Hip surgery: days 1-7-The Highs and Lows

So lots of lovely people have asked me whether I’ve had a hip replacement and if not exactly what did I have done.
To answer your question and to practice my writing therapy i’ll tell you…

Hip preservation or reconstruction surgery is relatively new and aims to prevent osteoarthritis occuring or worsening. It aims to preserve the joint for a few more years. Its most commonly performed in reasonably young/middle aged adults whose hips have prematurely given up or super fit athletes who have been subjected to great force, think long jumping or rugby. No prizes for guessing which category I fall in!

Its performed through arthroscopy/key hole surgery, but differs from other types in that the hip joint is distracted (femur pulled slightly out of the acetabulum/pelvis) through traction where a boot is placed on the foot and a bolster between the legs and force applied.

Its performed for a wide variety of reasons the most common being a torn labrum, which is the cartilage that sucks the femur into the pelvis and stops it dislocating. Or for Femoroacetabular impingement (FAI) which is where there is either a deformity with the femoral head (cam lesion) or abnormal socket (pincer lesion). Both of these cause the bones to rub through the labrum and cause a tear. It can also be used for Trochanteric Bursitis where the fluid filled bursa that protects the femur becomes inflammed.

I have all of the above conditions in my right hip. It causes sharp groin pain, burning inflammation throughout my pelvis when I sit or stand still, my hip is tender to touch, its makes all kind of pops and grinding noises amd sometimes gives out when i’m walking, i’ve lost count how many times i’ve fallen.

The surgery involves the torn areas of labrum either being sutured or removed and the abnormal bone being shaved or resurfaced. My orginal X-rays showed quite signifcant pincer lesions to both hips. The arthrogram on my right side showed an average sized labrum tear and pincer and cam lesions to my right hip.

Recovery times vary from 2 weeks to 6+ months. Prior to the operation my surgeon estimated i’d be on crutches for 2-3 weeks, back to walking pain free by 6 weeks, return to more active exercise and lifting by 8-12 weeks. This changed once they could see inside my joint on the day.

I have done a lot of preparation for surgery. I’ve got my Lupus under control, more so than in last 4 years. I am fitter and stronger then i’ve been in a long time. I’ve learnt and practiced a lot of muscle and mind relaxation skills. My main concerns are not the pain or the risk of the surgery but that the Lupus will flare up. I spend most of my last pre-surgery day convicning myself I can live with pain for ever more, ‘cos i’m fit now, it’ll be fine…then I fall over walking the dog…maybe not!

Perhaps when you’re the fittest you’ve been in years is the best time to undertake surgery? 

I hope so.

 Day of surgery

I was admitted at 07:15 and met with the surgical team and anaesthetist, changed into my glamorous gown, stockings and paper pants. By 08:30 I was on my way to theatres, I was first on the list which was great as the ‘h-angrys’ were setting in, I don’t do well either waiting or being hungry. I was nervous but used all my breathing and muscle relaxation techniques to stay calm and hubby keeps me amused with terrible jokes and bitter complaints about the price of the Guardian and take away coffee.

I was talked through the procedure and risks, estimated I’d be in theatre for 90 minutes. Then there was the usual problem of getting a canula into me as my veins don’t like to play. Much prodding, poking and apologies. But I felt very calm and trusted I would be looked after. Much easier on the nerves being the one lying on the table than watch your child do the same.

When I came round it was 13:30. A lot later than planned. My pelvis hurt a lot. I was inside a giant roll of bubble wrap with hot air being pumped round me, I had blankets wrapped round my head. The nurse explained that as a consequence of being under anaesthetic for longer I’d got cold and my temp had dropped to 32 degrees so I was being treated for post operative hypothermia! This is apparently not that unusual but it sounded quite dramatic at the time. My arms and shoulders shook for some time which worried me as I’d had a similar experience with shaking and not being able to control my body temperature during a Lupus flare up after I had a local anaesthetic injection in my back. But I used my self hypnosis skills and calmed myself down and within an hour I was warm and no longer shaking. The surgeon came in to see me but my memory of that is hazy, I just remember him saying the entire labrum was damaged and that there was years of accumlated damage to the joint lining and bones. There had been a small amount of bone scuffing ( when the joint is very tight and the surgical instruments scuff the bone as they pass through the joint), which I knew was a risk.  I don’t know the full extent of what all that means till my follow up appointment in 6 weeks time.

 Right now is time to focus on right now. One day at a time.

At 14:30 I was taken to recovery where I got to briefly wave to my husband as I was wheeled past, he had been waiting patiently for 6 hrs only being told I was still in theatre. By 15:30 the physiotherapist and occupational therapist arrived and got me out of bed and using crutches. Felt as though I was probably the best crutches user ever…in hindsight this was probably the oramorph’s fault.

They explained because of the more extensive nature of the surgery I couldn’t weight bear on my operated leg for 2 weeks,  nor could I sit on sofas or anywhere that would provoke a greater than 90 degree hip flexion ( hips lower than knees). Also told me not to allow any hip abduction, extension or rotation for 3 weeks to avoid dislocation.

Somehow managed to get dressed by myself using the handy ribbon and safety pin gadget the OT gave me, then sat down to the lunch I’d packed myself and the two extra bags of crisps my husband had purchased. As I munched my way through crisps, biscuits, fruit and nuts and a litre of fizzy water I really pitied the other patients around me who had only plastic toast and grey tea to greet them after their ordeal. Perhaps they’re not such big comfort eaters as me…I’m so hungry, so thirsty and i’m talking to anyone that walks past, everyone is my best friend, and i’m hilarious…i’m totally off my face!

By 17:00 the drugs are wearing off and I”m starting to feel really tired and its so hot, my pulse is over 110, which happens often so reassured nurses that was all normal, desperate for them to discharge me. I’m still oddly elated and convinced I can do anything. Hubby went to get the car and park outside the recovery unit, I was all up for walking out the hospital and through the car parks but nurses insisted not. They did try to suggest I sit in a wheelchair, but couldn’t convince me. Eventually after what must have been several minutes I managed to hobble 20 metres to the car with a nurse holding on to me. Not quite superwoman after all.

Then home, cursing, why oh why is the walk from our car to front door so far! I can only move my operated leg a few inches at a time, so walking is very slow.

Then finally sleep.

Days 1 and 2
The pain isn’t as bad as I’d imagined it would be, though I’m still well dosed up and pretty numb. Most of the pain is felt in my pelvis, low back and incision sites on my thigh. At this stage I can’t feel any pain in the actual joint. I have hardly any sensation between my legs in my ‘intimate area’ as my surgeon calls it or ‘your girl parts ‘ as my kids say. I was warned that some nerve damage may occur. 

I’m doing ok with crutches, going down our steep and narrow stairs is somewhat terrifying. I’m no longer the Olympic crutches champion I was yesterday. Manage to get outside in the heatwave that’s occurring, try and talk my family through watering the garden. Can stay out of bed for about 3 hours before needing to rest. Tried to reduce codeine dose and go 8 hrs without any, which is a mistake. Realise I can’t feel the top of my foot or front of my leg on the operated side, this foot is also a little blue, have a minor freak out before coming to the realisation that I’ve not felt this foot since before the operation. Put it down to nerve stress from the traction. I remove the massive bulky dressing from my hip, it’s really not too bruised underneath. Optimistically decide tomorrow I will wear clothes not PJs and walk outside, this doesn’t turn out to be the case.

Finding my hip stiffens up quickly so I’m doing small amounts of regular, supported, movement lying on my bed. Standing on the kids toilet step with my good leg while the other leg hangs feels amazing, I almost cry with how good it feels, my kids laugh along with me 😀

Really glad I’ve been doing so much yoga and have good strength in my arms and am able to balance well on one leg. Very pleased with my self hypnosis skills which are proving invaluable for pain relief and muscle relaxation. Find a chair yoga channel on YouTube. Feel very happy.

Day 3: Highs turn into crashing lows

Grumpy day, wake up at 05:00 in pain. Why is our only toilet downstairs?! Decide I need to take painkillers before I can be attempting stairs. I ask hubby for help at 06:30 he willingly obliges, we wake kids up with our clattering about.

I can’t do my usual things. I’m frustrated relying on others. I’m bored. I’m really tired. Feel hot and sweaty, the compression stockings are making one leg hot while the other one is freezing. Convince my husband to help wash my hair, which isn’t something we’ll do together again (!) but does feel better.

Hubby then goes out, people knock on the door but leave before I can answer, dog behaves like a barking lunatic, I give up and go back to bed.

Still grumpy, hubby tries to cheer me up by suggesting we drive to look at the sea, it’s a beautiful day, but I cant face getting dressed or walking as far as the car. So he talks me into playing board games, I’m even allowed to lie down while playing, something usually forbidden! He finds food for me and I instantly feel better.

My operated leg and pubic bone is still numb to touch but I can control, tense and flex muscles, so I’m assuming all is well and sensation will return in time. Patience is key.

Patience IS key. 

I can move my leg forwards a little further, but can’t even attempt abduction, which I’m not supposed to be doing anyway, but thought I’d give it a micro test. But nothing is happening.

Days 4-7

Sleeping is much improved. Waking each morning at 05:00 in pain but painkillers still very effective. Acute pain is such a different experience than the chronic inflammatory and neuropathic pain that Lupus causes. It’s much easier to deal with. From a psychological perspective, there is a reason for this pain, an improvement each day, and an expected end. Much easier on the mind.

Speak to my GP who tells me to keep wearing the compression stockings till I can weight bear. It’s currently the hottest June temperatures for 40 years and i’m not allowed a shower for 10 more days. But I’ve still not got much sensation in my lower leg or foot so agree that wearing them is probably for the best. Don’t really fancy a DVT. GP also tells me to keep up with the codeine and anti inflammatories for three more weeks.

I’ve progressed to getting dressed each day. I’m now independent with washing, dressing (apart from shoes and socks, and past 7pm when I no longer function) getting up and moving around. Best of all, take dog for a very short but time consuming walk. All great for self esteem/ control freak tendencies. Predictably I over reach on numerous occasions and end up with sore shoulders and wrists and feel shattered.

Managing several 20 minute sessions of yoga either seated or lying on my bed. Doing a lot of visualisation of my hip healing, this helps so much. ‘Mind over matter’ is very important to me.

These are my totally straight legs with neutral position hips, actually I think the left one has slight inward rotation, but this the right hip’s moment to shine!! 3 years since I could last hold my leg like that. 🙂

Onwards and upwards!

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