More Than You Really Wanted to Know About my Hip Operation - Pt 1, Hospital
Nestled on the edge of a retail park, it didn’t seem out of place that the receptionists on the main desk at the Disney-bedecked hospital were dressed as characters from Peter Pan, nor that the Physio Department had been temporarily transformed into the Sultan’s Palace from Aladdin. It was close to Christmas after all and I was suitably fasted and literally hungry for a new hip. Shown to my room by Staff Nurse Dopey I was admitted, labelled and queued to await the traditional visit from the Consultant to mark the all-important indelible arrow on my left thigh. A blood sample was required - this time taken by another of Snow White’s helpers - a hooded green-costumed Doc. Fortunately, there was enough of her blue ‘Theatre Scrubs’ visible to assure me that the procedure hadn’t been carried out by a complete randomer. The anaesthetist popped in for a chat - I was rather pleased he’d made no effort with Panto apparel. I was to be given a spinal block and, most importantly for me, a sedative - if I had any concerns about the whole procedure, it was about being conscious to any sawing noises. Then, finally, complete with marker pen and some brief words of encouragement came the Consultant and with a flourish I was good to go.
Time passes then I am collected and taken to the anaesthetic prep. room. My back is showered with freezing disinfectant and I have some local anaesthetic injections before the key spot is located for the big one - a warmth starts in my buttocks and travels to my toes leaving me unable to move anything. I am man-handled onto the trolley as bits of scaffolding are bolted around me to keep me still and on my side. A screen is hung in front of me – there is a sense of purposeful busyness and fortunately no sign of Captain Hook. The next thing I hear is the anaesthetist telling me that I have a new hip.
In the recovery room, I realise that I’d been out of things for about 80 minutes. I’m soon back in the bedroom with the promise of a ham salad sandwich in an hour if I can keep water down. Had some more fun later that evening - some abdominal pains were traced to a full bladder of which I had no sensation as the spinal block was still working - the cure was to be catheterised which was not as unpleasant as I had feared and made for a comfortable and uninterrupted night’s sleep.
Remarkably, given the length of the wound (8 inches), I was out of bed and walking with sticks the next day. I was only given strong (opioid) painkillers for the first 24 hours post-surgery and now am managing on not much more than paracetamol and codeine. Plenty of exercises to do so had better crack on.
There are a few forbidden postures that could result in a dislocation if not observed - like swivelling or folding to less than right-angle between hip and knee. Certainly my Consultant did not stress the ‘living with a new hip’ bit as he is very confident with his kit but it’s something I’ll need to consider - I think suggestions of me mastering the jive next year may be premature.
After 2 nights I was back home. Because I had just mild arthritic pain before the op, I’m not seeing any gain here but I am experiencing the pain from the surgery. Because of scarring, bone collapse and shrinking over the last 8 years or so, it will take time for me to start to see the improved hip function that was the prize for having the op. Not ahead yet but early days.
More Than You Really Wanted to Know About my Hip Operation - Pt 2, Physio
Time passes – Christmas and New Year come and go and 17 days on from the op. I’m back at the hospital. The dressing is removed and all is well so I’m instructed to moisturise and massage the newly-healed wound to train my brain to tune out the nerve end over-sensitivity that is typical post-surgery. I then transfer to the Physio Department to review mobility progress. I’m shown an example of the prosthetic I’m now equipped with and warned that I’ll now set off airport scanners and store security systems. Naively, I ask if I’m to be given a card to document the implant – no, says the physio – just show them the scar!
I’m manipulated into positions my left leg had not visited in years – it was challenging to let go the defence mechanisms that my body had instigated to limit motion to a relatively pain-free path. I’m shown a few further exercises to start to build strength and confidence in leading with the operated leg and then we go to the gym. I really wasn’t expecting to be put on a bike but I didn’t need to be told twice. I just couldn’t help a silly grin as I pedalled away – not that I was ever a mad keen cyclist but the hip rotation required to pedal was the first function that I lost and so to regain an ability after about 8 years was the first real glimpse of the success of my re-engineering. Next up was an analysis of my walk – or rather limp. Via some exaggerated ‘Ministry of Silly Walks’ marching, I was able to concentrate on lifting both heels in more normal motion and, remarkably, within a few laps the limp just vanished! My wife was almost lost for words when I glided back to the waiting area.
So some good progress being made. Lots I can’t do yet but some of that will come once I get the all clear to move on to sideways motion (abduction/adduction) building. Pain comes and goes – it’s not just a tapering reduction over time. I’m not really comfortable sitting or lying and getting in and out of bed (as you do) seems to aggravate. And then there’s the sting from the charge for my take home medicines - £60 for a box of blood thinners (Apixaban)! Probably well worth it for avoiding blood clots without the need for DVT stockings or injections but all the same – those profiteering pharmaceutical companies!
More Than You Really Wanted to Know About my Hip Operation - Pt 3, A Month On
“Hey Google, turn on bedside light”.
“Ok, turning on bedside light”.
As my eyes adjust to the self-inflicted rude awakening, so starts day 32 with a new hip. A minor milestone today as I take the last of my blood thinning tablets – they have side effects of nausea and anaemia so I’m pleased to see them finished. I reach for my medication log sheet – a dog-eared William Morris pattern clipboard holding a few pages of printed Excel tables. Oh yes, nerd-alert you’re thinking but when I first came home, there were 14 possible medication slots daily and keeping on top of them with notepads, backs of envelopes and Google Assistant alarms did not make for the best patient compliance. Fortunately (not in the normal sense of the word), when you need pain-killers, there’s a certain built-in reminder when they’re due. But what better application of data integrity principles than making a medication audit trail? Looking back at the log, it’s heartening to see the number of events reducing as I moved from “how long until I can have another?” to “that’s a bit uncomfortable, think I’ll take something for it”.
I shower and moisturize the wound that is healing well but looks a bit scary (going to need some serious air-brushing for my next modelling assignment) and there’s a bit of a ruckle at the top end. It’s still a bit sensitive and on the one occasion when I risked wearing jeans, I was in trouble with sensory overload from the stiff material in a very short space of time. I’ve had to resort to wearing track suit bottoms – you know the sort – black polyester with 2 white stripes down the side. Not really higher & intermediate managerial, administrative, professional occupations appropriate – at my age I should probably be attired in those slacks you see advertised at the back of the weekend papers alongside stair lifts and walk-in baths. With the joggers partnered with a zip-up black varsity college style top and nice warm peaked knitted slouchy hip hop hat my daughter got for me, I think I cut a bit of a dash. I doubt that Snoop Dogg needs help putting on his socks as I still do but that’s probably not the only point of departure.
My second physiotherapy session soon comes around. I debrief on progress over the 2 weeks and suggest that while the immediate effect of the initial retraining was not far short of miraculous, it did seem as if I had now plateaued. The physio examined me and acknowledged my progress – an extra 10 degrees forward hip rotation and much improved walking but counselled that until I had been seen by the consultant (early February), it was not possible to start the sideways rotation exercises that should facilitate a full range of movement. For now, we would focus on proprioception - the body's ability to sense movement within joints and joint position - the ability we have that tells us where our limbs are in space without having to look. Seems that I have to retrain my feedback loops to get back the stability and balance I had with my natural hip.
We transfer to the gym and stand in front of the full-length mirrors. Am I really that short and slopey-shouldered? The physio and I do a fair impersonation of Schwarzenegger and DeVito’s “Twins”. I’m instructed in performing a basic squat – feet forward, back straight, backside out. I only seem to be able to bob down a few inches and the physio notices that my left knee is turning in. He ties a band of elastic strip and I step into it and pull it up to my knees – I retry the squat trying to tension the band and keep the knees straight. A handful of squats and I’m really feeling that the muscles are being stretched. My next challenge is to walk forward heel to toe swivelling as if for a slow-motion Charleston. Then the same thing but backwards. My balance is all over the place. A bit like the apocryphal drink / drive test to walk in a straight line – I certainly would not have passed. And that was it. Next appointment will follow the session with the Consultant so hopefully, I’ll get the ok for the remainder of the exercises.
As many have pointed out, no doubt to allay my fears, a hip replacement is a very routine operation these days with very good outcomes. I hope my notes aren’t seen as trying to inflate my experiences to “man-flu” proportions – it’s just a memoir, a bit of fun.
“Hey Google, turn off bedside light”
“Sure, turning off bedside light”.
More Than You Really Wanted to Know About my Hip Operation - Pt 4. Consultant Review
NOW YOU’VE GOT TO BE IN AGONY TO HAVE HIP OP: MOST NHS TRUSTS NOW IMPOSING CRUEL NEW PAIN TESTS IN ROW OVER ‘RATIONING’
So read the Daily Mail front page headline in January ‘18 taking an temporary break from leading on cancer or house prices. Well, at least it wasn’t fake news - indeed, it wasn’t news at all - all surgical interventions carry risk and the likely benefit always must outweigh in the decision to progress. Despite my lurching loss of function and x-rays showing a worsening condition, my NHS Consultant six months earlier had only been able to prescribe a stick because at that hospital, they could only offer a hip replacement for pain relief and, as I was (inexplicably) not routinely taking pain killers, I didn’t qualify. Following the last holiday where my mobility had to be considered for even the briefest stroll, I realised that the time had come to become a burden to my health insurer.
Choosing an orthopaedic surgeon is not something you do every day. You might ask around to get some recommendations for a plumber or a roofer but the immediate consequence of a bad choice of tradesman can most likely be ameliorated with a bucket. Selecting the right person to cut you open and fiddle with your ambulatory workings is really a tad more critical so that’s why I asked my barber. As it happens, his wife was shopping for a hip and they had already selected a consultant from recommendations they had gathered. I’d done some background research myself - there’s so much profile information on line but for me it’s usually the photo that determines if they go on the short list. Having weeded out the normal prejudices (too old, too young, eyes too close together, resemblance to an axe-murderer, etc.) the next stop is the National Joint Registry where it’s possible to check up how many hip and knee primary replacements and revisions the surgeon has performed along with a jolly graph of 90-day mortalities relative to his peer group. I also deleted one possible after a Google search revealed him to have been previously suspended for domestic violence. Along with feedback from someone who had first hand (leg?) experience of my lead candidate and an unexpectedly specific pointer from a friendly Health Care Professional, the decision was made.
Overall, I’ve had very little contact with my surgeon – that is while being conscious: a brief initial meeting where he confirmed my hip was shot and I should consider its replacement and a follow-up where he reviewed the MRI scan and thought it 90% likely that the replacement would get a decent fixture in my radiotherapy-damaged pelvis. Seven weeks after the operation, I was back at the hospital to see the surgeon for a first review. On arrival, I was sent for an x-ray and was soon after called in to see the man. It’s a bit like trying to suck your stomach in when you emerge from the changing rooms at a swimming pool – you know you’re on show and here my gait was being scrutinized and I was doing my best to adopt an upright posture and to transfer weight evenly at each step. It’s a little crushing then when the first words are “You’re still leaning to the left”. But we were both happy with initial function, healing and pain levels and took it in turns to repeat “it’s early days” like a mantra. And it is true – a hip replacement is an injury that will take 4 to 6 months to heal fully.
The x-ray radiograph is displayed on the monitor. I’m no expert in their interpretation but I do a fair amount of DIY and had no trouble identifying what looked to me like three 2-inch number 8 screws projecting fan-like from the back of my new metal hip socket. I knew that the fixture was going to be screwed (as opposed to glued) but had assumed some dainty nuts and bolts and maybe a bit of metal plate - not something that would be about right for mending a garden fence. In contrast, the technology of a trabecular metal cup is amazing - I don’t know if I have the Zimmer model I found on the web but despite their strength and elasticity (they are made of elemental tantalum) they also have interconnecting pores to facilitate biological ingrowth.
My Consultant hands me a sample prosthesis to explain why I should not be over-concerned about dislocation. I feel I’m holding a £3,000 door handle. He asks how far up and out I can raise my operated leg - I offer a weak attempt - partly through lack of flexibility but also some ingrained modesty kicking in that you shouldn’t be thrusting your groin at someone you’ve hardly met. He’s not impressed and wants me to practise advanced ‘manspread’ to loosen things up. The movement I need to regain actually seats the ball head deeper into the socket so I don’t need to worry about popping the joint. He wants to see me again in 6 months because of my complications but that’s it for now. I have a short final session with the Physio to learn some sideways hurdling, some raises and some stepping all of which to his surprise present little challenge - so with instruction to keep active I’m shown the door.
At the end of the same week, I have an appointment with my GP. He calls me in and I feel his eyes analysing my walk as he follows me into his room. “Getting there” he offers – I go on the defence but it’s true that movement is a little clunky immediately after sitting. The meeting is largely a formality as my fit-note is due to expire and given my progress we agree a phased return to work.
More Than You Really Wanted to Know About my Hip Operation - Pt 5. Corollary - A Year On.
After somewhere in the region of 6 months I stopped being concerned if my recovery had plateaued and I just got on with life. Yes, there were things I still couldn’t do but there was so much more that I could. Now a year on, I rarely give it a second thought. I wonder how long the new hip will last?