My hip problems:
My hips had deteriorated rapidly over the previous 2.5 years (pain started the day after I turned 40 -- go figure!) with osteoarthritis due to developmental hip dysplasia. In layman's terms, my hip sockets were too shallow causing excess friction on too small a bearing surface on the ball of my femur, resulting in cartilage loss so that my hips were bone on bone, with lots of bone spurs and such. Any movement, including walking, was very painful, and my range of motion was severly curtailed. I was taking Voltarin for pain and getting acupuncture about once a week, and continued my martial arts training as best I could (amazing how you can learn to lock up the pain in a little box in your head), so I was in pretty good shape going into surgery.
I was determined to have both hips done at once because I did not want to go through two surgeries and two recoveries and all that extra time off work and off from my martial arts. None of the local surgeons I had seen would even perform bilaterals, so I was thrilled when I finally found one who said he would. However, he wanted to do cemented stems on me, and from the research I had done I was convinced that the uncemented hydroxyapatite-coated stems would give me a better chance for really long-term hips. I had also decided I wanted the new ceramic-ceramic prosthesis, and located all the trial sites nearby where I could get into a study. I got in touch with Dr. Bierbaum (Chair of Orthopaedics at New England Baptist Bone and Joint Institute) and implored him to let me into the study and give me two Osteonics ceramic-ceramic hips with the HA-coated uncemented stems, and fortunately he kindly agreed. I feel optimistic that these hips will last my entire life, or at least most of it.
Dr. Bierbaum highly recommends bilateral (vs. two sequential unilaterals) as it reduces risks for the patient (only one surgery therefore only 1/2 the risk of standard surgical complications such as with anesthesia, etc.), has a quicker recovery with an even gait (no painful hip as the "good" hip), and is also cheaper. He, and the hospital, REGULARLY do bilateral hip replacements and I think this is really critical for a good outcome.
I gave 3 pts of blood (tried to give 4 but got too anemic) during the 5 wks before surgery. (Eat lots of Total cereal to keep your iron up!). As it turned out, the entire surgery only took 3 hrs and I only lost one pt of blood, but they gave me back all three just to boost my hemoglobin levels anyway. My surgeon uses some sort of frame to hold the body in during surgery, and he would not let me choose an epidural for the surgery because he said the bilateral was just too long and uncomfortable in the frame (which comes up to your chest), so I had a general anesthetic which worked out fine (they added some anti-nausea stuff to it so I didn't have any problems with that, as I have previously).
Early post-op in acute care: days 1-3 post-op
The first couple of days after surgery were uncomfortable but not really that bad. I woke up flat on my back with both legs in slings and tubes all over the place -- an IV is in place for getting on-demand morphine (I could push the button whenever I wanted it), and that kept me feeling pretty mellow and not really that bothered by the awkwardness of the situation -- and a catheter was in place so I didn’t have to worry about going to the bathroom (don’t know if they do this for guys).
For me, the worst part of the first couple of days was that I was in a semi-private room and the woman next to me was a real whiner and always complaining to me, the nurses, her visitors, etc., and there were lots of beeps and interruptions by nurses and stuff so it was hard to just relax and sleep. If you can get a private room, DO IT!
My legs came out of the slings on day two and I was visited by a PT who helped me to sit up on the side of the bed, then stand by the bed using a walker. Moving my legs sideways was painful, but mostly was just SCARY because I didn’t know what to expect. Standing was also scary, but was a real surprise to discover it didn't really hurt to put weight on my new hips! The main sort of pain I had post-op is just soft tissue healing from the incisions and miraculously the pain deep in my hips was GONE! On day three I shuffled across the room about 5 feet and sat in a chair for about 1/2 hour and did a few sitting PT exercises. They also removed my catheter that day which meant I had to use a bedpan to pee, and that was uncomfortable.
The Rehab Center: days 4-11 post-op
On day four I was moved to the rehab unit where I got a private room, and things got a lot better from then on. I spent 8 days in the rehab unit (would have gone home after 6 but they were worried about a gall bladder complication), and this was well worth it -- if your insurance will cover rehab, go for it (but make sure its a good unit that handles a lot of bilaterals). I had two visits daily from the PT and one from the OT (who helps you learn how to dress, bathe, get around the house, etc.) and was soon walking the halls. I graduated from a walker to crutches about day 6 which was great and enabled me to get into the bathroom much more easily -- and on day 6 I got my first real shower!!! (Before that you just wash in bed, although I did manage to get my hair washed twice in bed by nice nurses aides). By day 7 I was doing stairs. By day 9 post-op I felt ready to go home. During my time in rehab I did lots of pull-ups from the frame on my bed, and was able to change positions enough to feel fairly comfortable (pull knees up or not, roll over and sleep on my stomach for a while, move over to the chair for a while, etc.). My surgeon does NOT use staples, but does hidden stitches and this was great --- not only is the scar much less, but I hear the staples are really uncomfortable during recovery. My incisions did get kind of red and swollen after a couple of days, so I generally kept ice bags on both legs for days 4-6 when I was in bed and this took care of it. I should also mention I was taking Chinese herbs that I got from my acupuncturist (without the knowledge of the hospital) that can dramatically speed healing, and I believe they did.
Recovery at home: 11 days - 6 wks post-op
I went home on day 11 post-op, and found that getting in/out of the car, riding in the car, using handicapped toilets in restaurants (I had a 4 hr drive) was really no big deal. They sent me home with Percaset for pain, but I hardly took any as I didn't need it (just took them at night to help me sleep the first couple of nights).
I had home PT visits 1-2 times a week for the first 6 weeks, and was religious about doing my PT on my own (my surgeon gives a fairly extensive set of exercises, so I worked 45 mins a shot three times daily for the first 6 wks), but was also careful not to overdo it, as this can cause problems, too. I augmented my PT with other approved excercises such as push-ups (on the bed) and crunches. When I had the chance, I would get driven somewhere where I could do more walking (it was February in Vermont, so walks outside were out of the question!).
At 3 wks postop I began working part-time (on my computer) from home.
Weeks 6-12 post-op:
At 6 wks postop I graduated to driving priveleges (manual shift) and a cane, and went back to work full time -- plus all bending restrictions and such were lifted (e.g. I can touch my toes, cross my legs, etc.). I used the cane for about 2 wks and then walked unaided starting at 8 wks post-op (and with no limp!).
Return to normalcy: 3 months post-op and later
I resumed practicing martial arts at 3.5 months postop, as well as biking, hiking, and other activities. My strength and flexibility have continued to improve, and by 18 months post-op I felt fully recovered. My hips feel quite natural and like part of me. I do still have lots of painless clicking and popping, which my surgeon says is probably tendons snapping around. I had a fair amount of aching in my femurs for the first year, but this diminished to essentially nothing by 18 months post-op. This is due to the bone remodeling that is occurring and does not represent a problem, but is just my bones getting stronger in response to new lateral stresses on the femur from the stem, and the high level of activity I pursue.
I train in Tae Kwon Do and Kung Fu usually 5-8 times a week for 1-3
hrs a shot. I avoid high impact stuff (e.g. no running or jumping or
against the heavy bag) and do not lift more than 40 lbs. Other than
I feel like a normal person again (instead of an old lady)! I really
to remind myself of the constant pain and limited mobility I had before
-- it really just seems like a nightmare that I've now woken up from.