Six Week Check-Up Goes Well!

Well, I saw Mr Apthorp on Friday for my Six Week Check-Up. Had an x-ray and then went through. He wiggled my leg about a bit and then asked me to stand on my good leg and lift the left leg up. I did this. I knew what was coming next though as I had read Laura's blog (she had her PAOs with Mr Apthorp too - see my recommended list). And, as predicted, Mr Apthorp then asked me to stand on the left leg and lift my right leg. It felt so weird and scary, but I did it. It was completely solid! And it felt brilliant to know it had healed so well.

Next, I was asked to try and walk the length of the room with just one crutch. I did this quite easily. Mr Apthorp then asked me to hold his hand and walk with no crutch. I did so tentatively! He then asked me to do it again, without holding his hand at all. I couldn't believe it, but I actually managed to walk, unaided up and down the consulting room several times. It was stiff and strange but I was perfectly strong.

When we sat down for the consultation we saw the X-rays of my new hip and it was amazing. Not only do I have a proper socket now, with a good horizontal coverage, but I could also see the screws, which are HUGE!. The hip is totally fused now, although it will apparently take up to a year to be fully 'finished'. I could also see the part of the pelvis that was cut to perform the rotation, and it is still cut. This will again take about a year or so to reconnect, but it is in a non-weight bearing place and will cause me no problems.

So, I was told that I am no longer 'precious'! I can try and do whatever I want, my hip is completely solid and can bear my weight. It can even bear Mr Apthorp's weight as he leaned on me with all of his strength and nothing moved. I can let my kids climb on me, and can practise walking without aids as much as possible (although it is recommended I use a crutch outside for stability). It was stressed that I need to ensure good posture, not to run before I can walk, or I will be teaching my muscles to heal in the wrong way if I am wobbling about. I will be getting physio and possibly hydrotherapy, presumably in the next couple of weeks, now that I am 'healed'. It is a huge relief to know that my hip is now strong enough not to worry about it. I don't mind if I get some muscle pain, the main thing is that anything I do can't harm the new joint now.

Mr Apthorp seemed very pleased with how the joint had healed and was very positive about me never needing a hip replacement now because of my condition. It's pretty hard to take that in. Having a dodgy hip has been part of me since I was born. It seems so odd to think that I am no longer that person, restricted by her body. It seems that in its new position my hip is quite 'cup shaped' as I had a natural curve in the pelvis which means my surgery has been even more successful than some, who even after PAO have a more 'saucer' shaped anatomy. Apparently anatomy does differ significantly between people. I didn't know that. For example, my nerve that feeds my quad muscle was nowhere to be seen when Mr Apthorp opened me up, which must be why I still have full feeling there! Mr Apthorp also goes in to operate through the pelvis to avoid cutting into major nerves and muscles as much as possible. As such, my quad muscle is also in tact. I guess this is why I feel so much better after my surgery, especially when I compare this experience with that of some patients, whose blogs I have read, in USA and Australia. I feel very, very lucky and grateful to have been referred to Mr Apthorp.

Anyway, after our appointment I spent the next day out with the family, walking round a National Trust, mainly with one crutch. I must have done about 2K walking. I couldn't believe it! My muscles ached the next day - but - MY JOINT DIDN'T. I've got the feeling, this is really going to be lifechanging. I'll keep you posted!

My Hip History
I had been born with a dislocated left hip, which had been corrected in infancy, but from which remained a dysplastic hip condition. A dysplastic hip means that the hip socket (the acetabulum) is a shallow dish shape that fails to cup over and cover the head of the femur. For me this caused few problems until, at the age of nineteen, I began to experience groin pain after activity.

This was something that I could pretty much put up with. However, after having my first child, at the age of twenty-eight, I began to develop further problems. I began to get knee pain and swelling, and I was beginning to limit my activity, to alleviate the degree to which my hip would throb after exertion. I imagine that lifting and carrying my daughter was taking its toll. I was referred to see a knee specialist at the Princess Royal Hospital, by my GP. I was given physiotherapy and a shoe insert, but Mr Mark Patterson quickly realised the root of my problems was probably lying with my hip and referred me to Mr Apthorp at the Conquest Hospital in Hastings.

Reading up about Mr Apthorp on the internet I learned that he was a pioneer in hip surgery, applying a very new ‘minimally invasive’ technique for hip replacements that was proving to be hugely beneficial for his patients. I saw Mr Apthorp, or one of his registrars, annually for a few years. My hip hurt but I was too young for a hip replacement, and as I was either breastfeeding or pregnant at each appointment there was no real option for me to undergo an operation.

By 2007/2008 I had had all of my children, life was pretty settled, but my hip continued to cause problems. By now I was in a fair amount of pain after activity, and experiencing a dull ache continually. At the end of busy, physical days with my children I would lie on the sofa and my hip would throb. I was young, fit, and slim. It seemed such a shame. However, I had resigned to put up with it. I was very lucky, compared to many people. I was still very active; I wasn’t suffering from any kind of serious illness. It just hurt, and I had learned to tolerate the pain. I also practised pilates once a week, which really helped me with my alignment and probably stopped me from suffering too badly.

And that was when Mr Apthorp’s registrar first suggested the PAO operation to me, at one of my routine appointments. An x-ray had revealed that I was beginning to develop arthritis in my left hip, hence my ascending pain levels. I was fast becoming a candidate for premature hip replacement surgery. But, I was told, there was an alternative.

The PAO Procedure
A periacetabular osteotomy involves cutting into the hip socket (the acetabulum) and rotating its position, so that it offers a better ‘cup-shaped’ coverage of the top of the femur, thus mimicking a normal hip joint. After moving the hip socket into place, several screws are inserted into the bone to hold the bone steady, while the joint heals and new bone grows and fuses the gaps in the acetabulum. Bone is an amazing tissue. It has a rich blood supply, and the flexibility to move and regenerate. As a leg can heal when it has been broken, so a hip can heal when it has been cut. However, after an operation like this, one should not weight-bear on the affected area for at least 6 weeks. This gives the hip area time to fuse and harden. It also means the screws can do their job without the risk of buckling or moving. After 6 weeks, weight can be passed through the joint again. The learning process then begins - to use the muscles, tendons and joints again, according to the new position.

The surgery is major. It is conducted under general anaesthetic and will last about 3-4 hours. However, afterwards the patient is left with a hip joint that is all his/her own. There are no foreign bodies (the screws can be removed at a later date) and so the hip cannot be rejected, and has the regenerative capacity of normal bone. The intention is to reduce or even remove the likelihood that the patient will need hip replacement surgery in later life.

To conduct the operation, it is important that the existing bones have not deteriorated to any great extent. If the joint is already riddled with arthritis then a PAO should not be offered. For more information on the detail of the operation, and its pros and cons, please see http://hipandpelvis.com/patient_education/periace. I found this site really useful when preparing for my surgery.

Making my decision
I had read about so many different procedures, knowing that one day I would have to address my hip pain, and hopefully rectify it. When I was twenty-five, my consultant in Reading – Mr Mark Dodds – had offered me a shelf acetabulaplasty. This procedure involved taking bone from another part of the body and moulding it to the shallow hip socket, to create a ridge above the femur. I was told it had a 50% chance of limiting my pain, and 50% chance of removing my need for a future hip replacement. At the time those odds were too low for me to contemplate surgery. I had always believed that surgery should be avoided unless it was to save a life. I had always felt that once someone cuts you open and starts messing about with your natural anatomy, problems would ensue.

I had also heard about the minimally invasive hip replacement surgery, and a hip resurfacing option. I asked a very patient Mr Apthorp about each of these – hoping that I could avoid such major surgery as a PAO and go for, what I considered to be, the ‘easier options’ – hip replacement, hip resurfacing or shelf acetabulaplasty. Mr Apthorp explained that if I didn’t have the PAO soon then I would have a hip replacement, probably within the next few years. I would be very young, and would need multiple replacements in my life if I went down that path, as they tend only to last 10-15 years. Because of the shape of my hip socket, I was told that resurfacing wasn’t an option. Mr Apthorp also explained that the ‘shelf’ procedure was also unsuitable as the new bone was not given across the whole of the socket, but at the lid, and so was unlikely to offer the stability and protection needed to reduce my pain.

The PAO however could mean I would never need a further procedure on my hip, if I was lucky. It could also mean that because a greater surface area would be created to distribute my weight through the joint more evenly, future arthritis could be prevented. In essence, my pain should be reduced or eliminated. The chances of these outcomes being realised was put at about 80-90%. Success following hip replacement, with its shorter recovery period, is about 95-99%.

What a huge decision to make! I have young children and knew that it could take up to three months before I could look after them again. Being non-weight bearing, and then learning to use my leg again with a crutch or stick, meant that I wouldn’t be able to care for my children or my home properly for quite some time. Practically, my Mum offered to move in to look after the children, with my husband taking on responsibility for my care, whilst also working as normal. I couldn’t be more grateful to my Mum, but it was a huge upheaval. The children would need to share a room, to make space for Mum. I would probably be bed ridden, or at least very immobile for some time. How would I get to cuddle and play with my 2-year old, if I was worried about jarring my healing hip?

I was also scared about the surgery itself. I have had two emergency Caesarean sections so have been under anaesthetic before, and I know what it feels like to be on morphine, and to be woozy and confined by my own body. I was also scared about infection, about hospital superbugs, and I was also concerned about going under general anaesthetic. What if it went wrong? There was a risk, albeit a tiny one, that I might not wake up. There seemed to be the potential for so many complications. It was frightening.

But, despite all of this I couldn’t get out of my head the prospect that after I had recovered from a PAO I might never need to have another hip procedure again. I might even be pain free for the first time in years. I could do so much more with my children, I could live a fuller life, and it would all be with my own bone.

I had great faith in Mr Apthorp. I trusted him and his team, who all seemed to be very knowledgeable, highly competent, and caring. With this at the forefront of my mind, and after massive discussions with my whole family, I took the plunge. I was thirty-three years old.

Preparing for Surgery
About a month before my operation (which was arranged for about 3 months after I had given my okay for the procedure) I had to attend a ‘hip clinic’ at the Conquest hospital. I also had to have some medical examinations to assess my health and fitness.

I now know that the hip clinic was a waste of time. I was in a session with patients who were going for hip replacement surgery. We were shown exercises that we had to do after our operations, and I immediately realised that these were weight bearing. I explained to the physiotherapist that I was having a PAO, and she didn’t seem to know what it was, or what she should be showing me. She decided that I shouldn’t be given crutches (unlike everyone else, to practise walking at home before being admitted to hospital), as I could learn to use them in hospital. I was then sent away. A few hours later I got a message on my phone to say the physiotherapist needed me to come back as I should have been given a DVD to watch, and they didn’t realise. So, I returned, and had to sit through a ‘knee clinic’ before watching a generic DVD on how to inject anti-blood clotting solution, after the operation. I also saw the occupational therapist who took details of my bed, chair and loo measurements at home, so that alterations could be made to these, to make them suitable for me when I returned home after surgery.

I then went to have my medical assessments (blood taken, height and weight, blood pressure and heart rate measurements).

I wasn’t given any advice at all on how to mobilise myself when one leg was non/touch weight bearing. At the time this wasn’t a problem, how could I know what knowledge was needed? I now feel let down, as I can see how much information I should have been given, to help me adjust to life in the immediate aftermath of a PAO. More on that later!

The operation
I was so scared the week before the PAO. I had packed my bag and made my decision, but was terrified of what lay ahead for me. I was dreading missing my family. On the night before, my Mum had moved in, the kids had moved bedrooms, my husband and I had moved into the room next to the bathroom. The occupational therapist hadn’t sent any equipment to our house. I thought that was normal.

I had to wash myself the night before in a solution to prepare myself for surgery. This was repeated the next morning. My husband and I woke up at 5am to get ready. We had to be at the hospital for 7.15am, and it was an hour and a half’s drive away. We set off nervously, driving through the dark, to find the surgical unit was all but dead – lights off, reception unstaffed. It was all a bit eerie. But, at 7.15am the place had sprung into life and I was shown to the Cookson Attenborough ward and given my own bay. The current cohort of patients was just waking up. They were all older than me, ranging from about 60-80 years.

Various people came to see me that morning – the nurse, the anaesthetist, and Mr Apthorp. At midday I was wheeled through to the operating theatre. I became very, very cold at that point, shivering uncontrollably. I was given several warm blankets, and told that it was probably just nerves; I was in a mild state of shock. I waited on the bed for a while and then was taken into a small room to be anaesthetised. I don’t remember anything at all after that.

Eventually (at about 4pm) I became aware of a lady calling my name repeatedly. I fought hard to try and wake up. I was in recovery. Once I had come round properly, I was brought back to Cookson Attenborough where my husband was waiting for me. It was over. Thanks goodness. I was so relieved.

The aftermath
I was hooked up to liquid morphine, had a catheter in, and because of low blood pressure I was put on a drip to get fluid into me. The first day after the operation is a bit of a blur. I remember sleeping a lot, and I know I had very low blood pressure. I was in bed the whole time. I had a little bit to drink but didn’t want to eat for the first few days. I felt woozy, nauseous and very tired and numb.

As soon as I could manage it, I kept a log of my symptoms and recovery. See below:

Day 1
October 8th. Little recollection beyond what is recorded above. Slept a lot.
Day 2
Felt grim – sick and light-headed. On liquid morphine. In bed all day. My feet are connected to foot pumps to prevent DVT. These are strange. They periodically punch (gently) the soles of the feet to keep circulation going.
Day 3
I asked to come off the morphine drip today. Fed up with feeling sick and weird. I also got out of bed and used a walker to go to the loo. Came back on crutches. Had the catheter taken out. Was given synthetic morphine to try – Tramadol – but I only had two doses as I still felt sick. Light-headed. Drinking loads of water to flush everything out of my system and to kick start my waterworks. By the end of the day I had also tried going up and down stairs on the crutches. Scary, but I need to learn as I live in a three storey house!
Day 4
Am now only using paracetemol and voltarol for the pain, and am also taking iron tablets to get my haemoglobin count up. I am walking to the loo on my crutches every couple of hours. No sickness today, and managed to sit in the chair for a longer period. My leg feels stiff and achy but not particularly painful. This is a big surprise!
Day 5
Sunday and I am going home. Jay picked me up in the car and drove me very carefully the hour and a half back to our house. Was brought up to the bedroom, which needed rearranging until it was right for me in my new immobile state. Was great to have my hair washed. Felt cold and tired. Now have 6 weeks at touch weight-bearing before I can try out my new hip. But I have lots of exercises to do at home in the meantime. It was wonderful to see the children again. Jason has been with me every day, but I really missed my little ones. No more voltarol.
Day 6
A difficult day. Felt shivery, cold, dizzy and very uncomfortable today. Remained in bed for most of the time. I have really sore bruises now, around the hip, and on my arms from all the needles. My bum is sore from sitting in the same position.
Day 7
I’m trying to organise a chair with the OTs. They had my bed raised before I got home, and provided a loo seat. But they didn’t sort out a chair for me. Eventually we got our local OT department to provide raisers for my chair, plus a perching stool for washing in the bathroom. They were very helpful. The OTs at the Conquest phoned to apologise for their lack of organisation and attention to my needs. Apparently this should all have been sorted before I even went to hospital so that I had everything here on my return. The last two days have been difficult and it has been a headache for Jason to have to deal with. At one point the OTs at the Conquest suggested he go trailing round charity shops to find a second hand orthopaedic chair! Do they not think he has got enough on his plate caring for me at the moment? Still, now that I have a chair I am so much more comfortable. Just to be able to change position is joy. My bruising on the hip is now jet black with elements of purple and yellow in places. It is the size of a dinner plate. I didn’t think about being bruised, but when I consider what was done to me, it stands to reason. Very tender though.
Day 8
October 15th. Sitting in the chair for long periods. I feel headachy and tired but more like me. I’ve been getting bored. I am not used to this pace of life. Jason put a TV in my room to help entertain me.

I have to take Clexane every day (an injection in the tummy to prevent DVT). I find it quite painful (even though Jay does it for me) because I don’t have much tummy flab. However, I have been given so much chocolate by my lovely friends that I am going to try and cultivate a spare tyre to make them easier. Fab! Sitting around eating chocolate all day? Maybe there are some benefits to all this.
Day 9
I sat up all morning, and even managed to go downstairs (with Jay holding my waist for support) to have a coffee and a change of scenery. I opened the window and had some lovely fresh air. I managed to get upstairs okay, but I do wish I had been given crutches before the operation to practise with. It is very tough using the stairs when I feel so precarious on them. Again, this was an oversight of the OT and physio team apparently.
Day 10
Every day I have to have a full body wash from a bowl of water, as I don’t have a walk-in shower. Jason had been doing this, but Mum did it for me today. I feel like a little girl again!

My tummy area is still swollen with, what I have read, is soft tissue damage bulging at the top of the pubis area. But the bruising is changing. The blackness is dissipating somewhat. I am trying to stand and walk about more. Went downstairs again and had a game of scrabble. I love getting off the top floor each day, as it is so important to have a change of scenery.
Day 11
My brother and sister-in-law came down to look after the children so that Jay could visit his Dad (recently diagnosed with cancer). My hip is being quite clunky still, especially when I stand up from sitting. I made it down to the bottom floor this evening, and then up to the lounge to watch TV and then up to bed. The most stair work I have done. I went to bed with a throbbing hip though, so exertion obviously causes pain.
Day 12
My sister and her boyfriend came to visit and play with the kids. Nothing symptomatic to report. Still need a daytime sleep each day.
Day 13
The District Nurse came today, so the dressing on the wound was removed and I got to see the scar for the first time. She said it looked well healed and neat, and took out the staples. I have to say that I am amazed. The top of the scar is like a very fine line, and there is no numbness or loss of sensation around it. The bottom of the scar reaches the top of the pubis, the top of the scar is roughly level with the top of the pelvis. It is big but there really is very little damaged tissue. It’s amazing.

I went down by two paracetemol doses today. I took 2 at 7am, and 2 at 3pm. I want to cut back as I don’t feel in particular pain. I also read a book about healing and bone regeneration today. Fascinating. Apparently by this stage a spongy bone will have formed to ‘fill in the gaps’ in the cut pelvis, so I probably have a complete socket by now. It then takes 2-3 months for the new bone growth to harden, densify and provide stability.

Did some work today. I felt like I could concentrate so I managed to get marking done and worked on my laptop. This is very pleasing.

I hate the puffy bits around my middle. I hope they go down. I’m trying to massage them a bit.
Day 14
Had 2 paracetemol at 2 in the morning, and then didn’t need any more until I went to bed tonight. I’m not being brave I just don’t really have any pain. It is just a dull ache.
Day 15
October 22nd. I lost my footing this morning and had to put my left foot down to steady myself. I don’t think I put too much weight through it, but it really scared me and hurt. This afternoon I started to feel sore near my scar and when I touched the scar I could feel the head of one of the screws. I don’t remember feeling it before and am worried I have dislodged it. Having said that it could be that I’m only feeling it because the swelling has gone down and I am lower on pain-killers. I think the screws are titanium so I don’t think they are likely to bend so readily. I took 2 paracetemol and went to bed to rest for the afternoon. I got up to see my parents-in-law who came to visit. Managed to get downstairs. Jay’s Dad looks frail but bright. We swapped a few stories about being an invalid, but I have got it infinitely easier than him. I feel very lucky that I know my situation is short-term and relatively painless. It really makes me think about all of the disabled and housebound people in the world who have no choice but to put up with far worse than me, and forever.
Day 16
Started new exercises today that can be conducted from a standing position. I have to move my leg to the side and then behind me. I can do it with no pain, but my flexibility is laughably low now!
Day 17
One of the nice things about sitting around all day is the amount of reading I can do. I am ploughing through novels that would normally last a month or so!

My muscles around the hip still hurt when I laugh, cough or sneeze. But I am now off paracetemol completely. I can’t believe that I now need no pain relief. I thought my recovery would be agonising. But it isn’t.

I go downstairs every evening or at least once a day but the stairs are still the scariest thing I do. I don’t have a banister to hang on to, so potential for slipping or losing my balance is high. I don’t go down unless Jay helps me.
Day 18
I looked on the internet to try and get some advice on what I am allowed to do. I don’t know if I am allowed to bend down, whether I can do more exercises, if I can lie on my side yet, etc. But there is an absolute dearth of stuff. However, I found a site with suggested exercises for people still fairly immobile after hip replacements. It said that I should aim to move my feet in circular motions 20 times an hour, to tighten the thighs at the knee 10 times an hour, and to squeeze the buttocks 5 times an hour. I did read about ‘touch weight bearing’ and the importance of ‘walking’ through the injured leg. By mimicking walking (by putting the foot on the floor, but not actually pressing on it) the joint and muscles heal better. I must admit that I often let my foot hang suspended, and use my crutch as my leg. This is bad practice apparently. So I am now consciously trying to amend that.

Apart from that I am stuck in the some situation and erring on the side of caution. I found some blogs where PAO patients are doing a lot more at this stage, some even trying to weight bear. But I won’t push my healing and I think it’s foolish to try and weight bear when the bone is still so spongy. It could cause all sorts of problems.

In terms of numbness I now have feeling mostly everywhere, and no problems with my quad (I have heard that in about a third of cases the quad suffers permanent nerve damage). The only area that is still numb is half of the pubis area, pretty much where I was shaved, and up to the groin crease.
Day 19
This morning is the first time I have been ‘left alone’ as a trial run for when Jay returns to work. I was left a jug of water and a flask of coffee, and a phone. Mum took the kids to Blackberry Farm and Jay shut himself in the office, pretending to be away, but there if I needed him. I coped fine. No problems at all. Jay will work from home for the next few days and then will start going back into the office.
Day 20
I left Mr Apthorp’s secretary a message yesterday and she called me back today. I asked her about the things I can do, but she agreed that I should continue to be cautious. I can bend if it is comfortable, but I need to be careful. I can lie on my side with a pillow between my legs, but she warned it can be very uncomfortable. So it looks like I have reached a point of plateau. I just have to sit tight until my 6 week check and allow the hip to heal.
Day 21
October 29th. Walking through (by touch weight bearing instead of non-weight bearing) has helped reduce the clunking I was getting. I also feel like it helps the circulation and the muscle tone. At this stage my main problem is the cold. I get so cold sitting around and my feet are freezing. At night, despite a thick quilt, socks and PJs I often wake up shivery and have to put on a cardigan. I simply don’t move in bed (apart from raising my knees occasionally). Weirdly my body goes into a sort of muscular stretch a few times a night. I wonder if this is at times when I would normally shift position?

It is three weeks past the operation now, and three weeks until I am allowed to weight-bear.
Day 31
November 9th. Four and a half weeks in. Practically all of the swelling has gone. The numb area in the pubis is still numb. My bruising has gone. The scar looks really good but the staple dots are still visible. Generally I am comfortable and used to my new pace of life. I have one week of Clexane injections left and less than two weeks until my check-up. The Clexane is better since I got a bit more fat on me, but I still hate them! The chocolates and flowers just keep coming though. I have some lovely, lovely friends and family, who keep me well stocked up, and lots of gifts of magazines, books and puzzle books come in really useful. I have been loaned a DS-lite for brain training too!

I have far fewer clunks and clicks in the hip, and I move about so much more in the day. If I don’t I get a swollen foot and calf. My muscles twinge if I accidentally put a bit of weight through the leg, or if I cough, sneeze or laugh.

I am trying hard with my exercises and making slow progress with the one that involves moving my leg to the side when sat on a bed with the leg outstretched. I find that difficult but am slowly getting there. The others are all fine. I still haven’t had a period since before the operation. Does surgery affect hormones?

Everyone is tired, and the novelty of the situation has worn off I think! It’s tough on everyone around me, having to care for me. I can’t wait to be able to pitch in again.