Reflections on hip replacement surgery – getting fit again!

Just under a month ago, I underwent hip replacement surgery.  However much I tried to find out about the actual surgery and the “getting fit again” process beforehand, the reality was somehow not quite what I had expected, and so I just thought I would note some reflections here for anyone else considering, or undergoing, this amazing operation!  The two most important things to say are that:

• It is an amazing operation; and
• It’s really important to remain positive throughout the whole recuperation process, which is why I am calling it “getting fit again”.

So, in the first place, why should one consider having a hip replacement?  Quite simply, in my case, the increasing pain from osteoarthritis was making life ever more painful and difficult, waking me up at night and really making it unpleasant to go for long walks, let alone runs or skiing!  Everyone said that the operation would transform my life, and the brilliant consultant with whom I spoke reassured me that this would indeed be the case.  However, here was my first challenge: at only 60 I felt really quite upset that my body was beginning to need such interventions.  I still felt young, and it was really difficult to come to terms with the implications of aging.  So, this was where it mattered to be positive, and to look forward to seeing all the things that a new hip would enable.

As the time drew closer to the operation, I also remember feeling very ‘strange’ about the idea of part of my body being taken away and replaced by a metal and ceramic “new hip”!  I hadn’t expected to feel quite like this, but the loss of “integrity” was something I had to come to terms with.

I’m sure that many things helped me address my concerns in the run-up to the operation: the assurance and matter-of-factness of the surgeon, the care taken by the nurse to reassure me during the pre-operation discussions, and the advice given in advance as to the exercises I would need to do.  One key message for the “getting fit again process” was that the angle between my back and my thigh should never be less than 90 degrees for the month after the operation.  This necessitated getting various bits of equipment, not least a raised toilet seat, a long shoe horn,  a grabber to pick things up with, and a sponge on a long arm for the shower (all shown on the adjacent image)!  Several people advised that I should get other equipment, but these four items were really all that was needed.  The final preparation was to make sure that I had a seat with arms that was high enough to ensure that my knee was lower than my hips when I sat down- again the 90 degree rule!  This actually proved to be quite a challenge, because we did not have seats with arms, and all were too low.  The solution was to get an old office chair that could be raised to the right height, and move it around the house.  Hard cushions for raising the level of seats outdoors were also essential!  I have to confess that I hadn’t realised the importance of chair arms, but normally when one gets up from a seat one leans forward, and that would mean the angle between back and thigh going well below 90 degrees!  So, I had to learn how to get up from sitting by pushing on the chair arms!  Incidentally, another rule was never to cross my legs for five weeks after the operation – again, not easy to obey, especially towards the end of the time once the pain was less.

So, with all the preparations complete, but still with much trepidation, the day of the operation came.  As ever when one goes into hospital, lots of tests needed to be done, and so there was much waiting around.  I just wanted to get it over and done with – but watching a test match on TV helped to pass the time away.  I wasn’t quite ready, though, when the anaesthetist asked me what kind of anaesthetic I wanted: a spinal block, or a general anaesthetic.  My immediate reaction was that I quite fancied the spinal injection since I could watch what was going on, and it served to reduce the pain in the immediate hours after the operation!  However, he made two observations that changed my mind: the first was that I really should not try to interfere in the operation, and I just thought that I could get so interested that I would be asking questions as to what was going on; and the second was that I would need a catheter, something I really did not want, but more about that later!  So, I opted for the general anaesthetic, and woke up a couple of hours later!

It is not easy to recall exactly what I felt like when I woke up, because of the drugs I was on to reduce the pain, but the after-effects of the anaesthetic gave me a rather blurred sense of reality!  I’ve not often had general anaesthetics before, but as on previous occasions they left me feeling rather “low”, and this time was no exception.  I was also plugged in to a drip, a drain, and something to help my breathing!  However, already as soon as I woke up I felt a different sensation in the hip.  The horrible aching pain deep inside was replaced by a much sharper pain on the outer part of the hip, and around the incision that had enabled the surgeon to do the operation.

However, there was no time to rest.  As soon as I was awake enough my new exercise regime kicked in!  My first night, I stood up only five hours after the operation; the next day I was walking on crutches; and the next day I could take a couple of paces without crutches.  After only four nights in hospital I was released.  All of the hospital staff were amazingly supportive, and the physiotherapists made sure that I went for short walks every day as well as doing my exercise regime three times a day!  Again, this was where being positive made such a difference.  I was indeed determined to get fit again.  It was, though, very strange, because this involved having to think consciously about how to walk again.  The operated leg didn’t seem to want to do what I had previously taken for granted, and I really had to think about how to walk!  This involved (I think) kicking the leg forward consciously onto the heel and then rolling onto the toes.  Another tricky and indeed quite painful thing was learning how to get into and out of bed! This involved standing by the bed, pushing the operated leg slightly forward and then sitting down, before swiveling round towards the un-operated leg side,  lifting that leg first, and then trying to get the other leg into bed!

The pain of the operation, though, was nothing compared with the difficulty and pain I had in peeing!  The anaesthetic had made it difficult for me to go to the loo, and my bladder filled up to such an extent that they were concerned that this could affect the hip.  So, I had to have a catheter drain put in the second night just to release all of the urine! Unfortunately, it did not prove easy to put this in (several attempts were necessary), and so once it was removed I was in considerable pain.  Of course, this caused very much greater pain when I tried to pee again!!!!  For anyone who has not experienced this, it is difficult to describe, but the nearest description is something like razor blades cutting me inside when I tried to pee.  Of course this in turn meant that I had an uncontrollable reaction that made me stop peeing, and so my bladder filled up again, meaning that they had to insert another catheter.  All I can say is that the pain of trying to pee was very, very much worse than the pain resulting from the operation, and if I hadn’t had the catheter problems I would honestly be saying that the pain of the actual hip replacement was really relatively minor, and very much less than I had expected!  It took a good fortnight before I could go to the loo again without pain.

Once home, the exercise regime started in full force, and it is here that my determination to do all of the exercises and focus on “getting fit again” came into force.  I felt exhausted and totally disinterested in doing anything for the first few days, but having to do the exercises three times a day gave me some focus.  Learning to walk properly, first with two crutches and then with one took some time.  I was doing two 10-minute walks a day by the second half of the first week, rising to two 15-minute walks or one 30-minute walk by the start of the second week, and then regularly doing at least 30 minutes a day by the beginning of the third week.  I had been determined only to use one crutch by the second week, but found that I walked with less of a limp if I used two crutches for balance.  Still, it really is not easy to walk properly again even now, 26 days after the operation, both because of the lingering aching pain, but also just because the leg will still not do quite everything it is told to!

Another positive thing has been the opportunity to go “swimming” especially on hot days.  I must confess to being someone who prefers baths to showers, and not being able to have a bath for five weeks has therefore made me long for a nice hot luxuriating bath when I am again allowed to.  However, being able to do my exercises in a swimming pool adds a different experience to the “getting fit again” routine, especially since the water takes the weight of the body and actually enables me to do much more.  If I am very careful in how I use my new hip, I can also swim gently, which is very liberating!

For anyone concerned about the size of a hip replacement wound, and how quickly it heals, I have been amazed at the pace of the healing process, shown in the adjacent pictures, with the left one being the bruising after 8 days, and the right one showing the wound (much closer with most of the bruising having gone) after 16 days.  The wound itself is only about four inches long!

The biggest challenges have been sleeping, dealing with the ever slowing pace of recovery, and having to wear compression stockings.  One thing about hip replacements is that you have to sleep on your back for about five weeks after the operation (the same rule as not crossing your legs!).  For those of us, like me, who are used to sleeping in other positions this can be a real challenge – especially since I am not a good sleeper at the best of times.  I also found it difficult in the early stages to deal with the pain at night (despite pain killers and the occasional sleeping pill), and only now after three-and-a-half weeks am I beginning to get back into anything like a vaguely normal sleep pattern. Being so tired means that I don’t have the energy to do all the things I want to, and so there is a tendency to fall into a downward spiral.

Then, the pace of recovery also slows down with each day (a kind of negative exponential curve), and I find this quite difficult to deal with.  In the first few days, I felt I was making huge progress very swiftly, but by the end of the second week it became more difficult to see regular improvements.  I know I am continuing to get better on a daily basis, and have now started walking completely without crutches all day, but the dull pain, and the inability still to do many things is incredibly frustrating.  This is much more of a psychological thing than a physical one, but having been “out of action” and not able to drive or do much for myself is very wearing.  I just want to be completely fit again so that I can be revitalised and use my new hip (shown adjacent!) to its full potential.

Having to wear compression stockings to prevent deep vein thrombosis (DVT) is also very wearing, and in hot weather it is incredibly uncomfortable – again especially at night.  I had not previously realised quite how serious concerns over DVT were with hip replacements, and not being allowed to fly long-haul for three months afterwards has certainly caused some considerable problems with respect to my work commitments.  However, on a more mundane level, wearing the stockings to help prevent DVT is very frustrating, and still requires assistance since I cannot bend down to put them on!

So, a real tip for anyone facing this operation, as indeed with many other operations, is that it’s very important to find especially nice things to do during the recovery period.  I have found that having very special things to look forward to helps immensely (such as visiting Windsor last week), because it gives a sense of purpose and pleasure when the pain and tiredness have a tendency to become overwhelming.

Finally, I just want to pay tribute to the amazing surgeon, anaesthetist, nursing staff and physiotherapists who made my stay in hospital such a great experience, and to everyone who has helped care for me and keep me up-beat over the last three weeks.  I am really looking forward to continued progress, and really being fit again!

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