My Two Total Hip Replacements
As scary as that sounds, these surgeries couldn’t have gone any smoother.
The author, completely recovered from his two total hip replacements, shows off Shintaido karate moves.
Photo by Koichi Ueda
In the fall of 2009, I noticed a pain down my right leg as I sprinted out of the batter’s box toward first base in a softball game. A few weeks later, the pain hadn’t gone away, and the iliotibial band on the outside of my thigh started to chronically knot up. Leg stretches, squats, and kicks became more difficult in my weekend Shintaido karate classes. I figured that I could manage the discomfort with more stretching at home, the use of a foam roller, and self-massage. After six months, the pain had increased to the point where I assumed I’d torn a muscle in my hip, and I went to see my Kaiser Permanente personal physician. He sent me for an X-ray and called me the next day.
“I’m making an appointment for you with an orthopedic surgeon,” he said. “There’s no cartilage left in the joint, and you’re a candidate for a hip replacement.”
In the moment it took me to process what he’d said, you could have knocked me over with a chicken wing. I was too young (60 is young, right?) to have such severe osteoarthritis. Maybe he was looking at someone else’s X-ray.
Quickly, I accepted the situation and went into research mode, devouring as much information as I could from the Kaiser and other medical websites and from my friend Danny who’d recently had one of his hips replaced. By the time I met with the designated surgeon, I knew I wanted to go with the anterior approach, a minimally invasive surgical technique that came into use in the 1980s but is still new and employed by a minority of veteran surgeons. As opposed to the more widely practiced posterior approach, a four-inch incision is made at the front of the hip, instead of closer to the buttock, and to gain access to the joint, muscles are spread, not cut or detached from the bone. Everything I’d read indicated that postoperative pain is less, the hospital stay shorter, recovery quicker, mobility less restricted, and return to normal activity swifter with the anterior procedure than with the posterior procedure.
The surgeon I initially consulted didn’t do anterior-approach replacements, so I asked if I could meet with the one that did Danny’s hip, Dr. Christopher Grimsrud. He looked at my X-ray, did a physical exam, confirmed that I was good candidate for the technique, in part because I was neither obese nor overly muscular, and explained the simple carpentry of the ominous-sounding “total hip replacement”: Cut open the leg; saw off the top of femur, which includes the head that forms the ball-and-socket joint; grind out the damaged cartilage in the socket; pound in the replacement parts—a metal (often titanium) stem with a metal or ceramic head, and a metal acetabulum (socket) cup with a plastic liner; and stitch up the incision. Cement and screws might be involved. My fear of the unknown (I’d never had major surgery) and of the risks (infection being topmost) was assuaged by Grimsrud’s Top Gun confidence, despite his Dickensian surname. Still, because the surgery is considered elective, and an artificial hip lasts about 20 years, and because I have a pretty high tolerance for physical pain, I decided to put off surgery as long as I could and let about eight months pass before I called to schedule my replacement. By then I could feel the grinding of bone on bone in my hip and I was starting to limp.
On Jan. 31, 2011, I reported to the old Kaiser Oakland hospital at 6 a.m., checked in, signed an acknowledgement that I knew I could die, or something like that, opted for a spinal block, augmented by a blissful cocktail drip of narcotics, instead of general anesthesia, and went under the knife at 9 a.m. Through the thick druggy haze, I could hear the saw, feel some pounding, and catch a bit of Bruce Springsteen’s “Dancing in the Dark” from a nurse’s iPod playlist. It all seemed to be happening off in the corner. A Tom Waits lyric came to mind: “What’s he building in there?” At 10:30 a.m., they were sliding me onto a gurney and wheeling me to a chilly recovery area, where I gradually regained my senses. A little after noon, I was in a shared room upstairs. Around 6 p.m. a nurse had me ambulating down the hall with a walker, and by about 3 p.m. the next day, after demonstrating I could pee and negotiate a low set of stairs (not at the same time), I was on my way home with a bag of medications and syringes to inject myself with anticoagulants for the next couple of weeks. The surgical wound, stitched internally and glued at the surface, wasn’t bad at all—I was taking showers after a few days—and giving myself shots became part of my morning routine (I don’t mind needles).
Little did I know I’d be back to have my left hip done. In 2011, it had shown little sign of aggressive arthritis, and after my quick recovery from surgery—back to commuting on BART to work in San Francisco in two weeks, back to softball and Shintaido in two months—I enjoyed almost five pain-free years, until I felt what I thought was a pulled groin muscle near my left hip.
“What has changed since you replaced my right hip?” I asked Grimsrud upon our reunion. “I’ve gotten better at it,” he said. “We almost always use a spinal instead of a general. We’ve reduced the medication protocols and switched to baby aspirin for blood thinning [no more self-injections in the belly fat]. We don’t catheterize you and often send you home sooner. And you’re five years older.” Yeah, well, and you’ve got a little more gray hair, I thought.
The maturity factors notwithstanding, my second total hip replacement, in the new Kaiser Oakland hospital, went even more smoothly (though I was less “conscious” of the procedure in my dream state). I benefitted from a private room with a view overnight, much better food, and an even faster recovery with greater range of motion, no use of a walker or crutches, only a couple of days on the cane, and a rehabilitation and return to robust physical activity that surprises even me.
In addition to the miraculous advances in joint-replacement, I attribute my good fortune in part to staying in decent shape over the past several decades, following a presurgery routine of core-strengthening exercise (private Pilates before the first operation), pre- and post-op therapeutic massage, ongoing karate practice with an instructor who is also a chiropractor, and, after the second replacement, adoption of a five-day-per-week schedule of classes taught by superb instructors at the Downtown Oakland YMCA: low-impact cardio sculpt (aerobics, strength, balance) and gentle movement aqua aerobics.
Good luck plays a part, too. My neighbor Vince was up and about without a cane or any other support the day after his hip replacement last fall, but my friend Danny had to have his redone because his prosthetic femur was a size too small. Another friend has some numbness in his hip due to a nicked nerve, and my sister now has one leg slightly longer than the other.
With more luck, I won’t need to have my hips redone, if at all, until I’m in my 80s, and I won’t have to take those rare complications into consideration. And if Medicare survives the next two decades, I won’t have to worry too much about costs: In 2016, I paid less then $300 out of pocket for what would have set me back nearly $50,000 without coverage.
Before my first surgery, Grimsrud warned me that I shouldn’t expect to feel like I have the hips of a 16-year-old. As I stride into the future, I’m quite happy with 67 being the new 47.
This report appears in the July edition of our sister publication, The East Bay Monthly.