Pictures and Notes from My Total Hip Replacement
I did very well initially. The operation went very smoothly. It was a little more involved than a routine THR, because the OS had to remove the broken plate and screws he had put in last January and install a hip implant with a longer femoral component than normal. The surgeon and his assistant were very happy with the results, and I bounced back from the anesthesia amazingly well — I ate solid food for dinner just a few hours after surgery, and I felt surprisingly good. Unlike some previous surgeries, the pain was very well controlled this time around, so I have no complaints on that. Even the hospital food seemed a bit better this time than in the past!
And it was essentially one week. I went in on a Tuesday and was discharged Saturday, New Year's Day 2005, feeling very well. It really felt like a grand new start for a new year. I was able to go home to my own apartment, with lots of help from friends and family, and was very glad to be out of the hospital and cuddling my cats. I had arrangements for home health care visits to check my incision and change the dressing, and a physical therapist to visit me at home twice a week. Everything went great; I felt very alert, energetic, rested, etc. I was motoring about on my walker with little pain, although of course I followed strict doctor's orders to be very careful and not move about more than I had to.
After a week of excellent progress, I woke up the following Saturday morning, Jan. 8, with my bandages and shorts soaked in blood-tinged drainage from my incision. I called the home health service, and the nurse who came out to see me said she thought it was just a pocket of drainage that had suddenly broken up and was leaking out. I didn't have any signs of infection, but when the incision was still draining on Sunday, then Monday morning, I called my surgeon and went in to see him a bit early (I had an appointment already scheduled for that Wednesday, but he wanted me to come on in). They took X-rays, and — believe it or not — it turned out that one of the cables they used in the surgery had come loose. That's why I was bleeding.
This was the sixth time that hardware implanted in my femur had failed. I've experienced broken internal rods, external plates, screws, titanium, stainless steel, and now a cable. Needless to say I was angry, frustrated, bewildered and scared. I had to go right into surgery Monday evening to take out the failed cable and put in new ones — the surgeon doubled up this time on both cables and fasteners. My surgeon's clinic is in a building adjacent to the hospital, and they literally wheeled me right from his office over to Admissions.
I had a pretty rotten time in the hospital the second time around — probably to be expected, since I was having another major operation barely two weeks after the first. I didn't bounce back nearly as well, but after a few days of hospital care and PT, I was once again discharged, on Friday, Jan. 14. There was some debate about whether I should go home alone again or possibly stay with someone, but I decided that I would be OK at home alone because I have a big family and friends/coworkers who all are literally poised to rush to my side at a moment's notice.
I am SO blessed by that. There's just no superlative strong enough to express my gratitude to my wonderful support system. Good friends and family are the greatest blessing there can be. Nearly every day that I've been home recuperating, my father has brought me a snack or treat at lunch, and my brother or my aunt have been taking care of dinner. One day when my dad couldn't bring me lunch, I called my boss, and she said she had just been thinking about me and wondering if she might be able to come see me and bring me something. That's the kind of TLC I have been getting!
I'm still very angry, frustrated and overwhelmed by the setback and complications, though, and I still don't have any real answers to my questions. My surgeon can't explain why the cable he used in the first surgery slipped. He and my cousin, the assistant, both said that they've never seen it happen before, and that it "shouldn't have happened." This time I was sent home with a large, bulky brace that I have to wear any time I am up walking. It goes around my hips and my left leg and supposedly holds my hip in a position that protects the healing area from too much stress and strain.
While I was still in the hospital, they put a PICC line in my arm so they could send me home with 10 days of IV vancomycin as a precaution against infection. I wasn't very happy about that to begin with, for two reasons: one, the procedure was VERY painful and traumatic, and two, I was not thrilled about taking such a heavy-duty antibiotic just to be safe (the culture they took of my wound during surgery came back completely clean). But my surgeon is extremely worried about possible infection because of my medical history of having had osteomyelitis in my elbow a few years ago.
Anyway, once again I managed to defy the odds by having no end of trouble with the PICC line. It never worked properly, and I can't tell you how many times I was told "this just doesn't happen with a PICC line." Finally, on Wednesday, Jan. 19, the nurse from home health just came and took it out. She started a regular IV for that day's dose of vancomycin. The IV lasted through Thursday's dose, but it slipped out and infiltrated just as I got to the saline flush after the dose went in. So she had to come back out Friday and start another one. That one held its own until I finished with my vancomycin on Friday, Jan. 28.
I had a bad scare over the weekend of Jan. 22 when, that Saturday night, my incision started draining fluid tinged with blood again. It looked almost exactly like it had two weeks before, except that the red color was lighter. I called the home health nurse at midnight, and she recommended that I call my surgeon's answering service. So I did, and his PA returned my call. He was very nice and calm and reassuring and didn't feel I should overreact. He said it was not at all uncommon for a wound to suddenly drain a lot even after 10 to 14 days, and that I would be in excruciating pain if the cables broke again, AND that the odds of the cables breaking again would be astronomical. But haven't we heard this before?!?
Needless to say, I didn't sleep very well Saturday night. I woke up at about 8:30 Sunday morning, and the drainage was much less, but still there. Another nurse from home health care came at about 1 p.m. and checked it all out, and he said all the same things the PA said Saturday night. He changed the dressing again, and took all my vital signs, which were all still fine. Since I already had an appointment scheduled with my surgeon for Monday, I just gutted it out until then, although I was in extreme fear and distress at the thought that something new might have happened with the cables or the implant.
Thank goodness, though, it turned out that this time the PA and the nurses were right. The drainage was just a hematoma — basically a large bruise under the skin that was draining. It's actually good for a hematoma like that to drain rather than clotting up inside. But the most important thing is that my X-rays looked "really good" and all my hardware is intact and in place. Hooray!!
The drainage was not completely harmless. I did have a little hole about the size of a dime where my incision hadn't quite closed, and that was where the drainage was leaking out. It could have presented a risk of infection, so I had to stay on the IV antibiotics for a few more days and watch the incision carefully. If the hole was still open and draining in two days, my surgeon said, he wanted me to come back in.
The rest of the incision looked good enough that they went ahead and took out the staples from the Jan. 10 operation. My leg was somewhat swollen, but he was not too worried about that; he said it was pretty normal because I'm not up and about, but I haven't really had this kind of swelling before. It wasn't really painful, but it was a bit uncomfortable and it looked icky.
I went home that Monday feeling better, if just a little apprehensive about the hole that was left in my incision. By that evening, there was already a pretty good amount of drainage on the new bandage they had put on at the doctor's office. So I changed it again myself, and the next morning, it was perfectly clean and dry! By Wednesday, the incision was closed and there had been no more drainage at all. I have a regular checkup scheduled with my doctor for tomorrow (Jan. 31).
As of today, Jan. 30, I am feeling very well. The swelling is almost gone, and I have no pain in my leg at all. I am still required to wear the brace and be still and quiet as much as possible, but I was cleared to work from home, which has greatly improved my mood. I feel a lot better now that I know my hardware is still holding in place. My next goal is to figure out how to get back to work in my office, but I realize that I may have to be patient (patience? what's that???) for a little while longer.
Left: The X-ray shown here is not mine, but it shows the use of a cable that is somewhat similar to the ones my surgeon used to add extra stability to my hip implant. This is not a normal part of a routine THR; it was done because I had a broken plate from a previous operation still in my leg, which had to be removed. Its removal left several screw holes in my femur, which could have led to further instability and/or breakage. The cables wrap around a metal cuff that essentially helps to hold the whole works in place.
The first two photos are more pre-op images, showing me in the waiting room with my grandfather. I'm all dressed for surgery, but you can see the IVs haven't been started yet, here. You can also see how much weight I have gained in the last nine months while awaiting surgery. I haven't been able to exercise at all, or really even walk normally. I am hoping and praying to lose at least some of this weight when I'm fully healed.
The next three photos are after the first surgery, the actual THR on Dec. 28. The first one was taken the day after the operation; I am sitting up in a chair, but you can see that I am still in my hospital gown, and that my face is a little swollen from the fluids and blood I was given in surgery. The second photo is on day three, showing me dressed in my own clothes and sitting up in bed. In the next photo, I'm sitting up in a chair, doing my ankle pumps. You can see the TED hose I have on both legs. These are worn for a couple of weeks after surgery to help prevent blood clots.
The next three photos show me after the second surgery. The first one was taken on a Wednesday morning, the second day after the Monday procedure. You can see the PICC line in my right arm. The second photo was taken at home that Friday, and I am demonstrating how well I can get around with my walker (in case you're wondering, those weird handles on top are called platform attachments. Because I have RA, my upper body strength is pretty limited, and the platform walker is easier for me to use than a regular one.). In the third photo, I am showing part of the hip abductor brace I was given after the second procedure to keep my hip muscles slightly relaxed and keep them from tugging on the surgical area.
And in these next two, I'm sitting down in my "nest" on the couch. You can see how I've set up everything I need around me, including my walker and a reacher, my laptop computer and some snacks. I've also piled up cushions and pillows on the couch to make it a little higher, which makes it easier to stand up from a sitting position. In the photo on the left you can see the lower portion of the hip abductor brace that goes around my thigh. In the last photo, I am trying to fend off one of my four cats, Mulder, who thinks his Mommy needs him to stand on her face in order to get better soon.
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