Physio turns Patient! My Experience undergoing a Total Hip Replacement
Never did I imagine that I would be lining up to have a total hip replacement at my age. I am very aware that I am getting older but it still feels a bit out of place.
I thought it might be helpful to give my account of going through this procedure, what I found hard and what I also found useful in the hope that it may help others when faced with an impending joint replacement.
How did I develop Osteoarthritis in my hip?
There are several factors involved in this answer. I played a lot of hockey and sport when I was younger but had a change in sporting direction when I went to Dunedin for study. I got involved more in running, which then transitioned to triathlon and then eventually focused more on cycling. I was lucky enough to be able to take this a step further and race professionally overseas for a number of years. As tends to go with the territory, I had a few crashes during that time. No broken bones but I do remember always landing on my right side and one crash ended in my hip getting pulled out sideways. This resulted in a labral tear (protective lining for your hip that helps with joint stability). At this time, I also found out that I have particularly shallow hip joints (borderline Hip dysplasia).
The combination of all these factors results in decreasing the stability of the joint, the labral tear exposing the joint surfaces leading to cartilage damage and essentially the start of osteoarthritis.
At the time of the initial injury the hip was quite painful but eventually settled and I was able to run, cycle, tramp, play with the kids and swim. Only in the last couple of years has the above all caught up with me, where I developed pain and restriction of movement leading to limitation of activities and sport.
Deciding to go ahead with surgery
My choice to go ahead with the surgery was made around the thought that my hip was only going to be get worse, more dysfunctional and it was getting hard to keep the area strong. I did some research on the different procedures and opted to go with an Anterior approach (DAA) rather than the more traditional posterolateral approach. The Anterior approach has a faster recovery, less post-surgery restrictions and is more stable overall. It also doesn’t disrupt the gluteal muscles quite so much, which is a good thing.
I was anxious leading into the Surgery, not really knowing if I had made the right decision, not really knowing what it was going to feel like afterwards and as is always the case with surgery there can be complications. It also doesn’t pay to watch or think too hard about what the procedure involves and just leave that up to the surgeon!
As a Physiotherapist turned patient… here are some of the key things I learned from this experience:
- Don’t delay too long in making a decision. Don’t wait so long for the surgery that your world becomes narrower due to the limitations in function, pain and the dysfunction you start to develop such as moving differently. The more severe the osteoarthritis (OA) becomes the unhealthier your muscles and tendons become, making it harder to get a good post-surgical outcome. I have done a bit more reading around this area lately and it appears that we should be doing surgery at stage 3 rather than 4 OA because of the changes that start to take place in the muscles that can become irreversible.
- Get into your ‘Pre-hab’. Strengthening and conditioning the area as much as you can prior to the surgery will help with recovery for the affected and the unaffected leg.
- Old sayings ring true: “Patience is a virtue.” “Time is a healer.” Healing takes time and I think it is helpful to think about progression in terms of weeks rather than days.
This also applies to time with crutches. I was a little surprised at how long it took before I felt like I could lose the crutch for good – 4 ½ weeks. I did have a few thoughts about whether I would ever walk normally again!
- It takes time for muscle function, proprioception (awareness of where your joint is in space) and confidence to come back.
- If possible, hire a Game Ready machine for post-surgery. It is a machine that uses a wrap that then fills with cold and compression around the area and really helps with pain and swelling management – it really was a game changer for me.
- Small regular bouts of movement are helpful even if it feels weird.
- Use pain relief. Surprisingly Panadol when taken regularly really helps. You’ll be prescribed different pain relief levels depending on pain. Pain impacts your sleep and sleep is important for recovery so if you are comfortable, you will sleep, and this obviously flows onto your recovery.
- Do your exercises. I found it so helpful (both physically and mentally) when I could start doing some cycling and swimming again and slowly adding some gym work in again (mostly upper body to begin but over time more for the lower body).
- Follow up with your Physio post-surgery. Even in the early days you have lots of questions, there will be bruising in other areas that is uncomfortable and your physio can help with this. They are also very good with advice around movement, reassurance and pain modulation.
I’m now 9 weeks in and it will probably take around 18months for the new hip to fully settle in, but I know I’m making good progress and feel hopeful of getting back into being able run around with the kids, to walk some of the Great walks, Cycle the epic trails around NZ and have fun!
