Many of you know the story of My Miraculous Wife - the blog post I did several years ago where Karen made an amazing recovery from major hip problems to actually do the Big Sur 21-mile race.
A few years went by and we were back to our active lifestyle, dancing Salsa and Swing, hiking, surfing, stand-up paddling, kayaking - you get the idea.
But then, Karen started having hip problems again. Our dance sessions and hikes got shorter and finally stopped. Walking was limited and even sitting was painful. This time, Karen's orthopedist showed us the arthritis in her left hip. Parts of her hip were bone-on-bone, and the best spacing was less than a millimeter where there should have been four millimeters. A very painful cortisone shot did nothing to help. Hip replacement surgery was the only viable option.
A few of my surfing buddies had recently had hip replacements and were now surfing as well as they did before the surgery. Other friends had had the procedure and raved about the results. We were hopeful.
We discussed their surgeries and recoveries with all of the people we knew, then contacted the doctors and asked for patient referrals. It quickly became clear that the anterior (front) approach had the best recovery times and the fewest complications. We decided to go with Dr. Nicholas Mast of SFHips in San Francisco. Although that would require a longer drive, from what we could see, his patients had the best recoveries. We met with Dr. Mast and his staff and got briefed on pre-op procedures and post-op plans. We scheduled the surgery for early April in Novato (the earliest available appointment).
Weirdly, the one physical activity that Karen could still do was downhill skiing. She couldn't walk well (I had to carry her skis to the slopes), but boy could she ski. The week of skiing before the surgery helped her get stronger (she had gotten pretty weak in the preceding months), and likely aided her recovery.
Your hip consists of a ball joint at the top of your femur (femoral head) that moves in the hip socket (acetabulum) which is part of your pelvis. The socket and the femoral head are covered in cartilage which helps lubricate the joint.
With an arthritic hip like the one in the photo at the top of this blog, the hip joint has deteriorated. The cartilage has worn away, lubrication is gone, and bone spurs develop. Movement becomes restricted and painful.
In the anterior approach hip replacement, a 3-4 inch incision is made in the front of the upper thigh. The thigh muscles are pulled away from the joint and the femoral head is removed. The hip socket is resurfaced to make it smooth and an acetabular cup is installed along with a lining. A ridged spike-like prosthesis with a titanium ball on top is inserted into the femur. Clamps holding muscles are removed and the muscles go back into place. The thigh is stitched up with dissolvable sutures and a sealed bandage is applied.
Hip replacement is one of the most successful major surgeries performed today. Nearly all patients report getting their lives back.
The Surgery and Time in the Hospital
We spent the night in Novato and made our way to the hospital. Surgery was scheduled for 10:30am but pre-op began two hours earlier. We met with Dr. Mast and with the anesthesiologist. Dr. Mast was personable and reassuring and talked about recovery times of his patients who often were walking over a mile within a week. He told us about one patient who went to dinner and a movie with his wife the day after surgery. This was very encouraging!
At 10:30, they wheeled Karen into surgery. About 11am, Dr. Mast came into the waiting room and spoke with a woman waiting for her husband who was now in recovery. He said that her husband could go home that afternoon. Then he turned to me and said that Karen was next.
Just over thirty minutes later, he was back and said that everything went perfectly. Karen would be headed to recovery and would probably be there about an hour. He said that since she wouldn't be out of recovery before noon, she would be staying the night. That was exactly what we expected.
Unfortunately, Karen was in recovery two and a half hours and once in her room, she continued to have numbness in her legs, so she wouldn't be getting up to walk yet. Apparently, people recover from anesthesia differently. However, once the numbness subsided, Karen did walk - with a walker - but she easily (from my perspective) covered the 150 feet required for discharge. Pain medication (we had chosen Tramadol) kept her comfortable and surprisingly, not at all loopy and it didn't upset her stomach.
The next morning, we had a visit from the occupational therapist who showed Karen how to get on and off the toilet, get into and out of the shower, and some clever tricks for getting dressed. A bit later, the physical therapist came by and invited Karen to walk to the physical therapy room about 500 feet away. He and many of the nurses commented on how amazing Dr. Mast's results were. No other surgeons compared. The physical therapist showed Karen how to get in and out of bed and how to climb stairs using a cane. We walked back to her room and prepared for discharge. Basic instructions were:
- No restrictions on movements other than no lunges.
- No baths, swimming, or hot tubs for 4 weeks - showers are okay.
- For the first week, walk five minutes every hour.
- Wear TED stockings (Thrombo-Embolic-Deterrent) stockings to prevent blood clots
- Taper pain medication as appropriate.
- Take an anti-inflammatory (Celebrex) for 30 days, and aspirin for ten days.
- Use ice consistently to reduce pain and swelling.
- Start physical therapy two weeks after surgery.
- Remove the bandage after 4 weeks.
- No driving until she stops the Tramadol.
- No risky physical activities which could involve falls for 3 months.
- Follow the instructions for exercises from the PeerWell application.
We made the lengthy drive home, stopping every hour so that Karen could walk for five minutes. Once home, Karen had no problem climbing the stairs (using the cane and handrail) to the second floor of our house, home to our living room, kitchen, dining room, and bedroom.
Karen was exhausted, so after dinner she spent the evening in bed, getting up to walk every hour. The only significant pain she had was in and around her left knee which was hugely swollen. With the anterior approach, no muscles are cut. Instead, there is a 4-inch incision in the skin and the muscles and ligaments are pulled away from the hip so that the surgery can proceed. This places major strain on the knee attachments.
We set up a mattress in the living room in front of the television so that Karen could watch TV when bored.
At this point, and for some time to come, I needed to be present to help Karen get into and out of the shower, get dressed, and to supply her with ice packs. I also provided massage of her thigh, knee, and lower leg multiple times a day.
Over the next few days, Karen did as the PeerWell application instructed with exercises and meditations. In addition to a guided recovery, PeerWell tracked her progress and reported back to Dr. Mast's office. Remembering Dr. Mast's words about the patients with amazingly fast recoveries, Karen increased her walks of five minutes an hour to ten minutes, then to more. However, it seemed the swelling and pain in her knee increased. She had expected to stop pain medication (others had done so at this point), but it wasn't possible.
We called Abigail, one of Dr. Mast's PAs (physician assistants), and she said that for the first week, Karen should really be reclined or lying down fully, except for the five minute walks. And, she emphasized keeping the walks to five minutes. As we later discovered, this is what the patients with the best recoveries had done. Dr Mast is a great surgeon, and as you'll see, Karen's recovery was remarkable, but Dr. Mast may be a bit over-enthusiastic about the pace of recovery for some patients.
For the next few days, Karen remained prone most of the time, doing the five minute walks. She could sit to eat, but needed to keep her leg elevated without too much bending at the hip. After day 7, she began increasing her walking time, very much aware not to increase too much too fast.
Pace of Recovery
On day 9 after surgery, I came down from my office to find Karen grinning from ear to ear. She asked me to watch and then proceeded to walk the length of our hallway without her walker. I was very impressed. She still used the walker to get on and off the toilet that day, but by day 10, the walker was history. And, so was the pain medication. Karen had begun tapering after a week (the setback from too much walking early on probably delayed that), but by day 10, she was done. However, we still iced after walks and before bed.
On day 11, Karen went downstairs for the first time using a cane and we went for a walk outside. After 10 days cooped up inside, Karen was ecstatic to be out and about. We walked to the end of the block and back several times that day. Karen used walking sticks (we'd bought them for hiking some years before). These are a better than a cane for walking as they allow for a more natural, even gait.
At two weeks, Karen had her first physical therapy appointment. After testing, the focus was on range of motion. Karen couldn't put on her TED stocking, socks, or tie her shoes by herself. She added the physical therapist's exercises to those recommended by PeerWell. However, she made a remarkable discovery - if she pulled the TED stockings over her knee, it greatly reduced knee pain and swelling - we should have done that from the beginning. Since her surgery was on her left side and since we have a car with an automatic transmission, Karen was able to drive. She was a bit nervous - an accident or sudden stop might be painful, but she was pleased to have more freedom of movement.
On day 15, Karen stopped using the cane going up stairs.
On day 17, she could walk downstairs with alternating steps.
On day 18, she could walk upstairs with alternating steps. At this point, we were doing several 20 minute walks a day on flat sidewalks - adding up to over 3 miles. Karen was cautiously increasing her distance every other day.
At three weeks, we went for a hike in Ano Nuevo. The total distance was almost two miles with a massage break at the halfway point. The uneven surfaces were much more challenging and tiring than walking on flat sidewalks.
At four weeks, the bandage came off and we did a wound inspection via video conference with Abigail, Dr. Mast's PA. Everything looked great. At this point, the Physical Therapist showed us how to start massaging the scar. We also started doing tougher hikes with more elevation and Karen started doing short rides on a recumbent stationary bike.
At five weeks, Karen could tie her shoes but with difficulty.
At 6 weeks, we started doing more significant hikes and Karen tried disc golf - this involves a dramatic twisting of the body with substantial pressure on the hips and a lot of walking. We also cautiously restarted our Salsa dancing at Salsa by the Sea at the base of the Santa Cruz Wharf.
At 9 weeks, Karen began doing daily yoga sessions (via videos) in addition to the physical therapy exercises and regular treadmill and stationary bike workouts. Her flexibility increased steadily. For all intents and purposes, Karen was back to where she was a year before the surgery - actually, better!
12 Weeks - All Clear!
After 12 weeks, Karen started biking. We're also very confident about some more difficult hikes - falling is no longer a major risk to the prosthesis. We're dancing regularly at full speed with dramatic moves and fast turns, and are back to our previous active lifestyle. Karen continues to work on getting stronger and on increasing her flexibility.
This past week we played disc golf at Kirkwood Ski Resort. The course is physically demanding, even if you're in great shape. We played the entire course complete with significant climbs at altitude, scrambling over rocks and cascading creeks, and making challenging throws on one of the most difficult courses we've played. Next week, we'll be doing more disc golf there, then cooling off by kayaking and stand-up paddling on nearby Silver Lake.
It's great to have our old life back again!
First, Karen believes, and I agree, that she waited too long for the surgery. Constant struggles with pain as our active lifestyle declined could have been avoided with an earlier surgery.
Choose the best surgeon and talk to his/her patients about their experiences and recoveries. If Karen needs another hip replacement, or if I do, we'll go to Dr. Mast again.
Don't be in a rush to get off the pain meds. There's no competition with other patients who may have told you they were done with meds after two days.
Last, and most important, be patient with the recovery. Go slowly and you'll get there faster.
I have to admit it. Even after the testimonies of my friends, I was worried about the hip replacement for Karen. It's a major surgery! But with an excellent surgeon, great support staff and physical therapist, and Karen's amazing work ethic and never give up attitude, My Miraculous Wife has done it again!