X-Ray Of My Total Hip Replacement Implant (© Photo ONLY, not x-ray itself, F. P. Dorchak, Oct 23, 2019)
DISCLAIMER
I am not a medical professional. These are only my observations and opinions, based upon MY situation. Everything I describe below may be slightly different for every other individual for a variety of reasons, including (but not limited to) fitness level, preexisting conditions, surgical discoveries, et cetera. I am merely giving readers an idea of what to expect during a Total Hip Replacement surgery and rehabilitation. Medical and physical therapy direction is specifically tailored to the individual, so my experiences may well be entirely different from anyone else’s.
I have begun writing this post two weeks after my Total Hip Replacement (THR), which was on October 23, 2019. As I’d done for previous medical posts, I’m doing this because so much contradictory or anecdotal information is out there. Yes, I’m adding to the anecdotal, however I’m doing this as close as possible to the actual surgery to record as much information as possible for those out there who need to go through this procedure.
I already talked about a lot of the pre-operation considerations and mind set, et cetera, at my meniscus surgery post, so, here I’m mainly going to talk about post-THR, but, in short:
I had an early Christmas!!!
The Surgeon
TAKE THE TIME AND DO THE RESEARCH.
I can’t stress this enough. There are many out there who “are the best” by any standard…that doesn’t mean that person is the best FOR YOU.
Does the practice deal mainly with sedentary people?
Does the practice deal mainly with sports medicine?
What are their rates of post-surgery infections?
How do you get along with the surgeon…his or her staff?
Is there an observational Recovery Center following surgery? Does this matter to you?
What is your overall FEEL of this institution? The Surgeon?
Is physical therapy included in the procedure?
Is there ANYTHING out there that is even remotely negative about the practice, other patient experiences, et cetera?
I chose Dr. Michael J. Huang.
I did not find even one thing remotely negative about this man or his practice. Anyone who even vaguely heard of him had only good to say. He won a place on the 2018 Colorado Springs list for Top Docs, under Sports Medicine. He instructs other surgeons on surgical techniques. He was recommended by a different medical professional and my physical therapist (PT), Phil Plante, PT, DSc, MTC, CMPT, COMT, FAAOMPT. I’ve been going to both of these gentlemen for about five years, nearly since I was first diagnosed with the “a THR is in my future.”
Dr. Huang and I have seen a lot of each other (so has “Dr. Phil,” as I like to occasionally call him, but I’ll get into that later): I’ve used him for each of his specialties: shoulder, knee, and hip. This guy is absolutely incredible. His work borders on the miraculous. I have a brand new shoulder, a refurbished knee…and, as far as things are currently going, a brand new hip. It’s nice to see my body again performing largely the way it used to. It’s nice to live in a time to have the ability to correct such issues. As previously mentioned, two of my issues were sports/athletic related and one…apparently?…genetic, but who knows…maybe doing all those front and side splits in my martial arts days contributed to my condition, PT said. Additionally, not one person said that any of Dr. Huang’s patients had any issues following their surgeries. Dr. Huang’s staff all emphasized how absolutely meticulous he is (and there was such passion in their voices).
And when I discovered that Dr. Huang performed a Fellowship under Dr. Marc J Philippon, at Vail’s Steadman Clinic, that clinched it for me. I wanted someone who studied under the best possible tutorship. As I’ve previously stated, I wanted someone who knew sports and athletics and the demands I’d be putting on my THR. Though a writer, I’m not a sedentary person. I want to use my THR like it’s meant to be used: as a hip (and shoulder and knee) for an active person who hikes, walks, lifts weights, and moves, et cetera. Dr. Huang himself works out and is physically fit.
And to top it all off, as I’ve also mentioned before: Dr. Huang has this incredible “light” about him! Such an increcible ENERGY. He radiates positivity and optimism. He’s friendly and engaging, and his staff is similarly gifted. He’s the kind of healer you want working on you. I went to another local leader in THRs, and I did not like the feeling of the office one bit.
But…whomever you choose…ask medical professionals and those who have already gone through their own THR. Not all surgeons are created equal, and neither are patients. Surgeries done ten or more years ago are not the same as those done today. The techniques and technologies have advanced, and though some may have performed more surgeries than another, doesn’t necessarily make them your best choice. Do your research…ask yourself what you really want out of your surgery and those other questions I mentioned above. Sure, sometimes you’re constrained by your insurance, but know that there are many skilled, qualified surgeons out there. You will find out who’s considered good, who “isn’t as good,” or who you really feel comfortable cutting into you. Hip and knee replacements are the two most commonplace surgeries today. Yes, they’re scary sounding, to get a few inches of femur lopped off and some metal, ceramic, and plastic inserted into your body, but, geez, you do not feel that stuff in you, and you can walk and hike and work out again (but no running, no jumping, no splits of any kind), and the alternative is no longer the only option! It’s okay to be apprehensive…you’ll be under anesthesia, and before you know it, that hour-and-a-half will have passed without you even realizing a thing, and you’ll wake up in a recovery room, with a couple of pleasant, concerned nurses looking after YOU, your significant other not far behind!
When To Have Surgery
All the doctors say when you can no longer stand the pain.
To this I add: when you no longer have the quality of life you want/need.
I did not have a lot of pain with my degenerating hip until the last couple of months, and that pain was brought on by inflammation, which was brought on by activity: hiking and working out. If I didn’t do either of those things, I wouldn’t have experienced pain, but my hip also would have degenerated much quicker, more bone spurs restricting more and more movement. It’s the “use or lose” syndrome. Because I kept as active as possible, right up until the very last moments, I extended the use of my hip and delayed the need for surgery. Movement disallowed the “easy” growth of those danged bone spurs. Dr. Huang was continually amazed I wasn’t feeling pain along those five years, when he’d take annual x-rays of my hip. And getting THRs in one’s 50s has become an increasing thing, as the surgery techniques and technologies have progressed, allowing the implants to last longer and become more robust. People want to keep and continue their quality of life while they can, instead of having to succumb to immobility at what is today, a relatively young age.
The Surgery
This surgery was very different than my previous two. Granted there is an implant inserted into my body, but there’s really nothing in there to “heal,” per se. The femur implant is driven (hammered) into the bone, and the socket (or acetabulum) is cleaned out and a “cup” (or “acetabular component”) glued in there. The femur’s implant has a ceramic head that is fitted with surgical-quality plastic that is then fitted into the socket’s acetabular component. I had a lot of bone spurs in there, and all my acetabular cartilage was…gone. The femur implant and hip socket (acetabulum) are roughened so that bone will knit with the implant and acetabular component, creating a solid connection. Screws are no longer used. Though surgical rehab stated 4 – 8 weeks recovery, it’s actually more like a year for total “assimilation” of the THR and bone.
Not all surgeons do this, but Dr. Huang then keeps you overnight for observation in a Recovery Center. This is a great thing! You will have a lot of questions and Dr. Huang wants to make sure that everything worked out perfectly. I’ve also been told that there are far fewer issues (think infections) when an overnight observation is employed in a Recovery Center (not a hospital), than when THR patients are admitted to hospitals or just sent home. At the Recovery Center I also received two physical therapy sessions—and yes, I was up and walking (with a walker) on the very day of my surgery.
Note: with all that was done with you, you may not actually get much sleep that night, because of all the wires and such attached. Feel free to get up and walk around with your walker. I did, until the night nurse upped my medication dosage, and I finally was able to sleep.
I had an anterior/lateral surgery, which means the surgeon went in at the front of my hip, just a touch off to the side. This also means no muscle was cut. When going in this way, the surgeon literally spreads apart muscles and nerves to get in there and mess around. So there’s less damage done to the body and a far shorter recovery period.
Dr. Huang told me that after he’d performed the surgery, he moved my leg “all over the place,” to make sure the joint was perfect. When I was wheeled in there, the operating table reminded me of a gynecological setup: the “bed” was short, literally just about long enough for the length of your back to lay down on, and your legs are attached to an “extension” of some kind, for each leg, that appeared movable. Your feet are inserted into tight-fitting “ski boot”-looking things that are then attached to these two “extensions,” or [apparently] movable “arms. So, I’m assuming that when he moved my leg “all over the place” it might have been while attached to these two extensions? I guess he could have also removed them, too. I forgot to ask him.
Post Surgery
Man, you may will be BRUISED!
My entire surgical leg was bruised from butt to the ankle. I didn’t feel anything from the bruises, but they look far worse than they are. Those bruises are simply a by-product of the surgery, and quickly dissipated.
Crutches Versus a Walker
Dr. Huang’s medical staff really, really recommend using a walker. I was just going to use crutches, but, I’ll tell ya, use the danged walker. It’s much easier, far easier than using crutches, and in a week’s time you will be using crutches anyway. So, borrow someone’s walker for a week and just use it.
Helpful Tip #1: When using the walker to get into and out of bed, always have one hand on the WALKER and one hand on the BED.
Helpful Tip #2: Hook the non-surgical leg UNDER the surgical leg when pivoting on the bed to enter or exit it. I.e., if your right leg had the THR, keeping the left leg straight, hook it under the right leg, placing the left foot to the right of the right foot, ankle-to-ankle. In this way you can actually lift (assist) your right leg with your left leg, and pivot the body as a whole, and not just using your hips. Don’t worry, the nurses should explain this to you.
Annotate
Get yourself a small log book or something, and write down every time you take your medication, date and time. Your at-home physical therapy (PT), which was a lot of isometrics (and walking). Don’t leave anything to memory. This is a good thing to have in case you need it. I had to reference it only a couple of times for questions I had, but it was also good for me, since you’re initially all drugged up and need to know when you took your last dose before taking another dose of something.
Hudson Lung Exerciser
Hudson RCI Lung Volume Exerciser (© Photo ONLY, not equipment itself, F. P. Dorchak, Nov 8, 2019)
You will get one Hudson RCI Lung Volume Exerciser. This cool little gadget is used to help your lungs regain their former glory, because being under for such major surgery and anesthesia can screw up your lung’s ability to breathe correctly…without a little help. They will tell you to use this for about a week. It’s actually kinda fun to use, and you can adjust the intensity. The object is to SUCK in air, not blow it out, and keep that little red ball banging into its confinement’s ceiling.
Leg Numbness
The surgical leg was (and still is as I write this a couple of days later) numb. This numbness has a term, which is usually associated with an illness, accident, or the wearing of “skinny jeans”: meralgia paraesthetica.Now, I’ve embedded a link about this, but don’t get all nervous (pardon the pun) and all about what the Wiki page says. You can also get this from surgery…hence, THR surgery. Both Dr. Huang and my PT say that it will go away. Read on.
I had my surgery just over two weeks ago, and it’s still numb—but not as bad as it was right afterward. This numbness is a function of the incision site, not the implant itself. My incision is about five inches long. Dr. Huang said that because of what they had to do to “get in there”…the incision itself, the spreading apart of muscle and nerves…all aggravates the leg nerves in this area. Even if your surgeon might have cut or nicked a nerve (one nerve, actually, lateral cutaneous nerve of the thigh), things will eventually heal and the numbness will dissipate in time. My physical therapist said it will also go away once I start exercising more.
Also while experiencing the general numbness down the side and “edge” of your leg, you’ll occasionally feel “prickles” or “spikes” or “pin pricks” of pain. And they can be momentarily painful. These are the nerves trying to regain their “equilibrium.” Yes, they actually tend to hurt—like a pin is JABBED into your leg (it does actually sting)—but it’s fleeting and you can massage it out. And this is exactly what you do: massage it gently and it goes away. Your massaging tells your nerves, “Hey, everything’s okay!”
Pain Versus Discomfort
I was continually asked about pain levels, and I kept telling everyone it wasn’t so much “pain” as “discomfort.” Maybe they thought I was full of it, but I don’t necessarily associate pain with being uncomfortable. So the nurses started asking me about my discomfort level. Only very few times, the day of and maybe after, did I feel any pain, but it wasn’t much, and as I said earlier is associated with the incision site (the scar)—NOT the implant in any way, shape, or form.
Yeah, you have about six or seven inches of Borg material inside you (including the implant’s head and socket’s acetabular component), but you simply do not feel it. Not at all. Not even a tich. What you will feel, however, is that five-inch incision.
My incision was wrapped in a state-of-the-art clear bandage that had an antibiotic strip running down the inside of the bandage, and lay against the wound. But it felt strangely like a five-inch piece of rebar was freaking welded into my skin. Rigid. Limited my movement just a bit (e.g., lifting up my leg, walking). This was the entirety of my source of discomfort.
Showering
You will need another to assist you for the first week or so. There’s really no way around this. You just can’t reach certain areas, and you need to be watched so you don’t fall. No modesty here, folks! Hopefully you know each other really well—otherwise you will afterward!
While in the Recovery Center, my wife and I noticed there were showers there. We asked if I could take one there before leaving to just clean up and leave one less thing for my wife to worry about the first day back. It might take some sweet talking on your part, but it shouldn’t be too hard to get them to agree to it. There was no soap and shampoo readily available in our Recovery Center, so pack some in your overnight bag, which you will have to pack if your surgery includes an overnight observation (“observation” is not the same as being admitted into a hospital, and should, therefore, also be covered by your insurance—if you’re not sure, ask). I hadn’t planned on that, so hadn’t brought any soap or shampoo, but the nurses managed to rustle some up and obliged. Then one of the nurses had to assist me during the shower. As mentioned above, no modesty, here, folks.
Bending and Splitting
With the anterior entry, you can actually bend forward to angles less than 90 degrees. Think sitting…then leaning forward to tie your shoes. You may not be totally successful at doing that yet, since your muscles have lost some of their flexibility, because of the nature of your hip issues to begin with, but you can still perform the forward bend.
Note: You cannot do this with the posterior entry.
Your staff and PT also will tell you to not do any “ballerina moves” until your THR has healed. This means no straight-leg movements to the rear or out to your side.
One thing you cannot ever do any more is front or side splits. This is where one leg goes directly in front of you, and the other behind you, and you’re crotch is positioned flat into the floor, and for side splits, the legs go straight out to your sides, crotch into the floor. I used to be able to do both. Well, no longer!
Walking
Walking is THE BEST THING you can do immediately following this surgery.
In the words of Dr. Huang, he said (partially paraphrased here) that “These kinds things take care of themselves. Walking around, being up and moving around takes care of 95% of it,” with “it” being THR rehabilitation.
I created a rut in our home walking round and round our living room! I started with the walker, then briefly with crutches, then found I didn’t need either, so went solo.
Healing
I kid you not when I say that in the beginning I was healing so quickly it not only was amazing the advancements I made day to day, but after a couple of days, I could notice the improvements hour to hour. Now, a little over two weeks later, I’m still improving, but things are dampening out some. And when you take longer walks outside, you may get sore. Just ice it and take it easier.
The body is simply amazing. And the more fit you were before your surgery, the quicker you will [most likely] heal. It also depends on your MINDSET.
I was given at-home physical therapy (PT) to do, and I still do it religiously! It was three times a day, icing after each session—but I also took two-hour naps—but it’s now down to twice a day. Since my surgery I’ve had four in-office PT sessions, and it’s amazing how I’ve progressed just between those sessions! You have to follow-through with it all, but as stated above, even if you do not have PT prescribed (because—no—not all THR doctors prescribe PT, which amazes me) keep in mind these words: “These kinds things take care of themselves. Walking around, being up and moving around takes care of 95% of it.”
WALK.
Once an hour or whatever is comfortable/prescribed for you. Then ice. 20 minutes on, 20 minutes off. Or once an hour, 20 minutes on/off. After each of my three at-home PT sessions, I sat and iced at least an hour, 20 minutes on/off. Then again, at night, while watching TV.
At least in the first week or so, when making turns, do SHORT, SLOW turns.
I also noticed, writing up this post, that sitting for a continued spell and writing all this up ended up tightening my hip, so I have to remind myself to get up more! Another reason for not pushing the getting-back-to-work-too-quickly…I’m not quite ready to be in any one position for eight hours a day.
Physical Therapy
As stated above walking is the best recovery for a THR, but physical therapy (PT), if you can get it, really speeds things along. I use Action Potential, and the therapist I see is the owner, Phil Plante. Phil is also an incredible individual, and the best therapist I’ve ever seen. He also came highly recommended by some industry professionals. Action Potential has several locations around Colorado Springs, and I’ve used most of them, and one that no longer exists. Absolutely any of the listed therapists are knowledgeable and capable to help you (again, I’ve used several over the years). Whomever you get, following your initial evaluation, you will most likely be handed off to a PT “tech,” I call em, the person who will actually put you through your rehab routines. You will be periodically evaluated by your main therapist, and, at least with Phil, I know he frequently watches me now and then as I’m being worked on, commenting here and there. Phil knows his work, as his bio states, and he instructs other therapists. Among other citations, Phil has his Doctor of Science in Orthopaedic Manual Physical Therapy, and is a Fellow with the American Academy of Orthopaedic Manual Therapists. Phil has treated me for each of the same three issues Dr. Haung did: shoulder, knee, and hip. Phil cuts through the smoke-and-mirrors and tells you how it is, and when he evaluates you…well, it can be a little unnerving. His attention is extremely laser focused and never deviates from you or your words. And he is soft spoken. Phil is another incredible soul I’m so glad to have found and had him be a part of my recuperation.
So…if you can get PT, grab it! You will be so much further along if you can find the right PT for you. As you did with your surgeon, do with your due diligence in finding the right therapist for YOU.
How Long?
Full recovery can take four to eight weeks, or so. If you’re fit before the surgery, maybe four to six weeks (my PT told me in my last session that where I’m at—two weeks, two days from surgery—is where most of his clients are at at the 4 – 6 week mark). I can tell you that two weeks out, I’m walking on my own…it’s not perfect, but it’s pretty damned good. I’ve since taken two 15-minute walks outside, and it feels great, though combining that with the PT sessions, I do tend to get a little sore later at night, so I ice. I still have some leg numbness and I want to see if I can let that work itself off a little more before I return to work full time. And as stated earlier, sitting for even two hours was too much, so I don’t think doing a full day’s work is quite there yet, which was why I’m doing a week part-time work-from-home next week. I will then return to work full time the following week. I just don’t want to rush things and want to take my recovery slower than I did for my shoulder and knee surgeries. I’m going to have this implant in my body for the rest of my life, it takes a little time to fully assimilate, and I don’t want to rush going back to work, where I could overdo one thing or the other and screw things up. As I said, I learned from my previous surgeries, and though this one is different than the other two, I still want to allow myself more room for error before returning full time to standing,sitting, or more actively moving around.
Working Out
I got seriously schooled here while in the Recovery Center!
Yes, when I had my two other surgeries, I was back in the gym pronto. But as one seasoned nurse instructed me, I need to allow my body to HEAL. That means not stressing it with other stuff, so that all of the body’s resources can be marshaled to do one thing: healing me.
And, yes, I knew better…but I took the hint when this one nurse spent so much time talking with (instructing) me about this, because (she said) she could see it in my eyes.
#GuiltyAsCharged
Yes, I was in the gym with my shoulder-in-a-sling doing bicep curls with my good arm, but, no, not going to do do that with my hip. Am going to give my body adequate time to recuperate and hold off until my PT tells me I can go. I asked my therapist tech and was told may the end of next week, as long as I use machines and don’t stress the hip joint. What I’m saying is, is to reign in your ego. You have the rest of your life to work out. And this, too, shall pass. Before you know it, you’ll be acting as is you never had the surgery—except that you have a new hip!
Be Grateful
When is all is said an done…send a Thank You card!
Not an e-card, but a real paper one. These people spent a lot of time and energy on YOU.
That surgeon…he spent his life learning his specialty just for YOU.
Those nurses? Devoted their entire lives for YOU.
Your physical therapist—devoted their lives to helping YOU.
Dr. Huang does a really cool thing: after your surgery, in your surgery packet, he includes a list of all the nurses and related people involved in your surgery. They all sign their names. I love that! Only one they don’t include is the anesthesiologist, so make it a point to get his or her name when they come to meet you right before your surgery.
The Recovery Center nurses all told me that only Dr. Huang personally visits all his patients the next day. They speaks volumes about this incredible soul.
In closing
Stay focused on your future, not so much that you just got opened up and had some metal inserted into you. Focus on healing. Visualize your end result of what you want your function to be: hiking, walking, working out, living pain free.
Visualize health.
Enjoy your reset body. These implants can last from 15 to 30 years, depending on how much punishment you put them through. There are alternatives to running and jumping—find them—and allow your new hip to do it job as-designed: give you back your quality of life!
Shoulder Surgery Posts
Shoulder Surgery, August 29, 2018
Post Shoulder Surgery, 2018
Knee Surgery Post
Knee Surgery – Meniscus Flap Tear
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