About Me: I’m 64, short (5′ 5″), and active/athletic (cross-training 6 days/week, including yoga). I used to be a runner, mountain biker, rock climber, and skier, but hip and back conditions gradually limited my primary activities to hiking and backpacking, which are the most important to me anyway.
My Long-Developing Hip Condition: My condition apparently resulted from a minor, previously undiagnosed deformity of the pelvis, with symptoms appearing late and developing over a very long period of time, so that I adapted to it and delayed surgery for many years, until absolutely necessary. And this long-developing condition ended up resulting in post-surgical complications that none of my providers anticipated or diagnosed, leaving me to figure it out in the end. I first noticed limited range of motion in my right hip when I began indoor climbing in year 2000 at age 48, and needed increased flexibility. Since there was no pain at that time, I just accepted the limitations. Severe pain in my right thigh appeared suddenly in 2007 and was diagnosed as referred pain, with x-rays showing total loss of cartilage in the right hip joint and large bone spurs on the head of the femur that were limiting the range of motion (flexion and external rotation). Because of the cartilage loss, my right leg was about 3/8 inch shorter than the left. I live in a remote small town in New Mexico, and my local surgeon recommended that I try physical therapy (and an orthotic to correct my leg length) at first, with total hip replacement as the ultimate solution when pain began to prevent my desired activities. Physical therapy taught me some lifestyle changes to prevent or mitigate the pain, and I discovered several other tactics on my own, so that I was able to maintain my desired level of activity until 2014, when the pain moved into my joint area and began interfering with my level of activity. In the pre-surgery exam, after reviewing the new x-rays, Dr. Pritchett identified the deformed pelvis as probable cause of the cartilage loss and subsequent bone spurs.
Deciding on Treatment: In early 2015, I scheduled a THR with my local surgeon, but a month before surgery he was hit by a car while cycling and severely injured. Then I remembered that recently, a younger friend from California had flown to New York for HR with Dr. Su, and after talking to him I spent a few weeks researching on SurfaceHippy and trying to contact various out-of-state surgeons, since no one in my state practiced HR. During that time, I learned about the recent withdrawal of BHR implants in smaller diameters, which meant that most qualified surgeons would not be able to do HR on my joint. Timing was against me in two ways: the smaller BHR implants had been withdrawn only months before, and as I was beginning to contact surgeons, I was notified that my ACA marketplace health insurance, which had a nationwide network, was being cancelled, to be replaced by in-state-only coverage. Implants in my size were no longer available, but if I wanted HR, I needed to get it done in the next 3 months while out-of-state providers were still covered. Fortunately, Dr. Pritchett called me as soon as he received my x-rays, pronouncing me an excellent candidate, and assuring me that he could resurface my joint using a cross-linked polyethylene cup instead of the withdrawn metal implant. He and Susan, his assistant, proved to be accessible and informative both by phone and by email, and I was scheduled for early November, well before my insurance deadline.
Planning and Preparing for Surgery: Since I’m single with no kids or close family or friends in the area, my biggest hurdle before surgery was getting someone to accompany me to Seattle and take care of me there between surgery and the two-week follow-up appointment. My first choice, an old friend whose travel and living expenses I would need to pay for the duration, had a last-minute health crisis of her own, so in the end I reluctantly agreed that my healthy 89-year-old mother would fly out from Indiana. She wouldn’t be able to help me much physically, but she could do the shopping and run errands. I had reserved a one-bedroom suite at the Downtown Seattle Homewood Suites on Pike St., which is near the hospital, with a kitchenette, a small grocery on the corner, and many restaurants within a two-block area. We both flew in two days before surgery, so there would be time on the following day to shop and attend the pre-surgery exam. Knowing I’d soon have a new joint, I hiked four miles at top speed over the hills of Seattle shopping for provisions the corner grocery didn’t have, including pomegranates whose seeds I would eat every morning and evening to prevent constipation. One thing we should have done before surgery was locate a toilet seat riser (with hand grips) for the hotel room; this turned out to be surprisingly hard to find. The day after my discharge from the hospital, my mother had to spend two hours in a cab roaming around Seattle from place to place, looking for the riser, and then the hotel maintenance man had to spend a couple more hours figuring out how to install it in our bathroom!
Hospitalization and Surgery: Surgery was performed at Swedish Orthopedic Institute, a dedicated orthopedic hospital with which Dr. Pritchett is affiliated. After being prepped, I had an unexpected two-hour wait to get into surgery, but after that everything went smoothly. As I regained consciousness afterward, the spinal anesthetic faded quickly and my pain level rapidly increased to 6, despite multiple doses of oxycodone and dilaudid, until the meds finally triumphed and I was moved to a hospital room. There, Dr. Pritchett showed up, enthusiastically reporting that my operation had been one of his most successful resurfacings ever. Physical therapists arrived, had me stand and walk about 80 feet in the hallway, and gave me exercise instructions. That night, I was awakened every hour or half-hour for nursing checks, and needed more pain meds. The following day, the Orthopedic Center staff became increasingly disengaged and hard to reach. The nurses disappeared into a meeting and failed to provide pain meds as promised, and physical therapists were rushed so I had no chance to ask questions before discharge. I experienced the worst pain yet while being transferred by cab to the hotel.
First Two Weeks: The physical therapists at Swedish had assured me that I could use a regular toilet seat, but the day after discharge, I almost passed out trying to lower myself onto the hotel toilet seat, so my mom spent most of the day arranging for a riser. Meanwhile, the pain kept getting ahead of me, so I had to keep taking the max dosage of meds trying to keep up. Even so, I completely avoided constipation, and had regular bowel movements from the beginning, by eating pomegranate seeds with cultured yogurt twice a day for the entire two weeks. Instead of warning about constipation and suggesting laxatives, the hospital should prescribe a high-fiber diet and probiotics! Seating turned out to be a problem at the hotel – all their chairs lacked lumbar support, or arms, or both. On day 3, after sitting over an hour in the living room, I suddenly experienced severe muscle spasms upon standing up, and barely made it back to the bed, where I took the anti-spasmodic meds included in my post-surgery prescription. I tried to wean myself off the pain meds, but the pain kept getting ahead of me during the first week. I followed my PT exercise instructions religiously, and the icing regimen to reduce swelling, and pushed myself to walk farther and more often, with my mom tagging along to supervise. On day 6, I climbed my first stairs and took my first walk outside with crutches, but experienced increased swelling and pain afterward. On day 7, I lurched most of the long hotel hallway without crutches, then experienced a bleeding rash, hot and cold flashes, and an upset stomach apparently due to a misdose of antibiotic, but managed to go the whole day without pain meds for the first time. The following week, I continued to increase my walking outdoors with crutches, but also continued to experience bad pain, especially at night, so that at my follow-up appointment with Dr. Pritchett, I had to get an additional prescription for pain meds. Then I flew back home, alone, in three legs lasting all day and half the evening, arranging for wheelchair assistance in the airports and relying on pain meds the whole way.
Rehab: Back home, despite Dr. Pritchett’s prediction that I’d be able to drive after two weeks, I found myself unable to flex and rotate sufficiently to operate my mini-truck with manual transmission and no power assistance. As it turned out, I wouldn’t be able to drive my truck until 8 weeks after surgery, but after the first few weeks, I rented and, with difficulty, drove a larger vehicle with automatic transmission and power assistance. For multiple reasons, rehab turned out to be incredibly frustrating, and early on I decided I never wanted to go through this kind of major surgery again. The first setback was getting into rehab. The week I returned was Thanksgiving week, and after that, my rehab facility of choice had a 2-week waiting list. So I booked a week of therapy at my second choice, was disappointed there, and re-applied to the first place. As a result, I didn’t get into regular PT until a month after surgery. Then, my young, yoga-obsessed therapist misdiagnosed the excessive pain I was experiencing, attributing it to poor posture and imbalanced gait. She set me on a course of exercise for months, progressing from home exercise to pool exercise, focusing on gait, “postural restoration”, pelvic floor relaxation, and building strength. I eventually convinced her that this was the wrong focus, because I had been doing hip strengthening exercises for many years and was plenty strong both before and after surgery. But I did gradually gain some mobility on her program, while still experiencing excessive pain and stiffness. Finally, 4-1/2 months after surgery, I was discharged from PT. I still had significantly limited range of motion, stiffness and soreness while walking, but my therapist basically gave up on me, advising me to continue stretching and foam-rolling on my own.
Complications: Dr. Pritchett had initially told me 7 months to full recovery, with continuing improvement for 2 years after surgery. Others seemed to recover much faster, so I was optimistic. After discharge from PT, I resumed hiking, gradually increasing my distance and speed, trying to rebuild my cardio capacity. But I was still experiencing quite a bit of stiffness after longer hikes – 6 miles or more – and I had bad days when the hip seemed inflamed. Seven months after surgery, I had regained my pre-surgery capacity, but then over a period of a week, the pain in my hip increased to the point where it hurt to stand, sit, or walk any distance. I ended up having to put all activity on hold for an entire month while unsuccessfully seeking treatment and trying to figure out what was happening. Finally, unable to get medical attention due to summer vacations and limited local resources, I began to figure it out on my own. My problem from the beginning of rehab had been a problem of hip geometry and soft tissue adaptation, but this had been unanticipated by anyone and had been ignored by my therapist. My long-standing condition, with a shortened leg and reduced range of motion, had resulted in the contracture of hip muscles, so that when the geometry was restored by surgery, those shortened muscles were now being overstrained, generating scar tissue throughout the muscle fibers. This scar tissue could now only be cleared, and the muscles lengthened, by long, hard work: a daily routine of deep tissue massage (foam rolling), long-duration stretching, and special exercises. I eventually confirmed this diagnosis with Dr. Pritchett, and a more senior physical therapist validated my therapy routine, predicting a recovery time of an additional 18 months.
Conclusions: Due to the long-term soft-tissue complications described above, now, almost a year after surgery, I’ve resumed intensive rehab, and still have a lot of work ahead of me. But I’m doing long hikes again, just accepting the pain on the assumption that it will gradually subside. Regarding Dr. Pritchett, I’ve been impressed with his accessibility and responsiveness from the beginning, and I believe that the work he did on my joint was fantastic – I have a new hip joint that will provide me with many more years of activity, especially as I overcome the soft tissue problems surrounding it. My only issue with the medical community, and my most important suggestion for other patients, is that the soft tissue around a joint, and its long-term history, is just as important as the bone and cartilage, and deserves just as much attention both before and after surgery. I can’t believe that I’m the only joint repair patient who experiences significant soft-tissue problems due to changes in joint geometry after surgery. Please consider this in your planning, and in your interactions with providers!