Patient Case Studies
| Susan Ward Susan,
48 an occupational health advisor and
paleopathologist enjoys music, cycling
and walking.
I also enjoy rowing but I
have had to forsake the river for the
confines of the gym and a Concept 2
rowing machine. I sing in a
“cathedral music” chamber choir
and play the flute. I am also learning to
play the cello – good for the
abduction of the hips!
When I’m not advising employees in
the workplace about ergonomics,
musculoskeletal disorders and return to
work programmes following illness or
injury, I am examining the human skeletal
and dental remains of past populations
(Anglo-Saxon, Roman, and Mediaeval) for
various pathologies attributed to
infectious disease, trauma and arthritis.
A developmental abnormality of my knees
has necessitated surgery from early
adolescence. Three years ago, what I
thought to be an acute episode of pelvic
inflammatory disease was diagnosed, by a
clinical examination and X-ray, to be
osteoarthritis of the hip joints. When my
pelvic X-ray was superimposed over those
of my father (a former football
goalkeeper, who went on to have a
bilateral hip replacement), the angle of
the head/neck of our femora and
distribution of osteoarthritis was
identical. Being young and fit, although
definitely not a footballer or a
goalkeeper, I was recommended for a
“bone conserving” hip
resurfacing procedure.
|
 |
Psychologically,
I was delighted with my new resurfaced right hip.
Physically, I was still in discomfort and
recovery/rehabilitation was slow and protracted.
Referred, on the advice of my physiotherapist to
another consultant Orthopaedic Surgeon, a revised
total hip replacement was performed in October
2004. Following a “text book” recovery
in the capable hands of my consultant and
physiotherapist, I had my left hip resurfaced
successfully in February 2005.
Performed under spinal anaesthesia, I watched my
second hip resurfacing procedure on a monitor, as
my consultant gave a commentary as to his
actions. I could see (in part), and knew what
muscles were involved, and have worked on these
as part of my physiotherapy programme both at
home and in the physiotherapy department.
Within 24 hours of surgery, I was partially
weight-bearing on a Zimmer frame before
graduating to the use of crutches. I then
progressed to two and then one walking stick.
Climbing stairs took a little more effort,
especially the descent. At four weeks I was
driving my car for short distances. Foot control
of the pedals was no problem. The main difficulty
however, was getting in and out of the vehicle
and sitting in one position for a prolonged
period.
I measured my physical post-operative recovery,
not in units of time (days, weeks or months) but
rather in increased activity and accomplishments.
One such accomplishment was the ability to bend
down to tie my own shoe laces.
Finding and sustaining a comfortable position in
bed and sleeping has been a little problematic,
but in consolation, I have discovered a wealth of
interesting programmes on the World Service, care
of the BBC through the small hours of the night!
On a practical note, I benefited not only from
the use of a long handled shoe-horn and a
“sock aid” but from the use of a
walk-in shower.
Mentally, psychologically and emotionally I was
supported in my post operative recovery by very
caring relatives and friends and by my confidence
in my consultant Orthopaedic Surgeon,
physiotherapist and in the staff at Corin who had
so kindly provided me with all the relative
information about the metal-on-metal hip
resurfacing device and answered all my questions.
Not only are my hip joints pain free, I have more
movement in them now then I’ve ever had in
the past, although I’m still working on
various muscle groups. Occasionally I experience
“percussive” sounds and sensations from
the hip region which if I am taken off guard, can
be a little disconcerting. I am assured however
that this is normal and will settle in time. When
dressing for the “occasion” I sometimes
need to be selective about footwear and use of a
shoulder or messenger bag in contact with one or
other of my hips generates an unwanted ache if
carried for any distance.
I am currently waiting for bilateral knee
replacements which is restricting the active life
that I would like to pursue. However I am now
confident that my hips can and will take the
strain of the knee surgery.
I have never forgotten the consultant Orthopaedic
Surgeon who advised me to take gin and tonic for
pain control and then return to him at the age of
60 for joint replacement surgery! Thankfully my
GP had the sense to prescribe suitable analgesia
and non-steroidal anti-inflammatory drugs as
required. In an acute stage, my physiotherapist
tried acupuncture as a one-off but not no avail.
My metal-on-metal hip resurfacing procedure and
revision total hip replacement has given me a new
lease of life that was denied to previous
generations. I am immensely thankful and
privileged to have been introduced to a
consultant Orthopaedic Surgeon trained, skilled
and experienced in this technique and to have
benefited from recent advances in material
sciences, bio-engineering and orthopaedic
surgery. In occupational health practice I meet
with some employees who have not had this
privilege and whose work and life-style is
compromised by pain and loss of mobility.
Conversation with such people is satisfying if I
can refer them on appropriately or to a
recognised website (www.resurfacingofthehip.com)
for further information or I can share on a
professional level, something of my own
experience. Sadly this is too late for my
Anglo-Saxon, Roman and Mediaeval forebears who
present me with extreme cases of arthritic and
degenerative joint disease!
| Rob Hooper Rob
Hooper is a University Lecturer whose
life was becoming increasingly restricted
by severe arthritis in his hip. At the
relatively young age of 57, he made the
decision to opt for Hip Resurfacing. The
operation has changed his life.
I am a married part-time
University Lecturer with an active enough
lifestyle – principally walking,
swimming, gardening and working out at
the gym. For some years, my left hip had
become more and more painful, and by 2001
my lifestyle had become severely
restricted. I was limping permanently and
sometimes had to literally crawl
upstairs.
A change of diet and various dietary
supplements did not seem to help. Steroid
injections had an immediate but
short-term effect and it was obvious the
problem was not going to go away. My GP
arranged for an X-ray which showed severe
osteoarthritis of the hip joint. She was
sympathetic, but said I would have to
wait until I was in my mid-sixties before
I could have a hip replacement. It seems
that a conventional hip replacement has a
finite lifetime before it needs a further
operation, and that this was to be
avoided.
|
 |
My
large group of student counsellor contacts became
very useful. I spoke to them about my problems
and was given information about a new type of
procedure – Cormet Hip Resurfacing, a device
developed by British company Corin Medical. The
Internet provided quite a bit of useful
information on this procedure and how it differed
from conventional hip replacement. Less bone is
removed, and the important feature is that the
whole implant is made of metal, which means that
it lasts much longer than the plastic in a
conventional hip replacement, and is therefore
suitable for younger, more active patients like
myself.
I was referred to a local surgeon who has been
using this technique for many years. Mr Krikler
was surprised that the severity of the
osteoarthritis was not disabling me more, and
showed me the Hip Resurfacing device. We
discussed this option at length, and although
seeing a video of the operation did nothing to
encourage me (I delayed for a couple of months),
after discussion with my wife Helen, I finally
decided I wished to go ahead. With the benefit of
private health insurance, I was able to arrange
the operation at a time that suited me.
The day of admission seemed to arrive quickly,
and after frantic last minute preparations
(including some urgent but painful gardening) I
was booked into the 5-star accommodation at the
Warwick Nuffield Hospital. Visits from the
medical staff included the highly personable Mr
Krikler, and the anaesthetist.
I was naturally nervous as I was wheeled into the
operating theatre at about 9am, not just about
the operation but because I had agreed to the
whole procedure being watched by video link by
about 50 visiting surgeons from around the world!
I was “out” for one-and-a-half hours,
but two hours after the operation I was back in
my room and speaking to my wife on the phone.
It was an uncomfortable first night, but the next
morning I had my first visit from the
physiotherapist, who got me out of bed and had me
walking a short distance with the aid of a Zimmer
frame. My wife and sister visited, along with Mr
Krikler, who told me the operation had gone very
well – but I was tired, drugged up and
grumpy that day!
The next morning I was feeling more comfortable,
I was able to sit by my bed for an hour, and
started walking on crutches. Day three saw me
tackling stairs and enjoying the friendly and
attentive nursing care. From then on I went from
strength to strength, showering, receiving lots
of visitors, enjoying the sunny room and good
food.
At last, six days after the operation I took a
final stroll round the garden before packing my
bags and heading home with my wife – great
to be back only one week after the operation. The
whole experience had been better than I had hoped
for. Mr Krikler was reassuring and totally
dedicated. The nursing staff and physios were
excellent and the accommodation really very good.
Very soon I was beginning to feel the benefits of
the operation.
Helen took a week off work to help me in the
first days at home, and with a bed downstairs and
the spring sun shining, I was full of optimism
about the future. Just nine days later I strode
ahead of Helen on my crutches as we walked in the
country for the best part of a mile. I was
diligent with my post-op exercises and had plenty
of rest, which I think was critical to my speedy
recovery. But was able to do some University
marking and work with visiting students. After
four weeks I took a long train ride to Devon to
see my family, and a week later I was back at the
gym and driving my car short distances – a
week ahead of schedule! Seven weeks to the day
after my operation, I was back teaching at the
University.
A couple of weeks later I suffered from an
infection around the scar which needed careful
attention. Maybe I had rushed my return to normal
activities a little, but antibiotics eventually
solved the problem. Cleanliness is so important
after major surgery of this type and maybe the
Jacuzzi was not such a good idea!
Six months on, and with the benefit of a long
relaxing summer, I feel almost back to full
strength. I have been scrambling on rocks in
Devon and walked for miles by the Italian lakes.
I continue to look after myself with some care,
but my progress is such that I don’t have to
see my surgeon again for a whole year.
The NHS is now recommending Hip Resurfacing for
patients under 65, and I would heartily recommend
it in preference to conventional total hip
replacement. I would have no hesitation in having
a similar operation when my other hip eventually
needs treatment – hopefully a few years away
yet – and would ideally have it in the same
hospital and with the same surgeon.
| Dr Vittorio
Testa Dr Testa is an
Italian Orthopaedic Specialist, who had
to give up sports due to arthritis in
both hips. After bi-lateral Hip
Resurfacing, he is back to a high
activity level and is even running
competitive mini-marathons.
I am an Italian physician,
specialising in Orthopaedics and with a
particular interest in the field of the
Rehabilitation. Sport has been a passion
of mine for many years, and for about 16
years I was a competitive middle and long
distance runner, including marathons.
However, I stopped running in 1993
because both my hips had started giving
me problems. This had started slowly, but
gradually worsened over a period of
years, until I was forced to stop
running.
Eventually, the arthritis was so bad that
I developed a pronounced limp, and my
daily life was badly affected. I
couldn’t even ride my motorcycle
anymore – another great passion of
mine for many years. It was time to get
treatment, and I was aware of the
relatively new Hip Resurfacing
procedure through my orthopaedic
contacts. At my age (44), I was not
prepared to have a conventional Total Hip
Replacement, with the limitations that
would continue to place on my lifestyle.
|
 |
I
had heard of Mr Krikler through a friend of mine,
and was eventually booked into the Warwick
Nuffield Hospital in November 2000, flying over
from Italy the day before the operation with a
medical colleague, who was to keep me company,
and actually watched the procedure.
Because of the problems of distance, I had
elected to have both hips done at the same time
– a so-called bilateral hip replacement.
Surprisingly, Mr Krikler did not think this would
affect my recovery time. Indeed, I was sitting up
in bed the morning after the operation and
walking that afternoon. The improvement was
quick. Already I was walking better than before
the operation, and managing stairs well, although
reasonably slowly and cautiously at this stage!
Just four days after the operation, I flew home
to Naples, well ahead of what one would expect
for conventional hip replacement.
After a couple of days rest, and less than a week
after the operation, I started my rehabilitation
- this being my specialist area, I had a planned
programme prepared which I hoped would get me
back to a good level of activity in a relatively
short time. I started with swimming and
progressed to an exercise cycle, then to actual
cycling, using my mountain bike, and doing
exercises designed to improve my gluteus muscles
and generally strengthen my legs, which had not
been used like this for years.
I continued the rehabilitation and exercise
programme, was back driving less than three weeks
post-op, and back at work full-time in 37 days. I
still had some stiffness, but no pain, and
already had back about 85% of normal motion.
Today I lead pretty much a normal life, both at
work and at home. I have returned to some level
of sporting activity and once again I am able to
ride my beloved motorcycle. I do avoid
unnecessary risks, and have replaced jogging and
running with cycling. Twice a week I do a long
ride – between 60 and 100kms.
Although Mr Krikler would certainly not have
approved, in January I took part in a competitive
mini-marathon, running the 9km race in just over
38 minutes and finishing 256th out of over 6,000
participants. I have to say that gave me the most
enormous feeling of satisfaction, after almost
ten years of being unable to run at all.
I believe my physique has helped me to recover so
well (I am 1.76m tall and 64kg), and in spite of
my disability had maintained a good general
muscle tone by keeping up swimming and cycling as
best I could in the period preceding the
operation, and only using painkillers when really
necessary. I am sure this approach would benefit
other patients planning to have this operation.
My advice is to keep yourself as fit as possible,
and keep your weight under control even if your
activity is limited. That way, Hip Resurfacing
can give you back a great quality of life.
Designed & built by GetOntoTheWeb
|