August 20, 2010 I was sent unceremoniously to the reception Tuesday morning at 7.00 and told “ticket number 20.” Administration was simple but they said I had been booked a room for two but they have none, so I will be in a room for four. I was sent to the room but spent the next two hours walking, as I knew that would be the last for a while.
About 9.00 my leg was shaved and I was sent to pre-op where I stayed for what seemed unnecessarily long. Eventually, I was wheeled into the operating theatre, with Dr. De Smet on the side looking at my x-rays. The theatre was suitably impressive, done out in dark blue, with what seemed a much too small operating table in the middle. I was transferred to that table and held on with one arm support. That is when the anesthetic must have started and I felt myself spinning and sinking.
I awoke in post-op neither particularly comfortable or uncomfortable and stayed for a couple of hours before going back to the room. In the room were three other patients, Mahmood who had bust his knee playing football, Luke, who had something done to his leg, and Yves. I still do not know what Yves was in for, except that he did not appear to be getting better. I would have liked to have been in the room with other hip patents.
Dinner came. George back at the Villa had warned me how bad the food was. Three slices of unpalatable bread with chocolate spread. I was not hungry. I was mildly thirsty, and there was water available, but I found if I drank any I got wind. Also with the bed bottle I could not piss.
This first night I was on morphine which comes though with the oxygen into your nose. There was an addition button for a morphine pump, which I would not dare use. I am not sure why they give you morphine. It does not make you feel better. It makes it difficult to burp and impossible to piss into those bed bottles. By night my bladder was full and I had to have a catheter inserted to drain me. This is both undignified and unpleasant. Through the night, though my bladder was filling up, I was determined not to have another catheter, and against the night nurses wishes I waited till morning.
The oxygen and morphine was removed in the morning, and another inedible meal came, with an anti-inflammatory and a codeine tablet. From then on codeine tablets seemed to come liberally, but I did not take any more than that first tablet. The physiotherapist arrived and got me on crutches. The first place I walked was to the toilet. It took me a few minutes to piss. From then on I was going to the toilet regularly and easily. Lunch was actually a cooked meal, but inedible. I was glad to be off the morphine and lucid, and with crutches could walk about readily.
The evening meal came and Luke got cheese with his dry bread. The cheese looked good. I could not understand why I got some identifiable spread instead. Luke thankfully gave me a slice of his cheese.
At night I was given another codeine and a sleeping pill. I took neither and did not really sleep.
In the morning, more drab bread, codeine, and thankfully more physiotherapy, which qualified me to leave the hospital. I got a bag of medicine and went down to reception to wait for the lift back.
August 22, 2010 Two days out of hospital and it is definitely getting better. I enjoy being with the other hip patients and getting physiotherapy.
I would recommend resurfacing, recommend the recovery, and although there were many (but not all) helpful staff at the hospital, it is a place with little joy of life.
The villa is significantly better.
August 26, 2010 Day six, Tuesday, I got a tram into the city, walked around the old quarter, had Belgium waffle with chocolate (not as good as I had hoped). In the evening walked around till we found a restaurant that looked promising. In my wife’s estimate, in total, walked about 5 kilometres (3 miles).
Day Seven, Yesterday, I was stiff.
Day eight, today, I feel stronger and want to go out again, but it is raining. Apparently, I am Dr. De Smet’s first uncemented and he does not yet intend to do them generally. All the other patients at the Villa either have the cemented C+, or those getting total have the Adler with ceramic ball and insert.
I am glad I followed your advice and got it done here.
August 30, 2010 Day Twelve
I am far from doing the splits or anything gymnastic, but I do notice that when I walk my hip swivels. Not much, but when I walk and put weight on my operated leg, I can perceptibly feel some rotation under my pelvis. I have not really had this natural movement for years. The other hip is still stiff and just moves slightly off of forward and back.
It is difficult as my muscles are not used to this movement. The last few years, the muscles of my legs and bottom have wasted, and now I need their strength to control my legs. So after fifteen minutes of walking, I can feel getting quite tight on the outside and inside of my thigh and calf. It is not just learning to walk properly again, it is training the muscles.
I know I do not need the other hip done yet, and do not know when that will be. But I do not mind if I have to get it done relatively soon.
Wish I could walk indefinitely as I used to.
September 2, 2010 Day Fifteen
Better than yesterday, but still a long way behind.
From the moment I left hospital I got stronger and had more movement every day. After I left Gent, I started to get some slight swelling around the incision, but I could still walk well. In fact, in Gent I had no noticeable swelling at all.
Yesterday I was due to get on the plane for a twelve hour flight. I got stiffer and stiffer all day, and my buttock around the incision got quite swollen. It was extremely uncomfortable traveling in the car to the airport, and I knew I would not handle the flight. So I missed my flight.
Today, I am not as stiff, but still swollen. I will have to reschedule the flight. I should have been there by now. I wish I was.
I am not sure why I have got swelling so late after surgery. Maybe I have been doing too much walking. Today I am icing a lot.
September 8, 2010 Well I have had my operation, and I am going to continue this thread. After the operation it seems even more important to have chosen the right surgeon.
In the end I chose Dr. De Smet, and perhaps I could not have done better, but here are my experiences with other surgeons and why I did not chose them. I had long decided that I wanted an uncemented resurfacing.
I live in Thailand and found two surgeons in Bangkok who do resurfacing and both at the time had done about fifty resurfacings and only offered the Birmingham device. The first one answered my questions but gave me absolutely no confidence. He was cocky and the whole hospital setup seemed merely to make money. I quickly discounted him.
The second surgeon I met in Bangkok is worth mentioning, Dr. Sitthiporn Orapin. He spent a long time with me, answered all of my questions and gave additional information. He definitely came over as a competent surgeon who is interested in his patients. Latterly, I met someone who had had a resurfacing done by him and was pleased. I would have preferred to have had the operation done in Bangkok so I would not have had to travel abroad, but I did not choose this doctor because (as I gathered from this site) he had done too few operations to be sufficiently experienced, and he did not offer an uncemented option. Additionally, the operation in Bangkok was not too cheap.
After this I started looking at England as I have family there.
I was interested in the Royal Orthopaedic Hospital as both Mr. McMinn and Treacy do operations there. The ROH web site includes information for a private ward and service (I am not covered by National Health or insurance), and looks as if they are well set up to do private surgeries. So I contacted them by e-mail and got no reply. Tried contacting them by phone and never got put through. Contacted them again a few weeks later by e-mail and still got no reply. This is no slur on the two surgeons, but what a ridiculous service by the hospital!
London would have been convenient to me, but many of the private surgeries in London would just have been too expensive.
I did contact St. Anthonys Hospital in South London, and initially was pleased. They replied quickly, with a reasonable quote and said that they could do uncemented. The surgeon would have been Mr. Richard Field, who they said would prefer to use the Mitch Per device. From then things went downhill. They suggested I contacted another secretary, who suggested I contact the first. They could give me no more information than was in the first reply. The Mitch Per device is largely unknown, and there is no information from the manufacturer. It might well be good but who knows? I believe Mr. Field has interests in its development as well. So I requested more information about the device and was told only Mr. Field could answer, and that I would need a private consultation with him that would start at one hundred and eighty pounds. I wrote back that this was not particularly convenient for me as I live thousands of miles away, and I requested his secretary for some information about the device, and also some information about the surgeon himself, how many resurfacings, etc.
I got no reply. I was angry at the time.
Not everything was bad about England. I contacted Mr. McMinn’s private clinic, and they were polite, very helpful, and perhaps the most efficient of anywhere that I had tried. Although I did not speak to Mr. McMinn personally, I was at last pleased to have had some good service from England, although by that time I had already decided on Dr. De Smet.
It was rather strange for me to contact a surgeon in Belgium. Belgium! I did not expect much. Dr. De Smet replied to me personally, politely, quickly and answered my questions. I was so pleased at being treated as a human by a surgeon that I decided on Dr. De Smet. I understand, now, that he might be the best in the world, although it is difficult for a prospective patient to gauge a surgeon.
So it seems quite simple to me. Only choose a surgeon that treats you as a human being, as only he will operate on you knowing that you are human.
September 11, 2010 There is a lot of debate on this site about what surgeons and what devices are the best, and there is some discussion about physiotherapy too. There is nothing about hydrotherapy, which in my short experience, seems to be almost as important in recovery as the surgeon, the device and anything else.
Hydrotherapy is a standard part of Dr. De Smet’s service, for THRs as well as resurfacings, so obviously he thinks it is important. The physiotherapist, Evelyne, who runs it, and I believe designed the course, is also quite proud of it. Quite simply it is doing straight forward exercises in a swimming pool, much of it based around walking properly, and quite obviously to strengthen and stretch the hip within strict limits.
Forty eight hours after my surgery, I was in the pool doing the exercises. Even so soon after the operation, walking and the exercises in the pool felt natural and without any fatigue. The first session was for half an hour. The next seven days , while I was at the villa, I was in for an hour.
Every day I felt stronger and more mobile. Everyone else at the villa did the hydrotherapy too, we all enjoyed it and got there early. The international patients are only at the villa for about a week after the operation, but the domestic patients appear to come back regularly, for up to a few weeks, specifically to do the hydrotherapy.
It took me eleven days after I left the villa to complete my convoluted journey back home and to find a pool. During that time I was generally strong, but did suffer some swelling, and did not really improve. Now I have got a pool I can use and have been doing the exercises, again, I feel as if I am improving quickly again. Sometimes I get up and walk, and forget that I am still supposed to use a crutch. Although I still need more range of movement and more strength, I like the feeling of my new hip. I can feel it rolling under me when I walk, which my other semi-arthritic hip certainly does not.
Even though I believe I had a great surgeon, it is difficult to gauge his ability, not being medically trained, and especially as I was oblivious and under general anesthetic when he did his work. So in my mind, as a patient, the hydrotherapy is making an enormous effect on my recovery, and I hope in the future performance of my hip. I would recommend all prospective hippies, not just to look into their surgeon and device, but to really consider hydrotherapy too.
September 17, 2010 I did get an uncemented C+. Both components, not a hint of cement. The acetabular component is uncemented as standard, but the femoral component is new. I specifically requested it and I am proud that I was Dr. De Smet’s first fully uncemented resurfacing patient. I hope it works!
September 26, 2010 Went out for my usual walk this evening. Five and a half weeks out, and my hip is getting better almost daily, but I feel lots of strain in all the muscles of my leg, and in my back, which is a continual reminder that I have a few compressed disks as well. I am not too worried about this strain, as it is mainly due to moving freely again. I get stiff if I sit for long, but once I am walking I loosen up.
Six kilometres this evening. I have walked further since the operation, but today I was really stretching out. My gait has improved and I have not walked with such long strides for a few years.
A few twinges. Every so often as I was walking, I did feel deep in my groin a rather uncomfortable and familiar feeling, a bit like toothache, centred right inside my hip.
Nothing wrong with the operated hip, it was the other side.
September 30, 2010 Six weeks out, and I was making progress pretty much daily. Not an even progress, some days I got stronger, other days I got more range.
Now I seem to have reached a plateau, not sure that I can perceive that I am improving. I know I need to get a lot stronger, my left leg is still smaller than my right, and I definitely need more range of movement. I can dry my foot now, but I cannot cut my toenails.
I get ‘startup stiffness’ and seem to need more sleep than before the operation. The good thing is that I can walk for miles, and this does mean a lot to me. Walking freely, with a good stride shows that the operation is a success already.
I realize that I cannot expect to improve at the same rate as the first week, or I would be superman within a few months.
January 9, 2011 Four and a half months out, and all is going well. I am still gaining strength and mobility, and now favour my operated leg over the other side.
But the scar is not going as expected. Initially it faded from red to pink and was a neat curved line. Now it is breaking up and there are at least three distinct segments with about half an inch of healed skin between the ends of each.
What is going to happen? Will the scar break up more and disappear? I cannot see the resurfacing device inside, so the scar was my only trophy. If that goes, how will I be sure I remember which side was operated, or will I know I ever had surgery?
It seems to be worse than this. The three segments do not perfectly line up. They seem to be moving around. I don’t want to end up with three separate scars on different parts of my cheek. They could move around further and break up into smaller parts. I could end up with dozens of tiny scars all moving around.
At least I can walk well.
March 7, 2011 Six months after being Dr. De Smet’s first uncemented C+, as to his intentions to continue with uncemented he said:
He will start doing them this week. A colleague of his (don’t know who) has done one hundred uncemented with good results. He will do uncemented in all cases which are good for it. It might be expected to be the standard form of resurfacing once it has fully proven results.
March 19, 2011 My resurfaced hip is definitely the best joint in my body, the only joint that moves smoothly. Seven months out I am still gaining range of movement, not just in my hip joint, but in my back as well.
No doubt after a few years of being lopsided, being straight again put some strain on my spine. Each time I stretch and gain further movement in my hip, I feel my back for a couple of days after.
Before the operation, I had no rotation of the hip at all. Now I can sit cross legged on the floor (not for long, and only with my operated leg tucked in, as the other hip is not as good).
April 14, 2011 Eight months out, and I went for my first run.
Have not run since I was diagnosed with OA a few years ago.
Did my morning PT and stretching and set off, one lap of the housing estate, just over two kilometers. Most definitely, my motion was not as fluid as it used to be, and an awful lot slower. But it was not uncomfortable. To start with, I could feel a mild arthritic twinge in my right (not operated yet) hip, but as I went on, it went away. My left hip felt well, but towards the end, I could feel my left thigh muscles. Walking up the stairs afterwards, I could feel some discomfort in the knee on my operated leg.
My conditioning is nowhere near what it used to be. I am glad I can run.
April 30, 2011 Follow-up After leaving the clinic in Belgium, the only follow up that is required is to send in an x-ray after one year.
Dr. De Smet, however, answers all messages. His replies are short, economical, but he answers every point. Having had about ten thousand past patients (3000++ resurfacings, 6000++ THR), he seems to remember me personally, and I am sure he does all his patients.
His physiotherapist, Evelyne, also answers all messages, and is helpful.
I will say that having been cared for so well at the clinic, I felt a bit lost for care a few days after leaving.
I have had follow up consultations with my local orthopaedist, who did not recommend resurfacing. And I got a six month x-ray, even though Dr. De Smet did not require it.
I recommend Dr. De Smet. Even though for follow ups, he is remote, his replies might take a few days and are short, he does not forget his patients.
When you get home, and when you are having the surgery, it is good to have a wife/husband/loved one to help you.
September 12, 2011 There are quite a few one year reports being posted, (a few three year, five and even longer too), so, never wanting to be conventional, here is my thirteen month report.
Broadly I am better (there, that was quick), or at least my left hip is. But it is not as simple as that. My left hip joint does now feel incredibly good, and I have got a large segment of my life back, that I had not realised that I had lost.
Amongst the other patients in Gent was a woman, my age, who had been a triathlete. We keep in touch. She was not suitable for resurfacing, even by Dr. De Smet. She got bilateral ceramic THRs. Although she is very strong, she had a bigger operation than me, and initially she recovered slower than me. Now she has continued to improve, and has taken up her sporting life again, apparently, at least as well as where she left off.
This has not happened for me. Although my left hip is excellent, the rest of me is not. In fact the smooth motion of the resurfacing joint just betrays the varying degrees of roughness of all my other joints. My back and neck are messed up from old sporting accidents and injuries, and probably a congenital disposition too. This does not preclude me from most activities in life in general, but I do not think I would want to push myself to any extremes, as you should do if you compete.
The other limitation is that I cannot abduct as much as I would like. All the other five movements (adduction, flex, extend, internal rotation, external rotation) have better range than before I knew I had arthritis. With my left leg (not right) tucked in first, I can now sit cross legged on the floor (not for too long). In fact, although infinitesimally, I think my range of movement is still increasing. But I cannot stick my leg out sideways as much as I would like. Two day after the operation, in the hydrotherapy pool, I was amazed that I could stick my leg out sideways at all. But since then this has been the slowest movement to increase.
I have most definitely got an important part of my life back. Four months after the operation, I climbed over my four foot fence to retrieve the dog, or a ball or something, I cannot remember. But I do remember my son saying, ‘Daddy, you can climb now.’ And I can. Now I like to play table tennis with my children. When we go to a restaurant, I can sit at any table, I do not have to ask for a seat with a back that is not too low. Long gone are the days when it was difficult to cut my toenails, dry myself fully after a shower, or put my trousers on.
I got my thirteen month x-ray last month, which was twelve months, and have just sent it to the surgeon, but not got a reply yet. It does show (as explained by my local orthopaedist), that the bone is growing into both components, and is growing denser around the connection between the femur and the device. This is important as I had uncemented. The x-ray also shows a slight narrowing in the joint of my right hip. I know. I can feel it when I walk now. Mild toothache in my hip. As yet, I have not lost much range of movement in it. It is probably worse now than last year because I am more active. I am not sure how many years it will be till it degrades to the degree than I need that hip resurfaced too.
In fact, I wish it would bloody get worse now, then I could have it done and be symmetrical for the first time in a decade. As I have mentioned, I would not mind having a total body resurfacing, if there was such a thing. Imagine, universal unrestricted smooth effortless motion.