I am 32, female, with congenital hip dysplasia in my left hip. I had three osteotomy surgeries before age 3 with the last one, the successful one done by Dr. Salter in Canada. Growing up, my hip was always weaker and would get tired, but I was able to be active and it didn't interfere too much with daily activities. About 5 years ago, my hip started getting very painful when walking. I finally admitted my hip was not just going to get better like it used to and went to see an orthopedic surgeon. I was told my hip was arthritic, that I was too young for a THR and that I needed to manage my pain so I was given Naproxen, a cane, and sent to physical therapy. This helped for several years and I slowly weaned myself down to the lowest dose of Naprelan I could handle. Symptoms started up again in 2000/2001 and I started intensive PT. Even with PT, my symptoms remained and after visiting a local orthopedist, I tried Voltaren (Diciclofenac) and had some pain relief. I started researching surgeons and hip replacements. I also tried many conservative measures: good shoes with shock absorbing insoles, glucosamine/chrondroitin, aquacise, adjusting diet, calcium, etc.

Initially I sent x-rays to Dr. Millis in Boston based on a suggestion that there may be an intermediate option like an osteotomy that would help. He responded saying that there was no other option for me than a total hip replacement as there was not enough bone to work with.

I live in Alaska, a state where I was told there are no fellowship trained joint replacement surgeons and given my unique situation and complexity, I should seek a specialist. So I looked in other states in the West and places where I had family. I did my own research and talked to several people on the Internet.

My x-rays showed bone on bone, cysts in the acetabulum and the head of femur. My femur
is shaped like a stovepipe, very large and straight. It was explained to me that although larger than the good femur in the right leg, it is weaker as there is less hard bone and the bone cavity is larger.

I visited four surgeons, all well known in the field, including those using ceramic/ceramic and those who are not. In the end, after asking all of them my questions and considering type of implant, bearing surface, timing, accessibility of doctor, and location, I decided to have surgery with Dr. Swanson.

Making the Decision "When I knew I was ready for a hip replacement."

-When not on NSAID, I shuffled, lurched, really didn't walk well. Significant pain when walking was my main symptom. I was able to sleep and had pain relief at rest as long as my hip was not in flexion.
-Walking that I used to do fairly easily 5 years ago (6 blocks), I could not do without using a cane, stopping every block to rest, and still having pain.
-Limited hip flexion making daily living and personal care more difficult.
-I was getting heartburn every day on NSAIDs.
-Lower back and right knee were being overused and starting to hurt.
-Daily living activities became difficult and exhausting (doing laundry, cleaning house, going to grocery store).
-We were considering starting a family and figured I could tolerate the weight of pregnancy and being off NSAIDs by using crutches, but I really didn't know how I would handle watching and interacting with a toddler. I was also reaching that crucial age for childbearing.
-Walking through grocery store--even off weighting on cart - was a dreaded chore.
-One of the surgeons said that yes, I was young, but given my hip structure and pain, even if I waited longer, I would still be young. Quality of life is important.
-Difficulty getting in and out of vehicle and sitting comfortably.
-I could not sit to eat at a table with any comfort.
-I was spending less and less time outside and I was not as interested in going out to do things, such as going for a walk.
-My hip was becoming all consuming.
-My husband and family had seen my deterioration over the years and were ready for me to do the surgery before I was. There was no pressure, but their support and observations on my "accommodations" to my increasing disability gave me needed perspective.

Surgery Preparation

April 2002. Appointment with Dr. Swanson. Scheduled surgery for June.

I am fortunate as I travel for work and had accumulated miles so that all trips to Vegas were only about $20. We stayed in a recommended hotel, which has a discounted rate ($50/night).

Pre-surgery I tried to stay as active as I could with aquacise, PT, stationary bike riding, and incorporating some specific pre-surgery exercises for my legs and strengthening upper body and arms. It really helped to be strong to lift yourself up and move on the bed in the hospital.

Once I decided on the surgery, I asked Dr Swanson and his staff what he wanted me to do for pre-surgery. As I am young and healthy (i.e., no other medical problems), we agreed that I would do the pre-admit for the hospital the day before surgery and Dr Swanson’s Physician’s Assistant would do the medical history prior to the surgery. I had a blood test locally and the doctor said as long as my hemoglobin count was over 13 he did not think I would need to donate blood in advance. My count was 14 so I just increased my intake of iron rich foods
prior to surgery to keep the count up. I did not take an iron supplement. I read recent research about donating blood and decided not to donate. I know my hemoglobin count dropped to 9 post-surgery and I was given iron supplements in the hospital, but I did not require any blood. The day before surgery I also needed to have an x-ray of my entire legs for digitizing to assist in correcting my leg length and making sure my legs were equal.

Surgery Tuesday, June 25, 2002 - Desert Springs Hospital

Surgery took about 1 ½ hours and I remember being in lots of pain and being sick in the recovery room. During surgery Dr Swanson noticed I had adhesions from old scars attached to the femur and he removed these. This combined with some leg lengthening had contributed to soreness.

I was in the hospital until Friday afternoon. I had a very bad reaction to the pain medicine. I spent a lot of the time Wednesday through Friday morning with nausea, weakness, and vomiting. I was taken off the continuous morphine drip Wednesday, which helped some and just left with the morphine I could control. On Thursday, I was given pain pills, which also made me very sick. I got a fever on Thursday, but it only lasted one day and I just used the spirometer frequently. I was discharged with Tylenol 4 to try and even that made me sick.
So from Saturday that first week, I could only tolerate Extra Strength Tylenol. I walked every day beginning the day after surgery, but not very far as I was unstable since I felt so sick. This set me back a lot as I didn't eat for those days (only liquids) and really didn't move very much.

PT started in the hospital, but for all exercises I needed assistance to move. I was fortunate
to have a family member in the room all the time and I would recommend this.
The hospital experience was not bad, but it was very helpful to have someone
there all the time.

Week 1 Post-op - Wellesley Hotel.
It was a tremendous relief to leave the hospital. I found during this first week that I got tired very easily. The trip from hospital to hotel was exhausting, a shower was exhausting, and a short walk was all I could handle. I continued the recommended PT starting with minimal repetitions. My leg was pretty swollen and extremely sore, especially the hamstrings. They were sore even to the touch. I needed help getting in and out of bed, as I could not lift my leg up and needed help in the bathroom for a shower. I did not feel stable when walking and wanted someone by me all the time. The adductors (groin area) and glutteals were very sore. I used ice compresses and heat alternately. Sleeping was miserable. I could not tolerate sitting in a chair for more than about 5 minutes, even in a very open, slouched position. I had my follow-up appointment on Wednesday. Everything looked good and Dr. Swanson explained my soreness and lack of flexibility, and recommended PT at home. He said I was fine to travel home, but said I should keep my feet moving on the plane and walk as much as possible. I started taking Bextra this week for inflammation.

11 Days after Surgery, Travel Home on Plane
I could not have traveled before this date, as I could not sit for very long. We had a 2-hour plane trip and a second 3 ½ hour plane trip. I arranged for wheelchair service for everywhere in the airports. We had a PFD boat cushion and an extra thick pillow, which were very useful in the wheelchairs (the wheelchairs in the airport are low and very uncomfortable), and I used the PFD for my back on the airplane seat while sitting on the pillow. I kept my feet moving all the time while flying and put the seat back whenever I could. It was very uncomfortable as my hamstrings and glutteals contracted and got very tight. We had first class mileage tickets and this helped (first class or the bulkhead would have been necessary for me). I stood up about every 45 minutes and after about an hour of sitting could not straighten my leg out. We had an ice compress that the stewards put on ice to get cold and that helped to ease the discomfort. I had practiced with the Travelmate (to pee standing up - http://www.travelmateinfo.com/index.html) and this was a must for the trip. I didn't have to worry about the type of bathroom I used. I was exhausted after the trip. As soon as we arrived home, I slept hard for 2 hours.

Week 2 Post-op
PT every day for an hour. Mainly heat, ice, light massage, assisted movement. I got stronger every day. Walked more, felt stable and was putting more weight on my leg. I still got tired easily but I was sleeping better.

Week 3 Post-op
PT 3X week. I started riding the stationary bike first with just the right leg with the left leg off to side (about 5 minutes). Added partial rotations of left leg (about 5 minutes). At end of this week my hip flexion is about 68 degrees. I can't yet get to 90 but I already have more flexion than pre-surgery. I have more energy some days than others. I am much more active moving around the house and that combined with more walking and increased activity in PT has made me feel some muscle soreness. Overall, I feel more energy and more like myself this week. It shows that I can sit and write this. I am still very careful - I try not to overdo any exercises, I don't go out in a vehicle unless necessary and I rest when tired.

Week 4 Post-op
At four weeks post-op, I am doing very well. My incision is a "mini" and just 4 inches long. I have no internal joint pain, but have had a lot of muscle and soft tissue soreness. I started doing full rotations on stationary bike (still not at 90 degrees). Using one crutch inside the house, two crutches outside, and doing more every day with more energy. I started mild PT 2 weeks post-op to help with this soreness and still use 2 crutches to walk mainly for balance and some weight bearing. I feel more balanced, and very stable on my hip. I am very happy with the results and for the first time in my life, I don't feel anything inside my hip. Before, even on a good day, I would be conscious of my hip and always think about moving it. I have also noticed that my leg moves independently rather than my left pelvis shifting forward. I would recommend Dr. Swanson without hesitation.

7-Week Follow-up Appointment with Dr. Swanson
I traveled to Las Vegas with two crutches, but generally used one crutch for walking indoors. I still got tired easily. Dr Swanson noticed I ended up possibly about 1/4 inch short on the operated side, but did not recommend anything as it may still be adjusting. PT was continued 3 times a week. I started driving after this appointment with standard transmission, so I had to use my left leg on the clutch for shifting. It was fine. At about this time, I stopped taking the Tylenol and the Bextra and stopped using the TEDS hose. I would occasionally find areas of discomfort like in the front of my hip or on the side of my hip about halfway down. It seems to be muscle soreness or some weakness if I overdid things. It would usually flare up and then subside in a few days to a week.

3-Month Follow-up Appointment with Dr. Swanson, October Visit
I was traveling with one crutch, using it for long walks, but sometimes not using it for short distances. I still had a slight limp and still needed to work on flexibility. Dr. Swanson suggested I consider using a 1/4-inch lift in my shoe to compensate as the leg length discrepancy was still there. Dr Swanson also recommended I continue PT until December. During this time, usually after I would overdo it walking or bending into flexion, I would have some soreness in the front of the hip (flexor area). Twice it put me back on two crutches for about a day or two. It would subside relatively quickly like it never happened.

6-Month Follow-up Appointment with Dr. Swanson
PT ended in December 2002 (total of 6 months of PT post-surgery). The X-rays look fine. The length discrepancy was still there. I traveled with a cane, but only used it for long distance walking. I was walking much better and the chronic limp was nearly gone. I was using the lift in my shoe. Dr Swanson thinks I could still improve flexibility and recommended continuing stretches on that leg. For long outside walks, I was still using one crutch (mainly to keep me from limping from habit—not due to weakness or pain), but by about nine months post-op, I was not using any walking aids.

1-year Anniversary Follow-up Appointment
There were no issues to raise during this visit. I feel great and the x-rays look good. The only observation is that sometimes I feel a muscle ache on the side of the leg below the hip and in front in the hip flexors. It seems to be muscle as it flares only when I am overly active or have done something differently—it feels like a muscle pull. When I’m tired, sometimes my limp comes back, but if I concentrate, I can pretty much control it. I have been experimenting with going without a lift as long as I don’t have backaches, as I don’t notice the discrepancy.

Milestones: I’m back doing aquacises 3X/week. I started doing Pilates at 11 months post-op and have really benefited from this exercise (watching my one precaution for bending). I also started occasionally riding an old, quiet horse at about 11 months post-op. I can walk a long ways comfortably. I have been riding a bike outside. I can sit Indian style comfortably (I’ve never been able to do this). I can make a figure 4 with ankle of operated leg on the knee of the good leg to put on socks (I’ve never been able to do this).

Suggestions
Research as much as you can and talk to others. Initially, I was really focused on the bearing surface, which is important, but after learning more about my femur shape, I also became interested in the advantages of the Zweymueller stem. Since I would be having surgery in another state, accessibility of the surgeon was very important. Dr Swanson answered my e-mails within 24 hours, which assured me that he would be accessible to me even while I was in Alaska. The mini-incision hip replacement technique was a factor, but not the main one, as I wanted the best possible implants and procedure for my situation.

For insurance purposes, both the doctor and the hospital were in my network, but they did require pre-authorization for the hospital prior to surgery. I checked on this pre-authorization with the hospital 2 days before and they had still not done it. When I explained the situation, they initiated the contact with my insurance company. Do NOT assume the hospital will do the pre-authorization with plenty of advance notice (I think they usually do it the day before). Especially for an out-of-state insurance carrier, the hospital may need prompting to start the pre-authorization earlier than they normally do. Dr. Swanson's office handled the insurance for the doctor and in my case, a pre-authorization for the doctor was not necessary.

Have someone stay in the hospital with you all the time, if possible.

Do as much as you can to set up house before surgery. Figure out where you will sit comfortably (we used wood blocks to build up a recliner so it was higher), set up a table for your water, the phone, etc., do laundry, clean house. I found that there are some things that are still difficult to do by myself during weeks 2-3 so having someone else there is helpful. In my case, my husband had to go back to work so my mother was able to come to help.

I am overwhelmingly pleased with the result so far. I can see improvement every day. My leg moves so much better and I know that the pain and soreness I am having will go away over time, as I get stronger and more flexible. I still use crutches, but have noticed that my chronic limp is gone.

I want to thank all those who have shared their experiences so others can learn. I hope this can be useful for someone else. Feel free to contact me jkswartz@99737.com

Kathy in Fairbanks, AK

For more information about congenital hip dysplasia visit the Link Library.

To read recent discussions on pregnancy after hip replacement visit the discussion board here.

Disclaimer:The information provided here is intended to educate the reader about certain medical conditions and certain possible treatment. It is not a substitute for examination, diagnosis, and medical care provided by a licensed and qualified health professional. If you believe you, your child, or someone you know, suffer from the conditions described herein, please see your health care provider immediately. Do not attempt to treat yourself, your child or anyone else without proper medical supervision.

©2006 Todd Swanson, M.D.
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The minimally invasive total hip replacement was developed by Dr. Swanson after being introduced to the concept in early 1997. Dr. Swanson began using the technique in May of 1997 and has continued to make improvements that now allow reliable surgery and reproducibly good results in most patients. Standardization of the technique has allowed teaching to other surgeons. Numerous physicians and orthopedic companies have shown interest in promoting “minimally invasive surgery” for total hip replacements.

The minimally invasive technique utilizes a 3-4 inch incision, much smaller than the 8-10 inch approach historically used for hip replacement. Patients require less anesthesia and pain medication, and mobilize more quickly. This results in both quicker recovery for the patient and a lower incidence of complications.

Patients typically recover from minimally invasive surgery in about half the time it takes to recover from standard incision surgery (6 weeks vs. 12 weeks).

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