The hip replacement is doing fine. Where to next?

July 25, 2020, San Francisco, California

My hip was replaced a little over a month ago. The recuperation has gone better than I expected. I have been riding my bike in the street for over a week now. I have more strength, climbing more challenging hills with no pain at all.

A year ago, my surgeon told me I needed a new hip. My options at that time were; replace it now, or get a cortisone shot and continue to use my original hip for a while longer. He said the shot may give me six months, if I was lucky. (I made it work for ten months, but clearly the last three have been tough.) He told me the success rate on hip replacements were 95% on average. It would be better than that in my case, because I am younger than most people in this predicament.

Then, the idea forming in my head was that there was a small chance that the hip replacement would go badly and I would be spending the rest of my life in a wheel chair. So, In August 2019, I decided to take the cortisone shot and travel the world for as long as I could. When I could no longer, I would get my hip replaced. In the unlikely case of being wheelchair bound. At least I would have some memories of traveling the world by bike.

It is difficult to express my deep appreciation of the technology that exists, and the highly skilled team that has made this technology available to me. My friend Sandy frequently says ” We are the luckiest people on earth”. I am in complete agreement.

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In the pre surgery image the right hip shows a normal layer of cartilage (at the blue arrow).  The x-ray image shows this as a gap between the bones.  This is completely absent in the left hip. There the cartilage has been abraded away by the arthritic femoral head. As a result the left leg bone had pushed its way up into the hip socket and was bearing bone on bone.  As a result, my left leg had become shorter over time, by more than one centimeter.  Post surgery, the artificial hip holds the left leg bone in its correct position.  As a result, my two legs are once again the same length.  
The horizontal dashed white line shows that the two leg bones are aligned post surgery.  A displacement of one centimeter is seen in the presurgery case (green spacer)

There are a number of variations on this procedure. The one I had did not involve any adhesives. The bones were machined to receive parts that are press fit into the machined features. The way it works is that my body will over time cement the parts in place. There are other healing processes going on that also take time. So, I was told not to rush getting back into shape. It may take a couple months. The best indicator that things are going properly is the absence of pain.

The big failure modes are luxation (movement of the artificial parts relative to the attached bones), and hematoma. There is also a possibility that the artificial hip can come apart, though not very likely. I was given lots of reading material detailing what movements are safe, how to climb stairs properly, etc.

When I awoke in post-op, my legs were still numb from the anesthetics. This wore off over the next hour. Within two hours I was walking under my own power albeit with a walker, and a PT nurse at my side. I took a lap around the hallways and climbed some stairs. I used the men’s room to take a leak, and was told I was ready to go home. Lucy joined me and we took Uber back to my place.

They sent me home with powerful pain killers. They told me that I might need them in a day or so, when the anisthetics are fully cleared. I never did. The biggest problem I had was an accumulation of lyphatic fluid due the healing of the incision. Lucy has some experience with this from work she had done in Santiago, Chile. She was adept at clearing the excess fluid with massage.

In the following weeks I was getting lots of exercise. My friend Tina explained that the lymphatic fluid problem is made worse by more exercise. The PT staff at Kaiser confirmed that more exercise will result in more lymphatic fluid. They also said not to worry much about it unless it is building up. It never did, though I was getting massaged three times a day by Lucy.

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After covering some of my favorite training rides near home. I met my riding buddies for the Saturday ride in Woodside. This has yet more climbing which was not a problem on my light weight Carbent Raven.

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Getting comfortable on my racing bike was a good step. The real challenge was the Azub recumbent tandem. It’s true that Lucy and I have logged thousands of kilometers on this bike, but it has been five months since we have been riding it at all. I was worried about the learning curve. As you may recall last January Lucy and I spent about a week riding it before we could go a single day without dumping it. With my new hip, I didn’t want to risk serious injury.

At first we were finding non-challenging rides to get our routine back. It was less than a week before we took it across the Golden Gate Bridge and down into Sausalito to explore all the neat places there.

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After lunch and a tour of Sausalito, we took the ferry back to San Francisco. We rode the tandem up Market Street through the center of town. It reminded Lucy of riding in Bangkok. I was not at all frazzled as I was in Bangkok. This town is my home. I know the rules.

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At this point, I think it’s safe to say there is no wheelchair in my immediate future. Except for some issues with the pandemic, the path forward is clear for me. Now, I need to go out and create more memories. But where?

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