Before your surgery

My hospital provided me with pre-admission instructions, and I'm going to guess that each surgeon and hospital has their own protocol for hip replacement patients.  Make sure you check with your hospital and surgeon at least a month before your surgery so that you can make purchases and plan out any pre-op activities.  My list below is what I was asked to do, and I'm including this just to give you a sense of the planning.

Instructions my Surgeon:

• Two Weeks Prior to Surgery
• Stop taking any NSAIDS (Ibuprofen, Aspirin, Meloxicam).  Why?  Because NSAIDS tend to thin the blood, and the surgeon wants to make sure that you are not at risk for too much blood loss during the procedure.
• Stop taking any Estrogen or hormone replacement medications.  Why? Hormones increase the risk of stroke, so this is to mitigate that risk.
• Night Before Surgery/Morning Of Surgery

• Wash with Hibiclens 4% cleanser the night before the surgery, and the morning of the surgery.  Why? Because skin normally carries a lot of bacteria and the surgeon wants to reduce risk of infection.  In my case, my surgeon had a very specific protocol that went along with the Hibiclens washing:
• Use freshly laundered towels to dry yourself (one towel at night and another freshly laundered towel in the morning).
• Wear freshly laundered pajamas to bed
• Change your bedding and sleep on freshly laundered sheets the night before surgery
• After your morning cleanse, wear freshly laundered clothes to the hospital

Questions to ask your surgeon and hospital staff before you are admitted:

• What is your pain management protocol:
• What is the game plan for immediate post op pain medication?
• What can I expect when I'm released from the recovery room?
• Will I be able to fill any post op prescriptions at the hospital (or will I be required to go to a pharmacy on my way home?)

•  Post Op Recovery Questions

• Will I have a catheter immediately following surgery? If so, how long will I have it in?  
• Will there be a commode in my room?
• Will I have a walker in my room?
• Will this be "my walker" to bring with me when I leave? Or will I have an opportunity to order one before I'm released from the hospital?
• Is there a reclining chair in my room?
• How soon after surgery will I have PT?
• Will I wear TED hose or have WRAPS available while in the hospital to help prevent blood clots? Does the hospital supply these?  Will I need any additional compression garments once I am released from the hospital? 
• Does the hospital allow my significant other to stay with me in the hospital overnight? If so, is there a place for them to sleep? Sidebar: my hospital allowed my boyfriend to stay with me overnight, however they didn't have a bed for him to sleep in.  He used the recliner chair and the hospital staff helped him with sheets and bedding! I'm not sure if this was truly "allowed", but no one questioned it and I'm sure the staff appreciated him being there as he helped get me fresh water, ice packs, and walked me to and from the bathroom, which freed them up to take care of other patients. 

 What to Bring To The Hospital:

• Non-skid booties or socks
• Comfortable, loose-fitting clothing: underwear, t-shirts, pajamas, sweat pants.  Make sure your clothing is roomy and stretchy as you are likely to SWELL and the last thing you want is to feel restricted or have your clothing rub or put pressure on your skin!
• Lightweight Bathrobe so that you don't have to show your behind if you end up wearing your hospital gown and want to get out of bed! Also helpful if your room is chilly!!
• Toiletries:
• Toothbrush & paste
• Dry shampoo (in case you have shower restrictions while in the hospital)
• Soap 
• Long body scrub brush (in case the hospital shower doesn't have a handheld nozzle).
• Deodorant
• Body Lotion

• Personal Items: Each hospital is different, however I suspect that most will say they are NOT accountable for lost or missing personal items.  Despite this, I took a chance and brought along these items. You can judge for yourself whether you are comfortable bringing these items to the hospital:
• iPad and charger
• I preloaded my iPad with several of my favorite shows, various music playlists and several Kindle books! The hospital TV selection was bad, so this really helped me pass the time!
• My hospital had WiFi, however it was an unprotected network, so I made sure to use my mobile phone as a secure "hot spot" whenever I was online.
• Mobile phone and charger
• Helps with keeping in touch with loved ones AND useful if you need to set alarms for taking pain medication.  In my case, the nursing staff was instructed to provide medication "as needed", so I found myself needing to set alarms in order to get my pain medication every four hours.  I'm sure each hospital (and physicians instruction) is different, so be sure to ask about this BEFORE you go to the hospital.
• Insurance Cards
• Medications

 

Recovery Equipment For Home

I was very lucky to have a great recovery set up when I got out of the hospital.  I had to travel to FL for my surgery, but fortunately, my older sister lives about 15mins away from both my doctor and the hospital where I had the surgery. 

And as luck would have it, she has a handicapped bathroom AND a TempurPedic adjustable bed in her home from when our elderly mother lived with her.

Now I realize that not everyone has this kind of a set up - but here is a list of things that helped me during recovery.  Also be sure to check out the list of recovery aids available on Bonesmart.

BEDROOM
* Bed: As I mentioned, I was extremely fortunate to have the use of a TempurPedic adjustable bed, which is pretty much like a hospital bed - it allows you to adjust the head and foot area, so that you can raise your head and elevate your legs.  The mattress is super comfortable, and adjusts to your body weight for comfort.   

Now I realize that not everyone will have access to this sort of bed, but if you can, try to make sure that the bed you're using for recovery isn't too firm or too soft.   

If your mattress is too firm, you'll find yourself pretty sore sleeping on your back, which is pretty much inevitable, even if you have no post op restrictions.  In my case, I was unable to easily move to my side (much less lay on my side) for the first 8 days - and that's with the SUPERPATH technique, which has no restrictions.  If your bed is firm, try to get a cushiony mattress topper.  

If your mattress is too soft, remember it will be difficult to move your body around for the first week or so, so try adding some firming support between the box spring and mattress (perhaps a piece of plywood?) to make your mattress more firm.  You don't want to sink into your bed, as you'll find yourself straining and wrestling in your bedding to move yourself about. 

* Pillows:  Pillows are important for your head, but they're even MORE important for supporting and elevating your operative leg.  I recommend using at least two long pillows for elevating and supporting, as they have the added benefit of taking the weight off of your hips and distributing it to other areas of your body.

* Tray Table: A tray table (especially with wheels, if you can find one) is extremely helpful during recovery.  My sister found an old hospital tray table at a local thrift store, and I used it for holding my medications, my bottled water, tissues and such.  It was so much easier to reach than the night stands next to my bed (which for most people, require one to roll over to the side to reach).  If you can find an old hospital tray, that's great, but if not, try to find an old folding TV table - something that can be reached without much effort (and without having to roll over to one side!).

* Note Pad & Pen: I kept my medicines in a basket on the tray table next to my bed, as well as a little note pad & pen.  This allowed me to make a schedule & notes each time I took pain medication.  For example, I'd make a little schedule like this:

• 7am: Xaralto
• 8am: Senecot
• 9am: Oxycontin & Celebrex
• 1pm: Tylenol
• 4pm: Dilaudid & Celebrex
• 8pm: Oxycontin
• 12am: Tylenol  

Not everyone may need this sort of checklist but for me, it really helped keep my medications straight, especially during the first week post op.

* Hip Kit:  Hip kits are sold online at places like Amazon and contain helpful little tools for those recovering from THR, like reach grabbers, long shoe horns and a nifty little device that can help you get socks on your operative leg.  I didn't get one of these before surgery, but will tell you that for the first few days of recovery, I had to get help putting socks onto my operative foot! 

* Ice Bags: Icing and elevating will become a key part of your recovery, as it's one of the easiest ways to add pain relief while simultaneously reducing swelling.  Bonesmart has a entire section dedicated to the art of icing and elevating, so be sure to read all about the benefits.  There are several ways to ice - you can make your own ice packets with zip lock baggies, water and a bit of rubbing alcohol, or you can purchase ice packs from your local drugstore or medical supply.  I used generic gel ice packs purchased from CVS.  I'd place one on my operative side rear and the other across my groin, and it really helped to relieve pain and bring down the swelling.  Another gadget that I purchased was an Aircast Cryo Cuff IC Unit and cuff.  After using it for my hip, I'd say it's one of those "nice-to-haves" but certainly not a necessity if you have gel ice packs.  The blue canister is essentially a large thermos that you fill with water and ice.  You plug in a small air hose so that the thermos automatically fills up a large hip cuff and constantly re-circulates the cold water through the hip cuff.  It's pricey, a bit of a pain in the rear to set up, but does help to provide cooling relief for about 5-6 hours, which is nice.  Again, from my experience, it's not necessary for hip replacement recovery, but is a nice to have if you want to alternate between the gel packs.  I found mine on eBay, but you can also find them online.

* Power and/or Extension Cord:  As you might imagine, recovery can be a bit frustrating, especially after the first week or so.  Your mind WANTS to get out and do things, but your body still needs to heal! For that reason, I spent a good deal of time on my laptop, so be sure to have a power source and extension cord near by! I also used the alarm on my mobile phone for waking up during the night to take my pain meds, so yeah, power is a good thing to have close by your bed!

BATHROOM
* Handicapped Accessories:  If you don't have access to a handicapped bathroom, you can buy several accessories to help you.  

• Handicap bars come in handy, especially in the shower but be VERY careful of those that attach with suction cups.  It's easy to forget that they are not permanently attached, so make sure whatever you buy has been tested beforehand to withstand you leaning and balancing without getting loose.
• Shower Seat these are not a must have, in my opinion, but do come in handy, especially if you find yourself tiring easy or need a place to hold your shampoos and soaps that
• Handheld Shower Nozzle If possible, try to get a handheld shower nozzle.  It really helps you to wash your hair and body without moving around too much.  Showers are slippery and the last thing you want to do is to fall on your brand new hip.
• Raised Toilet Seat These are a must for recovery and really help you to sit in comfort, especially the first few weeks of recovery.  There are several models out there - some are commode style and merely sit over the toilet with a large funnel type of attachment (if you use one of these, make sure it's aligned with your toilet bowl!).  I purchased a pretty standard raised seat without side bars, but there's several variations on the internet.  
• Non-Slip Rug Seems obvious, but you want to make sure you have secure footing wherever you are.  Make sure you have a good non-slip rug in the bathroom! 

Furniture  My sister had a lovely leather recliner chair in her home, however, the seat was quite low and the upholstery was very soft (you felt like you were basically sinking into the chair).  Chairs like this are great outside of recovery, but for new hip patients can actually be pretty uncomfortable.  Some people place pillows on top of these sorts of recliners or use lifts underneath to raise the seat. Again, I was quite lucky in that my boyfriend found a "like new" lift recliner chair at a local thrift store called The Catnapper. This chair was amazing for recovery as it lifted up (making it so nice for me, especially during the first week post op) and it reclined.  It became my go to chair for icing and elevating, and the upholstery was firm enough to support me, but soft enough for comfort.  As you'll see on the link, they are a bit pricey, but check the second hand market, as you never know what you'll find (who knew I'd find one for under $150 at a thrift store!).

Bonesmart also has an excellent guide on recliners, so be sure to check it out before you purchase anything.



 

   

My Post Op Recovery

Note: This is from my Bonesmart recovery thread/diary, and hoping it gives you an idea of how my post op & healing process transpired.
 

Day 1:
Hey everyone! I wanted to give a quick post op report from South Florida! My surgery was initially scheduled for 8:30am, but things were a bit behind schedule and I ended up going in at around 12:30p, in recovery by around 2p and in my own room by 3:30pm...talk about a whirlwind!
I opted for the spinal with happy juice and was so glad that I did - didn't feel a thing and felt pretty good afterwards in recovery.

The team at Bethesda West is amazing - as is Dr Grandic! I got to rock to The Rolling Stones in the OR (at least until they knocked me out!). My hip was really bad with AVN, so Dr G had to go a bit deep for my hip cup. My groin pain was pretty heavy gauge once all the anesthesia wore off but I was prepared thanks to all of the advice here and feel like we've got the pain management down now! I stood up for the first time at around 8pm and went "potty" and it was sooooo nice not to have the bone on bone pain - just the surgery pain (yay!!!).

I'm on IV Dilaudid every 3hrs for pain with Oxy in between & that seems to be doing the trick as far as managing pain. My pain levels were at about 10 before we got things under control (no fun!), and pain was mostly in my groin area - I suspect this is what Dr G was talking about when he said it'd be a tougher recovery than normal due to the damaged tissue that needed to be removed from my hip socket. Anyway, things are much better this morning (I'm icing and elevating!!) and I'm anxiously awaiting PT & my official "first walk"!

Day 1 Update:
Well, PT didn't go very well. I was able to walk with a walker from my bed to the door of my room but got pretty dizzy (and blood pressure went down pretty low).

Ah well....so much for my "big walk", lol. But it's all good - I know it's just too much, too soon.

On the upside, it felt good to actually stand on my operated hip - my groin is sore and stiff, but like many before me have said, the bone on bone pain is GONE, so I can deal with this!! I think once I get some time under my belt, some rest, and my blood pressure and pain meds in check, I should be ready to truly walk. But for now, just chillin' in my bed, icing and elevating, napping and relaxing.

Day 1 Evening/Day 2 Morning
My late afternoon PT went much better! I was able to take a little trot around the nurses station and only got dizzy once, so just sat for a spell and then went back to my room. Going to/from the bathroom is easy, it's the longer jaunts that seem to take a bit out of me, so I'll keep going slow and easy on those. BTW, my new hip feels really good!!! For the PT exercises, I was unable to do any true heel slides on my operated leg, and told my PT we'd try again another time. I'm not pushing myself with anything that causes pain on that side - and so far all I can do comfortably is knee lifts (working quads) and walking short distances.

My pain got a little crazy again at around 3am this morning, but we got it under control with some IV Dilaudid. Woke up at around 8am and it feels like I got hit by the proverbial 18-wheeler! Mostly muscle pain in the operated leg (butt and thigh especially), but to be expected as this is the day that the anesthesia and such is wearing off. I'm now on Celebrex, Oxy every 3hrs, with Tylenol in between, and soon Dilaudid pills as needed. We'll see how that goes or if I need to ratchet things up on the pain med side. Also taking Xarelto (will be on this for 10 days).

Day 2
Walked the entire floor this evening with my trusty walker and only had to stop once due to dizziness. I'm going slow and easy - my muscles still feel sort of achy and my operated side is pretty swollen (despite the icing/elevating) but it's SO nice to walk without the bone pain! Also have been getting up and down throughout the day for the bathroom, and spent about 3hrs sitting in the recliner.

The nurses changed my dressing tonight so I got to see my incision and aside from the ink-spattered looking bruise on my right butt cheek, things look good! I'm amazed that the incision is only about 3 inches long and that the little puncture wound is so tiny (and that Dr G and the other Superpath docs are able to do the procedure with such a small incision)! I'm still unable to shower but am told that I'll be allowed to once I go home, which we're thinking will be either tomorrow or Sunday.

Tonight I'm just hanging out - will spend my time icing and elevating in my hospital bed, and I have a bunch of movies downloaded to keep me entertained!   

I'm very happy with the hospital. It's new and beautiful and everyone who works here seems so caring and knowledgeable. My only complaint and I'm not certain this is a "hospital" thing, is that a lot of the pain management is really left to the patient. I suppose that's fine but if one oversleeps, wow...the "as-needed" drugs aren't given unless they are asked for 

Day 3
Slept through the night with Dilaudid and Tylenol, and after breakfast took a nice little walk with PT. All good this morning, except for some achy feeling in the groin and thigh muscle, mostly felt after walking or PT. After that, I got the "all clear" from Dr G, so I'm going home to my sisters to recuperate I'll have a home health aide come and change my wound dressing and in home PT to help get me walking even better. I also was able to shower today and WOW a hot shower never felt sooooo good!

I'm eager to get to my sisters and see how things go in a true home environment! Although I'm still sore and achy, I have to say that all in all, I'm very happy with how things have been going post op.   

Day 3 Evening
Well I'm home at my sister's house and it feels soooo good to be out of the hospital! I got here around 5pm last night, and my wonderful sister had everything all set up and ready for me! The hospital had made arrangements to deliver my shiny new walker to her home, so she had that waiting, along with some other items from the BS checklist: raised toilet seat, pillows, extra ice packs, etc. My boyfriend found a lift/recliner chair for me at Goodwill (it was like new!) and delivered it to her house before the surgery, and I'll tell you that it is one of the best things I've sat in post op! It raises up to your butt (so that you don't have to bend down when sitting) and then gently goes down, raises the legs and reclines! Ahhh it's hippie nirvana!

As many of Dr Grandic's patients have mentioned here on the board, Bethesda West doesn't have an in-hospital pharmacy, but they do offer pharmacy delivery service from Walgreen's. Dr G and the nurses made the arrangements before I was discharged and it worked out quite well for me. All you need is a method of payment and your insurance information. The local Walgreen's didn't have the Dilaudid in stock, but they made a run to another store that had it, and still managed to deliver my entire pharmacy order within an hour. Very convenient!

I spent the rest of the evening in my hippie chair with ice packs, and every hour or so paddled around the house using the walker - little trips to the kitchen, the bathroom, the patio. I'm doing everything slow and easy - and it feels amazing! I used my phone alarm to remind me to take my meds overnight, and also keep a little notebook by my side table so that I can jot myself reminders, etc.

Today is my first full day day of being "home" so I've got lots to keep me entertained while I recuperate: movies, tv episodes, kindle books and of course the internet! I might get dangerous on eBay or one of the other online shopping sites in this mode (ha!) but for now, all is good! 

Day 4  
 I spent probably 85% of my day in the recliner on Day #4, icing and elevating. I've got the pain meds down to a science, and was up & walking with the walker to go to the bathroom, the dining area for a bite to eat, or to sit outside on my sisters patio in 10-15 min increments here and there. I'm walking so much better each day - and Day 4 was no exception: I can now easily walk with a normal gait (one leg past the other) with the walker, and am getting pretty good at sitting and standing up! I try to practice my PT exercises in bed, but for the most part, have only been doing the leg circles (more for circulation than PT) as I feel like the walking has been enough exercise for me. My quads are already pretty strong from pre-surgery condition, so I have to admit the PT exercises have not been a huge priority for me personally. Maybe I'll change my tune when the in-house PT gets here, but for now, it seems to be working for me! 

My swelling seems to get worse at night, but I've been able to manage it with ice and elevation. The swelling is mostly around my rear and hips (not exactly the places that most women want to swell!) but I also have some swelling down my thigh and around the knee of my operated leg. I am using large ice packs purchased at Walgreens and they seem to be doing the trick. My only complaint is that they only stay cold for about 2hrs, so I'm constantly swapping them (luckily I purchased four packs - and I use two to ice each time). I also purchased an Aircast Cryo machine & hip cuff, but haven't used it...yet! I want to wait to make sure my incision is OK before I start anything that might 'compress'.  

My incision is still under wraps but as I mentioned in earlier reports, it's only about 3 inches long and sits on the side of my right butt cheek, high enough to be covered by a bikini. The puncture or stab wound is a little lower but is so tiny that I suspect it will fade pretty easily once it heals. I'm still all black and blue on my butt, but it is starting to fade a little each day.  

I tried staying up with my sister and her family to watch television last night but was only able to hang out with them for about 90mins before excusing myself to go and chill out in my bedroom. I was seated in their family room recliner (not my cool lift recliner) with ice, but the chair was a little too smooshy, so I wasn't as comfortable as I wanted to be. I can also tell that the "surgery drain" hits in different ways, and even just sitting and interacting with family can sometimes be a little too much drain! Sounds funny, but it's been the case for me - so that's when I go to my bedroom and just chill out!!  

Last night was another good sleep night - I woke myself up with phone alarms to take my meds, and still managed a decent night's sleep. I've been getting myself to/from the potty without any issues (thanks to the riser toilet seat) and have found I only needed the Senekot to help me with any constipation (yay!). I'm also drinking a LOT of water and broth in between meals, which seems to keep things "moving"  

I believe my home health aide should be here today to change my dressing so I'm eager to hear how my incision is healing. Aside from that, my plans today are to chill out, ice and elevate and catch up on some good kindle books! 

Day 5
Wow...has it really been almost ONE WEEK since I had this surgery? Kind of freaky to think about!!

So Day #5, I had my first at home Nurse evaluation and my first at home PT Evaluation. My incision looks good, though my butt still has all sorts of bruising around the incision! But the nurse was happy with how it looked, and with my vitals, so all good there. They'll come back out tomorrow to change the dressing again and check on me.

My PT adjusted my walker and stated that she feels I'm doing very well. She gave me Dr G's PT protocol so I could look it over, as the actual PT will start later today. It's essentially the same exercises that I've been doing/seeing for the hip: ankle slides, knee lifts, knee presses, and some standing flex exercises...nothing too crazy.

Aside from that, my day was pretty much business as usual: got up to eat, walk around a bit, then back in either bed or recliner for icing, elevating and chilling out. My swelling is going down a little, but it's still around my hip and butt area - and I can certainly feel it when I'm walking. My new hip feels good - but when I stand in place it feels "higher" than my non operated leg. I know that is to be expected, so I'm not giving it too much thought, but just an observation that it was noticed today. The new hip also feels "big" inside, if that makes any sense? Again, I'm not concerned, but just an observation as I was walking that it definitely feels different than my non operated leg, like the inside joint is larger or something.

Pain levels have been managed with meds so no complaints there.

Today will bring Occupational therapy over for a visit. I'm not really sure that I need them at this point, but will listen to what they have to say/offer as far as helping me around the house.etc.

Day 6
All is going well post op and today as I write this, I'm actually one week post op...so hard to believe! I'm walking better and better each day, am still taking meds and still have quite a bit of swelling in the hip and thigh area of my operated leg. I haven't ventured outdoors yet, aside from walks around my sister's outdoor patio/pool area, but feel really good and am not really concerned about taking a jaunt outdoors, other than to be careful of crooked sidewalks and other "gotchas"! I've even been walking without any aides for a few steps here and there in the bathroom and around my bedroom, and though I feel a bit "weak" on the operated side when doing this, it's nothing too painful or scary An occupational therapist came out to visit me yesterday, and once she saw how well I was getting around, getting dressed, etc, she "discharged" me...yay!

I think my biggest post op complaint is with the home health company that I've been assigned through my insurance company. A nurse was supposed to be here this morning at 10:30am to change my dressing, but never showed up, and never called. I called the main office and after being bounced around and placed on hold for like 20mins, was told "she's probably running late - I'll call her now and ask her to call you". It's been 30mins since that conversation and, um, still no call. Errrgh.

The company also manages the at home PT, and they were supposed to come out yesterday at around 1:30pm. They never showed up and at around 3pm, I received a call from the PT who said she could be at my house at 5pm as her schedule was "slammed". I get very tired each day at 5p, so told her to forget it, and instead to come today (Weds). She said that she was unable to come on any day before 4 or 5pm, and suggested that I call the main office to find someone else who can do my PT earlier. Double Errrghhh! So today I called them and again, they said they'd find someone and have them call me. Guess what? No one has called. I cannot imagine what it must be like for those who have a hard time getting along (I'm thinking the elderly who live alone etc) with such poor care! Luckily I'm in good shape, and am going for a follow up with Dr G tomorrow, so it's not like it's critical for the nurse to be here, but the PT?? Just a very eye-opening experience for me, and I intend to let my insurance know that the company they are using really seems unorganized, unprofessional and pretty much useless!

Ok, enough whining on my part - the good news is that I feel great, and am finding that it gets easier and easier to get around each day and all without that rotten arthritic hip pain that I've had to deal with the past 3+ years.  

Day 8
Hey fellow hippies! Today I had my first post op appointment with Dr Grandic and all is going so well! He took Xrays and is very pleased with how my scar is healing and with my mobility progress I have copies of my Xrays and will try to attach to this post - you can see my before/after, and note that I tried to blur certain areas for privacy hence the reason the pics make me look asexual! You'll see with my new hip, Dr G ended up placing one screw in my hip cup for stability - as my pre-surgery hip socket was such a hot mess! The other thing you may notice is a little charm on my non-surgical side: that's from my undergarments (which was pretty funny to see on the XRay!). At first my boyfriend was like "Um Doc what's that?" and I wanted to pull a gag & say something like "Dr Grandic, did that charm fall off a necklace???" but I couldn't make eye contact w/Dr G in time....ah well....funny moment!!

Let's see if these links work:



Dr Grandic also removed my bandage and I'm now allowed to go leave it uncovered, take a bath and go swimming if I want. It felt good to be really outside today, and I was even able to get into a Chevy Trailblazer (sans running board) with ease!! After my appointment, we went out for lunch, took a quick trip to Walmart for a new TV gadget, and all without any issues or pain.... I'm still using my walker, but have a sneaking suspicion that I can start using a cane. I'm not rushing it though - and will wait until I have a little more PT under my belt. I finally have things resolved with at home PT, so they will be stopping by tomorrow (finally!).

So all in all - things are incredible - I feel like a new person and am so, So, SO pleased with how things are progressing 

Day 9  
Here's a learning moment: At 8 days post op, if one decides to spend an afternoon at the store & then out to lunch - generally walking a bit more than "normal" - be prepared to pay for it just a little bit the following day

In all seriousness, today's not too bad, but clearly my bionic parts are telling me "hey, you did a little too much yesterday"! My groin is a wee bit sore, nothing that can't be managed with my meds, handy-dandy ice bags and recliner, but um, yeah, I'm sore!

I also had my first official PT appointment today. I really like my therapist, he seems to share the belief that one shouldn't push to the point of hurting & you can tell he clearly enjoys what he's doing He had me peddle on a little floor bike thingy for about 4mins, do standing side lifts, and the ever-so-difficult (for me, anyway) lifting of the operative leg from a seated position. He feels like I'm doing well for 9 days post op though, and again, made sure that the exercises were not causing me pain. I'm looking forward to more PT next week!

Aside from that, I'm pretty much just taking it easy. Walking as I can around the house, icing & elevating & trying to keep myself amused with reading, movies, tv shows and music. I'll admit that my post op guilty pleasure has been watching episodes of Dance Moms - I know, I know, pretty low brow, but hey, it passes the time and amuses me! 

Day 12 
It's been a couple of days since my last report, and I'm happy to report all is good I spent the weekend pretty much just relaxing, walking around the house, icing and elevating and have been sleeping though the night without the need for pain meds (yay)! I was a little sore following my Friday PT session, mostly felt in my groin, but it only lasted that day, was gone by Saturday. On Mother's Day, I went on a 45 minute car ride (with someone else driving) to visit some other family members, so just brought along my ice packs for the trip, and all went very well. I stuck the packs in the freezer while I was visiting and had them nice and cold for the trip back home - and I think it really helped as I didn't notice any new soreness, pain or being overly tired from the little adventure!!

This morning's PT was good - again, we're taking it easy with just 4mins of bike pedaling, sitting and standing leg raises, leg lifts, etc. I'm getting a little better at lifting my operated leg from a chair seat position, though I still feel it in my groin, and can only lift my leg about an inch off the floor. I'm listening to my body though, and am not pushing this, as I've already noticed that it is so much easier to do than it was just last week. Baby steps

I plan to spend today walking just a little bit more than last week (including outside) and then relaxing, icing, elevating. I'm starting to get a bit stir crazy though, so I'm going to do my best to keep myself occupied so that I don't overdo it!  

Day 13
Today I graduated from the walker to the CANE....yipeeeee! I'm so happy - it makes me feel like I'm making progress, not to mention that I was getting a little tired of navigating the clumsy walker!! So yeah, I'm one happy camper today!

I had my PT appointment this morning and was able to go 6mins on the little pedal bike, and do all of my other exercises. The leg lifts on my operated side are still a challenge, but it does get better each session. My therapist also feels like I'm ready for outpatient PT, so I'm going to discuss with Dr G at my appointment next week. Dr G has a specific protocol for Superpath patients, so it'll be good to get started on the stretching and other exercises he recommends. Walking on the cane feels good - I'm able to really put all my weight on my operated leg without discomfort, so I'll continue to use it, and will keep the walker handy just in case I need it. The really really nice thing is to be able to walk without the arthritis pain! I can deal with the healing/post op pain, but to walk without the crunching, grinding, lurching and pinching from O/A...priceless!!!

My incision is healing nicely and I only have a wee bit of bruising left. I'll have to take pics so that I can add my selfies on the 'badge of honor' page. Today was also my last day on Xarelto, so hoping that helps to clear up any remaining bruise color.

I plan to spend the day chilling with ice/elevation and will try to make an appointment to get my hair done this week (nothing like a little pampering to feel 'normal', right?). Aside from that, life is good - I can't begin to express how great making progress feels - and how much I truly appreciate all of the support, insight and wisdom I've received from everyone here at Bonesmart! 

My Badge of Honor
It's just under 3" long. The bruise below is where the Superpath puncture wound is - it's tiny so hard to see with my crummy phone camera!

  

Day 16 report
All is going well! I'm basically down to taking pain meds only when needed, around 1-2x/day, and am feeling good. Much of my swelling has gone down (yay!) and my bruising has all but disappeared. I'm still icing and elevating as needed, mostly in the late afternoon and evening.

I graduated from walker to cane earlier this week, but am now basically walking unassisted around the house. This isn't intentional - I just keep forgetting to grab it before I get up to start walking! But I've also been "home bound" for most of the week, so perhaps that's why I feel this way. I'm going out to get my hair done later this afternoon so I'll bring my cane and leave the walker in the car just in case I need it. But so far I feel really good when walking, and have no pain when doing so (which is downright AMAZING!).

Day 19 Report
Wow, what a difference 2+ weeks post op makes! I'm pretty much off the cane around the house (as I mentioned in my last update, I keep forgetting to use it!), but am definitely using it for my outside jaunts. I had no problems getting my hair done on Friday, and was able to easily sit in the salon chairs at the sink and at the stylist's hair cutting station - easy peasy

On Saturday & Sunday I did a little retail therapy and was able to walk two or three blocks with my cane before getting pooped out! I took it easy, walked nice & slow, but steady. I found that the hardest thing about walking outdoors is the work it takes to balance on uneven surfaces like cobblestone or grass. I could feel my body "adjusting" to balance, which is something that I definitely took for granted with my pre-arthritis real hip! It's all good though - no real pain to speak of, but I did get pretty tired afterwards.

I'm basically off the narcotics, aside from the occasional Oxy 5mg or Dilaudid 2mg pills, and only when I need them. I'm finding that Tylenol is enough for the most part.

I'm seeing Dr Grandic is tomorrow, so looking forward to getting his perspective on how I'm doing.  

Day 20
Today was my final post op visit with Dr Grandic, and he has given me the "all clear" to go back to Atlanta!

He took one more set of XRays and all looks good - everything is as it should be, so no restrictions whatsoever! The only thing to watch: my BP became slightly elevated in the past week, but he suspects its because of the Celebrex (which I had to go on right after surgery). Now that I'm off the blood thinner (Xarelto), I'm going to ditch the Celebrex and get back on Meloxicam as my anti-inflammatory, and continue to monitor to make sure my BP gets back to normal.

Aside from that - my scar is fine, my mobility and progress are fine - so I will start outpatient PT here in FL and continue when I get back to Atlanta. We'll do a Skype "visit" from Atlanta in about 6 weeks, but I also have his cell and email in case I need anything once I get back home.

By the way, I cannot say enough good things about Dr Grandic! Seriously - he's SO humble and compassionate (he gave me a HUGE hug when I left!). And I've never had a physician who was always available via text, cell or email - and who displayed such a great balance of confidence, compassion and genuine happiness for his patient's progress! The guy ROCKS in my book!!

Ok, off to ice, elevate and catch some sweet Florida sunshine!  

Day 23 
I'm officially 3+ weeks post op and life is good! I walked all around a local thrift store (more like a warehouse) yesterday using my cane, and while I wasn't racing, I managed just fine.  I'm finding that walking is best for me, along with some sessions on the little floor bike that was used by my therapist (and which I found at said thrift store for $5).  The thing that bothers me most right now? My groin gets sore.  Nothing like the old arthritis pain but there's an ache if I overdo things so I suppose it's my body's way of keeping things on the mend! I have really been taking it easy aside from little trips here and there, and I suppose the true test of my healing will be when I get back to Atlanta - back to my regular bed, regular bathroom and regular way of living!  It's Memorial Day weekend so I hope to spend time outdoors to get the last bit of Florida sun that I can!  I'm now off all narcotics with the exception of one before I go to bed, and only when I need it.  Aside from that, I'm taking Meloxicam and Tylenol as needed.  

Why SUPERPATH? My personal FAQ sheet

There are several techniques used for total hip replacement.  Generally speaking, there are three: the posterior approach, the anterior approach and the "north star" or SUPERPATH approach.

In layman's terms, the posterior approach involves access from the backside or the body, the anterior approach involves access from the front side, and the SUPERPATH approach is from the side.

Each technique has pros/cons for the patient and surgeon, and if you go through the Bonesmart forum, you'll find a ton of insight about the risks and benefits of each.

While some folks that I've met are convinced that one technique is "better" than another, I personally don't subscribe to that mindset.  At the end of the day, I feel that the end result is what matters, regardless of the method used to get there.

With that said, here's a quick personal FAQ sheet that explains why I chose SUPERPATH.  Obviously, each person is different, each situation is different, and what is "best" for one person may not be best for all.  

Hipster-chic’s FAST FAQs About SUPERPATH^®

Note: the information below is based upon (a) my own personal experience and (b) information gleaned from the Internet.  I’m not a medical professional by any stretch of the imagination; just someone who went through the Superpath procedure and thought it would be helpful to list some common Q&A info for others who may be considering the technique. 

Q.    What is SUPERPATH^®? 

A.    SUPERPATH^® stands for Supercapsular Percutaneously Assisted Total Hip. It’s a surgical technique used for total hip replacement, where no muscles or tendons are cut.   Because it is considered a “micro invasive” approach, there is typically less blood loss during the procedure or postoperative restrictions afterwards.  To learn more about SUPERPATH, go here: http://www.superpathhiptechnique.com/

Q. Why did you opt for this approach?

A.  There were several reasons for me, personally.  I liked the idea of a “micro invasive” approach, with nominal muscle and tissue trauma during surgery.  Additionally, I liked the idea of a surgeon working within the hip capsule, versus dislocating the limb as is done with both the anterior and posterior approaches.  For me, the procedure just made sense, and once I met the surgeon (Dr. Elvis Grandic, who has successfully completed more than 700 hip replacements using this method) it further cemented my decision. 

Q.   Is recovery time really faster with SUPERPATH than other techniques?

A.   I suspect that everyone is different in terms of his or her condition prior to surgery, so that can certainly impact how one recovers, regardless of the technique used.  From my personal experience, I was in very bad shape before surgery (my hip was beginning to collapse from AVN, and I could barely walk without excruciating pain, nor could I sleep through the night). I had been suffering from OA and AVN for just over three years, and over that period, my mobility decreased from somewhat active to borderline totally inactive. My surgeon told me that my recovery would likely be a little more difficult than what most Superpath patients experience because of my pre-surgical condition. I was pleasantly surprised, however, that I was able to get out of bed on the day of my surgery and, using a walker, walk several steps to use a commode.  I had significant pain that first day, but once the medical team was able to create a pain management plan that worked for me, the immediate hospital recovery was pretty much textbook, where I was able to walk using a walker, get myself out of bed, etc. My incision was glued, so I didn’t have to worry about the pain from any sutures or staples.  At two weeks post op, I am flying through PT and was able to transition to a cane.  I feel great and my incision is healing nicely (and only 3” long).  I have very little swelling and am finding that I only need minimal pain management drugs each day.   Is this “faster” than other approaches?  Who knows?  But this was my personal experience and for me, the experience exceeded my expectations.

Q.  How did you find your surgeon?

A.  I went to the SUPERPATH website and found this section (http://www.superpathhiptechnique.com/patients/find-physician.asp) where they list all US surgeons who perform the procedure.  Although I live in GA, I was willing to travel for the “right” surgeon, and I was pleasantly surprised to find Dr. Grandic in Boynton Beach FL, which, conveniently, is only 15 minutes from a family members home in FL, which is where I stayed following surgery.  I’ve since met others who traveled for the procedure, and took advantage of local hotels in order to be close by immediately following surgery.  And while this may not be a good solution for everyone, it is a possibility.  Again, in my situation, all the stars were in alignment, and after my consultation with Dr. Grandic, I “knew” he was the surgeon for me.

Q.  What about the restrictions?  Is it true there are NO post op restrictions with SUPERPATH?

A.   I had no post op restrictions.  No “45 degree” rules to follow, no sleeping with pillows between my legs, etc.  I’m not sure if this is the case for all SUPERPATH patients, but this was my experience.  My surgeon has a very specific PT protocol and I suspect that the exercises were selected specifically to ensure proper post-op healing.

50 ways to lose your femur: my introduction to Bonesmart

My first Bonesmart post:
"I stumbled upon this site and have since been reading, reading, reading - but thought it was time for a proper introduction I'm Lisa, diagnosed with AVN about two years ago and am now at the point where I need to get R-THR this year (my femur is collapsing!). There seems to be so many surgical options: posterior, anterior, SuperPath, so I'm a bit freaked out and somewhat overwhelmed by the whole thing (no surprise to any of you, right?!).

I'm hoping to find a surgeon that can do a minimally invasive procedure as I'm thinking it would be best for my lifestyle and goals at this point. I'm going to Dr. Bradbury over at Emory in Atlanta for my first surgical consult in March, and am looking to set up another with Dr. Grandic in Boyton Beach FL as soon as I can get an appt.

Anyway, just wanted to introduce myself & say hello - and would appreciate any insight & wisdom you have to share with someone about to go to their first surgical consult!!!

Looking forward to sharing & learning with you all" 

Within minutes of writing this, several Bonesmart members responded, and it was from there that found the Bonesmart library which contains articles on everything from surgical procedures, to pre and post surgical care, advice, tips and more.

I also had the opportunity to *meet* several patients who underwent a somewhat newer hip replacement procedure called SUPERPATH, which is a micro-invasive technique.

I was intrigued!

Below are links to my posts on the forum.  As you read through, you'll get a sense of the community, the shared wisdom and experience, and also an idea of the various options that I considered.

On wearing high heels again 
On my first surgical consultation
Holy sh*t! I've got a surgical date!  
Will my hip "last" until my surgery?
Tools for Icing 
On my way to Flor-ri-da
I did it! My post op recovery thread



 

Facing reality: I need a hip replacement

After hearing from Emory that there was nothing more that they could do, I came to the realization that if I wanted any sort of relief from my rapidly deteriorating hip, I had only one choice: a total hip replacement.

Emory had recommended one of their surgeons who used the "anterior" approach, but I went online and decided to learn more about the procedure - what kinds of approaches were out there, and how did they compare?  It was then that I discovered an amazing resource, an online forum called Bonesmart (www.bonesmart.org).

The next blog entries are taken from my posts on the forum, and I hope they provide some insight into what I learned, and how I came to chose my surgeon and hip replacement procedure.

Mesenchymal Stem Cells & Me

Emory University had quite a bit of information about their stem cell research online, which was intriguing to me.  The idea of regenerating my damaged cartilage seemed like a no-brainer, especially when compared against what, in my mind, was an invasive surgical treatment alternative!

I found several testimonials and videos from former stem cell patients who, like me, were in horrible pain and with the stem cell injections could now walk & enjoy a much improved quality of life.

I made the appointment.

From the start, the amazing staff at Emory told me that there were no guarantees.  My hip was really bad, and they shared that they had at least one person who's hip was worse than mine and the stem cells were beneficial, and at least two others who had a less damaged hip, but received no benefit.

My insurance company didn't cover the cost as they considered the treatment "experimental", but luckily for me, although costly, it wasn't an exorbitant amount of money. 

The procedure was pretty intense. The doctor had to extract my bone marrow from the back of my hip.  While they provide some numbing to the surface skin, there's not much they can do in terms of numbing bone, so yeah, it was a bit uncomfortable, especially when they needed to hammer into my back hip...ick!  After that, they take the marrow and put it through a centrifuge and using a fluoroscope, re-inject it within the hip joint.

About a month after that process, I had to return for PRP or plasma rich platelet injections, where they take cells from the patients blood and create a plasma rich soup that is re-injected into the joint.  The idea is that the plasma helps encourage additional stem cell growth.

Within a month after the procedure, I noticed improvement, which was SO encouraging.  It was the first time that I experienced an improvement without the use of cortisone.  And while I wasn't back to "normal", the procedure had greatly reduced my pain, therefore allowing me to sleep better and to walk better.

The relief lasted for about 9 months.  And then, slowly but surely, the crummy arthritic pain started to return.

The doctor at Emory ordered an MRI and delivered some bad news.  In addition to the wicked arthritis, my femoral head and hip socket was now starting to collapse from Avascular Necrosis or AVN.  My doctor also mentioned that it appeared I had an old injury - a cracked femoral head.  This is the same "injury" that my first ortho doc mentioned, and clearly I had some sort of incident (most likely while skiing, many years before) where I got a hairline crack in my femoral head.  I had no idea or recollection of any specific incident, however I do remember several major spills where I was indeed sore for weeks and sometimes even months.  I do recall one spill in particular where I thought I broke my tailbone - and the pain from that incident lasted months. 

With two doctors reviewing both Xrays and MRI, their opinion was that the "old" injury caused my femoral head to slant forward, and over the course of many years, it started shredding my cartilage.  Over time, my femoral head bone began to "die" via AVN, and was now collapsing.

My stem cell doc then recommended a surgeon over at Emory who specialized in anterior hip replacement.

I was devastated.