/ Hip replacement and climbing.

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pneame - on 19 Jan 2019

It sometimes seems as if most of the older generation on UKC have had a THR - total hip arthroplasty - a gruesome operation if you look at the pictures. Which I avoid. 

I'm coming up for one in a little over a month and have been much encouraged by the older threads on here. And even more by this - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489758/ It is interesting that the newest data doesn't exclude many activities - the author ascribes this to high litigation rate (US) vs low litigation rates (Europe), but I think it may also be that inevitably the wear rate data is from devices installed a while ago - these, by definition, will be using older devices and older approaches. 

HB1's rapid dive into activity has made me feel "yeah, it's a bit inconvenient, working from home and all that, but it'll be a breeze" - https://www.ukclimbing.com/forums/rocktalk/hip_replacement_post-op-675154. I'm sure it's going to be a bit uncomfortable (!!!) and I'm not looking forward to injections, although it turns out there are alternatives - https://www.verywellhealth.com/blood-thinning-medications-after-joint-replacement-2549527. No-one has mentioned injections so far, but it seems that unless you ask questions, no one tells you much. And that is not a key question! Of course I may give the distressing appearance of someone who knows what I'm doing and what I'm talking about (which is usually not the case). 

Anyway, it is going to be a large-headed standard prosthetic with a polymer lined socket and a ceramic head. My paranoia about dislocation was addressed by the surgeon by a demonstration  - you do have to be fairly heroic to dislocate a modern device. I also asked "how long do I have to avoid bending at the waist beyond 90 degrees". No restrictions in this regard apparently with the approach he takes (anterior-lateral). There are a lot more approaches than I knew about and I would rather not think too hard about any of them! 

Nevertheless, there is not going to be a nice band of ligament holding things together so I've been doing exercises for about 8 months now.  These are helpful in getting rid of any thoughts about not not needing the surgery (it doesn't hurt that much...). As I frequently say, I walk in to PT and limp out. And walking more than about 1/4 mile doesn't bear thinking about. 

According to my physical therapy folks, recovery from THR is pretty quick, unlike knees. So that's nice.

I'll be interested in any recent "tales from the UKC surgical team"...

 

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Darron - on 19 Jan 2019
In reply to pneame:

You may have come across my wife Marion’s posts on here. Marion is nearly 13 years post double THR and today she followed me up four routes here in Majorca (one of 6a). It’s forecast rain tomorrow though . Hope your THR goes well and you are back at it soon.

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pneame - on 19 Jan 2019
In reply to Darron:

Many thanks, Darron - Marion's posts are definitely encouraging. And Bob Kemp has lots of useful advice also. It is interesting that if you dig through the literature, pre-surgery PT is regarded as not effective by some people (working for the NHS?!!). I can't find the reference off hand as it disagrees with my direct experience (PT improved stability a lot) and my surgeon - "the fitter you are going in, the better the outcome". 

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Richard J - on 19 Jan 2019
In reply to pneame:

Can’t help on the recovery issue, but I’m now in a hospital bed wiggling my toes having had one done 10 am this morning. I can say the procedure itself was much better than my wussy first fears

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bouldery bits - on 19 Jan 2019
In reply to Richard J:

> Can’t help on the recovery issue, but I’m now in a hospital bed wiggling my toes having had one done 10 am this morning. I can say the procedure itself was much better than my wussy first fears

I'm glad to hear that. Best of luck with the recovery.

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bouldery bits - on 19 Jan 2019
In reply to pneame:

I have nothing useful to say. Wishing you all the best with the procedure and recovery.

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pneame - on 19 Jan 2019
In reply to Richard J:

Very encouraging! 

 

And thanks, bouldery bits!

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jon on 20 Jan 2019
In reply to pneame:

> I'm sure it's going to be a bit uncomfortable (!!!) and I'm not looking forward to injections, although it turns out there are alternatives 

Anticoagulant injections = needles

Oral anticoagulant (coumadin) = frequent blood tests = needles

Best cut out the middle man, no?

The aspirin option's interesting. I wonder how effective it is in this case. 

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colin struthers - on 20 Jan 2019
In reply to pneame:

Hi, I had my left hip done 8 weeks ago and it has recovered very well, I started back on the climbing wall last week and I can walk about 5 miles without too much bother. However, what I didn't expect was how much pain and discomfort would be involved post op and I was a bit down precisely because I hadn't anticipated that, I even started to wonder if something had gone wrong with the actual operation - it hadn't. Hopefully you will be luckier in this respect, but if you're not, at least take comfort from the fact that eventually it will pass and that the degree of pain does not seem to have any bearing on the progress of the new hip settling in. Unfortunately I have to get my right hip done as well but I suspect this time it will be easier, as I now know what to expect. Best of luck.

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Aly - on 20 Jan 2019
In reply to jon:

Warfarin is generally not used for VTE prophylaxis post-operatively so no need to worry about all the blood tests that requires.

 

Departments will differ, but some patients will just have LMW Heparin injections during their stay in hospital, and then anticoagulation ceased if they are mobilising and weight bearing well prior to discharge.

 

After elective hip replacement NICE guidelines recommend any of:

- LMWH for 10 days then aspirin for 28 days

- LMWH for 28 days (and stockings whilst in hospital)

- rivaroxaban (usually for 35 days I think)

Although aspirin is not licensed for this and I don't know what the evidence is like comparing the three.

 

Clexane needles are pretty tiny and hardly an ordeal, but I realise that is probably of little help to someone who doesn't like needles!

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Richard J - on 20 Jan 2019
In reply to colin struthers:

It’s the day after for mine today, and that all rings very true. Really quite painful quite a lot of the time, and getting out of bed to take a few steps to chair quite excruciating. Didn’t find the heparin too bad, though, despite my being really bad with needles.

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jon on 20 Jan 2019
In reply to Aly:

> Warfarin is generally not used for VTE prophylaxis post-operatively so no need to worry about all the blood tests that requires.

The link that pneame provided named coumadin as an alternative  https://www.verywellhealth.com/blood-thinning-medications-after-joint-replacement-2549527 I guess it's probably American which might explain the different thinking. I hate needles but I agree, those injections with tiny little needles didn't bother me - after the first couple, that is! I hated the compression socks far more!

 

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wilkesley - on 20 Jan 2019
In reply to jon:

I have been on Warfarin for some years now, after a couple of dvt's which had no apparent cause. Testing involves a pin prick in your thumb, which can be as infrequent as every couple of months, depending on how stable you are.

When I had my cancer op in 2017, I spent about a year on Clexane (heparin). You can inject yourself. It's almost painless. Top tip inject your thighs, not abdomen. It's not licensed for use there but works just as well.

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pneame - on 20 Jan 2019
In reply to Richard J:

I'm expecting to be in (considerable) pain, but Colin Struthers suggests that it ends eventually! It's the massive inconvenience - a product of the pain, but also of the need to make sure that muscles and tendons repair OK after all the pulling and pushing. To say nothing of the bone after the hammering and sawing. 

The whole thing makes me think of aid climbing, to be honest. Anxious anticipation. The boredom of sitting on an uncomfortable ledge, waiting and waiting and the general frustration of hanging in etriers while trying to do something precise with the gear.

I never really much liked aid climbing either.  

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Richard J - on 20 Jan 2019
In reply to pneame:

As the relentlessly cheerful physio just said to me, “do you feel like you’ve just been hit by a bus? That’s what most people say”. But I managed half a dozen steps with the frame, I can raise my knee 3 inches when this morning I couldn’t move it at all, and right now nothing hurts much at all. It’s going to be ups and downs, I’m sure of that - but before it was just down.

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pneame - on 20 Jan 2019
In reply to Richard J:

Good news - as Mrs pneame said yesterday "posting on UKC right after surgery! How macho!" 

She's not a climber and doesn't quite understand the relentless need for climbers to compare notes. Although she is a medic, so understands more than most. Although her favorite comment about our medics is "How do you hide money from an orthopedic surgeon? In a book!".  

A little unkind. I prefer a comment by a pretty good academic orthopedic surgeon I knew - "there can't be many careers [academia] where the price of failure [i.e having to be a "proper" orthopedic surgeon] is financial success". 

As jon and I calculated, they do have to work quite hard for their money!

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Bob Kemp - on 20 Jan 2019
In reply to jon:

I’d forgotten about the bloody compression socks - detestable things! 

I didn’t have a lot of pain post-op but there are any number of little discomforts like that in the first few weeks. They’re soon gone though!

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jon on 20 Jan 2019
In reply to pneame:

> "posting on UKC right after surgery! How macho!" 

Sharing pain is very theraputic!

 

 

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pneame - on 20 Jan 2019
In reply to jon:

I’ll bear that in mind when I’m told to stop moaning!

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HB1 - on 20 Jan 2019
In reply to pneame:

It looks like you've been doing all the right things pre-op. I grew to hate the injections, or rather the ceremony of it (it's true - it's a tiny needle, and it doesn't hurt. I stopped doing it actually, after 3 weeks - I don't think it's made much difference! Anyway they might prescribe pills instead)

I suffered next to no pain as such, but much discomfort (at night especially). You've probably gathered the sort of timetable to recovery you'll go through, having read what folks here have been saying. I'm a year plus post-op now (I've just been for a run this afternoon - running has come last of my activities) The climbing seems to be the best thing to be doing actually - all the moves you make help strengthen the hip I'm sure!

Good luck anyway! Anything you want to know more just ask. I was very grateful for all the encouragement and advice I got. YOU ARE NOT ALONE

Cheers       Richard

 

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Darron - on 20 Jan 2019
In reply to HB1:

Nice one Rich. .

 

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pneame - on 20 Jan 2019
In reply to HB1:

Thanks a bunch Richard - your (fairly) cavalier approach is just what I need. The medical community are pretty conservative and I don't think quite know what to do with people who don't take their advise/instructions  as gospel. 

The pain differences are interesting - although as I have often been told (often with a bit of rolling of the eyes) "patients aren't some sort of lab experiment, you know". I've often wished I could crank out a few clones of myself to see whether things make a difference in reality. But of course, in reality, my clones would probably kill each other (and me). And of course, in reality, they would have to have been with me all my life, doing the same things. Doesn't really bear thinking about.

The other comment I get is "pain is just in your brain, it's not reality". Yeah, right. 

 

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HB1 - on 20 Jan 2019
In reply to Darron:

Thanks Darron and Happy New year to you and Marion! Gill and I are off to Leonidio in March - that'll test the hip alright!

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jon on 20 Jan 2019
In reply to pneame:

Pain is temporary. A hip is forever. Well, sort of...

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Bob Kemp - on 20 Jan 2019
In reply to pneame

”The medical community are pretty conservative and I don't think quite know what to do with people who don't take their advise/instructions  as gospel.”

There does seem to be some truth in this, and it makes sense in many respects of course. But I think a lot of the advice directed towards joint replacement patients has been developed on the basis of experience with elderly patients. This hasn’t taken account of the way that improved techniques and materials have made replacements attractive to a younger patient group with bigger expectations and much better capacity for post-op recovery. So a lot of advice is simply not addressing this group. 

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Richard J - on 21 Jan 2019
In reply to Bob Kemp:

Perhaps one good thing about having this done in Sheffield is that the consultants and physios here pretty much assume without asking that you’re going to want to go climbing (at least if you’re a relatively fit looking 50-60 yr old).  All the advice I’ve had so far has been very encouraging.

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Bob Kemp - on 21 Jan 2019
In reply to Richard J:

Yes, geography and luck have an effect. I was fortunate that the surgeon who did my hip was a climber, so his attitude was positive and his advice about aftercare very focused. 

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Richard J - on 21 Jan 2019
In reply to pneame:

When I was in your position- a few weeks away from the operation - I was terrified about it, but like you took comfort from the UKC posts, as well as talking to a few people who’d had it done, Which is by way of excusing myself from banging on about my experience!

 I’m on day 3 now - done Saturday morning. Good news is I slept well & pain free (with paracetamol and codeine). Had the catheter taken out this morning, not exactly a laugh a minute but doesn’t take long (putting it in was worse).

The physio now starting to work me quite hard, walking with crutches and standing exercises. This is hard work and painful but you can see the point.

Looks like I’m going to go home tomorrow morning. I’ve had daily heparin injections but they’re sending me home with pills - didn’t catch what they were.

so yes, some pain and discomfort, but at this stage improvement is obvious too.

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pneame - on 21 Jan 2019
In reply to Richard J:

Very encouraging. Pain and inconvenience are my two big worries!

I'm fairly sure they intend to kick me out the next day (a Friday). I wondered about catheters - a few years ago I had a kidney stone that needed one for about a week. It was nice to not have to get up at night for a pee, but there were some downsides too...

It's good to get daily progress reports.

 

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Richard J - on 21 Jan 2019
In reply to pneame:

The catheter went in Saturday evening - I had some low blood pressure issues so was on a drip and they were urging me to drink loads, while a little bit of the spinal block was still stopping communication down there, so my bladder was fuller than comfortable. Going home the day after does seem quite abrupt, but I guess it depends on your home arrangements.

Here the deal seems to be they let you out when you’ve been up and down a flight of stairs on crutches, if there are no other complications. Just done that.

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pneame - on 21 Jan 2019
In reply to Richard J:

Some folks go home the same day - I think this is only the spinal block folks, though. In the dog eat dog world of US medicine, there's quite a bit of competition between hospitals / specialist hospitals / ambulatory surgical centres with the hospital complaining that the latter two get all the easy cases while they are stuck with the difficult ones - they all get paid the same rate. 

It's a bit of a simplification but it does result in minimal hospital stays, as a rule.

Regardless, the post surgery exercises are key and it sounds as if you are doing fabulously 

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Richard J - on 21 Jan 2019
In reply to pneame:

The spinal block is clearly a big breakthrough in reducing recovery time, but it’s one of the things I was worried about. You can stay fully conscious for it, and having heard someone cheerfully say that’s what she’d done, and though the hammering and jolting was a bit weird it was all very interesting.

 I was clear that’s not I wanted, and the anaesthetist took that on board and sedated me pretty heavily.

Propafol and diamorphine is a powerful combination - “I wouldn’t give you any drugs I wouldn’t want myself” the anaesthetist cheerfully said. I don’t suppose medics in the USA can make jokes like that!

 

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pneame - on 21 Jan 2019
In reply to Richard J:

I think you are right! One of the problems over here (it seems to me) is anesthesiologists, er, "self medicating". 

I've only had general anesthesia once, but I liked the "gazing at the ceiling and then nothing until waking up in recovery" aspect. Some things I just don't want to know. 

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Richard J - on 21 Jan 2019
In reply to pneame:

Propafol is wonderful stuff - I remember nothing between the injection and waking up, feeling very clear headed, in the recovery room, even though the anesthetist said I was talking to him during the operation. He was at pains to stress that Michael Jackson’s doctor wasn’t a proper anesthesiologist.

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Richard J - on 22 Jan 2019
In reply to pneame:

Back home now. To summarize my experience while it’s still fresh in my mind :

operation itself much less bad than I feared - spinal block + heavy sedation worked fine and gave a fast recovery 

there were moments when it really was quite painful - first time they get  you on your feet especially. But I found it got better quite fast. First night they gave me morphine, second night paracetamol and codeine, third night paracetamol by itself was just fine. Actually last night I just felt physically tired, like I’d had a big day out in the hills.

there were some annoyances, and that general sensation of loss of agency. The catheter wasn’t fun getting in and out but neither took long. The heparin injections were no bother.

The physio is hard work - as is just moving around, getting yourself in and out of bed, going to the toilet etc. Progress is fast but at first all movement hurts, though only transiently.

Now I’m home I’m determined to do the exercises. Got to wear the compression socks for 6 weeks. Instead of heparin injections they’ve given me 30 days of Rivaroxoban tablets.

 I’m sure there’ll be lots of frustrations on the way but the thought of getting out this summer is very motivating.

All the best for your own procedure!

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HB1 - on 22 Jan 2019
In reply to Richard J:

So - you're on your way. Good luck. Do the exercises and walk EVERY day (and watch your gait - it's all too easy to let the other hip do the work - walk as if you've a book on your head)

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petemeads - on 22 Jan 2019
In reply to pneame:

Hi. I have a 4 year old left Birmingham MoM hip and a 20 month old right Zimmer ceramic/ceramic THR. I wanted another BHR but the head of my femur broke off during the op - better there than on the Cuillin, I suppose. The ops were chalk and cheese - spinal both times, wide awake and happy, but getting the cannula into my wrist and the right place for the spinal took 2 goes with the second op and I was getting very faint and upset by the time the sedative took effect. Both times the operated leg filled up with fluid (log leg, they call it) and the first couple of days were pretty miserable, after that recovery went ok - home after 3 nights, exercises several times a day and walking as far as possible (had to be careful with the BHR, not supposed to be fully weight-bearing for a couple of weeks so lots of crutch use).

In both cases I was able to walk 5k within the month and jog it within 6 weeks, and on the bouldering wall within 8 weeks, trying not to fall off. Back to racing pace within 9 months, Left has done about 150 parkruns and Right about 60. Climbing up to V3 and easy E1/HVS. Biking up to 70 miles. Done Ben Nevis/Snowdon Horseshoe/Sharp Edge/Striding Edge/Yorkshire 3 Peaks etc - all much steadier than in my youth but keeping up with my big lad most the time...

But. Ran well December 1st, walked 12 miles in the peak(s) the next day, climbed in the fun competition on the Thursday and suddenly I was limping badly on my R leg. Managed the Nantlle ridge and the Moelwyns the next week but the pain over Xmas was not pleasant. Can walk about 3 miles at the moment but it is not like the original recovery where each day is an improvement. Hoping it is soft tissue and not a problem with the stem - surgeon said I would not be able to break the THR and to carry on as before, which I have. Can still climb and bike, and watch wife do parkrun...

Good luck - and I had Heparin injections in hospital, hated them, and baby aspirin for 6 weeks whilst wearing compression socks, which I didn't mind.

Pete

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jon on 23 Jan 2019
In reply to pneame and other hipsters:

I've got just less than three weeks to go till my second THR. The right was done in 2010 so now the turn of the left which has been far more painful than the right ever was, though over a shorter period. Despite my claims after the very successful outcome of the right hip that I'd have no worries/hesitation about the left when it came to it, I find myself scared shitless once again. Pneame knows all this as we've compared notes over and over and I'm embarrassed to say that he's a lot calmer about it all than me - despite his previous claims of feeling queasy about needles and saws etc.

I had my anaesthetist appointment yesterday and he assured me that it would be the full monty GA, which is a relief as I've no desire to be awake during all that butchery. On the subject of a catheter, my surgeon recommended against as it can unnecessarily irritate the prostate (of someone who's already had prostate problems) and also discourages the patient from getting up - something he sees as beneficial (if inconvenient/painful) to a quick recovery.

 

 

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Bob Kemp - on 23 Jan 2019
In reply to jon:

On the subject of fear, here's a curious thing that happened to me when I went for my hip op: I felt pretty sanguine about the whole business. I was very aware of what was involved having worked in an operating theatre at one point and seen a lot of THRs. I really wasn't too bothered. That persisted right up until I went in to get my spinal. I still wasn't nervous or worried at a conscious level - I've never been frightened of needles - but my body let me down. I was gripped by a purely physical fear, and began shaking like a leaf as they started. I don't know why - pent up adrenalin or something? I couldn't control it at all. But the anaesthetist decided that I probably needed a little more sedation, and I ended up sleeping through the op. Had some very pleasant dreams though, so it all worked out in the end. 

Bob Wightman reported something very similar in his blog about his hip operation so maybe it's a common phenomenon? Has this happened to anyone else?

(As a PS, this didn't happen at all when I had my knee replacement with a spinal. Odd.)

Post edited at 12:52
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pneame - on 23 Jan 2019
In reply to Bob Kemp:

> On the subject of fear, here's a curious thing that happened to me when I went for my hip op: I felt pretty sanguine about the whole business. I was very aware of what was involved having worked in an operating theatre at one point and seen a lot of THRs. I really wasn't too bothered. That persisted right up until I went in to get my spinal. I still wasn't nervous or worried at a conscious level - I've never been frightened of needles - but my body let me down. I was gripped by a purely physical fear, and began shaking like a leaf as they started. I don't know why - pent up adrenalin or something? I couldn't control it at all. But the anaesthetist decided that I probably needed a little more sedation, and I ended up sleeping through the op. Had some very pleasant dreams though, so it all worked out in the end. 

> Bob Wightman reported something very similar in his blog about his hip operation so maybe it's a common phenomenon? Has this happened to anyone else?

> (As a PS, this didn't happen at all when I had my knee replacement with a spinal. Odd.)

Most interesting - It does sound like adrenalin - as climbers we are (hopefully? probably?) fairly good at keeping a grip on  things until we don't. It reminds me a bit of an annoying tendency I have - towards the end of a long day, I've often seemed fine until the moment when I feel safe and then I just lose it in terms of energy etc. A particularly memorable occasion is taking 3 hours to get from Montenvers to Snell's field, normally about a 1 hour walk. It doesn't say much good about reserves of energy!

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Bob Kemp - on 23 Jan 2019
In reply to pneame:

What was weird about the experience is that none of the techniques I've found successful in calming my climbing nerves seemed to operate - it was happening at an involuntary level that didn't seem to involve any form of conscious control. 

Your stamina deficit seems more directly connected with adrenalin etc - burning up energy in the process of concentration, then wilting. 

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pneame - on 23 Jan 2019
In reply to jon:

> On the subject of a catheter, my surgeon recommended against as it can unnecessarily irritate the prostate (of someone who's already had prostate problems) and also discourages the patient from getting up - something he sees as beneficial (if inconvenient/painful) to a quick recovery.

So, once again biology intervenes to help us out in moments of need. Much like the cystic fibrosis mutation (I think this is the one...) gives you a better chance of surviving cholera and the sickle cell gene gives you a good chance of surviving malaria, the "old man's problem" makes your recovery from  THR better! Ain't nature wonderful. 

On that note, a few years ago a friend of mine (a bit older than me) got grief as he dived into his tent with one of those pee bucket things that you can buy...

One of the young turks: "Ha ha! Is that an old man's thing?"

Jim: "F$%# off"

 

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pneame - on 23 Jan 2019
In reply to petemeads:

>  the head of my femur broke off during the op

Wow. Shows you how much brute force there is in these surgeries. Our chief of staff at a children's orthopedic hospital I used to work at used to like to say "Orthopedic surgeons - strong as an ox. Twice as bright". 

That's all very encouraging, Pete. Thanks! 

 

 

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pneame - on 23 Jan 2019
In reply to Richard J:

> Now I’m home I’m determined to do the exercises. Got to wear the compression socks for 6 weeks. Instead of heparin injections they’ve given me 30 days of Rivaroxoban tablets.

 

All sounds good - the exercises really are critical. Apart from giving you some sort of measurable indication of progress, the musculoskeletal system is constantly tweaking itself based on the sorts of loads it gets, so you don't want to give it the wrong idea, as Richard(HB1) says. 

A vivid example of this is how archaeologists can identify the sort of labour a person did in their life based solely on the skeleton.  

And the new hip doesn't have the "support" that the old one had, although Jon and my discussions are making me realize it is quite a bit better than I thought. Apparently ( I discovered just a week or so ago) the body generates a rather feeble form of synovial fluid to lubricate it - I would guess that this starts to appear a few weeks after surgery when the membrane that covers bone has had a chance to grow back. I'll be sure to ask my surgeon... I'm sure he dreads talking to me "OMG it's like some sort of board exam all over again..."

 

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petemeads - on 23 Jan 2019
In reply to pneame:

Actually, I rather think it shows how pathetic my bones are - slightly osteopenic, and probably outside the envelope for a successful BHR. The surgeon is supposed to press hard and tap lightly to seat the metal resurface cap onto the shaped femoral head, but it has to happen in 60 seconds or so as the cement hardens...

Anyway, my new THR has been almost as good as the BHR, until last month. Seems to be improving this week but avoiding running for a while.

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Richard J - on 23 Jan 2019
In reply to pneame:

Yes, those bone cells need some mechanical signals to prompt them to get growing.  I have an adhesive-free system, with a hydroxyapatite coated titanium alloy stem, the coating being supposed to persuade the bone cells to spread onto it, which seems plausible enough to me.  

"It's a press-fit", the surgeon said.  Still bet he used a hammer.

I have a ceramic head and liner, so I'd guess the surfaces are hydrophilic enough that any fluid going will wet the surfaces relatively quickly.  

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HB1 - on 23 Jan 2019
In reply to pneame:

 Our chief of staff at a children's orthopedic hospital I used to work at used to like to say "Orthopedic surgeons - strong as an ox. Twice as bright". 

. . .  on the other hand, my surgeon at Wrightington was a young woman probably no more than  5'2" (in high-heeled boots as I recall) but Wigan-born-and-bred and tough with it!

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pneame - on 23 Jan 2019
In reply to HB1:

A woman orthopod! Rare indeed. As are women surgeons in general. It's a very "macho" endevour. We have a female neurosurgeon at our local hospital and she is awesome - you definitely have to jump through a boat-load more hoops (not all put up by old guard, either) to be a female surgeon although things are improving. And pediatric orthopods are more likely to be women. But I'm drifting off-topic...

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pneame - on 23 Jan 2019
In reply to Richard J:

I think cementless is the preferred route for uncomplicated surgeries - I vaguely remember reviewing stuff about hydroxyapatite-coated devices over 15 years ago. The key word is "vaguely" - I can't for the life of me remember whether the people who knew more than me thought this was a good idea or just a gimmick. It seems probable that the "good idea" folks won - as my orthopod says - "orthopedics in Europe is a bit ahead of the US". 

[rapid and non-rigorous dig through the literature - they've been around (in Europe) for quite a while - they work fine - with the usual caveats of a decent surgeon who knows what they are doing! And the usual pictures of "when things don't go so well" which thankfully are not common ]

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pneame - on 23 Jan 2019
In reply to petemeads:

> Anyway, my new THR has been almost as good as the BHR, until last month. Seems to be improving this week but avoiding running for a while.

Running is fairly hard on joints - although with good style (= fitness, usually) loads shouldn't be hugely higher than any other vigorous sport. The thing to avoid (IMHO) is "jogging" I look at people doing that and just cringe at the hammering they are giving their knees (they usually are not very fit and so their musculature isn't going to take up the slack as it would in a fit person).

This, of course is my opinion and so if someone is going to come along with better information, I'll stand corrected! 

 

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pneame - on 23 Jan 2019
In reply to Bob Kemp:

> What was weird about the experience is that none of the techniques I've found successful in calming my climbing nerves seemed to operate - it was happening at an involuntary level that didn't seem to involve any form of conscious control. 

Sounds like me and needles! I was treated as an emergency during a second attempt by a nurse at sticking a tube in my arm a few years ago - my blood pressure cratered and rather alarmed the ER doc (friend of mrs pneame). I should have known better than to look at what was happening - it's just natural to keep an eye on people who are approaching you with sharp objects. 

Somewhere in my reptile brain, a circuit flipped over - "play dead! play dead! then he won't notice you!"

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Richard J - on 23 Jan 2019
In reply to pneame:

My local biomaterials scientist, who I know works on materials for bone growth, gave it the thumbs up.

This bit of the north has actually seen quite a lot of innovation in this area.  I believe Sir John Charnley's original hip replacements, which he did in Manchester, were made by Thackray's of Leeds, which is now owned by DePuy.  I think it was actually a Sheffield company - JRI - that first introduced the hydroxyapatite coating for cementless implants (though mine is a DePuy device). 

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pneame - on 23 Jan 2019
In reply to Richard J:

> This bit of the north has actually seen quite a lot of innovation in this area.  I believe Sir John Charnley's original hip replacements, which he did in Manchester, were made by Thackray's of Leeds, which is now owned by DePuy.  I think it was actually a Sheffield company - JRI - that first introduced the hydroxyapatite coating for cementless implants (though mine is a DePuy device). 

Interesting....

For some perverse reason, I'd not looked at the wikipedia entry on hip replacement - it gives a nice history of device design. And a description of the various approaches. I probably should read more about the anatomy, but that has never been a strength of mine! 

Reading on - indeed your view that here will be good days and bad days is born out. Feelings of legs being different length etc etc. 

I'm astonished to read that the first hip replacement was ivory in 1891 - wouldn't be allowed these days.

 

 

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Richard J - on 23 Jan 2019
In reply to pneame:

To go back to the more personal aspects of the experience, it was a bigger shock than I expected to go from the controlled environment of the hospital ward to my house, nice though it was to be home.  On that first day the house seemed too big, on too many levels, the sofa was too low, the bed too high, the stairs too steep, etc etc.  I wish I'd spent more time before I went in thinking about what it would be like to navigate the house with limited mobility and doing a few more simple preparations.

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jon on 23 Jan 2019
In reply to Richard J:

Exactly what I thought!

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petemeads - on 24 Jan 2019
In reply to pneame:

With regard to running style, I use Garmin products that let me quantify my recovery from the operations, recording distance and pace when relearning how to walk and more recently both my running style and my cycling performance. When running, I bounce less than 95% of Garmin users - I find this comforting!

On the indoor bike trainer I was able to see how my legs shared duty at different power levels - currently the left is 51%/right 49% at normal power, this swaps over during sprints for some reason. The right leg does still seem a bit slimmer than the left, gets harder to build muscle with age, and with limping a bit at times.

I would advise anyone to use a GPS device to record their rehabilitation,  it makes the whole thing more rewarding as you improve times and distances walked/biked/run - and also offers a warning when you start to overdo things, of course...

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pneame - on 24 Jan 2019
In reply to petemeads:

That's a great idea - I've learnt quite a bit from my extended "prehab" and the big take home lesson is that easy does it. This, of course, requires patience. But having some sort of precise measurement is really invaluable to staying motivated during rather tedious recovery (or deciding "yes, I need surgery" at my stage). Jon and I were looking at a hip prostheses that has little temperature measuring devices in it - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0043489

The data sucks, as N is a ridiculously tiny number, but it was amusing the different reactions:

Me: ooh I want one! (obviously these are custom jobs and I wouldn't be able to get one if I pleaded and screamed)

Jon: no, it looks as if it would be weakened. (probably more rational)

 

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petemeads - on 24 Jan 2019
In reply to pneame:

Can't believe they range the device from 20 degrees - surely you would want the range 35 - 50, sufficient to cover all potential conditions from death's door to cooked? Does make me wonder about my MoM resurface though - perhaps a nipple to grease it with hyaluronic acid would be good for long days in the hills?

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pneame - on 24 Jan 2019
In reply to petemeads:

> perhaps a nipple to grease it with hyaluronic acid would be good for long days in the hills?

That would be good - but apparently the synovium grows back and provides some juice. Not such great juice as it is lacking the stuff that the surface cartilage generates in a proper joint, but it's better than nothing. So, my working hypothesis is that this probably takes about 3 weeks to regenerate and then the joint is ready for business. 

https://www.ncbi.nlm.nih.gov/pubmed/15046934

Like all good hypotheses, I expect it to be, in part, shot down in flames. 

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jon on 25 Jan 2019
In reply to pneame:

> That would be good - but apparently the synovium grows back and provides some juice. Not such great juice as it is lacking the stuff that the surface cartilage generates in a proper joint, but it's better than nothing. So, my working hypothesis is that this probably takes about 3 weeks to regenerate and then the joint is ready for business. 

That sort of bears out my experience of my hip feeling just a bit clunky at first, then losing that feeling after a couple of weeks. When I say clunky, I don't mean rattly like an old diesel engine, more the odd random clunk. 

 

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petemeads - on 25 Jan 2019
In reply to jon:

There's a gentle clunk from time to time from my resurfacing, which some people get and some don't, due to the shape of the cup - slightly more open than a hemisphere which allows space for the lubricating fluid to enter and swish about. Its called a polar bearing. Once its weighted the clunking goes away. The fancy new ceramic job has never clunked since about day 5, I'm not sure it needs any lubricant as the surface finish is so polished and hard. The very latest experimental hip resurfacing is all-ceramic, being tested by Professor Cobb at Imperial College/Charing Cross hospital. Suitable for females, younger and athletic people. Met the team a couple of years ago, he is convinced that resurfacing is the best option and the new device will remove the traditional objections. The latest ceramics are supposed to be indestructible and no worries about metal allergies. Professor Cobb did Craig Revell Horwood and Darcey Bussell's resurfacings, which won't mean anything if you don't watch Strictly...

Good luck with your forthcoming op, Jon

 

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Rigid Raider - on 25 Jan 2019
In reply to pneame:

Oooh  Darcey has been resurfaced? I'd have taken her with the old look. 

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jon on 25 Jan 2019
In reply to petemeads:

Thanks Pete. I remember when I first felt the clunks thinking that either there was something wrong or that it was something I'd just have to put up with. Thankfully it just went away! 

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pneame - on 25 Jan 2019
In reply to jon:

A very helpful warning - 1 less worried phone call in the future...

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jon on 25 Jan 2019
In reply to pneame:

... though of course if it doesn't you'll think it's too tight and bound to sieze up...

Post edited at 17:58
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petemeads - on 25 Jan 2019
In reply to pneame:

I subscribe to a couple of hip forums, Surface Hippy and Hiprunner.com, both American. There are some amazing stories of quick recoveries but the latest on Hiprunner is a chap who walked out of the surgery centre 5 hours after the operation (using crutches, admittedly) ten days ago who expected to go back to work today! Certainly there are many people who have had an outpatient hip but stayed in the nearest hotel for the first night just in case, but this latest story takes the biscuit...

 

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pneame - on 25 Jan 2019
In reply to jon:

> ... though of course if it doesn't you'll think it's too tight and bound to sieze up...

Er yes - you have me exactly measured

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pneame - on 25 Jan 2019
In reply to petemeads:

> Certainly there are many people who have had an outpatient hip but stayed in the nearest hotel for the first night just in case, but this latest story takes the biscuit...

I see what you mean! Inspiring. I will peruse those forums this w/end. Thx! Although running is a little over the top for me - curiously, as I used to run daily when I was a teenager but then discovered climbing/mountaineering at 16 and went steadily downhill. Literally when I discovered skiing. 

I'll confess that my mindset does tend to be "well if they want me up and walking the same day why can't I go back to my normal ultra-low impact desk-based job and kill two birds with one stone?" 

But the other mindset is "ooh goody some time off and I can get caught up on reducing the monumental size of my light reading list and if I feel energetic some cleaning and cooking". 

We shall see which one is dictated by the vicious bite of reality. 

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Richard J - on 26 Jan 2019
In reply to pneame:

Here's a really nice paper with some direct evidence for the idea that the new joint continues to "run-in" between 3 and 12 months, with direct in-vivo measurements of friction from instrumented hip implants.  The authors suggest changes in fluid characteristics as the cause; I wonder whether the surfaces are getting slowly conditioned during the period too

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0120438&type=printable

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Richard J - on 26 Jan 2019
In reply to pneame:

> We shall see which one is dictated by the vicious bite of reality. 

Here's how reality has bitten me, 7 days on from the operation.

On the positive side, the improvement in strength in mobility is really obvious and encouraging as I do the physio's exercises.  I'm able to get about the house with a single crutch, which makes me much more independent (the crucial test, being able to make a cup of tea and take it to my chair).  I've started going outside for (very short) walks with the crutches, which is great for the morale.

I still get tired quickly, though, often having to have a couple of naps in the daytime.  My leg's often sore, though the pain does go away with resting and I've not resorted to any pain-killer stronger than paracetamol since coming home.  I am finding sleeping well at night difficult - don't like being restricted to being on my back.  And the compression stockings do seem to get really uncomfortable and annoying.

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jon on 26 Jan 2019
In reply to Richard J:

 

> I've started going outside for (very short) walks with the crutches, which is great for the morale.

When I had my right done we had just moved to a tiny village and only really knew our neighbours on one side but were on nodding terms with a few others. One day I was hobbling along the lane on my crutches trying to make my 1km milestone(!) when coming the other way was one of the nodders. He smiled and greeted me with 'Ah voilà, c'est l'alpiniste!'

 

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Richard J - on 26 Jan 2019
In reply to jon:

This afternoon an elderly hiker, unknown to me, smiled and said "You're doing *really well*!"

I'll take encouragement from anywhere.

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petemeads - on 27 Jan 2019
In reply to Richard J:

Sounds like everything is progressing perfectly! Another week or two of rubbish sleeping and you will be past the worst - in my case it was getting up every couple of  hours to wee which became really depressing - and you will be able to lie on your side again. Target now is to keep walking, a bit further and/or faster most days, and you will find the rate of improvement quite surprising - I managed the Edale Skyline at the 4 month mark after my first operation...

Edit: ... and Cheviot from Akeld at 4 months after my second, according to Garmin.

Post edited at 10:34
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Richard J - on 27 Jan 2019
In reply to petemeads:

Thanks Pete - that's a really encouraging post.  I haven't really dared so far to set myself any goals or targets, but Edale skyline - whether after 4 months or a bit longer - would be a very good one.  I walked the south edge of Kinder last summer, hobbling a bit on sticks and munching NSAIDs, the result of which was a stomach ulcer scare and my GP telling me "we're both going to look a bit stupid if you end up in intensive care with a perforated stomach".  That's the last walk of any length I did before my operation.  

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petemeads - on 27 Jan 2019
In reply to Richard J:

Funnily enough, Kinder did for my second hip. I ran a decent 5k on the Saturday, went on the club walk around Kinder on the Sunday and even jogged a couple of downhills but by the bottom of Jacob's Ladder my right hip stopped working. The last mile into Edale was slow and painful witha new type of pain (I had been told it has two years left in it - an almost exact prediction). Weirdly, with Ibuprofen and a week off running, I got some use of it back and managed to run a 5k at a decent pace in February before it said "no more, please". Managed to get it done by May 2nd thanks to BUPA and until this year's club walk along Curbar and Froggatt did not look back. Still not running but walking nearly OK again now, hoping the next bouldering session does not set me back again...

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pneame - on 28 Jan 2019

In reply to Vasco Bull:

I'm impressed, Vasco - I suspect if I'd had a bilateral hip at that age I'd have become a total wimp. Although one never knows until it happens. 

I'm pretty sure the technology will develop - not fast, but by the time you need a revision it should be better than it is today by a fair bit.

It is always challenging to look at data for these already successful and long-lasting devices because by the nature of the beast it is a look into the past. That's why I and Richard J are rather intrigued by devices with (at the moment, limited) measuring gear inside them so that data that is useful can be obtained right now in real time. Amazingly, these sort of things have been done for the last 20 years, but in very limited numbers.  

One could envision some sort of rechargeable prosthesis that talks to your smart watch and gives a little nudge if you are (1) heating up too much (2) exceeding design loads. One could also envision climbers going "stuff that - I'm just going to climb!". 

One could, of course, also envision the sort of charging mishap that results in " Oh bugger! My prosthesis just blew up."

 

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pneame - on 28 Jan 2019
In reply to Richard J:

Very nice paper - good find!

Definitely food for thought. 

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pneame - on 28 Jan 2019
In reply to Richard J:

> the crucial test, being able to make a cup of tea and take it to my chair

That sobered me up a bit! Before I went to see the orthopod and got some steroid and some PT, I was having issues carrying three balanced empty catfood cans in one hand and opening a door with the other I was so unstable. After that, much better! 

So that will be another metric for progress....

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pneame - on 28 Jan 2019
In reply to petemeads:

I've been nosing around the garmin offerings - which device do you recommend for measuring gait? 

ATM I have an iPhone which I'm pretty sure lies to me (although mysteriously it is quite accurate on numbers of flights of stairs climbed)

Cheers

Peter

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Richard J - on 28 Jan 2019
In reply to pneame:

I took Pete's advice and charged up my Garmin (Forerunner 235), which has been languishing since I stopped running (March 25th last year, it tells me).  

Today's outing: 0.84 km, 3.1 km/h ave moving speed (2 crutches).  It's a base to work from!  (Curbar Gap car park to top of Eliminates Wall & back.  Perhaps more importantly, an utterly lovely January late afternoon, frosty under deep blue skies).

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petemeads - on 28 Jan 2019
In reply to pneame:

Hi Peter, the Garmin I use is the high-end 920xt, with the HRM-Run strap. It is the accelerometers in the strap that work out gait parameters like bounciness, ground contact time and balance, as well as heart rate, pace and cadence.

The downside is that you have to be running to get the full benefit - walking involves constant ground contact so all you get is cadence. The cheapest decent watch on Amazon that will use (and is bundled with) the HRM-Run strap is the 735xt for about £275. Since you are unlikely to be running this is definitely overkill. Any of the cheaper running watches will give pace and cadence, and allow you to store data on Garmin Connect for reference/comparison. Sorry if I misled you about the capability of these devices when just walking...

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petemeads - on 28 Jan 2019
In reply to Richard J:

Great stuff Richard! It certainly was a cracking day for walk. I managed 5 miles at 4 mph walking to and from our local park this morning, before breakfast, and this was the best I have walked in the last two months. Just a couple of twinges so hoping whatever I have done to myself is nearly healed. Without the Garmin I struggle to know just how well I am walking, apart from recognising when I start limping, as pace judgement is more difficult than when running, where breathing heavily is a clue...

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Richard J - on 28 Jan 2019
In reply to petemeads:

In retrospect I think the Garmin was giving me advanced warning of my worsening arthritis; never a good runner to start with, looking back it’s obvious that my pace for a given amount of effort was dropping away as my hip’s range of motion was narrowing, so even before the pain made it obvious I knew something was wrong.

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pneame - on 28 Jan 2019
In reply to Richard J:

I think climbing at our local climbing wall gave me the clue quite a few years ago. While it focusses on bouldering, which is not really my thing, I noticed that I seemed to be getting steadily worse and lifting my right leg to a high step would often require a sneaky tug from my right arm. That was a few years before I got the x-ray that said "uh oh!". That was in 2014 "moderate OA", as opposed to now. 

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pneame - on 28 Jan 2019
In reply to petemeads:

Thanks Pete - that was beginning to be my impression from persuing Garmin's web site (and, of course, that well known used-to-be-on-line bookstore). The walk/run switch seemed to be so that you don't muddy the running data with the walking data, rather than to get a different dataset as I was hoping. 

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jon on 16 Feb 2019
In reply to hipsters:

Update: Operated late afternoon Monday. Wandering around corridors with physio Tuesday. Corridors and stairs Wednesday. Home Thursday. Walked around town Friday. All good. 

Practically no pain, swelling or bruising compared to my right hip 8 years ago. Can walk with one crutch though I've noticed that if I do this I tend to lean on it too much so decided it's best to continue with two concentrating on staying completely upright, until gluteus medius has healed enough to hold its own.

Rest today due to slight cramp from yesterday's walk (note to self, patience, calm the f*ck down...). Still hate compression socks. Only 28 more anticoagulant injections to go, but safe in the knowledge that I have more than adequate rolls of fat in which to stick them.

 

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Richard J - on 16 Feb 2019
In reply to jon:

All sounding good...

Mine was four weeks ago today.  The wound has healed nicely, I'm mostly able to get around without crutches, doing my physio exercises religiously and walking every day - up to 2.5 km now (with poles).  No real pain - but I do get ludicrously tired by the evening and don't always sleep brilliantly, especially if I've overdone the exercise.  But the daily progress in strength and mobility is obvious and encouraging. 

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Bob Kemp - on 16 Feb 2019
In reply to Richard J:

Sounds great Richard! I remember the fatigue and sleeping issue. Having to sleep on my back was a killer for me. 

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pneame - on 16 Feb 2019
In reply to Bob Kemp:

Just had my pre-op instructions this week - no (apparently) restriction in lying position. In fact specifically says "if you lie on your side.....". But a lot of stuff about using a walker. I used to joke about zimmer frames. Not any more. 

Good grief it's a lot to take in. They really are not keen on crutches at all. To my surprise. 

Of course what you do in the privacy of your own home.....

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Bob Kemp - on 16 Feb 2019
In reply to pneame:

I had a kind of Zimmer frame with a tray on it at first, so I could move stuff around. That reminds me - I found a canvas shoulder bag handy so I could lug stuff around the house until I stopped using sticks etc. 

Post edited at 17:03
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Darron - on 16 Feb 2019
In reply to pneame:

In order to cheer you new hipsters up - a true story.

I know someone who had a THR with a spine anaesthetic. She was listening to music on her Walkman when, some way into the op The anaesthetist asked why she was giggling. She had just realised she was listening to The Saw Doctors.

Good luck with your recoveries all.

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HB1 - on 16 Feb 2019
In reply to jon:

It all sounds good Jon, and being an old hipster you know it'll keep getting better! There was an interesting discussion on R4 "Inside Health" around about end January last year. It concerned the effectiveness of injections and stockings  (and the enormous cost to the NHS) and concluded that in most cases they weren't helping at all ( and we'd all be better off without them). I stopped injecting just before Christmas 2017 - it doesn't really hurt but it's that moment just before you do it  - GRRRR! 

All the best        Richard  (I'm off to Leonidio next month - that'll be a test!)

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Rigid Raider - on 21 Feb 2019
In reply to pneame:

Nothing as heroic as a hip but three months ago I had my collar bone plated after three months of non-union. I've been surprised at the level of soft tissue pain, so much that I've half believed the surgeon hasn't woken up the bone ends and persuaded them to grow into the graft material he used in the gap. Tomorrow I have the 3 month x-ray so I will be either deliriously happy or extremely depressed. 

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pneame - on 21 Feb 2019
In reply to Rigid Raider:

I never though of hip replacement as heroic! Except perhaps for the surgeon who is the one doing all the brute force stuff. 

It's quite a bit of bone growth in repair of non-unions, so I would expect a fair amount of discomfort. # months does seem like a long time, however. Although that would be age-related. One of the reasons I'm aiming for a hip earlier rather than later (apart from reasons like walking more than a couple of hundred metres is quite uncomfortable and frustrating) is to get it done while I'm still, er, young (60 is the new 40 and all that). 

Your body is probably doing quite a bit of other repair as a result of the weirdness introduced by non-union. All that will have to be rearranged. My fingers are crossed on your behalf. 

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Bob Kemp - on 21 Feb 2019
In reply to Rigid Raider:

I get the impression that upper-body problems can often be more painful. I haven't looked to see if there's any data to back this up but I know from friends who've had severe shoulder problems that they can be acutely painful, and my personal experiences on a small scale back that up. 

Hope all goes well for you anyway...

Post edited at 22:56
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jon on 21 Feb 2019
In reply to pneame:

> I never though of hip replacement as heroic!

You say that now...

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petemeads - on 28 Feb 2019
In reply to pneame:

How is everyone doing? Peter, Richard, Jon (and anbody else with a recent hip). From the activity on this thread you are either recovering steadily without problems, or in no fit state to communicate!

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jon on 28 Feb 2019
In reply to petemeads:

Ha Pete, I was thinking of bumping this thread today as by my calculations, Peter has just one week left before his op. 

For my part I'm 17 days post op. The putting on and taking off of compression socks continues to amuse and enhance marital harmony. I have fourteen syringes left but few if any unbruised areas in which to plunge them. Crutches now cast aside though I do like one at my bedside to steady nocturnal wanderings. I have no fixed targets for distance walked as I just do what feels comfortable on any particular day - certainly 1km seems to tire me nicely and induce an afternoon nap. The final ten staples are to come out this afternoon, which will be nice - I noticed that when the first lot were removed on Monday that sitting was immediately much more comfortable. So very positive overall.

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pneame - on 28 Feb 2019
In reply to petemeads:

As Jon says - I seem to have passed all tests, bought walker (required to get out of hospital), bought forearm crutches ( for use as soon as I'm out of sight of the hospital ), bought a gadget for applying pressure to my legs at night (ordered by orthopod).

Great news - no injections, no coumadin, just aspirin and NO HIP PRECAUTIONS! Woohoo!

I am looking forward to it as (1) loads of encouragement on here (2) I am heartily fed up with not being able to put much load on my affected limb (although walking short distances (100 ft) is OK but speed and gait go to pieces thereafter) and (3) a 2 - 3 week holiday will be very welcome, even though I suspect I'll be "working from home" and doing exercises a fair bit of the time (while not sleeping, which Jon seems to be doing a bit of...)

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jon on 28 Feb 2019
In reply to pneame:

> (while not sleeping, which Jon seems to be doing a bit of...)

Yes, in fact both Richard J and Bob Kemp have also mentioned the fatigue. This afternoon I had the remaining staples removed then 45 mins of physio and I can feel a late afternoon nap coming on.

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petemeads - on 28 Feb 2019
In reply to pneame:

Great news from you both - do you know which device you are getting Peter? Ceramic head and crosslinked poly cup seems to be the current standard for cost/benefit and durability.

I had a rubbish December/January with my more recent THR leg, no running and plenty of limping, even used a crutch briefly on New Years day to watch MrsPete at parkrun. Resumed parkrun myself on 2nd Feb but not caught Mrs yet... Did get around the Edale Skyline a fortnight ago but absolutely knackered by the Mam Tor ridge (went the wrong way round). Walking OK again today, I reckon a nerve is getting trapped/squeezed in my thigh but not done anything about it yet, maybe get an MRI?

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Richard J - on 28 Feb 2019
In reply to petemeads:

It will be six weeks next Saturday for me - I had my follow up appointment with the consultant on Tuesday, everything seems fine from his point of view - I can at last discarded the hated compression stockings, from Saturday I can drive again (not entirely sure where the status of the magic six weeks comes from).  Yesterday for the first time I walked more than 2 miles cross-country at a decent pace.  

Looking back over the last couple of weeks there have been ups and downs.  Perhaps inevitably the pace of improvement becomes a little slower than it was in the first few weeks, so I did find myself a bit discouraged and low at times.  Also, about ten days ago - maybe equally inevitably - I was a bit overambitious in what I tried to do and found myself with my leg swelling up and some new pain.  That was a result of three days doing too much, beginning with the elementary error of agreeing to go to Ikea.  But after a quieter day or two everything got back on track again.

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pneame - on 28 Feb 2019
In reply to petemeads:

I think that's the type I'm getting - my surgeon is always amused by the barrage of technical questions he gets - I'm sure he isn't interested in training me to take his place, so I don't ask questions where the answer is "you'll get what I think is best"! Or I try not to. 

A trapped nerve is pretty painful - I would think more likely to be something inflamed. Jon will likely be along to tell you about bursitis. So anti-inflammatories might do the trick or steroid shots if a precise location can be found. I've become a bit of a fan of steroid shots. 

I expect good times and bad times - the body has to get used to a boat load of new biomechanics and so is going to rearrange itself a bit. I've got scoliosis (now I know it's there I'm more aware of it) which hasn't caused problems so far but I don't expect that to last forever. 

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jamscoz on 02 Mar 2019
petemeads - on 02 Mar 2019
In reply to jamscoz:

And on a somewhat smaller scale, I managed to just miss winning the "fun" (easiest) class in the Climbing Station winter boulder league - at 68, with two fake hips. Got a t-shirt for second place!

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pneame - on 02 Mar 2019
In reply to jamscoz:

Ooh excellent! Hip arthroplasty as a form of cheating akin to doping. 

Thanks for that!

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HB1 - on 02 Mar 2019
In reply to pneame:

> Ooh excellent! Hip arthroplasty as a form of cheating akin to doping. .  .

                 . . . It's over a year since my hip replacement and I reckon I'm beginning to climb better than I have been doing for at least the last 5 years or so (although I'm still asking myself at certain points "should be doing this?")

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Dave Cundy - on 02 Mar 2019
In reply to pneame:

Probably just as well that you can't get a new hip posted to you in a jiffy bag ;-)

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pneame - on 08 Mar 2019
In reply to HB1:

Surgery yesterday, out today. Escaped A catheter by the skin of my teeth. “No the nerve block should wear off by midnight! I’ll be peeing like a horse, honest!  

Thanks to all on here for encouragement. It made a difference. I wasn’t anxious at all. 

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jon on 08 Mar 2019
In reply to pneame:

Soon our demographic on here will be more titanium than bone... 

Walker or crutches? Keg of beer, Cuban cigars...?

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pneame - on 08 Mar 2019
In reply to jon:

Crutches as soon as I’m out of sight. I’ll apparently be unique. Which i am, of course. 

The rest? Probably “whatever you feel like but not when on pain meds”

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petemeads - on 08 Mar 2019
In reply to pneame:

Great to hear it was not so bad as you had thought, and you dodged the catheter. Just the next week of crap sleep and you are on the home straight...

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HB1 - on 08 Mar 2019
In reply to pneame:

Good to hear it's all going well! Actually I BEGGED for a catheter - my bladder was near bursting point, and painful with it. It  was only for a few hours, and they then took it out and measured the amounts in the peepot ( what a job Eh)

It seems a long time ago now - off to Leonidio on Sunday. Have hip -will travel!

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colin struthers - on 10 Mar 2019
In reply to pneame:

Hi there fellow hipsters. I had my second operation at Wrightington on Wednesday and it seems to have gone well. My surgeon, Ms Shaw was excellent and I would recommend her. However, here's a warning for you, if like me, the level of post operative pain you experience is getting too much...

In spite of the fact that the hospital staff kept assuring me that everyone reacts differently to surgery, Wrightington have a one size fits all post operative pain relief policy and are unwilling to give anything more than the minimum when in hospital and routinely send people home after two or three days with no more than a prescription for codeine, paracetomol and if you're lucky the lowest possible dose of oral morphine. 

In my case this was woefully inadequate. Whilst in hospital the first time I had 3 days of really poor sleep followed by a further week of utter misery before I dragged myself into my local GP. He expressed his astonishment and how poorly I had been provided for, immediately prescribed a higher level of slow release morphine and his exact words were 'someone is taking the piss here, I routinely see patients from other hospitals who are sent home with significantly higher levels of prescription'

My second operation was better because I had already arranged my prescriptions for home from my local GP before I went in but my experience in hospital was just as bad. On the second night, after the second prescription of 5mg of morphine had failed to touch the pain and left me moaning in misery at 2.30am I overheard the nurses discussing my case and the fact that it was policy to proscribe up to 10mg - so unsurprisingly I asked to see the doctor - who refused this. I slumped back into bed and told the nurse that I couldn't believe that in a modern hospital in the 21st century I was being left to suffer in this way. Ten minutes later she came back with the higher dosage I needed having telephoned directly to the on call anaesthetist who agreed with her but hadn't been consulted by the doctor. I was ok after that. 

So my advice if you go to Wrightington and find yourself in a lot of pain is this - don't wait, kick off big style from the beginning.

BTW I am not a wuss and wouldn't consider myself to have a particularly low pain threshold

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HB1 - on 10 Mar 2019
In reply to colin struthers:

Debbie Shaw fixed my hip too - she's a good'un ! Oh and I got all the morphine I needed. No problems there

Post edited at 18:25
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L Michael Johnston - on 12 Mar 2019
In reply to pneame:

This should give anyone facing this a smile .... Had mine completely replaced and the socket due to a serious accident in my early twenties around 1984 . I'm still on the original joint having climbed to a decent standard ever since ... Last year I managed the Snowdon horseshoe 3 times .. Ben Nevis and many others . I still boulder regularly although try not to jump off too much ... I have some limited movement but have  learned to adapt .. steep ground is best .. and a some discomfort but very little real pain . Think I might owe the NHS a bit !

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pneame - on 12 Mar 2019
In reply to Michael Johnston:

It did indeed make me smile - at that rate I'll be 100 before I need a revision. It's particularly reassuring to get all these climbers with old prostheses, as my new dread is sepsis - dire warnings about antibiotics for dental procedures (even tooth cleaning!).... but on to the present.

Now day 5 - good sleep every night, even in hospital (1 night) where the vampires visit at intervals. A bit stiff and sore, but the worst problem is where they stuck needles in me - all three sites are a bit painful. The biggest inconvenience is, of course, needing crutches, although only 1 needed for short distances (e.g. making a cup of coffee). 

Mostly, I just feel as if I overdid it a bit. Pain meds - 1 whole and 2 half percocets. None for the last 30 hours. I'm actually a bit astonished but suspect that there will be a bit of work to get my strength back.

Mrs pneame says I'm walking straighter than I have for ages. The pain from the hip as such is a thing of the hazy past. Surgeon said "you were right - it was in very poor shape" 

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pneame - on 12 Mar 2019
In reply to pneame:

One thing I learnt from talking to a senior nurse - knee replacements have ALL gone to outpatient here (no overnights in hospital) and she felt that hips would go the same way. In fact she was surprised that hips hadn't already gone to outpatient given that they are easier to recover from. So the order of play for a surgeon's day is knees first and hips second - my surgery was at noon. Which I thought very civilized. 

I think that is all a bit cavalier myself. 

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jon on 12 Mar 2019
In reply to pneame:

Ha Peter, Michael is being incredibly modest! If you or I come anywhere close, we'll certainly count ourselves lucky!

Post edited at 15:01
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jon on 15 Mar 2019
In reply to jon:

Four and a half weeks in and did my last anticoagulant injection this morning. And took of the compression socks for the last time. Bliss. The only complaint is the last (upper) cm of the scar doesn't seem to have healed like the rest, it's still slightly open - only skin deep - and a little sore. I was convinced when the nurse came round to take the staples out at two weeks that it was too early... Actually the staples pulled it together unevenly in that part of the incision, so I guess that didn't help. So I've put some steristrips across the incision and put a dressing back over it for protection. Just under two weeks to go to follow up appointment... and climbing!

Hows it going, Peter?

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pneame - on 15 Mar 2019
In reply to jon:

Congratulations Jon! I took my last antibiotic today.

It is going surprisingly well - the 8 days from surgery point for me

I ripped the wound covering off today with some trepidations (yes this was in my instructions! actually for yesterday) and no oozing bits suddenly appeared. Nevertheless, a gauze pad is covering things (not in my instructions). As you know, I was glued back together. It seems to have worked better than I would expect, but the scar location isn't an area where the skin does much except cover my insides - no nasty flexing. 

So every day in every way I'm getting better and better  https://www.youtube.com/watch?v=5IvxnK3xZtg as depicted on little graph in the health app in my phone that compiles the number of steps I'm taking. I'm sort of projecting tossing the crutches by this time next week (when I have my follow up). We shall see. I've got 2 more visits from a home PT person - the first two visits were from professional and experienced people. Today and next week - not so impressive. 

Sleeping quite well in spite of these two pneumatic things wrapping my calves and independently going "bzzzz" every minute for about 5-8 seconds. They aren't in sync, so it's an entertaining little symphony all night which must have a soporific effect as I'm sleeping better than I did. 

Not any pain from my high-tech hip joint, or even any clicks. There are niggling discomforts that move from place to place on a random basis as various things rebuild themselves. Occasional ice packs have been needed on the wound site. The occasional Percocet has been taken. 

In fact time for some more exercises now.....

Post edited at 21:33
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Richard J - on 16 Mar 2019
In reply to pneame and Jon:

Sounds like it's going very well.  Today is 8 weeks after the operation for me.  I think the joint is pretty stable now, so the physio is focusing more on rebuilding strength - lots of squats and lunges.  No pain at all.  I'm still very short on stamina, so it's taking me a bit of time to build up the walking distance beyond a few km.  I don't feel ready yet to try climbing, I think I need to build the strength up a bit more.

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IanMcC - on 16 Mar 2019
In reply to Richard J:

Post op ticklist:

Hip Replacement (E1 5b)

Good luck and quick recovery!

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pneame - on 16 Mar 2019
In reply to IanMcC:

Excellent. 

And to Richard J - I agree building strength will be an issue for me too. I usually feel quite sprightly around noon, but am significantly tired by the evening. And that's with doing almost nothing except exercises and short walks - around 0.5 miles / day according to my phone. A "few km" is still a distant goal. Onward and upward!

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jon on 16 Mar 2019
In reply to pneame:

> Onward and upward!

Steady on. Onward and flat to begin with

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pneame - on 16 Mar 2019
In reply to jon:

Well yes, I'm in Florida so my best option is a six floor parking garage next door to our office. Exciting stuff. At the moment I'm researching the trendelenburg sign.... and developing a modest interest in biomechanics.  https://www.youtube.com/watch?v=DkSTr7K-eAo 

I can hear yawning....

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jon on 16 Mar 2019
In reply to pneame:

No yawning here, that's a great explanation. The wobble board and theraband exercises are excellent for this. As is walking towards a mirror to see progress...

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pneame - on 16 Mar 2019
In reply to jon:

He's pretty good- even manages to make nerve anatomy interesting  https://www.youtube.com/watch?v=5YJJkK4Kw88

Super graphics - part 2 does shoulder stuff which may be of interest to some on here  https://www.youtube.com/watch?v=mKbk_ey_dEs

Post edited at 17:23
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petemeads - on 17 Mar 2019
In reply to pneame:

Impressive little videos. I was walking like that in December, seem to be over it now thankfully, but no real explanation what I had done to myself or how it got better, other than by not running for two months...

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pneame - on 17 Mar 2019
In reply to petemeads:

I walk like that (with crutches) every evening at the moment - but I'm training myself to not do so. If I find myself doing it I stop and fester on the couch immediately. 

These gait things are almost unconscious - it's really clever how the body tweaks its behavior to still work with no actual thinking involved. It "just works". 

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