On Fiday, May 24, 2013 Henry Warner had his right hip resurfaced at the Swedish Orthopedic Institute in Seattle by Dr. James W. Pritchett. Dr. Pritchett claims to have performed over 1200 hip resurfacing procedures. Specifically, I had the Birmingham Hip Resurfacing (BHR) procedure, as there have been several hip resurfacing systems offered worldwide. The BHR system is by far the most successful hip resurfacing procedure, with hundreds of thousands of cases. The BHR has been FDA approved in the US since 2006. What is hip resurfacing and how does it differ from the vastly more common Total Hip Replacement (THR)?
With a THR procedure, the femur is actually cut below the femoral head and a new ball and socket prosthesis is inserted. According to one medical source, there are essentially three types of materials used in a THR – cross linked poly (plastic), ceramic and metal. The size of the ball can range from 22mm to 40 mm.
In a hip resurfacing procedure, the femoral head is preserved. The acetabulum (socket) is shaved/contoured to accept a metal liner. Likewise the femoral head is shaped to accept a metal cap. Unlike the THR, the size of the ball is typically much large for a hip resurfacing as opposed to a THR. In my case, the ball is 52mm. This has the theoretical advantage of greater stability and lower likelihood of a dislocation than the smaller ball used in the THR.
Other theoretical advantages of the hip resurfacing procedure are that the patient can eventually resume full, high impact activities such as running, downhill skiing etc. after full recovery. The procure is advertized to have no limitations in terms of pre-operation activities that can be resumed. Many athletes, professional and amateur, have had successful BHR operations. One of the most notable being Floyd Landis of Tour d’France infamy. As I am a biker, I was encouraged by his success story.
Jill and Henry Warner arrived at Swedish Hospital about 7:30 in the morning. Prior to surgery I met with the anesthesiologist and surgeon. I knew beforehand that the standard approach for this operation by Dr. Pritchett was a spinal. The anesthesiologist confirmed this and discussed the pros and cons of a spinal versus general anesthesia. While I had trepidation about waking up with a spinal headache, I was reassured that the risks were low and positive steps could be taken to eliminate the headache in short order, should it occur. I also don’t like the idea of a needle anywhere near my spinal cord, but this fear was also reassuringly addressed by the anesthesiologist. I had already pre-determined that I was not going to “rock the boat” by asking for a deviation from their basic procedure. My reasoning was that the process they were following was resulting in a very high success rate, so who was I to second-guess them?
I did tell the anesthesiologist that I didn’t want to hear a thing. I joked with him that I didn’t want to hear someone yell out “We have a bleeder here!”. At precisely that moment Dr. Pritchett walked into the room, having heard my joke. For those of you who have heard or read of Dr. Pritchett, you know that he is a man of very few words. He will answer any question you have, but volunteer almost nothing. Some people have commented that this bedside manner (or lack thereof) is enough to discourage them from using him. But both my wife and I found him to be quite likeable and friendly. He is just not a talker. I was to be his second hip resurfacing of the day. He told me that the first one went just fine, so that sounded good!
Dr. Pritichett proceeded to shave the incision site with clippers, not a razor, as a razor can increase the risk of infection. He also signed his initials on my right hip with my concurrence that this was the hip to be operated on. While this is a low-tech action, it was reassuring to me that Swedish used such an approach to preclude operating on the wrong body part. We have all heard horror stories of a patient waking up only to learn that the operation was performed on the wrong limb or body part. It seems to me that this simple step goes a long way towards eliminating that risk.
I was wheeled into the Operating Room (OR) about 9:40 AM, lying on my back, fully conscious, as no anesthesia had yet been administered. As we passed one OR enroute, I smelled a distinctive odor of burning flesh. I commented on that as I entered my OR and Dr. Pritchett confirmed that they routinely cauterize the tissues to minimize bleeding. I was then asked to slide from my gurney to the operating table and, lying on my side, bend slightly so that the anesthesiologist could administer a local anesthetic prior to doing the spinal. I felt a very slight pricking. That is the last thing I remember.
My next conscious moment, or rather semi-conscious, was hearing voices. It took me a while to open my eyes. I kept having “dreams” or images of changing shapes and colors. I had no dreams of people. Just a kaleidoscopic type swirl of colors and shapes morphing into others. By the time I was conscious enough to lift my head, I saw that the wall clock was at about 11:45 AM. I found out later that the actual operation had taken only about an hour. It took me over an hour more in the recovery room before I was wheeled to my room. During the recovery room stay, I was asked repeatedly to wiggle my toes. At first I could not, nor could I flex my legs from the waist down. While in recovery, I was in and out of consciousness and continued to have the same sort of objects-only dreams.
I arrived at my room about 1:00 PM. Various people came and went. I could only remember the name of one nurse: Elena. I was asked quite often what my pain level was. Truthfully, it was never that high. I would answer a 2 or 3 (out of 10). I was still presumably benefiting from the anesthetic for pain relief.
About 2:00 PM I had my first meal. I thought that I might not be too hungry after an operation, but my appetite was healthy. I ordered a turkey sandwich on whole grain bread (no mayo), some almonds, a small bag of baked potato chips and several unsweetened cranberry juices to mix with my water. I had read articles of some people being very nauseous after an operation, but I felt fine. I was a little worried that I would eat everything, then get sick, but no nausea ever manifested.
Sometime between 3:00 and 4:00 PM, I had my first physical therapy (PT) session. I was instructed and then helped getting out of bed, which was definitely difficult, onto a walker. I then took my first steps with my new hip joint! The physical therapist had me traverse the good-sized room four times, then it was back to bed. She pronounced that I had done “real well”.
Lest you are wondering, it is typically common for hip resurfacing patients to take their first steps the same day upon which they are operated. I guess it is just because they can, plus the general consensus seems to be to start being as active as early as possible.
I passed the rest of the day napping intermittently while my wife stayed in the room. She is working on a knitting project and she assured me she was fine just sitting there while I was sleeping. About 7:00 PM we ordered dinner. As food takes about 45 minutes to arrive, we were warned that it’s a good idea to order well before the kitchen closes at 8:30 PM. I had salmon, mashed potatoes (no gravy) and a salad. I also ordered a custard dessert, a mixed fruit cup and several orders of almonds. My plan was to save the fruit and almonds for a midnight snack, which actually worked out rather nicely.
My wife left about 9:00 PM and I turned on the TV for the first time to watch Shark Tank. After the show, Elena came in and asked if I would like to roll over to my non-operated side. It had never occurred to me that this was an option, but I thought it was a great idea. It was quite the effort to get me on my side, as I had a massive foam pillow strapped between my legs to keep them separated. She unstrapped that and substituted two thick pillows. I then read my Kindle trying to fall asleep. For some reason, I was not having much success. About midnight, when someone came in to check my vital signs, I got flipped back onto my back and was then able to sleep. Thus ended Henry Warner’s first day in the hospital.