It has been exactly 7 days to the minute since I had my left hip resurfaced and I
just walked my first mile so this seems like a good time to write this note.
My story is similar to many of the stories on the Surface Hippy website. I
could never thank Patricia Walter and all the other contributing Surface Hippies enough for this invaluable
resource – it was the #1 resource I used while educating myself about my
situation and available options. What an awesome example of how technology
can empower the patient community!
At the age of 29 I was diagnosed with severe OA in my left hip, likely due
to a slight malformation of my femoral head which caused uneven pressure and
eventual breakdown of cartilage. The news was very unexpected and I was
absolutely crushed. The tears started coming once I got back to my car. It
wasn’t that I was thinking "why me" or anything like that but that I felt a
huge sense of loss. Everything about my life was active – a normal week
might consist of 50 miles of single track mountain biking, soccer, softball,
yoga, and the gym. Being active was how I relaxed – it was my only real
hobby besides reading. My journey to the diagnosis was a long one and
started with groin pain as a college soccer player – trainers and myself
would assume the pain was due to a strain or pull and I would rest. Several
weeks and I would always be fine. A blown knee and approaching graduation
took the focus off soccer and on to academics. Once I stopped competing at a
high level I paid little attention to a progressive loss of speed and
agility. I was athletic enough to compete just fine in recreational sports
and the years passed while I immersed myself in my professional life. I
naturally transitioned to sports that better fit my changing abilities –
yoga and mountain biking. I though I had just been slacking and yoga would
bring back my flexibility. It didn’t. I continued to loose flexibility, was
unable to run at speed, and groin pain had become a constant part of my
life. Eventually I realized I could not remember not using my hand on my
knee to pull my left leg into my car or picking something up without lifting
my left leg in the air behind me. Putting on socks and shoes was one of the
hardest aspects of my day. "Are you limping?" questions came from all
directions. It hurt to exist – awake, asleep, sitting, standing – chronic
hip pain now defined who I was.
Before I found the Hippy Surface website two themes defined the messaging I
received from medical professionals. The first was that I was too young for
this to be happening and that my situation was weird (fascinating insight).
The second was that this was a big shame, none of my options were ideal and
I should wait as long as possible to consider surgery because of my age. I
have enough experience in healthcare to know doctors are constantly wrong,
information disseminates at a snails pace in medicine, and there were other
people like me and I needed to find them ASAP. Finding the Surface Hippy
website was one of the best days of my life.
At my age I never considered traditional THR – if you’re reading this
neither should you! There are situations when THR is the only option but
they are rare. It is important to note that THR is a massive industry –
there are billions of dollars and lifetimes invested in this procedure. If
you think most physicians who have built their entire practice, professional
career, and sent kids to college by performing THR’s are going to be
impartial regarding resurfacing you’re nuts. I asked a physician at
Washington University why anyone in their right mind would ever consider THR
if resurfacing was an option. He seemed almost offended, stated it was a
perfectly good procedure (for him maybe) and I should consider it as a very
viable option. Doctors are people – its your hip, you’re the expert and must
take on the responsibility of the role. Ask questions and know the answers
you’re looking for.
In choosing my surgeon I met with teams at Washington University in St.
Louis, Dr. Su at the Hospital for Special Surgery in New York, and Dr. Gross
at Midlands Orthopaedics in South Carolina. The surgeon at Wash U was
primarily a THR surgeon who basically does resurfacing on the side. He had
completed about 60 cases in 3 years. I wanted someone with more experience.
I met with Dr.Su in New York. I left the meeting feeling very confident he
would do a great job and enjoyed our meeting. However I passed on Dr.Su for
several reasons. I wanted to go with an uncemented femoral component and Dr.
Su only does cemented. The Hospital for Special Surgery is an extremely
difficult facility to navigate (one appt. had me visiting 3 completely
different buildings) as is Manhattan (awesome town, unless you can’t walk) –
this seemed like a nightmare scenario after surgery. Some of the staff at
the Hospital for Special Surgery were also extremely unprofessional – staff
members making fun of and arguing with patients definitely had an impact on
my perception of the facility.
I choose to have my surgery with Dr. Thomas Gross in South Carolina for
several key reasons. Key factors included: surgeon’s experience specifically
with resurfacing; uncemented femoral component option; an incredibly
friendly staff throughout the facility; and easy access to facilities.
THR and resurfacing are two completely different surgeries – skill at one
DOES NOT necessitate skill at the other NO MATTER what any doctor might say
– the entire process, tool set, prosthetic components, etc. is completely
different. Resurfacing is going to continue to gain in popularity which
means more and more inexperienced surgeons are going to start doing the
procedure – I personally wouldn’t want to be someone’s practice. Ask your
surgeon how many times they have performed the specific procedure with the
specific components. The experience and skill of your surgeon is the single
most important factor in your success. It is only day 7 and the only pain
medication I took today was two Tylenol 7 hours ago and I’m sitting on my
couch with ZERO pain. I have almost ZERO bruising. I walked one mile today
without crutches or a cane and didn’t have any pain – I could have walked
another one, the last step didn’t feel any different than the first. I have
not heard any popping, clicking or other unnatural noises coming from the
joint. The OA pain is GONE! I know my joint and recovery still have a very,
very long way to go and I’m far from out of the woods – anything could still
happen – but I could not be happier with how things have gone thus far.
These results are all due to the skill of Dr. Gross.
While the contemporary uncemented femoral component option is so new data is
not yet available on outcomes it was an easy choice for me. I believe it
will become the standard. While a 20 year lifespan for a cemented component
is a great outcome it would still have me moving to a THR relatively early.
I need both components to become parts of my body – I need the connection
between the components and my body to be alive – I need the connection to be
bone. I personally saw cement as one more point of failure which added
variables to the overall system. Cement is not alive and cannot regenerate
Everyone at Midlands Orthopaedics was extremely professional – from the
front office, to x-ray, Nurse Nancy Smith, Nurse Practitioner Lee Webb,
and Dr. Gross himself. After having visited Wash U and the Hospital for
Special Surgery this professionalism was a giant relief. I finally knew I
found the team I wanted to work with. Dr. Gross was the first surgeon who
seemed genuinely excited about the components he used for the surgery. I
asked other surgeons, "What components do you use and why?" The general
answer before Dr. Gross was "I use ‘x’ mostly and it seems to work OK" – I
absolutely hated that answer! These guys should be experts on the options
and choose their tools of the trade with passion! I wanted to hear extremely
specific reasons why, of all the options, this doctor thought I should have
a particular piece of hardware in my body, potentially for the rest of my
life. No doubt they’re getting paid by the component vendors but I wanted to
figure out what other specifics they used to pick their horse.
I’ll share some of my advice for anyone facing the difficult situation of needing a new hip(s).
Find ways to get into or stay in shape. Your body is
a system – the stronger the overall system the better you will be able
to cope physically and mentally with the challenges before and after
your surgery and recovery. Find exercises you can do – swim without
kicking, use adjustable elliptical machines to find a bearable setting,
do upper body exercises, walk as much as possible. Rehabbing a hip is a
difficult task – you don’t want to have to rehab a quad, hamstring,
calf, etc. all at the same time too. My left leg was still very strong
at the time of my surgery – I can already tell this is an excellent help
in my recovery. You also want to get into the habit of a daily exercise
routine before surgery so you will have one less change you have to make
after – you’ll already feel comfortable with the daily routine of rehab.
You are the foremost expert on this planet regarding
your hip. Nobody else. Embrace this role and become an expert on every
aspect of your situation. Don’t let doctors intimidate you or pressure
you into any procedure or timeline. Ask specific questions and demand
specific answers, "how many hip resurfacings have you done?" – I had a
doc answer this question by lumping THR’s and resurfacings together 3
times and would not tell me the specific number eventually stating the
surgeries are basically the same which we all know is nonsense. If
you’ve studied the Surface Hippy site carefully, you have expert
knowledge and know more than a vast majority of doctors.
Take your time in choosing your surgical team. I
remember just wanting to get the decision over with and move on with my
life. If not for my very supportive family challenging me to make sure I
felt comfortable with my surgeon I probably would have gone with the
easiest option which upon further reflection would have been the wrong
Remember THR is a multibillion dollar institution –
there are vested interests and a great deal of economic momentum working
to keep THR procedures as the standard. Just because your local doctor
isn’t up to date on modern resurfacing doesn’t mean it’s not the better
option in many cases. Personally I do not see any reason why someone who
has the option of resurfacing would ever choose THR.
Keep a positive attitude. Life is difficult. Always
has been, always will be. I’m in a good place right now with my outcome
but a fall on ice, an infection, or some random car accident and the
game changes. Before I had my surgery I had reserved myself to accept
the worst possible outcome (well death is the worst but that would be
easy on me) which I saw as a long fight with infection, zero weight
bearing, and ending up with a THR . This situation would suck but I’d
need all my mental strength at hand to fight to get my health back. I
entered the hospital ready to battle. My right hip isn’t too far behind
my left so I’ll be on this journey for a while.
If you’ve found this site consider yourself lucky. Take your time, get prepared, and take your
life back from pain. I am so very thankful for my supportive family and my
beautiful girlfriend Meghan who traveled with me to South Carolina. I am
eternally grateful for and humbled by all the love and support I received
from Meghan, my family, and our friends.
Best wishes on your journey!
Joseph P. Tierney
Surface Hippy Newbie