of the net change (as do my riding jerseys) but I don't feel like I changed my eating habits. But about two weeks post surgery, with my weight having been stable, suddenly I just started the enblimpification. It's probably some depressingly simple thermodynamics that are the explanation (one extra cookie per day....), but the explanation I prefer is that the surgery has caused me to become photosynthetic, such that the spring weather has caused me to leaf out. Right. So now it's time for discipline and ramping up the riding miles.

Proof of two-hip status

2009-04-15T20:48:00.003-04:00

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.

2009-04-15T20:21:00.002-04:00

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?

2009-04-15T19:46:00.003-04:00

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

2009-04-15T19:35:00.002-04:00

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

2009-04-15T19:23:00.002-04:00

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.

2009-04-15T19:08:00.002-04:00

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.

Tomorrow, new hip #2

2009-02-22T13:03:00.003-05:00

As I noted in my last posting to this too-much-information blog, me hip, she be aching a lot. Whether due to lack of meds or just a final breakdown, it's timely as it makes the upcoming surgery feels more like a chance for relief, not something quasi-elective I've chosen to drag myself through.

I've been commenting to people how fortunate it is to live in a time where there are remedies like this. Maybe someday we'll look back at this barbaric procedure involving cutting and grinding and sawing and gluing and implanting, instead of some bioengineered in-situ repair. But not so long ago in human history, and for much of history, if you were in your 50's with rotten hips, you were an invalid and that would've been that. And of course, for many people in the world, that's still likely to be true. So all in all, I'll take the good fortune to be able to have this repair.

If I was headed down the ski jump during my post a few days ago, at this point I am close to the lip of the jump. The best and only forward is to go through with this. I'll report on Round Two when get back home from the hospital...

Rumbling down the ski jump again

2009-02-18T17:59:00.004-05:00

Five days until surgery. Things feel less organized this time, maybe because I'm paying less attention, or doing it while busy, or just making the been-there, done-that mistake. In any case, I've managed to get all the required pre-operative tests, donate blood to myself, and in general cue up all the needed schedule changes and such.

Because the old clunker has reached its end and because in the run-up to surgery I'm off anti-inflammatory medication, this hip really hurts. Much as I am not looking forward to the whole hospital visit and the recovery circus, I'm ready to axe this pain.

Soon I'll be in the more rarified and elite two-Birmingham club. For the first surgery, I was relieved to have discovered a concrete cause for my aches, and I was excited about the high-tech repair, though I was a little overwhelmed by issues of mortality and aging and decrepitude. In contrast, this time, knowing that this second surgery was inevitable, knowing all the steps and procedures involved, and knowing that things can work out well, the threat level seems set lower, more a level meh.

Middle-Aged Hip Returns: The Sequel of Symmetry

2009-01-19T22:21:00.005-05:00

Ayuh, things are going real well with the resurfaced hip, but now it's mate has packed it in. Over the holidays, my right hip started aching a lot. I spent lots of time standing during poster sessions at the American Geophysical Union meeting, and it really was a chore. All the old symptoms were back -- groin pain, sore lower back, pains running down my leg. The anti-inflammatory I'd been taking (diclofenac) wasn't really making any difference any more. After a few weeks of this getting worse, to the point of not wanting to ride my trainer, or even walk around much, I booted up the whole dance once again: referral from primary doctor, and then the visit to my surgeon, Dr. Ferrante in Easton PA. The result of that visit: February 23rd, I'm having my right hip resurfaced.

I can't say that the whole process is something I remember fondly, but if the outcome is anything like I've had with the left hip, this will be well worth it. I'm hoping for a pretty active summer, hence the decision to sneak in this surgery spanning our spring break (I'm teaching a grad seminar-- if I have to, I'll just drag the class out to my house and soldier on from there).

I'll report succinctly on what round two was like.

So far, so real good (left hip)

2009-01-19T22:13:00.004-05:00

A large gap in posting to this blog, but no news is good news. I had a great year riding my bike: I got in about 4200 miles, and in October 2008 I rode the Seagull Century, completing the ride at a crisp pace (for me) of about 19.5 mph. That's about as fast as I managed the ride about six years ago, and the ride include some real fast paceline intervals and some pretty frequent and rapid accelerations. I figure that at age 52 with a resurfaced hip, I'm doing pretty well.

I did some hiking over the summer outside of Tucson and also in Pennsylvania, without any issues. My visit with my surgeon in August, for the one-year checkup, was good: everything looks solid and in good nick.

Sometimes I do still get a small twinge in the resurfaced joint; it feels like I'm pulling scar tissue. And sometimes (but less often) I'll feel a small clunk, like when slumping in a chair and then dragging my heel back (I guess that pulls apart the joint just a a little). But really, I can't say that I notice the new hip at all anymore (but see next entry....).

Hip Traveling (and Status at 21 Weeks)

2008-01-01T21:03:00.001-05:00

I think I mentioned previously that I was due for some travel in early December. Here's a report.

Yes, Virginia, your artificial hip will trigger metal detectors. My itinerary was simple (Allentown to San Francisco via Chicago), so I only had to clear security once while leaving and returning (this is not the place for TSA stories and ranting about how we are surrendering our rights and succumbing to our collective fears, though that is a tempting topic...). Overall my experience with security was ok, but I'd guess that any one person could end up being treated far better or far worse than I was.

I traveled without any card from my doctor or copies of X-rays. There's no way you could expect security personnel to accept those cards and not do a search. I left plenty of time, and in each case the search took maybe 5-10 extra minutes (but see below). My single Birmingham prosthesis set off the normal walk-through detector. At Allentown I was directed to a screening area, where I was offered a private screening, which I declined. I had to wait for maybe five minutes while they finished working with and then helping an elderly lady put herself back together. The search was no big deal to me but the screener does get fairly familiar so if this bothers you a lot, request the private screening. At San Francisco, a brusque agent shunted me to a weird little roped-off spot that looked like a penalty box where I waited for almost ten minutes; they were very busy and the agent made a pathetically feeble attempt to get the attention of a male screener. I'm glad I wasn't on a tight connection.

A few lessons and things you might consider. (1) Yes, leave time if you can, but realize that if you have tight connections that involve leaving security and changing terminals (say, an international arrival followed by a domestic connection), you could be hosed by the extra time required. (2) TSA says they will respect your privacy, but lots of luck if you think that you can somehow explain that to a busy and impatient agent, and somehow have the whole process be discreet: you are going to set off the detector, the agent's first response will be to ask you to step back through, and they will not be expecting you to disobey and instead try explaining something to them. So just deal with this all happening in a public setting. If it really matters to you, don't travel with someone if you're trying to hide your hip from them! (3) One thing I realized that might be a big hassle one day are circumstances where you have to move through security multiple times (cancelled flights, etc.). If nothing else, popping out of the secured gate area will be that much bigger of a hassle. (4) On a related note, be prepared to set off metal detectors at all other places that employ them, not just airports. (5) In the case of international travel, especially to developing countries, I would definitely bring some sort of doctor's card plus a small image of a hip x-ray. When I think of traversing security on domestic flights I've taken in China, some visual evidence of your implant could really help if there is a language barrier. (6) Given my experience with just two screenings, one thing to keep in mind at a busy screening area is that if you are traveling alone, try to keep an eye on your belongings as they travel through the x-ray. You'll be unable to pick them up until you're done with your manual screening, so valuables, laptops, etc., plus your shoes, will be elsewhere for a while.

It's now some 21 weeks since surgery, and all is still well. The new hip feels good, with a few clunks now and then, and my unrepaired hip continues to lobby for its turn. I had a slightly odd experience when I laid down to retrieve something that had rolled under my bed, and while on my stomach, I somehow felt like I pulled something near the repaired joint. It kind of freaked me out (I wasn't twisting or anything odd) and it ended up feeling like a set back in terms of stiffness. But nothing dramatic happened and after two weeks I'm back to feeling fine.

For any reader who has cycling interests, here's some performance-related information. Understandably, this was my lowest-mileage year in a decade: I managed 2712 combined miles between the road and the trainer, with many more miles being on the trainer than normal. Still, given that I had the hip replaced in August, and that starting in late May I was pretty much crippled, 2700 miles feels pretty good. Of those 2712 miles, I managed 942 miles in the ~5 months after surgery, 211 of them on the road, after recovery but before cold weather. In the two months before surgery I managed only 282 miles that were pretty lame; in the five months of the year before that, I was able to do 1488 miles before my trip to Hong Kong and the rapid decline in my hip. My first (tiny) trainer ride took place 16 days after the operation, and my first road ride (of 15 miles) took place 51 days after the operation. I could have ridden outside sooner than that, but I didn't want to take the risk of falling onto the repaired joint, or encountering some environmental or traffic condition out of my control that would demand excessive torque or twisting. It was hard not to ride, but a femoral neck fracture is not worth it!

I have a follow-up visit with my surgeon next August 19th. I've already posted tons of too-much information, and I think it's time for some radio silence. I'll report any major changes or incidents. And, as is seeming likely, given the decline in my other hip, if I opt for surgery in June or July I'll report on the run-up to that.

I hope all the details and reports I've posted have proven helpful to others facing the decisions associated with hip surgery. So far I am really glad I went ahead with the procedure. I really can't remember what the pain on my left side was like (it is just gone), though what I'm feeling in my other hip does help me remember how much of a difference the surgery made. Good luck to you if you're in a similar boat!

14 Weeks: Report

2007-11-16T00:10:00.001-05:00

No news is good news: things are still going well. What triggered this posting was my ~3 month followup with my surgeon. I'm walking basically normally (my doctor sees a slight limp but that might be just the way I walk, or my other hip acting up). I stopped therapy in early October as I found I needed the time to get fully back to work, plus I felt that I could do the exercises at home just as well (I spent about $80 to buy some of the key PT bits like ankle weights, "standing foam", and such). The weather has turned cold after a long and strange warm spell, so I'm off the road bike and on the trainer, back up to 17 to 18 mph an hour, getting close to where I used to be.

I feel the occasional twinge or tightness around the new joint, and I still get some soreness around my quadriceps, but that is fading. At times the joint will shudder a little, probably something to do with lubrication. And if I put the joint in tension, say by stretching out my leg, and then dragging back my heel, there's just a wee creepy feeling, almost like a suction (which it probably is, if you think about it). The doctor feels that is normal, and may diminish. Finally, I still feel a little weakness or lack of fine control if I relax my bent leg: it feels a little floppy. So, I'll keep up some of the PT exercises.

I'm sure anyone that has read this far is desperately wondering: what about the u-trou test? Passed! I can comfortably drag on boxers or socks while standing, with no risk or feeling I might go down in a heap. Such a milestone.

At this point, the one lingering outcome of all this year's hip fuss is that the 15 or so weeks of little or no exercise before and after the operation did bring up my weight by about 8 pounds from where I'd usually be at this season. With cold dark weather coming and just the trainer to ride, I'm a-feared that Thanksgiving could be scary unless I seriously start to put a sock in it. Of course, this could be due to middle-aged metabolism, not middle-aged hip.

My next scheduled doctor's appointment is next August (!). I've been cleared to do anything, with no restrictions. I'll probably not post much more to this blog, unless something particularly good or bad happens. Fact is, my right hip is clicking, twinging, and moaning, and my doctor says it really does look bad. So who knows, before August, I could be posting Middle-Aged Hip Returns: The Sequel of Symmetry.

Oh... the only other thing that's looming is my first air travel since surgery. Security will be fun. Maybe I'll post about that experience...

Eight Weeks

2007-10-01T19:33:00.001-04:00

It's eight weeks to the day since my surgery. That seems like a good reporting point that might interest people.

This past weekend I put in two rides of 17 miles each, and managed the second one in about 15 mph. That's getting better, and now it's just a matter of restoring fitness, losing some pounds, and just plain riding the bike. I experienced no soreness in or around the repaired hip. I did feel more twinges in the other hip than I would have wished for: it looks like some planned obsolescence is striking, and the odds seem good that I'll be treating the other hip sometime before too long.

I'm still slightly tentative with my left leg (avoiding even little hops, and guarding it from large twists) but that may be in my mind as much as a physical limitation. I am walking as normally as I ever have, and any limping is due to my untreated right hip. The muscle trauma in my quadriceps continues to fade but is still detectable, just a bit. Mostly I can pass my Underwear Test: standing on each leg and pulling on pants is now fairly easy, although I have to concentrate some when balancing on my left leg. For clothing as grabby and stretchy as cycling shorts, I'm still being a little careful.

All in all, I'm feeling remarkably well and recovered, not just from the surgery, but from the hip trouble itself. I'm still skeptical about some of those reports about walking easily and unaided only two weeks post-op, but at eight weeks, I'm feeling energetic, strong, and confident.

Eight weeks is also a good time to throttle down this blog. I'll continue to report monthly, or if something special comes up. But for now, I'm going to focus on NOT thinking about the middle-aged hip!

Day 51: Back on the Bike

2007-09-26T19:35:00.001-04:00

It's been unseasonably warm and pleasant here in eastern PA and I've been watching the weather with a growing itch to get on the bike. I figured I'd wait until I was fully eight weeks past surgery, which would occur after this coming weekend. But today, I just couldn't take it anymore: I couldn't get a slot for physical therapy, so I headed home to exercise and ride the trainer in the basement, and then I just decided to go for it and take a road ride.

First of course, I had to find all my riding stuff (gloves? what gloves?), replace a battery in the cyclocomputer, etc etc -- I'm always clumsy and inefficient at the start of the riding year, and this is what this ride was like. Plus, as I mentioned in another post, I've been less attentive to natural things like the weather and sunset, so I got off to kind of a late evening start...

I managed a very comfortable 15 miles in 65 minutes. I know that's s l o w, but I didn't want to push things, and it's been 14 weeks of little exercise since that last crappy, sore-hip, rain-drenched ride that marked the end of my riding. Plus, I'm 8-10 pounds over normal summer weight and frankly I'm out of aerobic shape.

But at last! Back on the bike! It felt great: no pain (on my left side), no problems with balance or stiffness. I still have a little bit of a knot in my left quadriceps, but wow, it's just feels amazing to feel so much better, so soon.

The Hip Gets the All-Clear

2007-09-12T17:54:00.001-04:00

Yesterday on the 11th of September, five weeks and a day after surgery, my surgeon give my hip the all-clear: I can jog, hop, and ride without restrictions. That's great news, although I think I'll hold off on the hopping. My doctor did prescribe more therapy, as I'm still a little stiff and especially if I've been sitting for a while, I walk with a rocking gait at first (technical name: trendelenburg gait). He thinks this is due to some residual weakness in the hip region, possibly because my abductors were weak even before surgery tweaked the region.

I'll be taking aspirin only through the coming weekend, then I'm done with that.

With the no-restrictions news in mind, I pushed a little harder on the trainer yesterday: I comfortably did 10 miles at 16 mph, pushing a harder gear. Not exactly fast, but progress.

Before and After

2007-09-06T22:20:00.001-04:00

I'm trundling along, using a cane for longer distances and otherwise nuttin'. I still feel some tweaks high around the hip that keep me from walking normally at times, especially after sitting still for a while (I feel best right after the stretching in therapy, despite the exercise). I'm not quite ready to stand on my left leg and risk the mortification of tumbling to the floor in a tangled pile of legs and half-engaged u-trou.

BUT... the purpose of this post is to show you the before and after X-rays. That's what you've been looking for, right? One image was taken a month before surgery, and the other 10 days after.

Day 28 - Four Weeks In

2007-09-02T22:00:00.001-04:00

I was feeling like I was perched on a plateau, but I have been gaining some flexibility and strength. On Friday (two days ago), the elevator at work was gummed up somewhere, so I hiked up to my 4th floor office using the stairs, walking fairly normally. Yesterday we did a half-mile walk around the neighborhood, and I managed it without crutches, walking in style (in my opinion) and "a lot better" (in my wife's opinion). Anyway, for sure I wasn't waddling. I also got in 25 minutes on the trainer and today made it 30 minutes at over 15 mph. Aside from lacking some strength overall and definitely in my left leg and hip area, the main thing I notice now is some ligering tightness, and stiffening up if I sit still for a long time.

It's only been a month since surgery, so I'm feeling pretty good and optimistic at this point. Given statistics about femoral-neck fractures tending to happen in the first two months, I'm glad I'm halfway to that vague milestone. I also feel like I need to reign myself in and not overdo it until I'm further along.

Day 23 - Plateau and the Song of the Open Road

2007-08-29T18:53:00.001-04:00

Just a little more than three weeks after surgery, I'm now able to walk for fair bit without any support from a crutch. But after PT or a more active day scuttling around, I get tired and a little sore, which reverts me to a rolling, limping gait. Also, now that I'm more active and not on any anti-inflammatories, my right hip is making itself known (the silver lining of which is that I can compare and see how much better the new hip feels). Overall I feel like I'm on a small plateau, doing ok but still with considerable rehab to do.

The other thing is that it's just gorgeous riding weather, and I miss the bike. I realize that one great thing about the bike is that it makes you more aware of details like the weather: the temperature, wind, and rain all matter a lot, but not if you just blob around in your car. So I'm eager to get back, because I've just been blobbing around in my car for too long.

Oh, Right, About the Pain

2007-08-26T13:24:00.001-04:00

Sorry to get so caught up in all the details of surgery that I omitted one important report: what about the pain that I was trying to defeat in the first place?

Well, it's gone! I guess because there is still some stiffness and soreness in my left leg, I haven't been paying attention to this important point. In fact, I've already forgotten what the arthritic pain was like. The only small reminder are some complaints from my right hip, which will probably need work one day before too long.

Thinking about it, it really is astounding. 20 days ago I was limping and wincing, and as most hip sufferers will know, the referred pain - up and down the leg, in my knee, in my groin - was frustrating, widespread, and random. I was getting concerned that my limp was aggravating my knee, such that after surgery, I would have a great hip but a rotten knee and thus no net progress. Not so. All those pains have vanished.

Day 19: Progress! Stairs and Bike!

2007-08-25T17:44:00.001-04:00

Yesterday evening and this morning saw two big advances. First, I found myself able to walk UP stairs leg over leg, with only minor assistance from a railing. That doubles my ascending speed(!), and means my quadriceps muscle must be coming around.

And this morning, I got myself onto my wind trainer and rode for 20 minutes. I actually raised my heart rate! And sweated! A whole 3.5 miles!! Not exactly like riding a century, but I see a way forward back to fitness. Woo hoo!

Of course, I was careful to have a little platform to help mount the bike, and I alerted my sons to check on me should I fall and not be able to get back up. I'd been worried that twisting out of the clipless pedals might be hard, but it wasn't a problem. I did feel a little winded and dizzy at higher spin rates when I was down in the drops, so that will take some work. But overall, great to finally get some exercise.

Day 11: Freedom to Drive: Outpatient Life

2007-08-25T17:42:00.002-04:00

On August 17th, 11 days after surgery, I visited the surgeon's office and got the great news that a new X-ray showed everything looks good. The implant looks like a mushroom: I can't wait to deal with TSA at U.S. airports. As my left hip was involved, I was given the green light to drive (one of our cars, the Prius, is an automatic, so the left leg just has to cope with the parking-brake pedal).

Free to drive, I switched over to outpatient physical therapy, planning to go about 3 times per week. It's good to get some exercise and begin to push the leg with concrete goals like cycling and stair-climbing in mind. By about the 22nd, I was mostly getting around using just one crutch for a little support. On the 22nd, at PT I actually rode an exercise bike for about 2 miles worth of spinning.

Here's a timeline of how things progressed for me:

Day 0 - surgery; up in recliner
Day 1 - cathether out, first PT session, walking with some weight-bearing and two crutches; quadriceps stiff
Day 2 - PT twice, antibiotic IV done; some swelling in leg
Day 3 - discharged to home
Day 4 to 6 - quadriceps sore; swelling in leg; evening fever and some depression; just occasional Tylenol and one nightime Vicodin for pain. Took short crutch-assisted walks in neighborhood (maybe 500' total),
Day 7 to 9 - more energy, more flexiblity
Day 11 - visit doctor, ok to drive
Day 13 - maximum likelihood of blood-clot problems is two weeks after surgery; so far so good
Day 13 to 15 - start outpatient PT; participate in off-campus retreat for new program I am running
Day 16 - go back to work for a half-day; able to walk down stairs leg-over-leg
Day 17 - full day at work, several meetings
Day 18 - start this blog, discover that I can walk up stairs, ride 20 minutes on wind trainer (low resistance spin).
Day 19 - basically off all pain meds, including Tylenol. Am just taking 325 mg of Aspirin twice a day as pain killer. Back on wind trainer again, and am walking shorter distance around house without any crutches.

Day 3: Home from the Hospital

2007-08-25T17:41:00.001-04:00

We have a two-story house, and it turned out to be no problem to live on the second floor. I was able to crutch up stairs without problems, and since the renovated bathroom, the bed, and our best easy-chair recliner were up there, this way I could withdraw and rest. Descending for meals and visits by the therapist and nurse made for some variety.

I set up a recliner next to my bed, and gathered together some pillows, a big mug of icewater (you'll be thirsty for quite a while), reading material, cell phone and cordless phone, and my laptop (we have wireless, which is a great boon). This made for a pretty comfortable base with lots of options. Bless the recliner - it was home sweet home for a while.

I grew to hate the phone, because inevitably I would forget to schlep along the handset, and as I was expecting calls related to nursing visits and such, I could not ignore the wretched thing. So if you hate cold-calls by solicitors anyway, wait until you have to wrench yourself out of a chair, hobble to find the phone, and then enjoy a recorded message from some dufous...

You will probably have arrangements made for a visiting nurse and physical therapist. It's nice to be able to talk over your condition with someone, and to start work on mobility and strength. My therapist made a very good point about not rushing things: form, balance, posture, and gait are important. If you were limping before the operation, it may have been a long time since you've walked normally, and the goal of the operation is a restoration of full activities, not merely a return to gimphood. I know different people will heal at different rates, but I wonder if some of the miracle reports about people walking unaided after a week need to be asterisked: are they walking smoothly, or limping and gimping around?

A few things to know about:

First, it is very easy to feel lightheaded when you pop up out of a recliner, especially if you get into the shower and have nice warm humid vapors around. Make sure you have a place to sit or someone to help you, certainly the first time or two. Note that this is true in the hospital as well: be careful about trips to the bathroom, etc. You really don't want an uncontrolled fall onto your new hip.

Also, apparently it is common to experience post-operative temperatures in the evening, and you might find yourself with minor chills, sore skin, lower energy, or whatever symptoms you show when you run a temperature (we're talking numbers between 99 to 100 F, not the higher values that might indicate an infection and the need to contact your doctor).

Sleeping sucks. Until you get loose enough to roll over onto your stomach you're kind of stuck sleeping on your back or non-operative side, and for me that is a position that turns my brain on, not off. A pillow between the legs is not required for Birmingham people, but helped me when I tried sleeping on my side. Even once you can sleep in any position, I found that there was just enough tightness or discomfort that I would only sleep in blocks of 90 minutes or so, with lots of twisting and turning, which did not help my wife sleep. For a few days I reverted to taking a Vicodin at bedtime, but then I saw the recent news story about ramapant abuse and I decided to stop. If you can at all help it, do NOT nap during the day.

Finally, I felt - and apparently this is not uncommon - quite despondent and depressed for one or two evenings once I was back at home. I still felt sore, and incapacitated, and just miserable and sorry for myself and sorry to be causing such a fuss for everyone. This feeling passed as my energy returned and things healed up. So if you feel this way, tell people, but don't worry: the feeling is likely to pass.

Surgery and the Hospital Stay

2007-08-25T17:20:00.002-04:00

On the day of your operation, you will probably be asked to get up at an unearthly hour, take an antiseptic shower, and report to the hospital for admission and preparation. This is one time that you do not need to worry about lack of sleep, I promise you.

I chose to avoid a final decision on anesthesia until meeting with the surgeon on the morning of the operation. Everyone was 50-50 about using a general versus a spinal. I decided that I had no interest in seeing the operation, even if my memory would get wiped. And, as it turned out, if the surgery takes extra time, like mine did, then a general is the better choice. You'll have to make your own decision based on your condition and the advice for your doctors.

If you've ever had surgery of an kind, you'll know that one minute your wheeling along in a cart on the way to the OR, and then suddenly you're groggy and on your back in a different place. My surgery (on Monday 6 August) took over two hours because the surgeon needed to work a little harder due to my hip dysplasia.

I had been told that Birmingham patients do PT on the day of their operation. Well, sort of. It consisted of being moved out of bed to a recliner, maybe 1 meter in distance. I almost passed out on this long journey. Impressively though, my surgery ended at 10 am, and by 2 pm I was in the recliner, awake. My family visited and watched while I picked at my dinner (I had ordered the meatloaf selection as comfort food, but my appetite was beyond comfort, certainly any comfort that meatloaf could offer).

When I awoke, I had a urinary catheter, an IV for pain med, antibiotics and fluids, and a dressing on the incision but no surgical drain. The wound was closed internally by dissolvable stitches and externally by steristrips (compared to other Frankensteinian sutures I've had, the closure was gorgeous and tight; too bad this is not the most photogenic and oft-displayed part of me!). The catether came out the next morning (no real pain), the dressing got changed daily (no real pain), and I did PT morning and afternoon starting Tuesday afternoon (no real pain). Constantly asked about pain on the 1-10 scale (WTF is a 10 supposed to be: slowly being crushed by a truck??), I never went beyond about a 4, thanks partly to the opiates, including morphine over the first two days. Probably the most pain I had were brief sharp tugs in the area of the incision; these diminished over time as the wound healed and the sutures adjusted.

By the way, there are various ways a surgeon can access the hip, but if your view of the hip is of the hands-on-your-hips variety, you may be surprised to find your incision is on your ass as much as anywhere else! Hip surgery = ass surgery.

One thing to be prepared for is an unpleasant norm for post-operative, opiate-filled life: constipation. They give you some palliative stuff, but really, in my experience from years spent traveling in remote areas and using various "stomach" remedies, once an opiate gets into you, your intestines just go on holiday, extended holiday. What made my life worse was the toilet extender they had perched around the hospital toilet. I am not a huge guy, but sitting in there pinned my legs together in such a way that even if something was maybe gonna happen, nothing was gonna happen. I had to get home to find relief. If you're lucky, this will not be your experience. Moving on...

The biggest post-operative issue I had and am still getting over is the trauma to my quadriceps. If you have the right constitution, find one of the detailed surgical videos posted on the web and watch the Birmingham operation. You'll see that fairly early in the procedure, Igor the Assistant gets the word to dislocate the hip, and this involves a rotation of the leg that ain't natural. Your leg is twisted in a weird way, the femur is exiting the incision and I assume pressing up against connective tissue and muscle, and you are unconscious and not in a position to say 'ouch -- I'm cramping'. That goes on for like two hours. So I found that while I could bear weight on my hip, and right from the start could walk on my left leg with a walker or crutches, my quad was shot, and any attempt to raise it, say in a straight leg raise, let alone climb a stair, was hopeless. I don't know if this is just something that happened to me, or is common to hip operations, but I was a bit surprised. I thought that all the pain and trouble would relate to the incision and the cut tissue there, but that has not been the case.

I was discharged on Thursday (Day 3) and was able to crutch to our car (a Prius, with nice high seats), comfortably get in, and escape to home.

Run-up to Surgery

2007-08-25T16:59:00.002-04:00

Your experience in the run-up to surgery and during the procedure itself will vary enormously. So again, I'm just reporting my path.

If you've never had major in-patient surgery, you'll be impressed by the numbers of steps involved: scheduling tests, arranging referrals, and meeting with individuals. You'll need your personal physician's clearance for surgery, including an EKG; you may want to donate blood to yourself (autologous transfusion); you'll need a chest x-ray (inexplicably, a separate referral needed); you'll confer with the anesthesiologist; and you'll likely get involved in a pre-surgical information program. Plus, you'll be advised to buy some necessities to make life easier when you get home.

"Joint Camp" at Easton Hospital is a nice idea: you meet your approximate cohort of victims and you get a briefing and a chance to ask questions. Although if you're reading this blog, you'll probably have done lots of web research, it's still nice to talk to the supervisor for your care, and the physical therapst who you'll be working with. Also, this Jointworks Program has rallied all participating doctors to use similar protocols, simplifying andf streamlining care: this is good, because confusion in a hospital is bad.

One downside is that for the moment and for the next few years, resurfaced hips are still a novelty, and in orientations, in the hospital, in PT, and elsewhere, people give you conventional info and treat you overly conservatively. That's not dangerous, but it does leave you feeling a little underinformed and confused about YOU can and cannot do. The only solution for this is knowledge, and being a squeaky wheel.

Some pieces of advice about the immediate run-up:

I would delay buying the recommended "hip kit" until you see how you're doing and how home care is going. A hip kit is usually a sponge-on-a-stick for washing the lower half of your body, a sock-donner, and a grabber claw. The claw is fun and my sons and I enjoyed clawing things (think "Toy Story"), but so far I have only used it once when I dropped my glasses behind an easy chair, and was home alone. I could bend enough to wash all but my lower left leg, and hell, water was good enough for it, so my sponge-on-stick stayed unused. As for socks, it was summer and I wasn't going anywhere fancy, so a sock device wasn't critical. That said, it can be a little tricky and uncomfortable to get a sock on for the first 3 weeks, but not worth the device, at least for me.

You will probably be urged to use a walker in your recovery (you will be happy to use one at the hospital). I was too vain to be attached to such a device long-run, plus I wanted the greater mobility of crutches, so that's what I opted for. I had my wife bring the crutches to the hospital so that I could work and practice with them during physical therapy.

Either before surgery or while at the hospital you will be helped with arrangements for getting some sort of toilet-seat extender. These devices vary greatly. Without getting into the details, some of these suck, for a variety of reasons. I would wait and see how you are doing at the hospital: if you get resurfacing done, you might not need a higher toilet. In my case, we had happened to renovate our bathrooms recently, and given that everyone in the family was grown and no one is getting younger, we installed ADA-grade toilets that are a bit higher (I think 17 inches). This turned out to be more than fine for me, so I didn't bother bringing in any extra appliances. We also have a shower with only a small tread to step over (i.e., not a tub), and the shower has a separate hand-held unit, so that worked out well, too.

Finally, even though you might begin to feel like you are obsessively hogging attention with all your hip talk and endless blah blah blah about surgery, talk to people about your concerns and fears. I really began to feel spooked: (1) there is some finite chance of dying in all surgery (even if the hip-surgery odds are probably skewed by the traditionally older clientele); (2) even though you need the surgery, it still feels elective, so you are bringing down all these hassles on your family and on yourself, by choice; (3) the outcome is not 100% certain; and (4) somehow compared to past outpatient knee jobs and minor repairs, this surgery felt to me like some kind of life threshold, a gateway to old age and never-ending strings of medical procedures (if you're getting resurfacing done, most members of your cohort are going to be older than you). These are natural reactions and concerns, and your best way of dealing with them is to talk them out.

Once you wake up on the day of surgery, you're heading down the ski jump so things will go fast, and the only elegant way out is forward....

The Decision

2007-08-25T16:14:00.001-04:00

With a referral in hand, it was time to select some surgeons for a conference and to get informed about options. But ah, the web: so much to draw from, so random in its coverage. And ah, healthcare in the US: so much technology, so many constraints and bureaucratic complications...

Luckily for me, I follow cycling and so knew of Floyd Landis and the Birmingham hip. Or at least, I knew that he had had a replacement-type procedure that was well-suited for an active person. What else did I "know"? Hip replacements were for the aged; hip replacements were common and bring many people relief. But now, despite years of hints that this was coming, I felt ill-prepared to confront some important and pressing decisions about treatments and options.

We still had HMO coverage because of our two sons: I had always joked about switching to Blue Cross when the day came for old-age repairs. Well, oops, there I was, a member of Keystone Healthplan Central, which does very much NOT include all the practices in nearby New Jersey, and all the great hospitals in Philly. So reality #1 was trying to pick a surgeon from among those available. Based on some fairly random informal advice, I visited a first doctor, intending to go for a second opinion depending on the nature of the initial visit.

This first visit did NOT go well. After an interminable wait in the reception area and then the holding cell, the surgeon breezed in, told me I had osteoarthritis, but said he doesn't do hips! I would have to make an appointment to see another doctor in the practice! Grrr. A week later, it's the same tedious waiting-room drill, then a new doctor. He gave me a cursory poke or two and then announced what he was going to do with me. Very patronizing, not supportive, no options. He dismissed resurfacing, giving no reason (like, maybe he was't trained in it?), and he just told me that I would get a conventional hip using a ceramic prosthesis.

I rocketed out of there convinced never to return, but not much closer to making an informed decision. It was obvious that resurfacing was something that would take some sleuthing, so I used the Birmingham web site to locate local doctors who did the procedure and were in the HMO system. At the time there were only two, one in Reading (too far away), and one in Easton (not perfect but ok). So off I was to see Dr. Ferrante at Orthopedic Associates of the Greater Lehigh Valley.

Here's some advice that will matter most if you live far from a major city or have a more restrictive insurance plan: if you would like hip resurfacing to be an option, you MUST search ahead, because doctors will not necessarily clue you in to every available option (obviously this will vary among physicians). Jumping ahead in this tale, on two occasions after my operation, I met relatively younger people who were seriously bummed that they had not been told about resurfacing and were now facing some of the flexibility limitations that go with conventional hip replacement, plus the longer-term issue of possibly needing revision surgery later in life. You need to have a dialog with your surgeon, because resurfacing is not for everyone, but you also need to find a doctor for whom it is at least an option.

Anyway, the visit with Dr. Ferrante was great; he gave me all the time I needed to ask questions, and was open and honest about the pros and cons of the various options (waiting-and-coping; conventional hip but with larger metal or ceramic parts; or resurfacing). The only drawback: although quite experienced in hip surgery, Dr. Ferrante had only done three Birminghams.

It took me about three days of cogitating and web-reading to make the decision. I wanted the mobility and return to athletic activity that the Birmingham hip offered, plus given my age and activity level, the ability to replace a worn part with conventional surgery is a huge plus: while many web sites talk about revision surgery as "more complicated" you have to realize that to extricate the old implant pounded into your femur (and held in place by cement or more likely bone growth) requires a lot of surgical work and messing with your femur: that was not something I would want at age 70 or 75 or 80. I was willing to live with the long-term uncertainty about metal ions, and as far as my doctor's limited number of procedures, two factors weighed in. I felt too incapacitated and in too much pain to wait nearly a year to first change insurance plans and then find a new doctor. And, I decided that I would go with Dr. Ferrante's overall experience in hip surgery, even if not in resurfacing.

If you visit website like Surface Hippy, you'll see lots of advice not to do this, and tales of woe stemming from inexperienced doctors. Well, fine, but the basic rules of math say that no one gets to 200 without going through five, and I personally find it maybe a bit off-putting to operate on the principle that some other suckers are welcome to take the risk of the early surgeries every doctor has to perform. The other thing is that if you look at the numbers, the statistics are real marginal in terms of significance, and in a multivariate context like major surgery, it is quite hard to tease out simple cause-and-effect. I'm not against experience by any means, but it's my opinion that asking some fairly technical questions and getting a context for how a surgeon works can be an important and useful way to establish your comfort level and make a decision.

So I signed off on consent and scheduled the surgery for August 6th.

The Backstory

2007-08-25T14:09:00.001-04:00

Let's set the stage for this hip story. This will be a longish post, intended to let you compare yourself to my case to see if anything jives. If you're more interested in the surgery and the aftermath, you might want to skip this too-much-information report!

I'm a 51, male, and a college professor. To counteract the sedentary lifestyle, I try to road bike 4000 miles a year, which between travel and meetings, and the darker winter months here in eastern Pennsylvania, is about all I can manage if I include trainer mileage and can throw in some longer summer rides. I love cycling, and given the state of my knees (and hips), it's the perfect exercise. I've never raced, but I try to average 15 to 17 mph on the hilly rides around here, which I'm proud of even if it's a snail's pace for really good riders. All the riding allows for robust eating and the chance to work out the tensions that accumulate at work (even professors bear their crosses...). I'm 5'10", and seasonally fluctuate in weight between about 202 and 212 pounds with a fat content of about 25% (at least according to a Tanita scale in standard mode). (I told you this post would be boring!). The other reason I try to keep active is that for quite some time now my research has involved field work in the Himalaya and Tibet (see www.ees.lehigh.edu/groups/corners), and even in teaching we lead field trips, so being fit is important professionally as well as personally.

As I recently learned, I have mild dysplasia in both hips and considerable osteoarthritis, partly as a result of the dysplasia. The angle of my femoral neck is also quite shallow. Before my hips became the main focus of my joint discomfort, I was more worried about my gimpy knees, which are missing some ligaments due to untreated ultimate-frisbee accidents in grad school and in retrospect, too much jogging and running (leaping down trails in the Presidential range; humping out heavy packs of rock samples, all the dumb things we do when young...). Interestingly, I've been told by my doctor that the state of your knees is pretty much your fault, but for the state of your hips you can blame Fate.

It's hard to know when the hip pain began. Probably about 7 to 8 years ago I started noticing stiffness in my groin and my thigh after a hard day trekking. Also, standing or shuffling about, like at art museums or during poster sessions at professional meetings, really started to hurt to the point where I was starting to avoid such events. But biking did not cause pain, leading to awkward explanations about why I could happily ride 50 tough miles, but would start whimpering if threatened with a visit to MOMA.

About three years ago, a sampling trek in Tibet went wrong: we thought a route might gradually head up a glacial valley, but instead went straight up a vegetated cliff. It was a desperate few hours, requiring big lunging steps and unforgiving foot placement, and by the time we got up and then back down, I literally could not walk due to the sharp hip pain. When I returned to the US I saw my GP, and she diagnosed osteoarthritis. She put me on two forms of Diclofenac (Voltaran and Cataflam). It was a miracle: little pain, much improved range of motion, and I could ride my bike or play 18 holes of golf walking and carrying my clubs.

Time passed, and gradually the NSAIDs weren't working as well. Walking a round of golf was a crap shoot in terms of pain, I was avoiding museum-type standing, and meanwhile I was wondering about the long-term wisdom of eating the Diclofenac twice a day. In late 2006, at the end of the bike season I noticed that at the end of longer rides I was feeling very sore, and I was backing off agressive attacks on rises and hills. When the 2007 season started, the soreness was still there, but worse.

Then in May 2007 I went to a conference in Hong Kong, and it was nearly a disaster. Getting off the long flight, I could hardly get through immigration, and the daily walk to the conference and the standing around were just crushingly painful. When I arrived back at O'Hare, I honestly thought I would have to declare a medical incident and ask for a wheelchair to get to passport control. In the weeks that followed I could only walk with a painful and obvious limp. When I tried to ride, anything more than 10 miles left me very sore, and I couldn't push any power through my left side. The pathetic finale on June 18th was an attempted 15-mile ride where I got caught in a thunderstorm just as my hip gave out: I bailed, and crept home in a downpour, trying to spin granny gear long enough to get home.

I revisited my GP, who had me go for X-rays, and after seeing them, said she was sorry, but really the only thing to do was to see an orthopedic surgeon.

Welcome and Background

2007-08-25T13:54:00.001-04:00

I'm starting this blog 19 days after enjoying Birmingham hip resurfacing. My goal is to record my experience with this procedure. This includes my decision to go ahead, my concerns and questions, and finally my still-ongoing journey through the procedure and its aftermath. This will be an intensely boring and uninteresting story for most people - except those aching souls who find themselves with a sore hip and the dawning realization that they need to do something about it.

I'm targeting active, athletic middle-aged types who are finding it a little hard to believe that they are facing a major operation, and who are trying to navigate the piles of material on the web, which amounts to a tangle of dated material, excerpts from technical medical studies, and mostly, information for more elderly people who are looking at conventional hip replacement (but see the surface hippy site as an exception!).

It's important to realize that I'm not a medical doctor: I have a Ph.D. in tectonics and geochemistry, and this just makes me dangerous, not an authority on medicine and orthopedics! It's likely that other people have reported things better, and it's nearly certain that your hip and your condition will leave you facing details that will add up to a different experience. So please, treat this as one person's story, n = 1.