Part 1 of my Hip Replacement Series
This is Part 1 of my Total Hip Replacement Series. Part 2 talks about the things I got to make life easier post operatively, what I used to help me heal quickly and the things that helped me most in coping with serious leg cramps in my surgical leg. Both parts are being written for a sibling who’s undergoing a THR in about a week. Part 3 may or may not happen so I won’t waste time describing it here unless it does!
The miracles of modern medicine extend far beyond the relatively simple confines of total hip replacement technology…yet it’s that procedure, (formally known as THA or Total Hip Arthoplasty) which continues to astonish, amaze and even inspire thousands of Americans to place their complete trust and their future’s well-being into the hands of a total stranger.
As hip implants have been refined and the techniques used to implant them have been tweaked and modified, overall success and patient satisfaction have sky rocketed. We find ourselves in 2018 at a pinnacle of modern medicine. As it tends to happen every so often in the world of medicine, once again the full reality of its miracles can’t escape our observation.
My own personal evidence? Following a right-side total hip replacement 9 days ago, I wasn’t entirely prepared for an experience which surely has been nothing short of miraculous, if only from a purely logistical perspective.
Living My Own Personal Miracle
A Matter of Miracles
A Slightly Meandering Thought
I am truly my Father’s daughter. Shortly after reading this my 92 year old Dad, who somewhat miraculously still writes often at his own website PotPourri, shared with me an essay he wrote several years back, which I had completely forgotten about.
It’s somewhat surprising that I did forget since his essay, A Matter of Miracles is perhaps one of my all-time favorites, if for no other reason than the fact that my family and I are one of the central themes in his story. But it’s just a favorite story too. At the risk of sounding annoyingly obtuse…just go read it already…it will warm your heart and make you smile.
But what really makes me smile is how much Dad and I love to find the amazingness behind any simple idea or construct. The sheer joy we share while marveling at some of life’s wonders, like this YouTube video Dad shared with me today about Amazon’s robots…it’s like no other, and no one could appreciate this like we do! It makes me realize that I could not have been easily dissuaded from writing about the miracle I got to personally experience in such a profound and meaningful way ;-)
Above: My Before & After X-rays. A Hip Replacement Involves Removing A Large Amount of Bone That Comprised the Original Hip Joint and Replacing It with a Titanium & Plastic Prothesis
How Did I Arrive at the Point at Which I Needed a Complete Hip Replacement?
A Brief Orthopedic History
My history of hip problems was a lifelong one. The moment I was born my Mom’s obstetrician noted to my parents that I needed to be taken for a an evaluation of my hips. That was done and proved to be inconclusive. But it explained why my parents weren’t especially alarmed when my ability to walk was delayed significantly because my right leg ‘buckled under’ everytime I got going.
Better late than never I finally managed to wrangle control of my errant right leg enough to successfully walk. But that same leg continued to try and mess with me and my life for the next 60 years.
Some of the ways it did so were by causing my gait to be so off that my Mom took me to an orthopedic doctor who diagnosed Perthes as a youngster. It was a ‘mild case’ of Perthes, which is a childhood onset hip disease that a friend and classmate also had. But his was a much more serious case which required him to remain in a complete body cast for an entire year at around the age of 9 years old. The ugly nude-colored corrective shoes that I was forced to wear for years, while duly hated were quickly placed in their proper perspective when I found myself carrying around the little receiving end of the electronic box which our phone company had installed in my classmates dining room. His family’s dining room would be his home for the year that he lived in a body cast.
So, although fate stepped in that time to make sure that my misery was properly mitigated, later, as a teenager wanting to keep up with my peers in sports, I wasn’t quite as lucky. Mainly because I was constantly frustrated in not being able to control that wonky leg well enough to do most of the things that I deemed important.
This historic image from 1969 documents the first total hip replacement performed in the U.S., a technique developed by Mayo Clinic Department of Orthopedic Surgery. Development of the total knee replacement technique followed in 1971. These successes ushered in a new era of hip and knee health. I was 12 at the time and my overall health was good because of Mayo’s.
Their doctors in Rochester had performed a different kind of miracle by bringing me back for the brink of death just a few short years earlier when I suffered from a random and bizarre case of total kidney failure. This followed a fall on the playground which had resulted in badly scrapped knees that had become infected with Strep B…leading to childhood Nephritis.
Things like snow skiing (downhill) and water skiing (I was part of a ski show) for example were sports I excelled in when performing left-sided maneuvers or even making left turns. But my right side was a completely different story. Probably the hardest part was my lack of understanding of the causative effect which my wonky leg played in these seemingly dramatic childhood and teenaged events. It was years later as an adult and a parent, that I began to put the pieces of this puzzle together correctly.
Although truthfully, I have to give most of the credit for this insight to an amazing downhill ski trainer who could see the blatant differences that I could only sense were happening.
Surprisingly, even though a constant theme in my life was this oft-repeated series of accident prone mishaps leading to casts, crutches, boots and ultimately surgery, which sort-of forced the issue…the abnormalities I lived with for 60 years were never really given a name. Hip dysplasia and Perthes, while bandied about, didn’t really fit as a proper diagnoses. So I gave it my own diagnoses…which is how the wonky leg descriptor came into being.
You can see in fact that my description didn’t really consider my hip to be the sole bearer of all the problems I experienced. Responsibility was equally shared with a wonky foot and a wonky ankle too. Later in life a wonky knee joined forces. That’s why, when my foot surgeon told me that he thought that I needed a total hip replacement I was in a state of total disbelief. This was something that had never been mentioned before…even as a remote possibility. The fact that the leg of my surgical foot was pointing in a 90° angle away from its proper direction, that it stubbornly refused to be forced back into its proper alignment, and that it had begun something which I imagined closely resembled my early childhood ‘buckling’ problem notwithstanding…my immediate reaction was one of shock and disbelief.
What Makes Hip Replacements the Modern Day Miracle of Medicine in 2018
First it’s Because Present Day Hip Replacements Are Very Different from Their Predecessors
Almost every aspect of this surgery has been optimized from its 1960’s origins.
Advances in anesthetic techniques make the procedure much less painful while decreasing side effects and dependence upon opioids, which allows patients to walk more quickly after surgery (usually within 4 hours) and to leave the hospital earlier (often the same day or next day.)
Improvements in procedures which tend to cause less internal damage and use smaller incisions means that healing times are greatly reduced.
For example, many of the newest minimally invasive, muscle sparring procedures used today may require much greater surgical skill and technique, and sometimes even specialized instruments…but their resulting shortened window of rehabilitation makes them attractive to younger generations. As a result there’s been a significant increase in the overall number of procedures performed. The average age of patients undergoing joint placements including both hips and knees is decreasing too. Patients in their 20’s, 30’s and 40’s…once almost unheard of, are commonplace today.
So these new procedures, coupled with a lot of advances in the reliability of the prothesis that are used today are what’s moved this type of procedure from the medical marvel category to that of miraculous.
2nd it’s because people who would once have been crippled by arthritis for the rest the of their lives can now go on to lead normal, active and highly productive lives.
People who are younger are increasingly undergoing both hip and knee replacements, and some recent studies are even showing that these types of procedures seem to increase overall life expectancy by a small amount.
When I was researching the type of procedures that are used today I encountered roughly 30…but those fall into larger general categories which Mayo’s wrote a nice overview of last year that I’ve shown below.
The type of hip joint implant which utilizes metal stems and polyethylene cups or the newer highly cross linked polyethylene (HCLP,) which are afixed to the bone without cement, appear to cause the least number of long term problems by withstanding unexpected wear better and exhibiting less part failure, and less long-term biological implications. Also Ceramic joint surfaces can reduce friction and avoid the chance of metal corrosion in the joint. The combined results of these improvements mean that a new hip joint should function well for many years…quite possibly much longer than the original estimates of 10-15 years.
This is especially important for people in their 20’s, 30’s and 40’s…who have the most to lose from typical implant problems like wear particles being distributed internally and tissue irritation like pseudotumors. This 2014 article does the best job of describing those types of problems by implant type.
B. Sonny Bal, M.D., writing for eMedicine wrote a great overview of the entire minimally invasive hip replacement process pictured below and found here.
Not Your Grandma’s Hip Replacement
The ‘miracle’ aspect of modern day hip (and knee) replacements didn’t really hit home with me until I read this enlightening short blog post by a guy who’d just undergone cardiac surgery. The observations he made while still admitted about 2 other guys who we’re there for total hip replacements helped me to recognize how truly miraculous these new procedures are.
Fast Forward Back to My Present Day Decision to Undergo A Total Hip Replacement
Once my mind was made up there was no looking back.
I’d been preparing for surgery for weeks, and was frankly a little bit surprised at how much preparation was required. Through a series of online tutorials which I received daily emails from my surgeon instructing me to visit, I was instructed that I needed to get our house ready, myself ready and my life suitably placed on hold.
All told, the preparation took about a month. I approached the class, educational resources and the daily online checkin’s my surgeon required very seriously. I followed their instructions to a T (almost.) I diligently worked out specific muscle groups surrounding my hip joint. I removed any and all small rugs, cables and impediments which might cause me to trip or fall post-op. I prepared a place to sleep downstairs (which involved getting some new, inexpensive furniture,) and I practiced with my crutches so I’d pass the hospital’s test and wouldn’t be required to bring home a walker like most new hip recipients.
The Day of Surgery
In spite of all the preparations, I’m not gonna lie…the day of the actual surgery was a bit tense. But then the procedure went well and it only took about an hour an a half. My surgeon used an anterior direct approach, which is considered to be one of the more minimally invasive, or muscle sparing procedures…but perhaps not the most. I discovered there are 2 main approaches…anterior or posterior…but roughly 30 modifications of these 2 main approaches that each involve slightly different rates of recovery. It wasn’t easy learning what my expected rate of recovery might be, and in fact I never really did!
No one ever talked to me in detail about that part. So I was left to assume…and my assumption was maybe a month. The specific type of procedure performed, which might have the most significant impact upon recovery rate, was never guaranteed. Because you never know what might crop up at the last minute. So I guess I was somewhat lucky that the original plans were able to be executed as intended in the final ‘actual‘ plan.
Even so…remember no one told me what to expect in any kind of detail. Probably the person who came closest to this was my physical therapist who I met with only once pre-surgery. His description was vague and not specific because I didn’t know until that meeting how much I really didn’t know about my own procedure!
Also, vagueness was probably due to the fact that there’s a huge amount of variability in recovery rates, based upon a patient’s age and overall level of health as well as their overall level of physical fitness too. Perhaps because my own physical fitness level had been less than stellar…primarily because my hip prevented me from doing so many things…my expectations were low.
Here’s What I Can Do at 9 Days Out
- Walk unassisted without crutches or a walker. But everyone wants me to continue to use my crutches for just a little while longer…just to make sure.
- Go up and down stairs the normal way…I should be careful however…especially going down. I should probably also use the ‘easy way‘ with a crutch for a while…just to make sure. (The ‘easy’ way involves taking just one step at a time, landing on each step with both feet instead of just moving quickly from step to step with each foot.)
- I can drive!!! Since it was my right hip that was replaced I find this nothing short of a miracle! However, once again I’ve been advised that I should take it easy at first. Maybe even take a few short practice runs first…which given my driving record makes a lot of sense!
- In short I can do much more now than I could 9 days ago. 9 days ago arthritis prevented me from doing many things. Some as simple as sitting in a car, others more taxiing like running. I didn’t think to ask if running is advised yet but given my physical therapists general instructions of do what I want letting pain be my guide, I imagine I could if I wanted to.
Here’s What I Can’t Do at the 9 Day Milestone
- Lunge – I was cautioned about this type movement upon being discharged from the hospital.
- Jump & Hop – The only reason I know this is because my ever humorous husband (and my rock throughout this process) did ask at my 1st PT session today.
- Have a Dental Procedure…I need to wait 3 months and when I do I need to take an antibiotic first.
- Sleep – But not for obvious reasons. In fact, sleep is generally encouraged….I simply can’t do it.
Lifting My Leg is Still Difficult
My Inability to Sleep is the Only Real Problem I’ve Experienced
Its kind of a big problem though. What’s preventing me from sleeping is cramping and charley horse types of pains in my surgical leg. In fact, overtime, what began as just nighttime pain has become pain I experience almost all day long. The pain is a moving target. It can occur in obvious places like my hip, groin and buttocks, but in less obvious ones too, like my knee, calve and ankle. One reason this presents a bigger problem is because of Deep Vein Thrombosis, which is a significant risk following any hip replacement. DVT symptoms resemble the symptoms of the leg cramps I’m experiencing too. So, while there was this undertone of worry initially by my surgeon, I was pretty sure that I didn’t have DVT, and that fact was confirmed by an ultrasound.
What this does mean however for someone else who like me may also be prone to restless leg syndrome or nocturnal cramping, is that they too may experience these symptoms. They may become more profound at night, and so far at least they’ve proven very difficult to treat.
My PT guy believes there are due in large part to the amount of trauma that the surrounding areas underwent…cartilage and tissue damage I’m guessing. He also believes they may emanate in part from a significantly different gait that I’ve assumed post operatively.
Why My Postoperative Gait Might Be Different
One thing that no one mentioned to me and that I also failed to discover during my own research is that limb length discrepancies are fairly common following Total Hip Replacements. Most often the surgical leg ends up longer than the other…at least initially.
Mine was and appeared to be almost 2″ longer than with my former hip. But this amount has already decreased and should do so even more in the future. 2 Weeks post surgery I’d estimate the disparity to be about 1″ now. There are multiple reasons for this. First is that many patients experience a sort of general ‘settling’ of the hip joint. Next, the surrounding area may remain swollen for a long time prior to finding a new permanent position. This swelling could obviously result in a temporary length discrepancy. Last, the leg can also just feel longer because the amount of erosion from arthritic processes may have decreased overall leg length overtime…and the new prothesis has actually brought it back to the correct original length.
Below: My prothesis is made by DePuy
While the explanations for longer surgical leg length make sense…they don’t do much for dealing with the pain resulting from it. I’ve had a solid week to experiment and the cramping and pain is some of the worst I’ve ever experienced. My former remedies have failed to yield positive results. So, I thought I’d include a small section on what I discovered did help me tremendously in coping with this pain. Because pain management post operatively is stymied by patient’s ability to use so many of the solutions which would otherwise be obvious…but which currently are not allowed.
Things like NSAID’s and even NSAID topical treatments aren’t allowed due to potential post op bleeding. Another soothing activity which is prohibited currently is soaking in warm water or whirlpools…because the incision (which I haven’t seen yet but is protected by a massive sized 12″ bandaid) can’t be submerged.
My Recommendations for Leg Cramps While Sleeping (and While Awake too!)
I’ve run through the full gamut of past proven and folk remedies for the nocturnal leg cramping problem…everything from Hyland’s Homeopathic Tablets and Ointment to Topical Magnesium, calcium citrate, mustard, dill pickles and electrolyte beverages like Gatorade. Many help a little but none work well enough to stop this most stubborn, persistent, and almost continuous problem. It began just at night but worsened to all day, everyday.
Only one thing has given me consistent relief…and I’m as surprised as anyone to find that it works for me!
While in the hospital they employed these inflatable leg compression devices on my lower legs which combined with compression socks were intended to prevent blot clots and deep vein thrombosis. They worked well and I got compression socks for home use too. It in searching for the hospital’s compression system I found it was $5000…not worth the cost for home use. There are others on Amazon and the main price categories tend to be around $300 or around $1000 for full leg compression..,which I wanted. But I couldn’t find any of the around $300 units which would arrive at my home soon enough to be of use for me. The earliest would have been about a week out (it’s St. Patty’s Day right now.)
So I ordered that set knowing I could return it and called Amazon Customer assistance. They assisted me in finding this less expensive set for $129.99. I had seen it but thought the reviews weren’t promising and it wasn’t one complete leg unit but multiple units which looked confusing, had a lot of cords and was potentially cheap and nonfunctional. But I did order it because it was available for delivery the next day.
Putting it together and using it initially were beyond confusing! It truly took both my husband and myself to figure it out and get this unit working. But our perseverance paid off big time…because this one device has been a Godsend…and it’s the only reason I’m now sleeping through the night!
Below: The Amazing Leg Compression Device Which is Helping with all My Leg Cramping
A Few Reason’s Why The Soheryii Air Compression Leg & Foot Massager Has Been So Amazing
As I mentioned…I thought I wanted one long leg sleeve…but it turns out my pain is constantly moving…and by having the different sized pieces I can place them exactly where my pain is. Second…I read that a lot of the more expensive units had such strong pressure they were more uncomfortable than relaxing…I needed relaxing. This one has a default setting of 5 but it goes up or down from there. I generally go down to 2 which is perfect for me. Third…the long leg parts zip…the shorter leg cuffs use strong velcro. I can unzip the zippers some but it’s not as effective as readjusting the velcro positioning. Therefore the velcro allows me to customize the pressure even more than the electronic control does.
I use these massagers every time I sit down, because leg cramps begin within a few minutes of sitting down. What happens for me is I’ll be sitting with my legs extended and elevated and some ice packs on and feel comfortable….say maybe for half an hour…and then I move. That’s when the massive cramping sets in. I can’t move, walk or do anything for the next few hours without massive leg cramping. So if I’m walking around doing stuff…which I do a lot of because I have a lot of work to get done…the pain ebbs and flows with my consumption of Gatorade, dill pickles…etc. If I’m sitting I just put the massagers on and maybe some more ice and I’m good to go!
A Few More Leg Cramp Remedies I’ve Found That Are Helping To Resolve Them Permanently I Hope
Because The Cramping Isn’t Getting Better On It’s Own
In the past I’ve had some success with homeopathic remedies…so I decided to try everything I could find. Hylands makes both a tablet and a topical cream that’s helped me some in the past…I got both and feel the cream is more immediate this time. Another homeopathic remedy for leg cramping in tablet form is made by Boron, and is called Cuprum metallicum and it comes in both 30c and 6c strengths.
A great homeopathic remedy for any kind of injury or trauma is Arnica. Arnica promotes healing and it comes in tablet, cream and gel form…I’m using the cream and tablets. Trumeel is yet another homeopathic remedy I’ve found which works well for pain management. Unfortunately you can’t get it in the states anymore, which I discovered the last time I wanted to refill it. Amazon did have a foreign source for it but it’s expensive and slow to arrive. But I did re-order it sometime back a year or 2 ago…mine came from Russia…and I’m glad I did…because now I have it to use. Trumeel is somewhat unique because it also has anti-inflammatory properties too.
Last I tried an ultrasound machine…without much effect, and I just obtained aspercream rub after reading that it helps too…but I haven’t tried it yet.
Photo by Ronald Cuyan on Unsplash
Phases or Levels of Healing Best Define the Long Term Process for Rehabilitation Following Total Hip or Knee Replacements
The way the human body heals can be thought of as a process which begins at a rapid pace on a slightly superficial or outward realm. It’s rate slows down as healing moves inward to much deeper, more substantial levels…ending at the point upon which the structural integrity for the whole mechanism in question…be it a new hip or knee resides.
Therefore, my miraculous 9 day recovery while primarily a superficial one, does hold up under closer scrutiny as well. What’s missing can probably best be described as ‘strength.’ Over the course of the next few weeks and months, my aches and pains should lesson while my bone and tissue continues to grow and gets stronger. Everything should begin to meld and form a new normal for my brand new hip joint. This process should near completion within a year to 2 years. So, what the minimally invasive moniker really refers to is a significantly less intrusive early phase which allows patients maximum uptime time and minimum loss of productivity.
Some Additional Interesting Facts About The Modern Day Medical Miracle of Hip Replacement Surgery
1969 was the year in which Mayo’s physicians (from Rochester, Mn.) undertook their first total joint replacement procedure…they chose a hip replacement as their test case. It took 2 more years to perfect the technique enough to perform a complete knee replacement in 1971.
Although the first THA was performed by Mayo’s physicians, Sir John Charnley, a British orthopedic surgeon, is widely acknowledged as having developed the fundamental principles of the artificial hip and is credited as the father of THA.
Success breeds popularity…total hip replacements in 2018 have never been more popular. Roughly 300,000 of them were performed in the United States alone in 2017.
If you’re interested, Dr. Dunn, a retired surgeon recently published a fascinating video overview which covers the entire history of THA’s, with a focus on finding the best prosthetics, in January 2018. But it’s not for the feint of heart. Learning about some of the problems with these implants can be frightening if you’ll soon be using one personally.
My PT Said No…but soon :-)
One More Medical Miracle I Lived to Experience
I don’t remember the actual sequence of events, and how the unfolded, but my dad wrote a story on his website about how Mayo Clinic save my life when I was seven years old. The part that’s confusing to me is how I came to write about it on my sister website vsatrends. But it is a great story so here’s a link to how I almost died and how Mayo clinic save my life when I was seven years old…told from the perspective of my father.
Part 2 of My Hip Replacement Series
Part 2 is much less about the story behind my hip replacement and much much re about the uts and boots of what I used to survive the first few weeks. Because I had a lot of ‘anciallary’ pain…brought about by the surgery, but not directly due to it, my surgeons’ office didn’t really help much to address it. Nor did the pain meds I stopped taking relatively early for that exact reason.
I’m a big believer in alternative therapies. If traditional medicine can’t address a problem then I let alternative resources take a stab at it. This approach has worked out well for me in the past and did so here too. But it’s a lot of ‘trial and error’ and which is something my OCD focused mind excels at. So Part 2 is a long and exhaustive treatise of what did and didn’t help me or work for me. Ranging from homeopathic remedies to nutritional supplements and even diet!
Keep in mind too, that what worked for me my not work for you. However, it gives you many alternatives where before, there appearred to be none.
If you or a family member or close friend isn’t undergoing a total hip move r knee replacement I doubt Part 2 would interest you, unless you have an interest in learning more about natural, herbal or homeopathic solutions for injury and pain.
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