My Hip at One Year

This past Wednesday was the first anniversary of my hip replacement surgery. I can't really say it's back to normal, nor am i sure what normal is now. I don't have any pain bearing weight on it, but it's definitely weaker and i still have some difficulty lifting that leg. I'm not sure if my hip flexor needs more rehab, or if i'm dealing with an ongoing process of healing for muscles that were significantly traumatized.

I'm back to doing my martial arts training at a near full levels of effort, although i don't spar or grapple. I've done a lot of cycling, including another century ride; and i can even jog for short distances. On the other hand, i'm the heaviest i've been for years, and i've lost most of the substantial aerobic base i took years to build up.

I get asked fairly often if the surgery was worth it. I think so, but i don't think a year is long enough to say for sure. The deciding factors in the long run will be how close i can get to my previous physical condition (adjusted for age), and whether any radically better alternatives show up. I don't yet consider the lifetime of the prosthetic itself to be a factor, because i'm not convinced that in even a decade the methods of dealing with worn-out joints will be the same as they are now. There are so many younger people getting joint replacements now, that i think the demand for better, different solutions will increase dramatically.

My Hip At Six Months

Tomorrow is 6 months since my hip replacement surgery. I'd love to say that i am completely normal and good as new, but for the last month or so i've had some pain in the front or side of my hip that i hope is tendinitis. I can bear weight on my hip, i can ride my bike without pain, and i can swim without pain; but lifting my leg straight up as one would do in kicking outward or lifting your leg into a high seat (e.g., my truck) is painful. It seems to be getting slowly better, so i'm hopeful that all of my spare parts are still in place. Still, i wished to be essentially back to normal by this point, so i have to admit to some disappointment.

When i last visited my orthopedic surgeon, he said that i could "bike my brains out". He probably did not understand the license that gave me to overdo it. I now regularly ride 50+ miles at a time on the weekends, and i favor hills and other challenges. I also do regular tai chi and i've been testing my leg on kung fu forms. I suspect this is inappropriate behavior for a hip-replacement patient, but i'm not inclined to take it easy until forced to do so. At this point in my life this is what i have to live for, so i'm clinging to it with all the strength i can muster.

There are things of which I may not speak;    
There are dreams that cannot die;            
There are thoughts that make the strong heart weak,  
And bring a pallor into the cheek,    
And a mist before the eye.      
And the words of that fatal song      
Come over me like a chill:                
A boy's will is the wind's will,  
And the thoughts of youth are long, long thoughts.

My Hip At Three Months

Today is three months since my hip replacement. I am probably a bit further in my recovery than average, but i'm not where i wish i were. I've been biking for a few weeks now without any pain, and i've been doing tai chi for the last two weeks. In general, regular motions are not too bad, but any sort of eccentric motion is both difficult and sometimes painful (twists, lateral steps). My left leg is still very weak compared to my right, and i find that i sometimes use my quads and calves to compensate for weak glutes and hip flexors, which puts pressure on my knee.

After a year of physical deterioration, i feel very impatient to get back into some sort of shape. I'm about 20 pounds heavier than i was when i was running regularly, and since i still have limited mobility i feel... old. I tried to come to terms with the things that i would not be able to do after the surgery, but i'm not quite over the psychological impact of going from being somebody who was in abnormally good shape to somebody who pretty much meets people's expectation of a 46 year-old man.

The only goal i have set at this point is to ride the Tour de Poway Century ride in early October. However, i also hope to get back to my normal weight by the end of summer, and get the strength back in my left leg. I'm trying to do Tabata-style training to compensate for the lack of hard cardio , but i find i'm not quite fit enough at the moment to get through the full sets for exercises like push-ups and pull-ups. I can do squats, however, i'm not sure that i'm working both legs equally.

At this point i'm still stubbornly convinced that i can get back to some physical level that will make both me and other people forget that i am an invalid. As i approach 50 i realize that most people's expectations will be lower, but i've spent the the last decade among people who were 50, 60, or 70 and still pushing the envelope. There will probably be a day when playing golf or taking walks will seem adequate, but i hope that day does not come soon.

What To Expect After Total Hip Replacement

I see a lot of articles and forum posts that either try to set expectations for after THR surgery, or ask questions about what to expect. There are no correct answers, so i hope to provide one more data point. My facts:

• I had my surgery at the age of 46.
• I was very active until about a year prior to my surgery (marathon runner, black belt)
• Mine was a left total hip replacement necessitated by osteoarthritis.
• I had a posterior surgical procedure. My procedure was also "cement-less".
• My new hip is a Stryker model with ceramic surfaces.
• My surgery was on Monday afternoon, and i went home on Tuesday evening.
• My first time standing was the morning after my surgery. I walked three times with a walker on that day.
• I used a walker for the first week and a half after my surgery, and then i switched to a cane.
• I had at-home physical therapy for the first two weeks.
• I had to self-inject blood thinners for three weeks after my surgery. This sucks.
• I started driving about 2 weeks after the surgery.
• I returned to work after 2 weeks at home.
• At 4 weeks i could walk without a cane.
• I had outpatient physical therapy from 2-6 weeks (twice a week).
• At 6 weeks i started riding my bike trainer.
• At 10 weeks i started doing tai chi again. My left leg is still weak at this point, but not painful.

I'm at about 11 weeks now. For the last two weekends i've ridden my bike on the road, for almost 2 hours the last time. I can walk for about an hour, but i get some pain around my incision near the end of that.

Should you come across this via search engine or something, don't hesitate to ask questions.

Hip Hip Hooray

Sorry, i'm running out of hip puns for these titles.

It's been almost 7 weeks now. I can walk pretty well-- most people would not know that i am still rehabing from surgery. I've done a couple of 15-minute sessions on my road bike trainer without any discomfort. I still have trouble with stairs and i can't really do any motion that puts much torque on my hip, but most signs are encouraging. This is the first time in almost a year that i've been able to walk without a limp.

I finished my outpatient physical therapy this week. I'll still have to do various exercises for the foreseeable future, but it's nice to be past the regular hospital visits. I'm eager to get back to some sort of routine-- maybe at least start doing tai chi in the next few weeks. My biggest frustration at the moment is that there is very little information on what i can or should do once i'm relatively well recovered. Obviously, there are pain and flexibility thresholds that you have to deal with, but information on what's possible otherwise is vague or unavailable. Generally anyone with a normal THR, regardless of the joint type, is warned against "high-impact" activities, but beyond running and basketball the guidance is limited. I gather that most doctors are conservative about post-THR activities, both because they don't really know how the latest generation of technology will last and because most of their patients are so old that they get no objections.

I don't regret the surgery, because whatever limitations i have now are less constrictive than the constant and unavoidable pain i had before. But i do feel a bit like a guinea pig in the sense that i will probably have to constantly experiment with what i can and can't do, and i won't know the consequences until i either do some damage or reach an age where i am necessarily sedentary anyway. Whatever. I guess i was on that path before, finding the barriers and the limits to what i could endure.

Update on My Borg Implants

It's been three weeks since my surgery now. I've been walking with a cane for the last week and a half, and i can take small steps unassisted. There are still certain things i can't do, like bend past 90 degrees at the waist or cross my legs, but things are slowly approaching normalcy (i can't say "returning" since this is my new normal). I've returned to work, and i can drive (one of the benefits of having a left hip surgery).

I'm eager to get back to some level of physical activity since i feel like a large bucket of Kentucky fried chicken at the moment. I have managed to do some low-key weight lifting, and i have a set of rehab exercises i go through for my hip, but i really need something that will make me sweat. It'll probably be 6-8 weeks still before i can do anything too strenuous, but i'm hoping i might be able to start some swimming before then (i assume you sweat when you swim even if you can't tell).

I haven't quite come to grips with the idea that i am partially artificial yet. Since i'm still swollen and weakened from the surgery, i can't say that i notice a difference between the real hip and the replacement hip, but i have this image in my head of a gap in my body filled with machine parts or makeshift framing. Or like a patch of bondo on the fender of a 1960s Chevy. Although i no longer have the hip pain that bothered me before the surgery, i can't shake the feeling of "otherness". I'm hoping that when the hip strengthens and i can walk normally that i will eventually just forget that it's not "stock".

My First Week as a Cyborg

Today is one week since my hip replacement surgery. At this point i can walk fairly well with a walker and my pain is minimal. I actually managed to get up (and down) my driveway this afternoon with my physical therapist. That was encouraging because going up and down inclines prior to my surgery was very painful. My leg is still pretty swollen and the area around my incision is so stiff that it feels kind of like i have a 2x4 taped to my thigh.

The surgery last Monday went fairly well, although it started later than it was supposed to. Surgery is sort of a 5-phase process. There's pre-op where they get you into an embarrassing gown and nifty socks, set you up with an IV, take your vitals, shave appropriate areas etc. Pre-op has this monitor with all of the on-going surgeries, like flight departures at the airport except it doesn't update to show you delays.

After pre-op is another staging area, where multiple people come around and ask about your medical history, and they mark the area for surgery so that there's general agreement about what's being done. This is also where you consult with the anesthesiologist. In my case, she recommended a spinal, which basically means that your lower half is completely turned off, so they give you an extra sedative to keep you in a medium sleep.

Next they take you to the actual operating room. Here they administer the initial anesthetic (spinals feel really strange), transfer you to the operating table, and knock you out. If you're lucky (as i was) that's the last thing you'll remember. I don't really remember much about the operating room. It was larger than i expected, almost like a classroom. My x-rays were on one wall. There were several people there when i was rolled in, but not the surgeon.

After the surgery, there's a post-op area (although that's not what they call it). I'm not really sure how long i was there. I woke up there, and was still pleasantly morphined. I can remember being in the room, with other patients and a few nurses, but i'm vague on what they actually did in this room.

Finally, they take you to a regular hospital room. I was catheterized and had a blood drain connected to my incision, but i didn't feel too terrible. I think it was around 2 in the afternoon at this point, but i'm only sure that there was still daylight. I was happy to find that i had no post-operative nausea, but i kept expecting it, even after i ate dinner.

I made it through the first night, and at 10am on Tuesday the physical therapist arrived to help me stand and walk for the first time with a walker. It was fairly hard, but i still had some morphine in my system so that helped. I managed a full lap around the hospital floor, which is apparently unusual. I did another lap later in the day with an occupational therapist, and finally made another excursion in the afternoon.

I was originally expected to go home on Wednesday, but because i had shown good progress they arranged for me to go home Tuesday night. The first couple of days at home were a bit tough (on me and my family). All of the biomechanical processes of standing, sitting, lying down, etc. are pretty tough. It hard to get from place to place with a walker, and you can't really carry anything with you.

So far, i've been really lucky. I never had any post-op nausea, and i haven't had any bad reactions to the Vicodin i take for pain, or the blood thinners i have to inject myself with every day. I've had a decent appetite, and i haven't had any problem with infections or fevers. My physical progress is encouraging and i get a bit more mobile every day. I'm hoping that this week will show as much progress.

Pre-Op

I'm trying to get away from the litany of woe that this blog has become, but i can't think of a way to put a cheerful spin on my impending surgery. I am about 2 days away from the event now. I look forward to an end to the irritating pain that has accompanied my every move for the last year, but it's difficult to accept that i will never run another marathon, never spend another Sunday afternoon running down some trail, never fight another sparring match, never play another pick-up game at some random basketball court.

I'm trying to focus more on what i can do. I'm thinking that i will try swimming. There's a good master's program in the community in which i live, and i've started to identify events that i can train for in the future (the Alcatraz swim is intriguing). I probably won't be able to spar in the style that i've become accustomed to, but i think this might be an opportunity to work on boxing. I hope to be able to revive my interest in backpacking, since at least the long walks will get me into the same territory where i would previously have run.

The remainder of this month is probably going to suck. I'll be in the hospital for a few days, followed by physical therapy and daily nurse visits for a while. I have to take blood thinners for 3 weeks after surgery. I've never had a general anesthetic and i don't really know what the aftermath will be like. I cling to the idea that in a month i will be essentially normal, except that i will have entered a new phase of life in which certain activities are no longer an option.

Probably the worst part of these weeks leading up to the surgery has been the sense of isolation. I've always had relatively few people in my life that i could have meaningful conversations with about things that are important to me. There are not that many people who have both an intellectual side and also understand the compulsion to run long distances, or the desire to fight, or even the general notion of taking on physical challenges. There are even fewer people with those qualities who have had to accept giving up all or some of it. Strangely, my current workplace is the first where there are several people who run or do other endurance events. When i hear people talking about doing a half-marathon or running a trail, i get this indescribable sense of being outside of their world, looking in. I imagine that it's like being a ghost.

The nurse at my orthopedic surgeon's office said that i might be the healthiest person for whom they've ever done a hip replacement. I take some comfort in this. A doctor acquaintance once told me "we know how to fix joints, but we don't know how to fix hearts". He meant that people should be more concerned about the damage done by lack of exercise than potential wear and tear to joints (though the inability to fix broken hearts applies in the more poetic sense as well). So, while i'm bummed about the limitations imposed by having an artificial hip, i'm also well aware that far worse things can happen.

Not So Hip

I've been fortunate in my life that, except in a few rare cases, reality has been better than my expectations. So when i went to an orthopedic specialist on Tuesday, even though my expectations were that i had some structural damage and might need surgery, i was mildly stunned to hear that i have degenerative osteoarthritis and my only real option at this point is hip replacement surgery.

From the x-ray it was pretty clear that the cartilage is gone from my left hip and i have bone against bone. The bone has been in contact long enough that cysts and spurs have begun to form. There doesn't seem to be any ameliorative therapy for this.

Most significantly for me personally, this essentially ends my marathon career, and certainly ends my quest for a sub 3-hour time. At this point i am not sure that i will be able to run at all, and I don't know how much if any of my martial arts i will be able to continue.

Needless to say i'm a bit depressed about this-- being the crazy runner guy has been my identity for the last several years. The brochures on hip replacement talk about how you'll be able to return to activities like bowling, golf, or shuffleboard; which makes me want to scream and throw things. I could do those things with one good leg. Still, given my nature i expect that i will find some new activity (biking, swimming, etc.) that i can pursue to ridiculous degrees.