Learning to live with less mobility: hip dysplasia and surgery
I can’t believe it’s been more than a year since my knee replacement. And if I’m honest, I can’t believe I’m still having to use walking aids of some sort quite regularly. I guess the nice English euphemistic phrase would be that the outcome of my surgery is 'not quite what I’d hoped it would be'. I have to get used to having less mobility.
The medical bit
There is nothing wrong with my new knee itself - surgically speaking that’s a success. And after a visit to my hip surgeon at the start of the year we can see that my left replaced hip, now 20 years old, has not deteriorated as a result. In fact, it’s in great shape for something that’s supposed to have a life of 15 years. My right hip – dysplastic but never bad enough to be replaced – is not orthopedically affected either. However, its rotation has been changed by straightening my leg, and so my hip flexor does limit my knee flexion which is an interesting new twist. In short, my right hip worked better with a valgus ‘knock’ knee to compensate for its limited range. But that’s why my old knee wore out on one side!
In short, whilst each of the parts in isolation is OK, something about the whole combination is more limiting. For the first time in 20 years, I feel disabled again, not just differently-abled. And having less mobility has taken some time to get used to.
Transport challenges
I have written about the social model of disability before. In essence it acknowledges that it’s the world around me that’s disabling. As well as having to use crutches to get on and off trains (high steps, wide gaps, limited handrails, people in the way, time pressure) I also have to consider - and frankly over-plan -any journey. Spontaneity is difficult. I have to think ‘do I know the station I’m going through? does it have lifts, are the steps crowded, can I hold onto a right-hand side handrail not a left-hand side one?’ I have to consider carefully what I can carry; I need the lightest backpack possible and I can’t carry anything in my hands. I can never buy a coffee and carry it on and off a train, I have to pack a flask that fits in my rucksack. When I get to the train, what happens if the seat reservations aren’t working because there are half the number of planned carriages (a regular on East Midlands Trains) - will I even get a seat? And then of course other people are unpredictable, moving hazards; equally I am a hazard to them. In short, any journey is a continuous risk-assessment from start to finish and that makes it exhausting.
I’m lucky that right now my job allows me to work from home most of the time. When I was recently looking for a new job, there were many where the 2 days per week commute into central London meant I didn’t even apply. So many employers these days are brilliant at reasonable adaptations once you get to work, but they can’t control the journey. And being the only team member who doesn’t turn up onsite can be isolating.
Leg length discrepancy
One of the other disabling factors is having to manage my leg length discrepancy. For five years prior to my hip replacement, I got used to having both an external shoe raise and inner insoles but for the last 19 years I was able to just use inner insoles that could fit into most shoes. I’m now back to having just four pairs of adapted shoes and them all being sensible, robust shoes. First world problem obviously, but still annoying. If I’m travelling with a small rucksack I can’t carry a spare pair for evening vs. daytime. And walking with bare feet is no longer an option with one leg so much shorter than the other.
It’s not all bad news…
There are lots of positives here. I’m pretty fit and healthy and with the right shoes and sticks I can walk. I swim well, I still sing, I manage to garden in small bursts albeit with painkillers, I can work, I have a supportive family and partner who does all the physical work when we go camping so I can still enjoy that experience. And compared to many people with hip dysplasia, I am not in constant, chronic pain and I am so thankful for that.
My knee doesn’t hurt much and it won’t degenerate rapidly like it was without the surgery. I have only had one posture-related migraine in the last year, whereas I was having them once every 2-3 weeks in the year before my last op. (The strain of my shoulders/neck trying to hold me steady can give me a headache which becomes so bad I develop a migraine - especially after singing or walking a long way). I’m not missing those!
And with my straighter right leg and the left shoe lift, I am officially taller (well on one side at least). For the first time in my life, I’m the same height as my sister!! It took me 51 years and 13 surgeries but it’s a win 😊
I have lived my life knowing that I can’t always take walking for granted. In the last year I have had to learn to live my life with a little less mobility. But still live it well.
Jill Pringle was born in Sheffield in 1971 with bilateral hip-dysplasia. She has had several surgeries including open reductions, leg lengthening, hip and knee replacements. Her blog raises awareness of living and walking with the condition and to raise money for Steps Charity Worldwide - you can donate here.
“Still on crutches?!” 9½ months post knee-replacement with hip dysplasia
Well, intermittently, the answer is “yes”. I’m still on crutches and yes, it’s annoying me! I find myself at the strange post-surgery stage where I’m more stable than I was before, but less mobile. I meet other people who’ve had a knee replacement after me, or know someone who has, and they’re off crutches and back to full fitness which is a little deflating.
It’s not pain that leaves me still in need of walking aids. It’s 50 years of weakness in my left hip and leg due to hip dysplasia; which of course is what caused my right knee to erode so much in the first place. My surgery has restabilised the knee but hasn’t fixed the root cause. Nor can it be fully fixed. As my physio said to me a few days ago “some muscles on the left side don’t work and never have, so we can’t rely on those like I might with other patients.” It will also take the full year to build up more functional movement.
So where does that leave me right now?
My new knee has less range (bend) but is much more stable (my own knee joints are hyper-mobile so move more than they should and wear more quickly). My orthotics mean I stand much straighter. I’m not in much pain but my muscles start to ache if I stand still for a long time, or walk for too long, and so that strength needs building. I’m weaning off the crutches based on each situation; the types of movement and duration for which it’s required.
- At home I don’t use the crutches at all. The stairs are OK as we have a rail on both sides and as long as I don’t have to hold anything in either hand, so I always have to wear clothes with pockets. If I have a mug of tea I have to place it on the step in front of me and work my way up the stairs 2-3 at a time following the cup. Over the last 6 weeks my physio prescribed an outdoor obstacle course to help me find my ‘centre’ and to move sideways, around or over them (see demo by my cat). So I’m able to walk around the garden with no sticks and do some gentle gardening but without bending or squatting.
- Around the local area I’ve now progressed off crutches and onto walking poles. This has two benefits; they take less weight, so it forces me to use my legs more whilst still allowing a natural rather than lurching gait. And they are also light enough to carry - my goal for the next six weeks is to alternate 1 minute with them, 1 minute off and then build up the time off the poles incrementally.
- To travel into London for my weekly choir rehearsal, I still have to take my crutches. The main reason for this is to get off a train. We still haven’t found a way of getting off a high step down to a platform whilst also traversing a horizontal gap. Next idea is to try stepping off backwards (I’ll let you know how that one goes!). The crutches also help at train stations or other places which for someone like me, is a huge moving obstacle course, every person a trip hazard. The crutches signal to them to avoid me. What I most long for is the chance to buy a coffee at the station and be able to carry it - target #freehandsday!
- I’m now back to working 3 days per week and on set days. I’m very grateful to have a six-month contract that allows me to work from home 99% of the time. Not only does this remove a commute or more trains but also it means I can swim every morning and still be at my desk for 9am (the pool is in walking distance). Sitting is not easy – with one hip 2.5cm higher than the other, a very crooked pelvis, and flat glutes - I lean to one side, balancing either on my hip bones or coccyx. So I try to adjust with my spine and upper body which leads to lots of shoulder and neck pain. The other advantage of WFH is that I can control the environment, desk and chair setup, no boxes, no trip hazards. Never has this been more important. And I don’t work on Mondays which means I have the energy and time to get into London for Choir – singing is my endorphine boost but getting there takes energy!
- The combination of orthotics and external shoe-raise is working well to address my leg length discrepancy. The sad thing is I have to wear something on my feet all the time (see adapted cosy shepherd slippers in the photo) so I can’t walk barefoot without one foot being on pointe! I’m also developing some pain in my left toes so the orthotic needs some adjustment (in progress). I do now have four pairs of shoes adapted so at least I can have some variety!
Don’t get me wrong. In many ways and overall life is good. I’m confident that my surgery will pay off. And I’m not in chronic pain which is not the case for so many people with DDH.
I’m just impatient. I want to progress more quickly. I want to get back out into the hills and do some walking, and that feels like a very distant goal.
Living with hip dysplasia is a ‘one step at a time’ challenge. Most steps forward, some backwards and all steps a little bit wonky! DDH is a lifelong challenge that many people like me face – 1-2 people in a 1000 to be exact. My story is just one of them.
Jill Pringle was born with bilateral hip dysplasia in Sheffield in 1971. She has had several surgeries including open reductions, leg lengthening and hip and knee replacements. She writes this blog to raise awareness of CDH/DDH and undertakes walking challenges to raise money for Steps Charity Worldwide who you can support here.
Camping, Singing, Walking. Doing things I love with and without crutches.
So this weekend I took my new knee camping! I love being outdoors but I have to admit to feeling nervous about it, post knee replacement. I associate camping with a fair amount of crawling around on my knees as we tend to go to basic campsites, with a small tent and minimal furniture; an inflatable mat not a bed; a low folding chair with no table. In short, not ideal for someone with my range of mobility issues on crutches.
And yet I love being in nature and the simplicity. I don’t go camping for home comforts.
We tried a new campsite this time and, as it turned out, it was the perfect pitch for me. Each camper gets their own little bathroom hut so I had somewhere to sit to get dressed (try pulling a pair of shorts or trousers on if you can’t stand on either leg independently and there’s no seat). There was also picnic table next to each pitch, so I had somewhere to sit at a table and so some variety by switching between this and my camping chair (important if, like me, your hips aren’t level so sitting in one position for more than 30 minutes is painful). All of this meant I only had to get down to the floor once a day, to get into bed, which is now about shuffling on my bum instead of kneeling.
What was also lovely, was being able to walk about the campsite without crutches – just like I do now at home or in the garden. It felt natural. This is a big shift from a month ago on holiday in Northumberland – when I felt much more reliant on crutches for most of the time. Especially walking on sand to experience the dunes at Bamburgh!
Getting off the crutches full stop is still proving difficult. I need to be able to walk for a while and then use the crutches once I’m tired – and so build up that distance. But that would mean carrying them until I need them, which of course changes my gait. I need my arms free to help me balance. I started walking up and down our road to build strength, but the pavements slope which knocks me off balance. I’m going anywhere crowded, I need my crutches to keep other people at a distance – it’s a visual clue for them to slow down and give me space.
I also need them to stand for any length of time, my knee and my feet (in their new orthotics position) get tired without the extra support. I’ve loved getting back to singing in choirs, and of course it’s been possible to mix sitting and standing in rehearsals. I’ve only taken part in short concerts to date. My first longer concert, where I have to hold music, is not until November and I’m grateful for that break to build my strength. I don’t have the ideal physiology to be a singer where posture is so vital and it requires stamina.
Then again, I don’t have the ideal physiology for camping or walking either! As Steps say, people with DDH can’t take walking for granted.
I’ve been at this stage before - after my hip replacement this last part of rehab felt so slow. I had one leg I could rely on then; despite my hip dysplasia being bilateral, in reality my left side was my weak side, my right was more dependable. This time it’s 50/50 which side is more stable.
I know it will happen. I have faith there will be that point where I forget to pick up my crutches and it feels more normal without than with them. Until then I need to do more swimming – perhaps with flippers – and more walking in the garden. Not just pottering but consciously counting my steps without crutches.
Jill Pringle was born with hip dysplasia (DDH). She’s had numerous surgeries including closed and open reductions, leg lengthening, and total hip and knee replacements. Jill’s blog is all about embracing being differently-abled.
Leg-length discrepancy – a DDH journey of shoes & surgery
Owing to my hip dysplasia and somewhat ‘wonky’ pelvis, my legs have always been different lengths. But that leg length discrepancy has varied over time. If you’ve ever had a go at cutting your own fringe (never advisable I find it always leads to endless tinkering one side then the other until it’s too late and you're scalped...) then you will understand the journey my legs have been on. Every so often leg length becomes an issue, and by replacing my knee and giving me a straight right leg for the first time in my life, my left leg is once again too short!
Most people with DDH have some form of leg length discrepancy and managing the impact of that is much discussed in forums such as those managed by Steps Charity or the International Hip Dysplasia Institute. Even a small difference can cause back problems that we don’t need on top of our hip challenges. There are different ways to manage this and two I’ve experienced; adaptation of my shoes (external raises or orthotics inside the shoe) or leg lengthening surgery.
I finally got to walking aged 3 ½ after a fair amount of surgery and I gradually grew quite lopsided. Whilst my left leg looked shorter – and standing I would lean significantly to one side - the problem wasn’t that the leg itself was shorter. Rather that it had been set so much higher (because the socket was missing) and so it rested close to the top, not the bottom of my pelvis.
In 1988, at the age of 16, I had my left femur lengthened. This was a relatively new surgery developed to help people with restricted growth like dwarfism. It was also being used for people like me who had significantly different leg lengths. This surgery essentially broke my femur in two, screwed in an external fixator either side of the gap which I then turned ¼ mm every day for several weeks with an Allen Key (yep, looked just like the ones we dread from Ikea!). This lengthened the gap, into which new bone grew. Once the new bone hardened the pins were simply unscrewed, the wounds healed quickly, and I had a longer left leg. It didn’t hurt to turn, to be honest the most painful part was cleaning the pin sites which would get infected (a bit like soreness of a new pierced ear or belly button) and I had some sciatica as the nerves and tendons had to stretch to fit.
What that surgery gave me, aged 16, was my first ever experience of standing almost straight. My shoulders were level, and importantly for my singing, I could expand both sides of my lungs equally. My voice tripled in size overnight! I was also able to walk with much less of a limp until my late 20s until my left hip was so worn and arthritic my pelvis was shifting and length was again an issue. This time it was managed by adding an external shoe raise to my left shoe (between the shoe and the sole).
The downside of the lengthening surgery came when I had my hip replacement in 2003. Normally in cases like mine a surgeon will address the leg length discrepancy whilst fitting the new hip and so level the hips. But of course, now, my left leg was too long! By now you should understand the fringe-cutting analogy – LOL!
What it did do, is reset the hip to where it was after my leg lengthening surgery, and so I no longer needed the external shoe raises, but a much shallower inner orthotic. This was great as it’s more flexible – the orthotic can be moved from shoe to shoe, rather than being able to wear only the shoes that have been adapted.
So why am I writing about this now? ….and sharing photos of my bad 1988 perm to boot! Well, by replacing my right knee and thereby straightening that leg, it is once again too long – almost 2.5cm. If I don’t address this, it will be difficult to get off crutches and I will start to cause the same problem that led to my knee replacement where my leg bends inwards to compensate for itself and causes abnormal wear.
And so last week I was back with the podiatrist to analyse my gait and figure out the combination of external and internal raise I'm going to need. This morning I posted a shiny new left trail shoe to have an external raise added – 13mm at the rear gradated down to 4mm at the toe. Once that arrives back my podiatrist can re-asses the inner orthotics which are also designed to manage my foot position, size difference and the hyper-mobility I have in other joints.
It's amazing what modern healthcare professionals can achieve isn’t it? Not just in surgery but with a holistic approach to our biomechanics.
Meanwhile I continue to swim 4x a week and walk locally on my crutches, and I’m amazed how many miles I have clocked up on my Virtual Pennine Way challenge. Since I re-started, post-surgery, I have walked a staggering 62 miles on my crutches. Which means there are just 6 miles left to go to finally complete the full challenge I had to abandon last year.
Thank you to everyone who has cheered, liked, supported and donated along the way – see you soon at the finish line. Love Jill xx
Jill Pringle was born in Sheffield with bilateral hip-dysplasia. She has had several surgeries including open reductions, leg lengthening, hip and knee replacements. Her blog raises awareness of living and walking with the condition and her walking to raise money for Steps Charity Worldwide to which you can donate here.
A diary of ‘firsts’ for my two-month-old knee
It’s been exactly two months since I had my right knee replaced, which is part of managing my hip-dysplasia. As you can see from the six photos, the wound is now nicely healed and my knee is much less swollen – and so, less painful. I’ve kept a diary every day of my recovery and I thought it would be helpful to share the firsts along the way to this point. It’s been a nice way for me to reflect on my progress, not just how far I have still to go. The goal is to get back to walking without poles or other walking aids, and so get back out to happily rambling in the countryside or standing on stage to sing.
Week 1:
I was actually out of bed and up on my feet late afternoon on the day of my surgery and was able to bend to 30 degrees. Once the restrictive bandages came off on day two, I was able to take my first walk using a walking frame and sit in a chair to eat dinner with my leg elevated. By day three I took my first steps with crutches and on day four had successfully used them to get up and down a short flight of stairs for the first time. This meant I could go home. The first two days at home however were incredibly hard – our Victorian stairs were more challenging and I missed the structured days of hospital.
Week 2:
After a couple of days at home my partner and I were in more of a rhythm using the continuous passive motion machine (CPM) I’d hired, walking up and down the ground floor of the house on crutches, doing three lots of exercises each day, and between that sitting with my leg elevated with a bag of peas on my knee. This second week was incredibly difficult due to the constant pain and sleep interruption – most nights no more than 2-3 hours in 30 minute bursts. 10 days after my surgery I had the staples out, which made my leg feel less stiff, and by the weekend I took my first steps outside in the garden, and my first cup of tea outside accompanied by birdsong. Freedom!
Week 3:
The third week saw three incredible firsts. My first hydrotherapy session and the sheer joy of getting into water and really feeling my knee move with ease. This was followed by my first night of sleep. And at the end of the week, my first trip outside to get a cup of coffee in a local outdoor café. All of these improved my confidence because they felt like normal “Jill” things to do.
Week 4:
By week four I was able to get my knee to 70 degrees on the CPM, although less without it. I started to do normal things around the house a little more – make my own cup of tea albeit I needed help to carry it to a seat; fill up the bird feeder in the garden; do some very light cleaning. We could handle our first visitor to our routine and so my sister came to stay. It was so lovely for me to spend time with her, and for my partner to get a bit of time off from helping me get up, dress, wash, eat etc. That weekend I was finally able to have my first shower rather than flannel wash, and to go out for lunch at a local pub. Whilst sitting still was hard (they had a table which allowed me to elevate my leg) and I needed to use an old dressing-gown belt to lift my foot into the car, that first social activity was a huge step.
Week 5:
Finally, this week, I said goodbye to the surgical stockings and my legs started to feel a bit like my own again! I was able to stand to make dinner for the first time and progressed to walking up and down the road on my crutches, not just in the garden. I saw the consultant one month after my surgery and whilst I was progressing well, my knee flexion (bending) was stuck at 70 degrees. Unless I can get past 90 degrees by two months, I will need a manipulation under anaesthetic. Which I don’t want.
Week 6:
Perhaps the threat of more surgery spurred me on and by the end of this week I had the CPM at 80 degrees for the first time and 78 degrees without. By now I am way more confident on my crutches, using them alternatively in a more natural walking pattern and so my average steps per day jumped from an average 3,000 the previous week to 7,000+ including a walk to the River and back. In this week I had my first day showering and dressing with no assistance, regaining some important independence.
Week 7:
Six weeks prior to surgery I’d had to stop taking HRT, so I was overjoyed to restart at this point and have my first evening watching the TV without half-hourly hot flushes! I also made my first independent visit to the local co-op and call into my cat’s vet to pick up some medication for her. Two friends came to visit and I saw a couple more on zoom – all of which has been so welcome, to break up the day and have different conversations, with people I love.
Week 8:
Finally, at the end of this week, I passed the 90 degrees bend mark, albeit passively on the CPM. I walked to the local pool to restart my membership and had a lovely hot chocolate in their café – my first drink out without someone accompanying me. My average steps per day exceeded 10,000 for the first time, which is back to my pre-op levels. And at the end of the week, albeit with a fair amount of pain and effort, my quads locked my kneecap enough to lift my leg straight off the bed. I also saw the podiatrist for the first time, who added more raise under my left heel as a temporary measure until I get measured for a full orthotics adjustment.
Week 9:
The big first in this week was getting into the local swimming pool, and properly swimming. I’m normally in the pool a minimum of three times per week so my whole body has really missed this exercise. My back and shoulders – which have been working overtime on crutches – were very grateful! I was able to walk all the way along the riverside and had my first walk up and down a slope (tortoise pace downhill which requires most knee stability). The reward was a cup of coffee in the local arts centre. For the first time I got the CPM machine to a 100 degrees bend, and we officially measured a 94 degrees bend in both hydro and physio. I successfully managed to demonstrate this to the surgeon today, which means no surgical manipulation - hurrah!
Orthopaedic surgery is not for the faint-hearted and this has definitely been the most challenging I’ve had. There’s still, of course, a long way to go before I’m walking without aids and able to live my life fully once more. There are also some important firsts still to go; driving and public transport being the next steps for independence before I could restart social activities like choir or meeting friends away from home.
But I have come a long way over the last two months. Huge thanks to my partner for his support day in day out. And to all of you for following and cheering me on!
Jill Pringle was born with bilateral hip-dysplasia and has had various surgeries including open reductions, leg lengthening, and hip and knee replacements. She blogs and walks to raise money for Steps Charity.
The knee-replacement rehab rollercoaster
So today is four weeks since I had my total knee replacement! I had osteo-arthritis caused by my 50 years of walking differently due to my congenital hip dysplasia. The last four weeks of rehab have been a real rollercoaster – both physically and emotionally. I have now stopped spontaneously crying at very random things unrelated to my surgery. But there are still days when this rehab very hard and where I take a proverbial step back to inch forwards.
My first hydrotherapy session had given me a couple of days of real benefit and sleep and so my expectation was the same from the second. Instead, it led to a very painful couple of days where all my exercises and my time on the CPM machine were tough and the pain made me cry. It all felt too much. And then things started to improve again, as I once again felt the benefit of further stretching and bending my knee. “No pain, no gain”. My third session today - whilst painful - demonstrated how much my quads have improved and how much further I can bend my knee than two weeks ago. And how much farther I still have to go to reach 90 degrees. We’re currently at 70.
What’s proving hard to shift is the inner part of my knee, where scar tissue is being stubborn and my ligaments have been straightened for the first time in my life. I have always been knock-kneed and now I’m trying to train my knee to bend in a straight line. And it doesn’t like it!
Part of the challenge getting the CPM machine above 70 degrees is my dysplastic right hip – which starts to hitch because that’s what it’s always done. And so now I sit on a table with my leg dangling to get my leg further. Whilst painful this feels more natural.
I can still see improvements each day. My sister came to visit for a couple of days over the weekend and take over “carer” duties from my partner. On both days we were able to nip out for a bite to eat in a local café or pub, and I was able to sit at the table, albeit fidgeting a lot, for about an hour. This is big progress and felt so very amazing to do something that all too often I have taken for granted.
Just like a rollercoaster, surgical rehab has its ups and downs. And now I’m on the rollercoaster there’s no turning back, I have to keep riding the highs and the lows. Because in the end, I will have knee that gives me back the stability that allowed me to walk the South Downs Way, and protects my DDH hips for the future.
Thanks for following the journey xx
Jill Pringle was born with bilateral hip dysplasia in 1971. She has had several surgeries through her life including leg lengthening, hip replacement and now a knee replacement. Her blog shares her journey living and walking with this common condition and she raises money for Steps Charity; you can donate here.
Getting my new knee moving: hydrotherapy
Yesterday two really great things happened – I got into a pool and I slept.
You all know that I love to swim. Walking down the steps into the hydrotherapy pool yesterday almost made me cry with joy. As I walked deeper into the water my body relaxed limb by limb – the first time since my knee replacement two and a half weeks ago. I felt supported and the heat was like jumping into a radox bath. My 30 minute session with my physio went so quickly, but in that time I was able to squat a bit, paddle and bend my legs, stand on tiptoes and my heels, and walk without tensing my upper body. Some of the movements hurt a bit, yet the joy of moving far outweighed that. For the first time in nearly three weeks I felt like I had my body back.
This knee replacement is definitely the hardest of my surgeries. I was warned that for all people a knee replacement is harder to get over than a hip replacement. As you know from my last blog post, not sleeping has been a real issue. Not being able to bend the leg has limited the positions I can lay in and my body wakes me every hour or so to move. Whilst lying on my operated side can help me get to sleep, it’s painful for the knee and increasingly for my right hip. So, it’s a constant nodding and waking routine where I get limited rest in each 1 hour cycle – also apparently normal with knee surgery.
Then last night, after hydro, it was easier to turn, and instead of waking hourly with big gaps in between snoozes, I managed a couple of 3 hour sleeps. My joy today is palpable.
My scar has now just about healed. Just a couple of steri-strips and scabs to come off naturally over the next week. I also took my last blood thinner last night, so I’m looking forward to an evening in front of the TV tonight without the shivers. And by the end of next week I can finally lose the surgical stockings and go back on HRT, so hopefully goodbye to the hot flushes too.
My days continue in a rehab routine of threes. Physio exercises three times a day; Walking in my shoes/orthotics for 15 minutes three times a day; CPM machine for 30 minutes three times a day, and pain meds three times a day. I also now have to start varying how I sit every 30 minutes – legs up, legs as down as a I can get them. All day this has me like an “ill-sitting hen” as my mother would have said. My cat, who thinks my lap is her personal property on-call, is not at all amused by this constant moving.
But it’s all progress. Small steps towards a more normal life. I’m intrigued to see how I’ll walk in six months’ time. My right leg is now even longer than my left so I already know I will need even bigger orthotics in my left shoe. But that’s a job for eight weeks post-op, not three.
For now, the next step is to use more hydrotherapy and physio to get my knee to 90 degrees within two weeks, when I next see my consultant surgeon. He was very clear that if I can’t do that, he will have do a manipulation. He was also honest that “you really don’t want that” and that it will be extremely painful. So that’s a clear goal – 90 degrees under my own steam in two weeks. At the moment I can get 55 degrees on the CPM machine and 45 degrees myself. Which I guess is half way to target.....
I’m back in the hydrotherapy pool on Monday and I can’t wait. Until then, have a wonderful weekend. Jill xx
Jill Pringle was born with bilateral hip-dysplasia with her left hip dislocated. She has had multiple corrective surgeries including leg-lengthening, a total hip replacement in 2003 and now a knee replacement in 2022. Jill writes this blog to raise awareness of hip dysplasia and walks to raise money for Steps Charity Worldwide.
Sleepless in Surrey: my knee replacement
I had my total knee replacement 10 days ago, just 2 weeks after my 50th Birthday. By my counting this is my 12th orthopaedic surgery, my last being a total hip replacement in 2003. My brain had conveniently helped me forget some of the realities of recovering from surgery. And it turns out that with a knee replacement there is a specific symptom of sleep interruption that didn’t come with any of my past hip surgeries.
Arriving at hospital, getting into the gown, and chatting to the anaesthetist and surgeon all felt very familiar territory. The mild anxiety of waiting (although I was lucky and first up; so down for surgery just after 8am) was also familiar. I had expected a spinal anaesthetic but to be sedated throughout, but the anaesthetist discussed with me the benefits of being awake; benefits for my recovery and also for not requiring an oxygen mask (a phobia from those childhood surgeries where you were ‘gassed’ to sleep with a big black mask). And so I chose to be awake. I can’t begin to describe the weird sensation of the table vibrating from the drill, and the sound and motion of a hammer on my knee, but without any feeling or pain. Yet it was interesting to hear the the consultant and his team discuss the exact angle they were going to plant the knee – 1 degree this way and so forth – until they found the right place. There was a fear that my still dysplastic right hip might make it hard to find the centre of rotation, but it didn’t.
I was also allowed to take my phone into surgery and listen to music – so my surgery was to the accompaniment of music by Bach, Holst and Vaughan Williams. I steered away from choral music so that I didn’t start singing!!
Recovery was very quick on day 1; I was still pretty numb so pain-free and without the anaesthetic I was able to eat quickly and importantly, for a Yorkshire girl, drink plenty of tea :-)
And then the pain started through the night. And with it, the insomnia. Now, I’m used to surgery and the fact that painkillers are required to get me through the early stages, especially at night. I had been warned that a knee replacement is much more painful than a hip and I can 100% confirm that’s the case. After my hip surgery I was able to sleep between pain meds; this time, not really. With today’s modern technology (a fitbit) I can tell you that on average, I had 1-3 hours sleep that week. And that sleep interruption still continues. I’m told that it settles after 3-4 weeks and I’m really hanging on for that because it’s so draining. I dream of the day I get into bed and feel my body relax rather than tense.
Thankfully, in hospital my days had a rhythm dictated by others - punctuated by times to take drugs, times to get up and mobilise with the physio, and mealtimes.
After four nights it was a joy to come home, to see my partner and my cat, and to be back in familiar surroundings. The first two days were really hard; after one night of my not sleeping, we ordered a spare bed for the dining room so my partner can, at least, sleep through my insomnia. It took us two days to get into a rhythm of how to wash, when to do exercises, when to rest, when to walk around, when to sit with a bag of peas on my knee to reduce the swelling. Since Monday we’ve figured that out more, and it is easier to cope within the schedule we have created.
Yesterday was an interruption to that schedule. I was back at hospital having my staples removed (quite painful I have to say) and seeing the physio. The wound is still a little bit open, so I’m steri-stripped up, but it does feel lighter and more flexible without the staples.
So until the wound fully heals I need to be a little more careful with bending the knee for a few days (no more videos of me on my CPM machine until next week).
Walking with crutches is OK and I’m well-practised having owned a pair since I was seven. But I am challenged by the fact that I naturally hitch my right (DDH impaired) hip, rather than using it normally, and so it was clear in the physio session that there is some ‘unlearning’ to be done. My left side – subject to all the other surgeries – is not strong enough to stand on (I have never been able to stand just on my left leg). Getting up our Victorian stairs is fun – I’m supposed to lead with my left leg, which I have never done in my life, and sometimes if I’m tired my partner has to push it onto the step for me. The joys of being differently-abled and where the bio-mechanic ecosystem that the new knee is fitting into is not in any way normal!
Every day some little things get a bit easier. And for that I’m grateful. I’m also grateful for an amazing partner who is able to be at home with me and shows enormous love and patience in looking after me, and being my carer as well as my boyfriend. I couldn’t do this without him.
Love to him and to you all xx
Jill Pringle was born with bilateral hip dysplasia (DDH) and has had a life of surgery including open reductions, leg lengthening, a hip and knee replacement. She writes to raise awareness of her different-ability and to raise money for Steps Charity who support people who can’t take walking for granted. You can donate here. Just £5 provides and information pack for someone newly diagnosed with hip dysplasia and their families.