Friday, May 27, 2016

My Minimally Invasive Total Hip Replacement With A BIOMET G7 Titanium Hip



On Monday May 23rd I had a new titanium hip replacement done. 

The reason I am blogging on this, versus Facebook, is that I am going to use this as a way to document the history of this Total Hip Replacement (THR) and the PT, lessons learned in the hopes that it might serve to help someone else going through the same circumstances and operation.  

I have at the end of this "Important Things I Learned After My Hip Replacement" a list of things you might find helpful.  Legal disclaimer, I am not an MD and this is just my set of thoughts from my single data point of one replacement surgery.  Listen to your Dr. and not me. I am doing this in case I need another surgery years from now, or other folks that might find some of this of interest.  If it makes anyone's recovery a little easier, then that would be all I could hope for.

FYI, if you find this of use and want to tell a friend or family member who is having a total hip replacement, here is the URL to remember:  http://TinyURL.com/DavesNewHip

I thought I would repeat this advice at the beginning that I have at the end in my important notes section.
  •  The THREE most important decisions are:
    1.  Pick a great surgeon and do ALL the prep the Dr. tells you to do.  I had an incredible surgeon. A surgeon who has done over 1,000 hip replacements and does at least 50 to 75 per year turned out to be a good number for me.
    2. Pick a great PT.  I had the best.  She helped me work through the many challenges I had during my recovery that I would have NEVER been able to figure out myself.  I put in an average of two hours every day doing PT.  I think that made all the difference in the world.  If don't do the PT, you are cheating yourself.
    3. Pick a great "coach" as they say in the "Joints in Motion" Course.  I had the best coach in my wife of almost 33 years Julie.
 

The brief background on this is that my right hip has bothered me for about 7 years (my guess, but I cannot say for sure, is when I had to throw my bike down on Loudoun County Parkway to avoid being run over by a pickup truck is where my troubles began because I went down hard on my right side and had to trash my bike, my bike helmet and I was bloody), but I had more good days than bad days.  Then at the  end of October 2015 I hit the proverbial knee in the curve and I did not have a good day for 6 months.  This simply meant, not being able to walk without a limp and losing my range of motion on a weekly basis.



Above is me walking (without the knowledge I was being filmed by my wife) and as you can see, I have to use both hands on my hips and have a severe limp.

I was in HUGE denial mode as well as my wife Julie can tell you - maybe it is a "guy thing" or more likely a "dumb guy thing" :-)  I was blaming it on tight muscles and other rationalizations.  When I finally went in to see my Primary Care Provider on April 15th the right hip came back with a diagnosis of:


CLINICAL HISTORY: Right hip pain.
FINDINGS: AP and frog-leg lateral views of the right hip were obtained.
There is no fracture or dislocation. There is a severe degree of joint
space narrowing involving the superomedial aspect of the right hip with
associated dysplasia of the femoral head. Also noted is osteophyte
formation at the acetabulum.
There is a mild degree of joint space
narrowing involving the superolateral aspect of the left hip joint. No
significant bone lesions are identified.

Impression

1. No evidence for acute osseous abnormality.
2. Severe degenerative joint disease involving the right hip joint.
3. Mild degenerative joint disease involving the left hip joint.​
I was sent to see a orthopedic surgeon who quickly cut (pun intended) to the chase.  "Dave, if a normal hip for someone your age is a 1 and the world's worst hip is a 10, you are an 8. You have only one option and that is a total hip replacement."   He also told me that he has personally done over a 1,000 hips and he goes with proven technology.
The first thing he told me after surgery was "it was even worse than the x-rays indicated and it was filled with osteoarthritis."

The surgery lasted one hour and 15 minutes.  I have a new BIOMET G7 titanium hip. 

Here are a few cool things about titanium from the chemicool site:

Harmful effects:
Titanium metal is considered to be non-toxic

Characteristics:
Pure titanium is a light, silvery-white, hard, lustrous metal. It has excellent strength and corrosion resistance and also has a high strength to weight ratio.
Titanium’s corrosion rate is so low that after 4000 years in seawater, corrosion would only have penetrated the metal to the thickness of a thin sheet of paper. (3)


What I like about the BIOMET G7 is that the liner can be replaced if needed and there are literally over 1.6 million of these in individuals around the globe.  I discussed more exotic materials with my surgeon, but he quickly pointed out that these more exotic materials can fail in very nasty way inside the body.  A good friend of mine has a brother who works in manufacturing and knows just how good these new hips are from a strength standpoint, said of the BIOMET G7, "it's lined with ultra high molecular weight polyethylene. That stuffs so tough if you drill a pilot hole in a block of it and then try to drive a wood screw through it, you'll still tear the head off the screw before you penetrate the block.  You should be good till you're 80. Then you *might* have to have the liner replaced."

The technology of these new hips are mind-blowing. I am really lucky.


Above is my youngest son Tim, my middle son Michael and my lovely bride Julie who visited me that first day of my surgery.

Prior to surgery, everyone was required to take "Joints In Motion" two hour course which talks about the do's and don'ts after hip or knee surgery.  This is REQUIRED before surgery and I thought it was a GREAT course.

With hip replacement surgery, there are two things to be very careful of to AVOID the chances of the new titanium ball popping out of the new titanium socket.

  1. NEVER have the angle between your chest and your surgical leg's quadricep become LESS than 90 degrees.
  2. NEVER cross your surgical leg over your non-surgical leg. 
While this is rare, it is VERY important to remember.

Also, with any surgery you always have to worry about blood clots - that is why I have the compression stockings on all the time for 6 weeks and do the ankle lifts as well.

Also, when you go to the dentist, it is recommended that you have antibiotics.  The exact regiment will be up to your surgeon.  I found this:

"Developing an infection in and around a total hip or knee replacement is one of the most catastrophic complications that can occur. During a dental procedure, it is possible for bacteria from the mouth, teeth or gums to travel through the bloodstream and settle in an artificial joint. The use of an antibiotic pill prior to dental work has been thought to lower this risk. Orthopedic surgeons have historically recommended the routine use of antibiotics prior to dental work due to the catastrophic effects of a prosthetic joint infection and the relative safety of a single dose of oral antibiotics."




Above is my arthritic right hip.




Above is my new BIOMET G7 titanium hip.



Above is my hip after surgery.  You can see purple writing on my hip.  That word you see at the bottom is "yes" upside down and above that is my surgeon's initials that we are replacing my right hip.  Believe it or not, there are recorded incidents (not with my Dr or my hospital) of the wrong hip being operated on over the years.  I was told this by my surgeon as the importance of checklists.  I don't know if this is a global statistic, but I am always more than glad to see checklists in place when it comes to cutting on my body :-)


Above is my swollen right leg 5 days after surgery.




Above is me 4 days after surgery with the very nice fruit basket from my friends at AMT (the folks who own IMTS, MTConnect and MTInsight).  Thanks to Peter and Doug and the ENTIRE AMT crew!  Our yellow lab, Photon, is lying down in the background.   I am also with my new, very bestest friend - my walker (ok, my mom's walker that she is letting me borrow :-)

The high level plan is to be riding a stationary bike at the 3 weeks mark and back out riding my hybrid bike on the W&OD bike trail by September.  Getting in and out of my Corvettes will be a little trick, but I am sure I will get that figured out as well :-)  Here is a car assist grab bar that pops into the door latch on either driver or passenger side to help someone get out of a low car, BUT NOT A CORVETTE as the Corvette as the loop on the door and NOT the door jam.  See at the end of this post for HOW to get in/out of a Corvette without another device.

I will keep adding on to this blog as sort of a diary for me and others on my progress.

Before I give any specifics on the hospital and the Dr. who did the surgery, I want to get their permission. What I can say is that I could NOT be MORE impressed with ALL aspects of the care, the surgery, the post-op hospital care and how everything has turned out at this point in time - Friday May 27th.

  • May 23rd surgery - spent one night in the hospital and walked around some on the first day of the surgery. 
  • May 24th they took me for a walk before breakfast and I nearly passed out 20' feet into my walk.  I had to have a chair brought out.  They said I should have had breakfast before my walk and that was the issue.  I went home at 6pm, took it easy that first night at home
  • Night of May 24th, right leg swelled up because I did not keep ice on it -- putting ice on my hip and quad really helped out. If you are a guy, your best friend will be the urine bottle you can buy from the hospital store to be able to store near you bed to make it easier instead of having to make N number of trips to the bathroom in the middle of the night.
  • May 25th took it fairly easy only doing exercises  -- I can already tell that the pain is different.  I have surgical recovery pain versus pain in my hip
  • May 26th went up and down 15 steps to 2nd level.  This felt like climbing and descending from Everest :-)
  • May 27th first day of PT - one hour long.  I now have a specific lists of exercises I will do each day.  Likely 2 to 3 hours of exercise each day.
  • May 28th went for a longer walk outside and tried to back the pain pills from 3 hours to 4 hours to see how that might be better in terms of getting up in the middle of the night.
  • May 28th was the first day of a bowel movement post surgery.  I bring this up not to have too much detail, but because this is a real issue after serious surgery because opiods will absolutely back you up.  I followed the standard recommendations of taking laxatives such as colace prior, during and after the surgery - along with tons of fruit, miralax and tons of liquids.  IF that did not work, I was told to use Magnesium Citrate which works a very high percentage of the time. Maybe 3 hours of sleep.  Tried to sleep on left-hand side again, but too painful/difficult.
  • May 29th - continued success with BMs.  Slept upstairs and making continued improvements - me walking 6 days after surgery

  • May 30th one week from surgery date. LOTS of walking. Was able to sleep on side for 20 minutes without pain - no sleep, but no pain. Getting used to only 1 to 2 hours of sleep at a shot before waking up. Sleeping on back is something that I never do. EACH day has been BETTER than the day before which is thrilling 
  • May 31st - started to back on Vicodin
  • June 1st - everything continues to get better and going for longer walks - continued to cut down on Vicodin
  • June 2nd - continued to back down on Vicodin as pain level is very low except for a couple of exercises -- walked 1/4 of a mile with walker -- no ice at night and continued to cut down on Vicodin
  • June 3rd - sleeping is still a challenge.  Finally can sleep on left side.  I have heard an believe that pain killers affect everyone a little differently.  Yet another reason to get off these pain killers, which I hope to get a green light on when I have my two week checkup next week. 
  • June 4th better every day.
  • June 5th ordered an elevated rest pad since rebuilding this in the middle of the night from 5 pillows is getting very old - especially for Julie :-) 
    • Note, I am going to return the elevated rest pad because last night I went without it and slept the best of any night since before the surgery. I also think ( do not know for sure) that having your legs raised when the swelling has gone completely down MIGHT have to led to more times I had to get up and go to the restroom.  I found lying on my non-surgical side is now possible and I can sleep.  I found it more comfortable and better to protect cross-over of my legs by having my surgical leg behind my non-surgical leg which keeps my hips more in-line.  IF I have my other hip replaced, I would buy that raised pad because the mound of pillows just falls apart over time is my experience.
  • June 6th continued progress
  • June 7th received a perfect review at my two week post-op review.  I could NOT feel any better right now! I am completely off the pain killers as well.  I do not need to cover the sutures and if they do not fall off by this weekend, I can take them off. I next see my Dr. the first part of September and just keep up the twice weekly PT.  I also dropped 8 pounds in the past two weeks, which was great.  Ten more I am at my weight my GP wants me to be at.
  • This will go to weekly updates as I really could NOT be more pleased with my new titanium hip! 


  • Below is my hip at 15 days.


  • June 13th - 3 weeks from my surgery I started driving and using a cane inside the house.  Below is my scar at 3 weeks.

  • Below is me finally getting out with my 2016 Corvette Stingray at 3 weeks 5 days. Julie and I went to Breaux Winery in Loudoun on a beautiful day.  It felt great driving the 2011 Corvette Grand Sport as well.

  • At week 5 I was able to ride the stationary bike with zero tightness or discomfort.  That was a big deal.  
  • At the 5 1/2 week mark I totally gave up my cane.
  • At the 6 week mark, I went for 2.3 mile walk with Julie.  I was able to stop wearing the support hose today, which was very nice. My gait is still not perfect, but I had trouble walking 15 feet before the surgery, so I am thrilled!  I used cyclemeter to track our walk. The fastest speed was because I forgot to turn it off in the elevator :-)



A few days later I walked:



  • Week 7 -- I really feel like I am almost back to normal, except for the fact I can't put on my right shoe yet because I do not want to take a chance on over stretching.  I did four hours of yard work on this past Sunday July 10th and had zero issues.
  • Week 8 --I went on a 27.5 mile bike ride on the WO&D and had zero issues.

  • Week 9 I did my standard 40 mile ride on the WO&D and it felt great.
  • At 9 weeks and 5 days I had my last PT session which I passed and I received the marching orders going forward - which I will follow religiously.
  • At 10 weeks and 6 days I went on a 54 mile bike ride from OC, MD to Cape Henlopen and back.



  • The main thing I need to work on now is symmetry of my walk as for the past six months and longer I have had a swinging right gate to deal with the hip -- it has actually been an issue for many years and it will take me awhile to get it perfect, BUT this is key because when your gait is now symmetric, you CREATE OTHER PROBLEMS!

  • RESOURCES NOTES:  there are TONS of great information from your Dr., books and info on the web regrading this surgery. 
Important Things I Learned After My Hip Replacement

  •  The THREE most important decisions are:
    1.  Pick a great surgeon and do ALL the prep the Dr. tells you to do.  I had an incredible surgeon. A surgeon who has done over 1,000 hip replacements and does at least 50 to 75 per year turned out to be a good number for me.
    2. Pick a great PT.  I had the best.  She helped me work through the many challenges I had during my recovery that I would have NEVER been able to figure out myself.  I put in an average of two hours every day doing PT.  I think that made all the difference in the world.  If don't do the PT, you are cheating yourself.
    3. Pick a great "coach" as they say in the "Joints in Motion" Course.  I had the best coach in my wife of almost 33 years Julie.
  • Try to borrow the walker, reachers (things to pick up stuff since you cannot bend over) and other things if you can.  Not sure I want to borrow someone else's raised toilet :-)
  • Having a walker on main and bedroom level was a HUGE benefit for me.
  • It turns on you need need TWO reachers - one reacher and one when you drop that reacher :-) 
  • Below is the device that makes it possible to put socks on by yourself (you slip the sock over and the ends lock around the indent near the white straps and you just pull it on, next to the shoes are the long shoe horn, the EZ reacher with trigger grip and then the round wooden tool that is used for getting your shoes straight and misc. movement of stuff you cannot reach.  If you notice my tennis shoes have the elastic shoe strings which were GREAT and saved me from buying some stupid, ugly slipons that I would ONLY wear after surgery and were NOT as comfortable as your own tennis shoes.




  • Having LOTS of gallon size baggies of Karo syrup in the freezer is key when you get home The first week you should ice on for 20 minutes take a break and get it back on.  That first night home is very important.
  • Get elastic laces for a good pair of tennis shoes.  You won't be able to tie your laces for a few months,
  • Each day was better than the previous day.  I would say the first two weeks were the "toughest", but even that is too strong a phrase as I felt MUCH better right after surgery.  Probably a better way to state is that you want to be patient with yourself the first two weeks in realizing that you will need help around the house. The big challenge was that the pain killers gave me headaches and made me notious, as well as I had difficulty sleeping, BUT I was so thrilled to have a new hip that I did not care.   
  • I cannot thank my wife enough for all of her help during this time.
  • Expect sleep to be tough (at least it was for me).  If I napped during the day, I looked at that as a good thing because it was hard for me to sleep on my back and sleeping on my sides was a non-option for almost the first two weeks.  Hopefully, pain killers work out better for others.
  • These pain killers affect people in different ways.  I have heard some people sleep a lot and others it is a challenge. I was in the latter category.  I worked hard to get off them as soon as possible.
  • Rails on both sides of steps is KEY when you first start going up the stairs.
  • The first time you go up a big set of steps will seem like Mt. Everest.  ALWAYS have a spotter going up/down steps until you are 1,000% comfortable.
  • You WILL need a raised toilet.  DON'T get the type that has the rails on each side, but instead get the one that looks like a balloon was put in the toilet set to raise it up 6 inches.  The reason is that you will want to spread your legs wide and the type with the rails will NOT allow you do that.  Your walk will help you get up initially from the toilet in the first few days.
  • When you start walking more with your walker, you will wear out the tennis balls.  There are different types of walkers with tennis balls.  Some have a tennis ball that you saw (not cut) in a "X" with each line being an inch and then you place it at the end of the walker.  The stupid designed walkers are the ones that LOOK like tennis balls, BUT it requires a separate "pad" that you need to buy that goes into the "tennis ball" at the bottom of the leg. I purchased these "walker ski glides" made of heavy duty plastic that worked out great for long walks outside.
  • If you need to bend over at the 6 plus week mark, use the golfer picking up a putt method where the surgical leg is straight and your bend over on the good leg.
  • Attitude and prep is everything.  I kept riding the bike right up until a week before the operation to keep my weight down, but more importantly to keep my muscles in good shape.  When you go to PT you will see people who are in shape and those who are out of shape.  Take a wild guess on who does a lot better in the shorter amount of time ? :-)  
  • I was told that leg extensions are perfectly fine UNLESS you had an ACL operation

What I found worked for me getting in/out of my 2016 Corvette Stingray was using the mid part of the seat near the headrest and putting my arm on the door near the window and either pushing up or lowering myself down.

Here is advice I received on the Corvette Forum, take your pick on what works for you.

I was very fortunate to receive advice on the Corvette Forum on how to get in/out of a Corvette after surgery from AJ:

First, if you can park in a secure area/garage, take the roof off. It makes getting in/out much simpler.

How well any of this works will depend on your arm and upper body strength.

(Roof Off) Open the door, step in with your right leg, grab the wheel and top of the A pillar. Start to sit, using both the wheel and A pillar to support and guide yourself in and down. Slide down the seat back if you need the extra support.

If you have sport seats, careful of the logo in the headrest.

To get out, grab the A pillar as high up as you can reach and the top center of the steering wheel. Pull yourself up, stand up straight, then step out and down.

Alternate, with roof on or off: Use right hand on A pillar to help lift yourself up while rotating your legs out to the ground. Relax. Get your feet as far under the car as you can, and straighten your back. Use leg muscles to stand straight up. Use your arm on the A pillar for support and extra lift. You can also use top center of the steering wheel with the other hand to help push yourself upright.

This method is going to be hard on the seat side bolster

Getting in (roof on):
Stand at about the same angle as the door.
Move right until your right left is touching the body of the car.
Grab the top center of the steering wheel w/ your right hand.
If you can twist, left hand at the top of the A Pillar.
Start to sit, pulling hard on the wheel to guide and support the rest of your body on the way down with the A pillar hand. Legs in one at a time.

Getting out (roof on):
Rotate your entire body so you are 90 deg to the seat.
Wiggle forward until you are more or less sitting on the bolster.
Put you feet as far under the car as you can.
Left hand on either the door frame or about 1/2 way up the seat back, the other on the steering wheel or A pillar, as needed.
Push yourself out and up with hands and simultaneously use the strength in your "good" leg to stand straight up.

Hopefully, the directions make some semblance of sense, and some combination of the above may work for you.

Exercises I was doing at the end



1-Aug 2-Aug 3-Aug 4-Aug
Hip Abduction (Lying) 30 repetitions; 2 times per day



Standing Knee Lifts 2 sets of 30



Single Leg Raises



Bridge on Bed



balance on Right foot



Rubbing Scar & IT Band w/Tennis ball



Lying on side-leg lifts -- back against the wall



Standing Left hip raises



Step over, right leg down



Sit to Stand



left leg down, step with right leg -- keep hips level and square -- concentrate on knees then hips then BOTH -- many sets



Leg extension machine - 15 reps two sets



Walking



Stationary Bike



laying on stomach lifting leg in the air



lunge stretch - back leg straight and stretch hip



Hip hike



left knee bent -- single leg raises