Total Hip Replacement – Part 1 Preparation for surgery

My journey started about five years ago. As a massage therapist, I was increasingly aware that the range of movement in my hips was poor. But as a reduction in range of movement is often gradual, I was able to rationalise with myself that nothing was wrong except that I was getting older.  I was 45!

My poor range of motion was particularly noticeable on abduction (moving my leg out to the side) and medial rotation (twisting my hip inwardly).  I was also in some discomfort if I had to walk for any length of time. The crunch came when I was running down the stairs and a crippling pain in my left hip forced my hip to give way.  I was able to steady myself but I was unnerved. A subsequent trip to the doctor and then the X-Ray unit showed I had arthritis of the hip joints and hypoplasia. Hypoplasia is a condition when the hip socket hasn’t properly formed and can lead to advanced degeneration of the hip joint. As a result of this diagnosis, I was determined to keep as fit and active as possible, as that was my best hope of maintaining my quality of life. I didn’t know how inevitable a hip replacement was, but it wasn’t something I relished so I implemented a consistent regime of massage, chiropractic, acupuncture and exercise, as well as a healthy diet with the emphasis on unprocessed home cooked food packed full of nutriton and supported with supplements. I’d like to think that all my efforts to stay as fit and healthy paid off, but ultimately there isn’t a parallel universe where there’s a Tracy Russell, who doesn’t exercise, eats take-ways and munches on pain killers to compare my progress to!

Five years on and the cracks were beginning to show! I knew it was time to have my hips looked at again. This is a list of the classic tell-tale signs of arthritis of the hip, that I experienced. It is not a definitive list of all possible symptoms, simply a list of those symptoms I experienced.

  • pain in the joint on weight bearing, particularly going upstairs
  • difficulty flexing the hip to raise the foot, to climb over obstacles, with either a straight or a bent leg
  • walking with a limp
  • muscle aches on over left gluteals, ilio tibial band and lateral left knee on walking more than 100 metres
  • fixed flexion deformity making lying supine uncomfortable
  • leg length difference
  • sharp pain and stiffness when making the first step, moving from sitting to standing
  • exhaustion at the end of the day, but exhaustion in the context that I was still running my busy massage therapy clinic, as well as running a home with 2 beautiful but demanding children

So it was with resignation, as I couldn’t continue living like this, that I sought advice from my GP. He referred me to the musculoskeletal unit at the Freeman Hospital, Newcastle. So on 13th December 2013, after a short consultation, examination and review of my X-rays, I was told that both my hips would need to be replaced. A part of me expected to be told that the left hip needed replacing. But there was also a part of me that was living in hope that there was a quick and easy resolution to my problems which wouldn’t need drastic intervention such as surgery. I definitely didn’t see two hip surgeries coming!

The waiting list for surgery was about 18 weeks. So part of my strategy for coping with these overwhelming emotions, was to work out a plan to be as prepared, that is as fit physically and emotionally as possible, for surgery. The plan below covers the strategies I put in place to get me through the impending 18 weeks. But as Rabbie Burns so eloquently put it, ‘the best-laid schemes o’ mice an’ men, gang aft agley’. A letter arrived at the end of January informing me that my surgery had been pulled forward to February 13th 2014 – in two and a half weeks!

Regardless, the plan was important whether I was having the surgery in February or April. A date in February just gave it more urgency. Here is what I did. My plan covered three main areas:

  • to ensure that my muscles were as strong as possible. Not only the leg muscles but after surgery I would need strong core and upper body.
  • to ensure that my body, but particularly my hips, were as mobile as possible.
  • to ensure that my general health was as good as possible to cope with the surgery and help the recovery process
  • to ensure that I nurtured myself emotionally to cope with the roller-coaster of emotions, that were to come. I felt that looking after my emotions would aid the recovery process.

THE PLAN

The Physical

  • 1 swim a week. Starting at 30 lengths of front crawl and building to 50 lengths. Front crawl is a tricky stroke to get the hang of but so much better for your fitness and your hips than breaststroke. Check out  http://www.swimming.org/swimfit/health-front-crawl/ for some great tips. There’s also a useful training video, which really helped me.
  • 1 cycle a week on a stationery bike. Starting at 5 kilometres and building to 10 kilometres. As with the swimming, I kept an eye on the time to maximise the fitness benefits, but I wasn’t a slave to the clock. Some days I could hardly turn the pedals at first, so it wouldn’t have been sensible to push it too hard and then be in pain later. But there wasn’t a session when I didn’t feel better after getting off the bike than before I had got on it. This definitely helped with my mobility and with my strength.
  • 1 leg strengthening session. Leg strengthening exercises focused on isolating muscles using equipment at the gym to develop quadriceps (leg extension), hamstrings (hamstring curl) and calf muscles (seated calf machine).
  • 1 upper body strengthening session to strengthen chest, back and arms. As well as the feel good factor from doing these exercises, I was hoping that, with a good strong upper body, I would be more mobile using crutches, post-surgery.
  • 3 times a week Pilates to promote core strength and mobility. For this I used My Pilates Guru app. I have done pilates for many years so I would say I knew the basics but I found this app really helpful in structuring the sessions and saving me from too much repetition and getting bored.
  • Regular chiropractic treatments helped to minimise the discomfort in my back, which was compensating for the fixed flexion deformity in the left hip and the leg length difference.
  • Regular massage therapy with Isabel Mineyko , my lovely associate at The Therapy Rooms. These treatments helped to relieve the discomfort in the gluteals and lateral left knee.

The Nutrition

  • My basic principles for healthy eating were continued during this pre-op phase. I mainly eat home-cooked family friendly meals. I eat 6-8 portions of vegetables and fruit a day, with the biggest proportion being vegetables. Thankfully I love dark leafy greens and they seem to be one of the foodstuffs that is universally considered healthy. (Please don’t tell me there is some new research suggesting that dark leafy greens are bad for you!) I eat 2-3 portions of fish a week and keep red meat and smoked foods to a minimum. I find a diet low in carbohydrates, which is very popular at the moment, very difficult to maintain but try to vary the type of carbohydrate I eat and keep my carbohydrates as unrefined as possible. I try to include essential fatty acids daily in my diet from not only oily fish but also nuts and seeds.
  • I have also believed that whilst the majority of our nutrition should come from good old honest food, I have always found a good multi-vitamin and mineral supplement, a vitamin C supplement and a fish oil supplement very helpful to my overall general level of fitness. In the lead up to the operation, on the advice of my health practitioner, I added to this Solgar’s Ultimate Bone Support and Pharma Nord’s Bio-Glucan Plus, to support my immune system.
  • I was conscious of the fact that, as movement and exercise became more and more difficult, so was keeping my weight under control. And as everyone knows, carrying excess weight is detrimental to arthritic joints. I used My Fitness Pal to keep a check on my calorie intake. But, in all honesty, I didn’t have the time or the emotional energy to be too zealous with this one. I also wanted to ensure that my diet is packed with nutrients which isn’t always easily married to calorie counting. And I often use food as a comfort, so inevitably, during this stressful time I did resort to food. The good news is that despite becoming less active and eating occasionally to comfort myself, I didn’t gain weight during this lead up to surgery.
  • 24 hours prior to surgery I started taking the homeopathic remedy, arnica, which is thought to be helpful for bruised and traumatised tissue.

The Emotional Side

It’s often when faced with a big challenge that you realise how strong you are but it is also when you find out what your weaknesses are. Facing Total Hip Replacement was certainly one of those challenges that was going to highlight the chinks in my emotional self. After the diagnosis, I experienced various emotions not dissimilar to The Five Stages of Grief, described by Elizabeth Kubler-Ross  in her pioneering book, On Death and Dying.  The five stages of grief, is the series of emotional stages that someone experiences when faced with impending death or other extreme, awful fate. The stages are shock, denial, intense concern, despair and finally recovery. After the initial shock and denial that this was really happening to me, I got locked in to a loop of intense concern, where I couldn’t think of anything other than my impending surgery and despair. The following things helped enormously :

  • talking to people who had successfully undergone THR and being encouraged by their stories of how the surgery had transformed their lives.
  • I got the chance to speak with my surgeon, a week before the operation to discuss issues I had. This was invaluable as I had ‘technical’ questions about the surgery which only he could answer. The questions such as ‘what happens to the muscle attachments and ligaments that are attached to the bone that is removed?’ could only be answered by the surgeon. In doing so, he allayed my fears that key attachments would not be disrupted.
  • visualising myself post surgery, being fit, well and active.
  • taking Bach Rescue Remedy daily but also when waves of panic overcame me.
  • meditating on a regular basis. I particularly liked Complete Relaxation Lite: Guided Meditation for a Happy, Stress Free Life. I found his voice soothing. But as we are all different, I suggest doing your own investigation to find a CD or app that suits.
  • planning and sorting out so that my home life and my business would run as smoothly as possible whilst I was out of action. I won’t bore you with the details but, for me, part of the anxiety was about what was going to happen to The Therapy Rooms whilst I was out of action. By sorting this out (as much as you can, in advance) I began to be less stressed about the operation.
  • I used the help and support from a reflexologist, chiropractor and massage therapist, which not only supported me physically but also provided invaluable support emotionally.

So the big day is looming. I’ve done as much as I possibly can to prepare myself. The next stage is the surgery and the critical 6 weeks post operation!


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