The Joy of Modern Surgery #1

Why I needed major surgery.

I recently had major surgery. After years of dealing with the pain and limitations, I had my first total hip replacement. I get to have my next one in October, replacing my really really bad hip. Having two bad hips at a relatively young age is a bit strange.

My surgeon told me I was too young for this. He inquired if I had been in an accident. I was at least 15 years younger than everyone else at the hospital in the orthopedic unit. So here is the story of how I needed 2 total hip replacements at a relatively young age.

When I was a kid I really didn't protect myself from injury. I jumped off buildings and out of trees, ran my bike into a moving car and never rested and recovered much. I played sports as a youth and in high school, and would return to play long before the doctors recommended.

I never broke a bone, though I should have many times. I did damage the soft tissues a lot, with sprained ankles, broken noises, and pulled muscles. The childhood injury at the source of my hip was playing soccer on wet grass with slick shoes. I was 15.

My sister's fiance, Joe, and I were in kicking s soccer ball in the park behind our house. I wasn't even wearing athletic shoes. The grass had been watered not long before we went out. It was Joe's idea, likely just wanting to connect with his fiancée's little brother, I guess (I was about 6 foot, so I wasn't that “little”).

My leg shot out to my right and I did the splits the way no man or boy should ever do. The pain was immediately extreme. Somehow I got up and made it to my house about 200 feet away and into my bed. I didn't move for hours.

That night, my father came home from work and wondered why I was laying in bed, screaming. He took one look at me and carried me to his car and drove me to the Emergency Room. ER took some X-rays and said nothing was broken and everything should be good long term without surgery. They gave me Tylenol with codeine and sent me home.

I don't remember if I even stayed home one day from school. I do remember some kid mocking the way I was walking the few days later. Walking was different, but I didn't want to let it hold me back. After a few days, I had largely overcome the injury and moved on.

For the next few decades my hip would hurt with substantial physical activity. I got used to it. I still played high school sports, hiked up mountains and down canyons, including the Grand Canyon, won dance contests, worked out, moved furniture, etc.

When I brought it up with doctors, they always asked, “Is it interfering with your life? Are you in too much pain to function?” My answers were always “no” and “no”.

Twenty years ago I took the deposition of an orthopedic surgeon regarding some alleged construction defects in his home. One of his claims was that mold from the construction defects in his custom home prevented him from doing as much medical research. I asked a number of questions to understand what he was doing.

The doctor worked with a medical device company as a researcher. He was one is the developers of the “micro hip replacement” and he spent hours every night evaluating cases to get approval and move the implant off the experimental stage. With the alleged mold, his head hurt and he claimed he couldn't do anything.

During a break, I asked him about my hip and whether I should look into it. He told me how much better the procedure was at the time and how the recovery process had gone from 6 months in a body cast to a month. He told me that everything was improving with hips and that the longer I could wait, the better it would be. He advised me to wait until I couldn't live my life anymore.

In the years after that I lived my life without limits. Sure, my right hip hurt regularly, but not so much that it interfered with my life. I never thought it was broken just damaged. I periodically would bring it up with doctors, but they just didn't think it was time.

5 years ago I was in excellent health. I went to the gym often, walked miles on a regular basis, and could lift and do anything, except run. Running hurt too much. I even hit a thousand pounds on the leg press.

Four years ago I first noticed I always grabbed on something to stand up. 3 years ago I noticed that walking had gotten much more difficult. 2 years ago I had difficulty on a hike. A year and a half ago I noticed it hurt a lot to walk to the back of a grocery store if I didn't hold on tightly to a cart. I had just accepted that I was having issues that were getting worse, but it took months to accept that it could be really bad.

I finally went into the doctor to start looking into the issue last November. My doctor sent me for an x-ray and said I had “severe bilateral osteoarthritic hip dysphagia”, or two broken hips. I didn't understand what that meant at first. I was a bit shocked. I had no idea it was that bad.

She said that it I would likely need 6 months or a year of physical therapy before insurance would approve the surgery. I started physical therapy and my physical therapist related much of the same, and discussed that she had replaced a hip a few years earlier and was back to work in 2 or 3 weeks.

My primary care doctor referred me to an orthopedic surgeon. I got in to see him right away. When I mentioned the reason for the consult, the receptionist said, “Oh, I didn't know he did those.” Not a good sign.

The surgeon took one look at my x-ray and said I needed immediate surgery and that I could get it the next week. I was a bit surprised as I didn't think it was that bad. I knew it wasn't good but this seemed excessive. After all, I walked in from the parking lot without using any device to support me.

The surgeon reassured me it was really that bad. He discussed that my left hip had been prematurely worn out because my right hip was so bad. I was still shocked.

Later I met a guy who was not bad enough off to get approval for this surgery, but had been on disability for a decade. That I was in much worse condition but working daily seemed crazy.

Several people mentioned this other orthopedic surgeon. He is extremely busy. It takes months to get a consult. He uses a different technique than most doctors.

Most hips are replaced with the posterior method. The surgeon goes through the back of the upper thigh, cuts through muscles, and then cuts out the old bone and implants the new ball and socket.

The anterior method is newer, about 10 years old, and requires a much more skilled surgeon. The surgeon goes through the front of the upper thigh, moving away the muscle. The surgeon then cuts off the ball, cleans up the socket, and puts in the implant. Recovery time is generally shorter.

After some consideration, I went with the second surgeon. It required a longer wait for the consult and surgery, but I will discuss that in my follow up post.