UKC

Hip replacement and climbing.

New Topic
This topic has been archived, and won't accept reply postings.
 pneame 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-repla.... 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"...

 

 Darron 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.

OP pneame 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". 

 Richard J 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

 bouldery bits 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.

 bouldery bits 19 Jan 2019
In reply to pneame:

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

OP pneame 19 Jan 2019
In reply to Richard J:

Very encouraging! 

 

And thanks, bouldery bits!

 jon 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. 

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.

 Aly 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!

 Richard J 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.

 jon 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-repla... 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!

 

 wilkesley 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.

OP pneame 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.  

 Richard J 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.

OP pneame 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!

 Bob Kemp 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!

 jon 20 Jan 2019
In reply to pneame:

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

Sharing pain is very theraputic!

 

 

OP pneame 20 Jan 2019
In reply to jon:

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

 HB1 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

 

 Darron 20 Jan 2019
In reply to HB1:

Nice one Rich. .

 

OP pneame 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. 

 

 HB1 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!

 jon 20 Jan 2019
In reply to pneame:

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

 Bob Kemp 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. 

 Richard J 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.

 Bob Kemp 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. 

 Richard J 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.

OP pneame 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.

 

 Richard J 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.

OP pneame 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 

 Richard J 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!

 

OP pneame 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. 

 Richard J 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.

 Richard J 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!

 HB1 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)

 petemeads 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

 jon 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.

 

 

 Bob Kemp 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
OP pneame 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!

 Bob Kemp 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. 

OP pneame 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"

 

OP pneame 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! 

 

 

OP pneame 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..."

 

 petemeads 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.

 Richard J 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.  

 HB1 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!

Post edited at 17:34
OP pneame 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...

OP pneame 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 ]

OP pneame 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! 

 

OP pneame 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!"

 Richard J 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). 

OP pneame 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.

 

 

 Richard J 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.

 jon 23 Jan 2019
In reply to Richard J:

Exactly what I thought!

 petemeads 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...

OP pneame 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)

 

 petemeads 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?

OP pneame 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. 

 jon 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. 

 

 petemeads 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

 

Rigid Raider 25 Jan 2019
In reply to pneame:

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

 jon 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! 

OP pneame 25 Jan 2019
In reply to jon:

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

 jon 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
 petemeads 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...

 

OP pneame 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

OP pneame 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. 

 Richard J 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.0120...

 Richard J 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.

 jon 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!'

 

 Richard J 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.

 petemeads 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
 Richard J 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.  

 petemeads 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...

OP pneame 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."

 

OP pneame 28 Jan 2019
In reply to Richard J:

Very nice paper - good find!

Definitely food for thought. 

OP pneame 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....

OP pneame 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

 Richard J 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).

 petemeads 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...

 petemeads 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...

 Richard J 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.

OP pneame 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. 

OP pneame 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. 

 jon 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.

 

 Richard J 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. 

 Bob Kemp 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. 

OP pneame 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.....

 Bob Kemp 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
 Darron 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.

 HB1 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!)

Rigid Raider 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. 

OP pneame 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. 

 Bob Kemp 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
 jon 21 Feb 2019
In reply to pneame:

> I never though of hip replacement as heroic!

You say that now...

 petemeads 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!

 jon 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.

OP pneame 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...)

 jon 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.

 petemeads 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?

 Richard J 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.

OP pneame 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. 

 petemeads 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!

OP pneame 02 Mar 2019
In reply to jamscoz:

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

Thanks for that!

 HB1 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?")

 Dave Cundy 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

OP pneame 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. 

 jon 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...?

OP pneame 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”

 petemeads 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...

 HB1 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!

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

 HB1 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
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 !

OP pneame 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" 

OP pneame 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. 

 jon 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
 jon 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?

OP pneame 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  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
 Richard J 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.

 IanMcC 16 Mar 2019
In reply to Richard J:

Post op ticklist:

Hip Replacement (E1 5a)

Good luck and quick recovery!

OP pneame 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!

 jon 16 Mar 2019
In reply to pneame:

> Onward and upward!

Steady on. Onward and flat to begin with

OP pneame 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.  youtube.com/watch?v=DkSTr7K-eAo& 

I can hear yawning....

 jon 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...

OP pneame 16 Mar 2019
In reply to jon:

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

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

Post edited at 17:23
 petemeads 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...

OP pneame 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". 

OP pneame 30 Mar 2019
In reply to pneame:

Now 3 weeks post surgery and starting physio 3 times a week for a month. 1 session so far and I sense that it’s going to be exhausting!  

In reply to pneame:

Question: was it both hips or one hip? I'm having a total HR of my left hip in 2 1/2 wks time.... Other hip is 100% OK.

OP pneame 31 Mar 2019
In reply to Gordon Stainforth:

Just the one rt side. As for you, the other looks mostly fine. 

It was ( so far! )less painful than I expected. But I suspect that the hard work is yet to come. 

Feel free to email with worries. Or get the mental wattage of the abundant ukc hipsters here!

best of luck. 

 jon 31 Mar 2019
In reply to pneame and Gordon:

> Now 3 weeks post surgery and starting physio 3 times a week for a month. 1 session so far and I sense that it’s going to be exhausting!  

My physio was twice a week and was exhausting. I think the overall take away from all this is that basically you'll come out of the op with the same as when you go in - less the pain, obviously. The rest is up to us and the physio. I think lots of exercise right up to the day before the op pays dividends. 

I have an old (a very old 75) friend who had a TKR a couple of years ago. She was/is very overweight and could only just waddle around the garden by the time she had it done. I'm pretty sure she expected to be leaping around like a lithe 20 year old, post op, but of course she wasn't. I've a feeling she didn't do any physio either. Now she says the whole thing was a waste of time and isn't going to have the other done. Stubborn old people, eh?

 I had my 6 week follow up last week and got the go ahead to go climbing, which I did (very gently) on Friday. Now that WAS exhausting! My feet hurt. Ditto fingers. I've also been having really 'tired spells' recently, and Friday was no exception - almost falling asleep on my feet walking down from the crag! But the hip was fine, which is good.

Post edited at 09:13
 HB1 31 Mar 2019
In reply to jon:

Good to hear you're back at work Jon! Of course it's tiring - most things are at our age. It's 16 months since my THR and I'm doing lots (just back from 10 days in Leonidio - the climbing up and down to/from the sectors was the biggest challenge) and I still worry that perhaps I shouldn't be doing so much, but what's the alternative? I get a bit of a sore hip sometimes, but that's to be expected. 

I do hope that all the other hipsters out there are realising what a good choice they made (or might make in the near future) - it really does make a difference!

Cheers       Richard

In reply to pneame:

Thanks for your reply. I'm slightly alarmed by how long it's going to take to recover ... Basically, I'm very lame, but think my muscles are still quite strong. But maybe they're not as strong as I think. 

 jon 31 Mar 2019
In reply to Gordon Stainforth:

> I'm slightly alarmed by how long it's going to take to recover ... 

On the plus side though Gordon, you will recover - you wouldn't if you didn't have it done. Just being pain free is worth it, everything else is a bonus!

 jon 31 Mar 2019
In reply to HB1:

The main problems were sore finger skin and painful feet and calf muscles. I suppose my choice of crag didn't help - a longish walk, very rough slabby rock... I'll have to find a steep shady roadside crag with smooth handholds - that isn't called Raven's Tor! Will report back.

Post edited at 13:28
OP pneame 31 Mar 2019
In reply to Gordon Stainforth:

2 things, Gordon;

1 Hipsters shopping list 

     Deluxe Post Knee Operation Hip Replacement Kit Recovery after Surgery Pack (Amazon)

     Forearm crutches (NHS may loan you these?)

     Walker (ditto) - I scoffed at this, but actually it's been quite handy for getting out of bed in the morning and for those, er, nocturnal trips.  

     Vitamin C and multivitamins. - the vitamin C is needed to get tissue repair

     Most important - someone to look after you a bit while you can't go shopping/cooking. It's important that they tolerate some whining. 

2 Exercises

    I was given set of exercises to do several times a day - basically they strengthen the obvious muscles a bit, but most important, they strengthen the stabilizers around the hip joint (some of these will likely get cut during the surgery, but the others will still work and the cut ones will recover better anyway). Essentially, you stand lightly supported and do a set of leg extensions sideways, backwards, knee lift forwards and foot backwards. 10 for each limb. One other - lie on your back and do slowish leg lifts so your foot is about a foot or two from the floor. Oh, yes - the one I forget - clench your buttock muscles, hold for 10 seconds. Repeat 10 x. 

There are all sorts of little (and not so little) annoyances, but like Jon says!

edit - start the exercises now. And carry on with them. They seem like nothing and maybe trivial, but they do seem to make a difference- as far as I can tell! There's no control, of course ("cloned pneame - you can sit around all day doing nothing"; "Oh thank you pneame! What are my long term prospects?"; "Dismal, but you will be happier than me at first"

Post edited at 14:17
 Richard J 31 Mar 2019
In reply to Gordon Stainforth:

Good luck with it, I don't think you will regret it, though it's true that recovery takes some time.  I had a total hip replacement, LHS, 10 weeks ago yesterday.  I'm pretty much back to normal for everyday life activities, but I'm still short of stamina and I tire easily.  The last few weeks have been a bit of a cyclic process of feeling fine, then doing too much, then having to rest up for a bit - the 'tired spells' Jon describes sound very familiar.

I haven't tried climbing yet, unlike Jon (my physio, though happy with my overall progress, advised against it until after 12 weeks).  I'm enjoying getting out walking, by now I can make a good pace and feel pretty steady on my feet (I take walking poles but generally only use them for a bit of steadiness on very rough or sloping ground) but although nothing actually hurts, after a few miles I find myself really tired.  My physio said this was entirely to be expected and it's just a question of building up over the weeks and months.  But it's a much better situation than before the operation, when the pain made it really hard to enjoy getting out at all.

The advice pneame gives is very good - take a bit of time before you go in for the operation to prepare your home for coming back to with limited mobility, and do the exercises!  I'm convinced they really help, as well as helping you measure progress day to day.  If my experience is anything to go by there will be some low points too and it's as well to be prepared for that.

 Chris_Mellor 31 Mar 2019
In reply to pneame:

Huh, whippersnappers. A hip replacement is nothing, nothing at all .  I've had both hips done, both shoulders resurfaced and both knees replaced, and I still climb. Just work at the post-op physio and retraining. It'll all come back and you can say; "Up yours" to the disease that struck you down and stopped you climbing, running, walking, whatever. Each op is a really significant event with a lot of pre-op worry and post-op jitters as odd aches and pains come along and progress gets interrupted for some reason. But 6 months post-op and things are getting better strongly and you can look back and say the op was essential and the results great. As some one else said once; "Just do i."

In reply to pneame:

Thanks for your extremely helpful reply. I would have answered today but have been in transit, because I have an Radio interview with the Beeb tomorrow ... has to be a good reason to get out of bed these days

> Most important - someone to look after you a bit while you can't go shopping/cooking. It's important that they tolerate some whining. 

I am so fortunate to have Freda doing exactly that, as always. I really don't know how I'd manage without her.

In reply to Richard J:

> Good luck with it, I don't think you will regret it, though it's true that recovery takes some time.  

Well, mine is so severe that I have no choice, and I'm extremely fortunate to be having it done now in just over a fortnight (it's been brought forward 3 weeks). What's so mindboggling for me is that the very first symptoms only started to show up in mid November. Within about 5-6 weeks I was pretty much bedridden.

Thanks for all your other advice.

OP pneame 31 Mar 2019
In reply to Richard J:

Very impressed Richard!  I did 10 mins, about 1/3 mile in one go yesterday and I’m somewhat regretting it today. My attitude is improving though and I’m now in the “no pain, no gain” mindset. 

My biggest problem is likely excessive impatience   

OP pneame 31 Mar 2019
In reply to Gordon Stainforth:

It’s interesting how it can progress differently- I believe Jon’s second hip was more like yours whereas mine is the product of several years of fairly steady deterioration. 

I’m sure there’s a research project in there somewhere....

In reply to pneame:

Mine must have been deteriorating for years without my realising it. Almost certainly the direct result of the enormous impact it received when I fell off in Norway in 1969. I suppose the first symptoms were about a year ago when I started to get stiffer, but just put that down to old age. In November, muscle pains in the thigh: still nothing to suggest that it was anything to do with the hip.

 petemeads 01 Apr 2019
In reply to Richard J:

Well, I had a very low point at Xmas with my THR hip that was over 18 months old - even using a crutch one morning to spectate while MrsPete did parkrun. Got very miserable. Restarted running 2nd Feb, took a few goes to catch Mrs but back to decent speed a week ago. The next day rode a 105k hilly bike event, another 65k on the Tuesday plus wall bouldering in the evening, a couple of limpy but fast walks Thurs/Fri then the Edale Skyline inside 6 hours on Saturday, in perfect conditions. Thoroughly knackered now but done no damage, despite the sprint finish in Hope!

Still no idea what went wrong over Xmas but thankfully back on track. Looks like the devices are pretty bombproof but the puny human bits can get upset even at nearly 2 years...

OP pneame 01 Apr 2019
In reply to Gordon Stainforth:

> put that down to old age.

It is old age, Gordon. We are well past our sell-by date even if in our minds we are still 20-something. 

I had muscle pains also - I put it down to horrendous unfitness. But it was just (at least partly) my body compensating. Now it has to recompensate.... 

OP pneame 01 Apr 2019
In reply to petemeads:

That is odd - I'd have been extremely depressed. Your endurance is impressive and you make an excellent role model for me! Even though I don't run. 

OP pneame 20 Apr 2019
In reply to Gordon Stainforth:

How are you doing, Gordon ?  Post surgery now?  

In reply to pneame:

Yes, it went very well, thanks, but it feels mighty sore today. But have already been walking around my room using crutches a few times. Am in excellent hands. 

Post edited at 19:57
 Chris_Mellor 20 Apr 2019
In reply to pneame:

Best wishes to both you and Gordon post-op. Hopefully you will both be back climbing in a few months.

OP pneame 20 Apr 2019
In reply to Gordon Stainforth:

Excellent news, Gordon! I found the pain post-surgery to be less than I expected (although still definitely there) and am finding the pain during physio to be more than I expected and a bit random - first one thing hurts and then another. Mrs pneame yells at me occasionally while watching my gait with a critical eye, and gives me lectures about what my brain is doing (1. you've had years to learn that awful gait and now you have to unlearn it!; 2. your right hip is now your good hip so stop behaving as if it isn't!; 3. and so on....)

OP pneame 20 Apr 2019
In reply to Chris_Mellor:

Many thanks - I revisited your comment about it being an up and down process - it is always helpful to remember that - my physio said the same thing yesterday. In contrast, I expect a nice linear process where you get better every day - not the case at all. 

In reply to pneame:

Came home yesterday and recovery starting well. Walking a bit, now keeping crutches a few inches above the ground most of the time. I managed to get hospital to give me the xrays of before (Feb 12) and after (Apr 20), and have now stuck them together in photoshop:

http://www.gordonstainforthbelper.co.uk/images/GPelvis12Feb2019&20Apr20...

OP pneame 23 Apr 2019
In reply to Gordon Stainforth:

That (before) left hip looks absolutely dire, Gordon! And the after hip looks like the bees knees. 

You are doing better than me - I was almost stick-free at about the 2 week point and then had a bit of a relapse. I'm now getting to almost stick-free again (6 weeks). 

I have quite a few people yelling at me..... which helps!

Post edited at 21:45
In reply to pneame:

Yes, I found it fascinating as someone with next to no medical knowledge. You don't have to be an expert to see just how bad my left hip was. BTW, does the worst of the pain go after about a week to 10 days ??

 HB1 23 Apr 2019
In reply to Gordon Stainforth:

When I was a little boy I annoyed a rather unsympathetic GP by being unable to distinguish between an ache and a pain. I'm still not sure. Surgery affects everyone differently of course. I maintain that I had little or no pain post-op. It ached, and 18 months on it still does after a run, or a day's climbing, but that's to be expected. I do remember just one day, only about ten days post-op when I was out for a walk, and the suddenly I was in great pain, and struggled to get home (and I was only a short distance away) but it didn't last and next day I was back to my, by then, usual 2-3 mile walk. 

Persevere! It's really, really worth it!

In reply to HB1:

Thanks. I'm feeling very positive about it. Basically finding it 'an interesting experience'.

 petemeads 30 Apr 2019
In reply to Gordon Stainforth:

Second the "interesting experience" bit - doing the research, making the call to see a surgeon, committing to surgery, the apprehension before anaesthesia, the first few days of being useless, then the daily improvements in walking, running, climbing etc - twice! The whole process of getting both hips done, over a period of 4 years to where I can be climbing in Font, biking a hilly 105k, running 24:30 5k, all at the age of 68 has been fascinating. I do not care to think what the alternative would have been like...

Pete

In reply to petemeads:

Update on my situation. A very steady improvement; pain subsiding slowly by the day, now (11 days after op) quite minor, and I no longer need crutches at all - though I use them out of doors for safety, but not to put weight on; sleeping well, appetite good. New hip feels strong and sturdy. Absolutely no risk of falling over. It's just like have two good legs, but one has bruise on it

 petemeads 30 Apr 2019
In reply to Gordon Stainforth:

Brilliant! Keep it up...

 Richard J 30 Apr 2019
In reply to Gordon Stainforth:

Very glad to hear its going well.  I'm a bit more than 3 months past my operation, and I had a great week last week - my first climbing outing.  Some easy climbs at Windgather - but it felt much better than I'd dared hope.  The physio told me that climbing would be positively beneficial, as long as I didn't (a) fall off, (b) do any egyptians.  I'll take care about the former, didn't know how to do the latter even with a good leg.

 HB1 30 Apr 2019
In reply to Richard J:

You're obviously doing really well! Although I was climbing at the wall after 7 weeks, it was 4 months before I ventured outside - to Windgather too actually - and another month or more before I led a "proper" climb. After 18 months I'm still not climbing quite as I would like, and I'm aware of the  hip's vulnerability (but accept also that it's probably OK  doing all these physical things - is it just climbers, or are there folks everywhere hip-hammering?) But you just have to get back on the horse don't you!

OP pneame 30 Apr 2019
In reply to Gordon Stainforth:

> does the worst of the pain go after about a week to 10 days ??

<looks at insanely OCD notes....> yes, that's roughly my experience. I was taking anti-inflammatories for about 3 weeks which helped quite a bit - it seems to be a surgeon preference as to whether these are used. They stop calcium deposits (apparently a side effect of repair in trauma) but on the other hand slow tendon healing and integration with bone. 

The thing that always fascinates me is that inflammation and repair are basically two sides of the same coin, in much the same way as bone is constantly being broken down and re-deposited. 

When I was a teenager, we were taught that biological processes are incredibly efficient. They aren't. They just churn away basically digging ditches and filling them in. At least in warm blooded creatures.  

OP pneame 30 Apr 2019
In reply to Gordon Stainforth:

>  I no longer need crutches at all

Way ahead of me Gordon! I'm more-or-less crutch free during the first 2/3 of the day but start getting stiff and sore by about 6pm. At the 7.5 week point now and finally making reasonably rapid progress. 

A couple of quite vicious muscle spasms at around the 2 week point were not very helpful!

In reply to pneame:

Gosh, I almost don't like to tell you how well it's going for me. I was actually getting worried about how long the pain was lasting (with one day when it got worse), after 9 days! It's been getting rapidly better today. Of course, I realise a relapse can happen at any moment, but so far it's looking very good. 

OP pneame 30 Apr 2019
In reply to Gordon Stainforth:

It's interesting the different pain control regimes that are used - apart from general anesthesia, they also sloshed some stuff into the joint capsule before they stitched it up AND gave me a spinal block. So I was really completely pain-free for the first 24 hours and then there was some discomfort. But never so much that I  was guzzling opioids like candy and in fact I still have about 2/3 of what I was given. 

I was encouraged by several people (wife, visiting nurse, visiting physio....) to slow down a bit. Possibly advice I should have taken!

Based on a paper I grabbed the data from (for which I have lost the reference) you are easily in the top 10% for recovery rate - of course it isn't a competition!

In reply to pneame:

For the operation I was just given a spinal injection plus a sedative. Completely pain free (but very dramatic: the sounds of them working on it, more like a carpenter's shop than a surgery!) Once the local anaesthetic had all worn off the pain was moderate, but I have followed their regime of painkillers, four times a day, absolutely to the letter. Lots of codeine, ibuprofen and paracetemol. Have now halved the codeine and will probably be off it completely in a day or two.

I think I was very fortunate with the surgeon - i had had him highly recommended. He's done over 3000 HRs.

PS. For the first 7-9 days I was doing the simple exercises they told me to do, but apart from that, was not doing very much (spending most of time in bed) concentrating very much on the initial healing process and getting the pain down. That really worked for me, so that in the last couple of days I've been walking a lot and that has been hugely beneficial.

Post edited at 22:21
OP pneame 01 May 2019
In reply to Gordon Stainforth:

Pretty much my immediate post-surgery too, although my cocktail was prophylactic antibiotics, celebrex (the anti-inflammatory) and flexeril. 

I'm always hugely impressed with people who are conscious during the surgery. There are some things I don't want to experience. Although the rational part of my mind says "it can't be any different from a sustained dental procedure..."

For some reason the US regards codeine as the work of the devil, but opioids - well they are the business!

In reply to pneame:

Spectacular improvement today, too, only 12 days after op. I don't need crutches at all, and am happily walking around house and garden with minimal pain. Have halved the codeine and will probably just be on paracetemol by end of the week. 

The op was strange because I remember feeling incredibly comfortable; I mean really comfortable. It was only moderately alarming (sounds and quite violent movements - without pain) and although it took 70 minutes it seemed like about half that. The sedative they used is obviously very clever.

 jon 01 May 2019
In reply to Gordon Stainforth:

> The sedative they used is obviously very clever.

Which is why I just don't understand why the US has such a problem killing people by lethal injection. 

 Richard J 01 May 2019
In reply to Gordon Stainforth:

> The sedative they used is obviously very clever.

Propafol?  As the anaesthetist said to me before my operation "Lovely drug.  If it's good enough for Michael Jackson, it's good enough for you."

In reply to Richard J:

I've no idea. But very likely, I suppose.

OP pneame 01 May 2019
In reply to jon:

I think some drug companies take the moral high ground (!!) and refuse to sell stuff to people who are going to use it for ritual killing. So they have to make do with whatever they can get.

Or something.

 jon 01 May 2019
In reply to pneame:

Drug companies, taking the moral high ground...?

OP pneame 01 May 2019
In reply to jon:

I was attempting facetious without the facetious emoticon....

Whatever that is. 

As a general rule, though, drug labels regard things that kill patients as a bad thing. You don't usually see, on the label, something like "for a lethal dose, give 30ml IV over a period of 2 minutes. More rapid delivery rates may cause discomfort" 

 jon 02 May 2019
In reply to pneame:

> As a general rule, though, drug labels regard things that kill patients as a bad thing. You don't usually see, on the label, something like "for a lethal dose, give 30ml IV over a period of 2 minutes. More rapid delivery rates may cause discomfort" 

Or 'recommended by the Texas Correctional Facility'...

Deadeye 08 May 2019
In reply to pneame:

Hi

Can I join in the recovery thread please? Mine was done yesterday so I'm sat in hospital.

Interesting that you (? Might have been Gordon) thought it very hard to dislocate. The numbers I found say 1 in 50 in the first 6 months and 1 in 25 over 5 years.

Is there anyone on here who had one and is back climbing wide bridges? Or have you had to modify your route selection?

 jon 08 May 2019
In reply to Deadeye:

I can bridge much further now than before! 

Deadeye 08 May 2019
In reply to jon:

I'm liking the sound of that!

OP pneame 08 May 2019
In reply to Deadeye:

> The numbers I found say 1 in 50 in the first 6 months and 1 in 25 over 5 years.

Some of the data will be based on older designs which had smaller head sizes - the larger head sizes (which include the double mobility type that Jon has) are just mechanically more stable - they have to be rotated much further to actually come out of the socket. 

Then, there's the approach used - some result in less damage to the muscles that stabilize the joint. 

And then, there's the surgeon - there's a good bit of hand waving and "that's the way it's done".

I was chuffed to bits when my surgeon said "no hip precautions" as it is a bit of a pain avoiding bends greater than 90 degrees. It freaks my physio out and she (I think) has treated me as if I do have hip precautions! 

Based on the UKC dataset, you should be walking reasonably happily in 2-3 weeks, although YMMV, of course. I found the couple of weeks holed up at home went surprisingly quickly and was remarkably pain free, although I've still got residual pain/weakness 8 weeks out - mostly first thing in the am and in the evening. 

And, of course, good luck and welcome to the hipsters of UKC!

Post edited at 13:31
Deadeye 08 May 2019
In reply to pneame:

Thanks. I'm on a fairly traditional brief - no acts angles, crutches, etc.

 Pete Nugent 08 May 2019
In reply to Deadeye:

Just to add my experience to the discussion...... I had my Left THR mid-Sept 2018 (anterior approach). After the first couple of days, my pain was minimal....so I was lucky. I was suprised that nobody came to see/dress the wound until the stitches were removed 10 days after the op. I guess the thinking is too leave well alone unless there are signs of infection/other complications. Again, in my case the wound has healed nicely. I was given Apixaban anti coagulants for 30 days & again experienced no complications. Ironically, my surgeon had his hip replaced some 6-9 months prior to mine & was self injecting Heparin but experienced a clot on his lungs. I am aware of one other person who has also had blood clots etc post surgery. So complications can and do happpen.

Over the next few weeks, I was able to increase the distance I could walk, initially with crutches & then without. I observed hip precautions for 90 days and went on a snow shoeing trip as soon as they were finished. I managed to second some ice climbs in Feb....the climbing was ok, but trying to get to the routes in deep snow was a real problem...so in retrospect may not have been too bright an idea!!

I began to get out on the wall in Feb &  am now leading HS outdoors The main issue I have is a lack of flexibility.  After 6 months I could not put on socks/tie shoe laces. After extensive (and painful!!) physio , I can now just about manage these tasks with a struggle...it can still take 10 mins to put on socks and tie my shoe laces.

I am continuing to have physio/do pilates in the hope that my flexibility will further improve in the coming months. Like some of the other correspondents, I expect to need my right hip to be replaced in the not to distant future....but this would present real problems in managing everyday tasks whilst (bending down to pick up stuff etc) whilst the flexibility in my left hip is restricted.

 Pete Nugent 08 May 2019
In reply to Deadeye:

PS; I had an epidural but was (thankfully!) blissfully unaware of what was going on during surgery. One complication I experienced resulting from the epidural was the inability to pass urine. This was very uncomfortable and stress inducing and did cause me to feel feint. I needed a catheter to be inserted & the relief was immediate. Thankfully, there was no complications e.g. infection resulting from the catheterisation. I also had an uncontrolled bleed when the canula in my hand was removed; I became aware of this when I heard a trickling sound as my blood gathered in a pool on the floor......Nurse come quickly!!!

OP pneame 08 May 2019
In reply to Pete Nugent:

> The main issue I have is a lack of flexibility.  After 6 months I could not put on socks/tie shoe laces. After extensive (and painful!!) physio , I can now just about manage these tasks with a struggle...it can still take 10 mins to put on socks and tie my shoe laces.

From what I can gather, hip range of motion issues can be dealt with at any time - I notice that these tend to come and go (although a couple of months isn't a lot of data!) and I try and be diligent to keep flexible. My range of motion is definitely a good bit better than it was pre-surgery.

Conversely, with knees there's a "window of opportunity" for range of motion, so the physios are very aggressive about making sure you meet targets.  

For hips, it's all soft tissue stuff (muscles, tendons and ligaments) so it's just a case of keeping them from shrinking. But I will note your experience and keep my "hip kit" around!

I remember when I was 19 doing stretching exercises (no physios then) to get my leg to bend properly after a gash in my knee had been excised and stitched up - as I recall it took a few weeks and that was just stretching some scar tissue. And I was young. 

If there's one thing I've learnt, it's to be patient.    

In reply to pneame:

An update with mine, 19 days after the op. All still going well, although there were a couple of days over the BH when the pain increased slightly. Possibly being too ambitious too soon (haven't needed crutches at all for 10 days). Walking about the house, and even outside for up to an hour each day, but also spending a lot of time in bed resting. The last day or two the pain has diminished a lot, to little more than a dull ache, and when I'm in bed I'm hardly aware of it. I certainly hope to get back to moderate hill walks well before the end of the year, but I'll take my time and always take it very carefully. I have no wish to dislocate it. And really, I have no ambitions to rock climb with it, though it's just possible I may.

Deadeye 08 May 2019
In reply to Pete Nugent:

Hi Pete

Do you mind me asking how old you are?

I'm 55 so am really hoping to go back to doing some of the things (but not all) that wore it out the first time! I'll stop running but I do want to climb!

 Richard J 08 May 2019
In reply to pneame:

> I was chuffed to bits when my surgeon said "no hip precautions" as it is a bit of a pain avoiding bends greater than 90 degrees. It freaks my physio out and she (I think) has treated me as if I do have hip precautions! 

I had conflicting advice, but the other way round - the surgeon was more cautious and insisted on the 90 degree limitation, but the physios (I've seen three so far) were universally more laid-back about that.  All three of the physios I've seen have been positive about climbing (less so about bouldering, clearly the impact from even short jumps down probably not a great idea).   

I'll be four months after the operation in another week; I managed an 8 mile walk at the weekend, which left me tired but fine.  As I mentioned above I've been climbing a couple of weeks ago, which felt much better than I feared.  Clearly recovery does take time and one probably shouldn't rush, but I'm feeling reasonably confident about getting back to hill walking and climbing.

OP pneame 09 May 2019
In reply to Richard J:

90 days with hip precautions - I'd have gone a little crazy... 

It does provide a useful metric for what 95% of patients should expect to be the outer limit of recovery (i.e by 90 days all the tendons, ligaments and muscles around the joint should be good and the chances of falling over spontaneously should be nil) - and makes me feel a lot better about the sluggish and rather whiny  state I'm in first thing in the morning and last thing in the evening!  

My physio was muttering about 6 months yesterday.... 

Good grief. Time for another perambulate down the hall outside our office.....

I'm impressed with 8 miles. 10/10 for effort!

 Gman 10 May 2019
In reply to pneame:

Here's a short video of my rehab so far following total hip replacement in February this year. Please don't laugh too hard at the bit showing my first attempts back at the wall after 12 weeks!

youtube.com/watch?v=elRDkpVczR4&

 petemeads 10 May 2019
In reply to Deadeye:

Hi Deadeye - a different Pete replying! Not sure if you have read some of the old hip threads, excuse the repetition if you have - I am 68, my hips are 4.5 and 2.0 years old, the newer one is a ceramic THR, the older a metal BHR. In both cases I was running within 2 months and indoor climbing, carefully above mats. Generally run 5k parkruns every Saturday, around 24/25 mins nowadays, but prepared to jog downhill on longer walks like the Edale Skyline. Just back from a week in Font (it's much harder than I remember!) but the hips were fine. There are plenty of people running on fake hips, and Andy Murray seems to be close to playing well again. Modern materials seem to last much longer and take impact better, wear and tear is not such a worry as when ordinary polythene provided the bearing surface - my physio signed me off for running at 6 weeks and my surgeon reassured me I would not break my latest device. Then again, I have less time to wear it out than you do....

Deadeye 10 May 2019
In reply to petemeads:

Thanks everyone. 3 days post op now but nowhere near Gmam's video and had a bad day yesterday (cramps). Feel stronger today and have walked a little with crutches but nowhere near as freely as the vid!

 Gman 10 May 2019
In reply to Deadeye:

It'll come mate. Just keep hoofing the pain meds down in the initial stages. If its cramp then it sounds like soft tissue rather than the joint itself. Unsurprisingly considering the abuse the muscles have been subjected to. That settles down over the weeks and months. My vid puts a positive spin on things but I can absolutely assure you there were dark days when I could barely get out of bed. The bad days gradually become fewer and farther between. Keep the faith.

In reply to Deadeye:

Incredible for me to think now that at exactly this time three weeks ago I was being wheeled into the operating theatre, and now, today, there is virtually no pain left. Just a slightly sore bum and some aching of thigh muscles from walking. Just taking a few paracetemols. More or less complete mobility restored, without any need of sticks. Seems near-miraculous to me. Now I have to get on with the business of building up strength again. I've climbed quite a lot of stairs, but haven't walked up or down a steepish slope yet, so may start doing that today.

 Gman 10 May 2019
In reply to Gordon Stainforth:

Fantastic effort Gordon. I still can't get use to the lack of pain I now have. Long may it continue.

OP pneame 11 May 2019
In reply to Gman:

> It'll come mate......I can absolutely assure you there were dark days when I could barely get out of bed. The bad days gradually become fewer and farther between.

Excellent vid - emphasizes the need to put in some effort! Even more valuable, though, is your sub-text. I'm currently wrestling with pain in my my vastus lateralis (as identified by Mrs pneame + site of entry by the surgeon) which is obstinately refusing to go away. 

OP pneame 11 May 2019
In reply to Deadeye:

> 3 days post op now

The first 2-3 weeks are a time of quite startlingly rapid changes - I rather enjoyed that stage as it wasn't boring at all. I seem to be at the glacial improvement stage now, and, given my extreme impatience, find that this stage is worse even though I can do most low impact things. 

The key moment, as pointed up upthread, is being able to make a cup of tea/coffee and navigate to somewhere to sit down and drink it! That's a good feeling. 

OP pneame 11 May 2019
In reply to Gordon Stainforth:

> Seems near-miraculous to me.

Truly awesome - I may yet be converted to the idea that general anesthesia is not the best thing in the world. 

 Gman 11 May 2019
In reply to pneame:

Have you tried mobilising the wound site with Bio-Oil or something similar?

youtube.com/watch?v=_7LSCJKImXE&

OP pneame 11 May 2019
In reply to Gman:

That's a good idea - I've still got some raised tissue at the ends of the wound which it was not recommended to do anything with just yet. The middle, however, looks fine and not being very into massage stuff, I've tended to ignore advice to massage it. In spite of knowing how pernicious scar tissue can be, getting stuck to everything. 

Probably time for another dose of mental adjustment.... one of many!

In reply to pneame:

Well, there's still just a slight dull ache. I'm alternating been short periods walking around house and garden (and up and down stairs, the biggest strain on the muscles) and resting in bed. Have had really good afternoon in bed writing, and not nattering on UKC, thank god.

OP pneame 11 May 2019
In reply to Gordon Stainforth:

> Have had really good afternoon in bed writing, and not nattering on UKC, thank god.

Excellent - but surely nattering on UKC involves writing?

In reply to pneame:

Writing on the internet keeps me away from writing about what interests me, or more to the point, what I should be writing on (a book that's taken about 7 years so far, with interruptions/family probs etc)

 colinakmc 11 May 2019
In reply to pneame:

N

> Running is fairly hard on joints - although with good style (= fitness, usually) loads shouldn't be hugely higher than any other vigorous sport. 

Not fully backed by the evidence - habitual runners tend to have a bit less wear & tear than non runners. At least according to Runner’s World sources!

1

New Topic
This topic has been archived, and won't accept reply postings.
Loading Notifications...