Hip Replacement Journal

Surgery Minus Eighteen Months

The report is back from the xray: severe osteoarthritis with spurs (I am irresistably reminded of John Wayne). My gp suggests referring me to a sports medicine specialist for further consultation. In some ways I would like to go straight to an orthopaedic surgeon, to save myself some time on a wait list, but the gp says that the other guy may have non-surgical options, and in any case it's good to get as many opinions at this point as possible.

Surgery Minus One Year

I meet the sports medicine specialist. We discuss options, of which there are few at this point. All the medical possibilities except very powerful anti-inflammatories become less or virtually ineffective once you have reached the “bone-on-bone” stage. He recommends surgery. I ask about the so-called “Birmingham procedure” - a resurfacing rather than a replacement - which has become much talked about, especially among people of my age: it is the new baby boomer procedure. This doctor does not recommend it for me. He tells me that it might be okay for someone with less existing damage, but even then the resurfacing can wear off and cause kidney damage. It is not permanent, as often rumoured, and by no means the ideal treatment it sounds. We agree that a total hip replacement is the way to go for me, and he will send out bids for referrals to the surgeons with the shortest wait lists.

Surgery Minus Six Months

I meet the orthopaedic surgeon for the first consultation. He does some physical tests, watches me walk and then calls me into his office to discuss options. The chair beside his desk has a briefcase on it, and he makes me stand to look at my xray. After a few minutes, I ask him if I can move his briefcase and sit down; he says “that was a test, and you just passed!” There is really no doubt - I need a total hip replacement. I am to have a top-of-the-line ceramic joint housed in titanium; space age, and promised to last my lifetime. This remains to be seen, but just in case it will be a “non-glue” procedure, meaning that my own tissue will grow into the housing. It takes a little longer to heal, but is stronger, and the advantage is that it can be broken again if I should need a replacement for the replacement somewhere down the line. I leave armed with a booklet all about “Your Total Hip Replacement” and now I wait for a surgery date. I'm told it will be 4 - 6 months.

Surgery Minus Six Weeks

I get a date! It's a little later than ideal, but at least now I can make plans.

Surgery Minus One Month

I am called in for a consultation with the surgeon. We go over the procedure one more time, and I am asked to sign permission forms. He also asks me if I want to donate my hip (who would want it, I wonder?) and whether I am willing to participate in a Canada-wide study of joint replacements. I agree to both, and sign two more forms giving permission for data to be used. I ask about what I can expect in terms of driving, time off work and so on, and he assures me that I'll be back at work in 4 to 6 weeks, driving in about the same amount of time, possibly sooner. I drive an automatic and it's my left hip, so this will make it easier to drive when the time comes I'm told that I will have to have a pre surgical physical with my gp, a class with occupational therapists to help me to prepare for post op, another appointment at the hospital for a pre-op consultation, and a pre-op x-ray.

Surgery Minus Ten Days

I go for pre-op x-ray. Apparently the surgeon uses this as a template when doing his work. I'm not sure why this doesn't fill me with confidence.

Surgery Minus One Week

Hip class. I am the youngest person there, and the only one not to walk into the room on a walker. I feel like a fraud (then I remember the spurs). Someone asks me if I'm there as a caregiver for one of the elderly patients. Um... no. Two vigorous and energetic young occupational therapists go through all the rules for the care and feeding of a post-op hip. No bending at more than a 90 degree angle. No crossing the legs or ankles. Go up and down stairs one foot at a time. We are taught a mantra: “Up to heaven; down to hell,” which means that you step up on your good leg and down on your bad. The full implications of the “no 90 degree rule” become clear: you can't put your socks on, you can't tie your shoes, you can't reach forward for the toilet paper when sitting on the toilet, you can't have a bath because you probably won't be able to turn the taps on and off and in any case you won't be able to get in and out. You can't use a reclining chair or reclining bed because the incline might make you go past that 90 degrees when you bend forward to get up. It's all rather overwhelming and rather scary. We are given a long list of equipment that we have to buy aids to help us pick things up off the floor, devices to help put socks on, long handled shoe horns and bath sponges. They also demonstrate the anti-coagulant injections that we’ll be giving ourselves post-op. These are to prevent DVT - deep vein thrombosis, or clotting - potentially one of the most dangerous complications from surgery. Apparently because we have to fast before surgery, which lowers blood pressure, and are immobilized afterwards, we are at some risk for this. So we take warfarin - the same thing they use in rat poison - to prevent this, as well as being given strict instructions to wiggle our toes and rotate our ankles once an hour every waking hour for the first few days after surgery.

Surgery Minus Six Days

Pre-op doctor's appointment. This is fairly routine. Doctor wishes me luck.

Surgery Minus Four Days

Hospital pre-op appointment. Again fairly routine. Because I am donating bone, I have to answer all kinds of deeply personal questions about my past sex life and travel patterns and respond to queries about whether or not I have ever been an intravenous drug user. This is, on the whole, comforting rather than annoying - it’s good to know that the screening is so rigorous.

Surgery Minus Three Days

I buy equipment, plus antibacterial sponge that I will need to wash myself the morning of the surgery.

Surgery Minus Two Days

I suddenly realize that this is really going to happen and become deeply scared.

Surgery Minus One Day

I put my dogs into kennels and deliver my cat to the friend with whom I'm going to be staying after surgery. I stop the newspaper, empty the fridge, clean my house - all the things I would do if I were going away on a trip. It will be at least a week before I am home again. Nevertheless, I try and set a few things up for maximum efficiency when I do return home.

Surgery Day

First thing in the morning, I shower, using the antibacterial soap. I pack a small bag, call a taxi and head for the hospital. I am conducted to the pre-surgical area, where a nurse gives me a robe and some booties to put on. I have an intravenous line inserted, and I wait, nervously (where is the valium when you really need it?). The anaesthetist comes to introduce himself (now will I get some valium??) and review the procedure. A nurse comes and writes a black X on my left leg (this definitely doesn't fill me with confidence). I am wheeled into the theatre (aha, at last, sedation!). The surgeon is there, and the anaesthetist, and it seems like dozens of other people. And then... it begins.

I wake up in the ward, feeling no pain, but feeling like an extra from a science fiction movie, tubes running out of my groin, my arm, my nose. There is also a drain on the incision on my hip. The nose tube is removed almost immediately. I have an “on demand” pain reliever that will kick in when the spinal anaesthetic starts to wear off, and I'm given a brief lesson in how to use it, but at first, I am floating happily on a cloud of anaesthetic. I am reminded to pump and rotate my feet once an hour to help ward off DVT.

Astonishingly, later that evening, I get out of bed and stand up.

The night is bad. The anaesthetic wears off, and it takes a while to get the intravenous pain meds to the level that controls the pain adequately.

Surgery Plus One Day

I wake feeling reasonably okay. I learn, however, that I would make a lousy drug addict, as opiate pain killers disagree with me. A dose of the pain killer adequate to control the pain well makes me nauseous and although I was hungry for breakfast I immediately throw it up. This is, in fact, my day of puking. Otherwise, things went well. I am taught how to inject myself in the stomach with warfarin, which I can't help but think of to myself as rat poison. The catheter is removed, and I am able to use a commode beside my bed. I walk several steps beside the bed. Despite all the puking, I receive several visitors and feel quite pleased with myself.

Surgery Plus Two Days

I'm now taking pain meds by mouth, and no longer so nauseous. The big milestone of the day is walking to the bathroom and back. Three times! Physiotherapist comes and we do some light exercises on the bed. More of the foot circles: check. Bend your knees: check. Flex your “glutes” - bum cheeks: check (!! this is actually very important, so I'm pleased). Hip abductions. Um... no. It is amazingly difficult to do hip abductions (sliding leg in a V sideways); in fact, it was simply impossible, but the physiotherapist says this will come with time.

Astonishingly, although my leg is naturally stiff and sore and there is pain around the incision area, I can already feel that the awful grinding pain in the joint is gone.

I am to be released tomorrow! Wow.

Surgery Plus Three Days

I walk down the hallway to a little wooden staircase and am given a lesson in stairclimbing - up to heaven; down to hell - I can do it! Then I go to the walk-in shower room and have a blissful real shower and wash my hair. This process makes me as tired as running a marathon, so I'm allowed to return to the ward in a wheelchair. There, I await my release forms. My friend, who will be my caregiver for the next week or so, comes to collect me, and we wait for another friend to come and collect us in a van. Getting into the van is difficult (note to self - next time, arrange different transport or have someone use my car, which is more suitable for handicapped person) and once more I'm exhausted. We arrive at my temporary home, and I make the LONG walk (really only about 30 feet) up to the house, climb the stairs, and collapse in a chair on the porch at the top.

Fresh air is so wonderful after the hospital, and although I'm tired, I'm happy to be sitting looking out at a beautiful view. In fact, I feel wonderful. Not really in too much pain, just achey and weak, and happy to have got through each little hurdle.

We arrange for my warfarin and pain meds to be delivered, and that afternoon, after a nap, I inject myself with rat poison and do my physiotherapy.

Surgery Plus One Week

My daily routine soon evolves to getting up slowly, then after breakfast doing my exercises and shooting myself in the stomach with rat poison, dressing, sitting, if fine moving out to porch for lunch, moving back indoors for afternoon exercises, short rest, supper, more sitting, then bed. Gradually this is supplemented with short walks and a little computer time, but basically that is about as much as I can do. A shower on one morning makes me so tired I have to have a nap in the afternoon!

At the end of the week, I have my first official out-patient visit to a physiotherapist, and am pronounced fit to abandon the walker and just use a cane. This is a significant milestone, as it means, effectively, that I can now return home. With one hand free, I can carry things from one room to the next; without that, living on my own would be extremely difficult. I am very lucky for my kind (and available) friend and give a thought to other single people who may not be so fortunate. The health care system tends to assume some kind of family caregivers in place, and really does not make much allowance for the person living alone without close family - surely I'm not that unusual?

Surgery Plus Eight Days

I have staples (yes, staples) removed by gp and make the great migration home. Clio the cat and all my clobber loaded into my car and unloaded again in my little house, after which I'm too tired to think straight. But I'm home.

Surgery Plus Two Weeks

Check up with surgeon. This goes well. I'm pronounced fit, and more importantly given clearance (after shameless begging and pleading) to drive in another week.

Am feeling some side-effects from the warfarin - dizziness and breathlessness. Only a few more days to go on it, and am looking forward to giving it up. Also I really can't get used to injecting myself in the stomach. I really would make a lousy drug addict!

Otherwise, I continue to walk more every day, and am managing to go up the street and almost around the block.

Surgery Plus Two and a Half Weeks

Still not able to walk very far, but I'm getting stronger and the exercises are getting easier every day. Physiotherapy is tough but useful. Did you know that you have not one but three different kinds of glutinous (edit: I meant gluteous, of course, though no doubt mine are in fact glutinous, that's why I have to exercise them. I think I'm going to be Mrs. Malaprop when I grow up) muscles in your hips and buttocks and the gluteous maximus (the ones in your bum) are actually the least of your worries in this instance? The glute minimus and the glute something or other else are on the side of your hip and those are the ones that help you stand up straight and not tilt your hip over sideways when you walk (those are what you shimmy when you strut like a model on a catwalk). Those are also what the surgeon slices through when you have a hip replacement, so it's important that they be strong before and that you get them back afterwards or you may walk with a limp forever afterwards. I do hip abductions, standing and lying, now, 3 sets of ten in the morning and as many as I can in the afternoon. Later, I'll do sideways leg lifts and clamshell raises. Get a hip replacement: get in shape!

Surgery Plus Three Weeks

I get in the car for the first time since before the surgery and bring my dogs home! Yay.

And another milestone: the last of the rat poison! Double Yay.

Surgery Plus Five Weeks

Back at work! Not that I wouldn't have minded a little more time, but I manage okay. I have a “handicapped” parking sticker for the duration, and people will carry books for me if necessary. I amuse my students by holding up my cane proclaiming “You Shall Not Pass” in full Gandalf fashion. Not being able to bend makes it difficult to plug in a computer or add paper to the Xerox machine, but, hey, sometimes that's not a bad thing!

I will continue out-patient physiotherapy for the next few weeks, and do exercises at home, but really everything's going just about as well as I could have possibly hoped.

Surgery Plus Two Months

I walk into my surgeon's office today without my cane. And am pronounced fit. I saw my x-ray - this extremely solid looking joint looking as if it has absolutely no intention of dislocating ever. He (my surgeon) said “congratulations, your hip will only keep on getting better from now on.”

Now that my incision is healed, I'm able to swim again for the first time since before the surgery. That feels really good, too. It is great to get the heart racing and to move the rest of my body. I'm so much appreciating my body these days: feeling strong and fit and healthy.