Before and after hip xray: hip replacement to hip revision
So here is my new hip! With a handy before (hip replacement) and after (hip revision) comparison Xray. First thing that strikes me is that there’s a lot more metal than pelvis now. Due to my hip dysplasia, I’ve never had much pelvis on that side (which was the difficulty with getting my childhood reduction surgeries to stick). The challenge for the hip revision was to extend the socket and so that bit you can see on the right hand side of the Xray is the custom 3D printed metal socket doing just that job.
I was talking to a friend a few weeks ago about the fact that I was finding it difficult to visualise my new hip because I hadn’t yet seen an Xray. And in that conversation it became clear how much I understand my condition through the hip Xrays I’ve had through my life. I have never not had a mental image of what my pelvis and hips look like and I suspect that’s the same for anyone diagnosed with CDH at birth. And so I suddenly felt lost. Now, I ‘get it’. I can see what my orthopaedic surgeon has done and I can finally connect the image with how it feels. It’s reassuring to me.
The last few weeks have been very boring. I’ve been diligent and consistent with my physio exercises, and maintaining all the restrictions around precaution height and restricted movements. For the last 3 weeks I have at least been able to go for longer walks on my crutches, but I still can’t go anywhere where I need to sit.
I saw my Xray when I had my 6 weeks post-op check up this week with my orthopaedic consultant. He seemed pleased with my progress - wound is healed well, no infections, no thrombosis, nerves appear to be undamaged and the leg is “pointing in the right direction”. He was also happy that I’m taking things slow and steady - something he wants me to continue for the next 7 weeks. I am still to stay on crutches as by far the biggest risk is falling. As he said, in essence it’s like having a big fracture in my pelvis and that needs caution. I guess if I fall and damage this, there’s no more pelvis to play with, and now I’ve seen the Xray my brain gets that so much more.
So it’s more of mostly the same.
- I asked if I can swim yet, we compromised on me adding supervised hydrotherapy into the mix, as long as I take it carefully.
- Continue with the physio with the advice of take it slowly and carefully.
- I can however start to play with lowering the precaution height of chairs very gradually - eg removing one of the three cushion - as long as I never bend more than 90 degrees. As this progresses it will give me a little more freedom to at least walk further if I can sit on a bench or in a cafe to rest half way.
- Still no bending, twisting or climbing into the over-bath shower though….so still the strip wash regime continues into September. At least when I go for hydrotherapy I’ll be able to have a shower afterwards - can’t decide if I’m more excited about getting in the pool or having the shower!!
If I'm honest, I had mixed feelings after my appointment. Obviously the overriding positive feeling is that I’m progressing well in his expert eyes, and that surgically he is considering this a success. But I also had a feeling of dashed hopes. Hopes that I could start to do more, more quickly - particularly swimming or driving, which would give me more independence.
But this is not my first surgery and I know that by sticking to what I’m asked to do, the end result will be more positive. This too shall pass. And my independence day will come :-)
Meanwhile, stay tuned, thanks for following. Love to you all x
Jill Pringle was born with hip dysplasia in 1971, in Sheffield (then called congenital dysplasia of the hips). She's had many orthopaedic surgeries as a child and adult. Jill writes this blog to share her challenges with walking as a differently-abled person.
Post-Op recovery: 1 month milestone
It’s one month today since my hip revision surgery. I find this week 4-6 period of post-op recovery the most boring. The first week is mainly feeling ill and getting over the trauma. Weeks 2 and 3 are about getting more mobile as the swelling and pain subsides; balancing movement with rest. But the second three weeks can drag - I no longer feel ill, I’m not in a lot of pain, but I’m still really restricted in what I can and can’t do. My exercises are still quite restricted, I have to vary my sitting position too regularly to sit in one place for any length of time. And there's not much variety in the days. It's the boring phase!
For those who haven’t read a previous blog post, I had a full revision surgery of my 22 year old hip replacement, one month ago. I’ve had 13 surgeries all due to being born with bilateral hip dysplasia (CDH) with one hip socket missing along with a lot of my pelvis. You can listen to more of my history on this Steps Charity Podcast here.
So what am I up to every day?
Walking, always with crutches.
As well as continuing to march up and down the garden, I’m now also taking a walk around the block each day, on crutches. Walking is by far the best PT for post-op recovery. The surgeon was strict about using crutches for eight weeks, even indoors, and to date I’ve been using them together (ie both crutches go down together as I take weight on my operated leg). As of yesterday, my physio has added a small amount of walking in the garden using the crutches reciprocally, which means a bit more weight through each leg, and a bit more of a natural walking pattern. Sadly, I still can’t walk to the local cafe, as I can’t then sit down (chairs not high enough to meet the precaution height). Nor am I braving the local coop as there are too many ‘hazards’ like people, wet or uneven floors, baskets etc to feel safe. But the daily walk is enjoyable, and extends my bubble beyond the home.
Physio exercises, with some progression.
After a hip replacement you get one NHS physio appointment for post-op recovery and a pack to follow a standard progression plan. So I decided to use a private physio who has worked with me for the last 20 years. She knows my history (so we’re not starting from scratch with me having to explain how different my hips are). She also knows who my surgeon is and how he likes to work. And most importantly, she knows all the ways I can find to ‘cheat’ the movements I find most difficult! Over 50+ years I have become very creative in this regard, but that gets in the way of me exercising the muscles that actually need to learn to work properly. For someone like me, with a complex case, it’s important that the physio doesn’t expect to do much that’s standard, and can be bio-mechanically creative - ie find different positions or props that help me exercise the right muscles safely.
For the last two weeks exercises have been:
- Standing: Heel flexes, Hip abduction, Hip extension, and then standing on my operated leg (with crutches) and moving the other one into various positions (looks like an odd tap dance!) - so that I get comfortable with the left leg taking the weight and encouraging independent movement of each leg.
- Laying: knee/hip bends, hip abduction with knees bent, hip adduction with knees bent (pushing on a rolled towel) and pelvic tilts with knees bent (but still NO bridging allowed).
For the next 3 weeks this has progressed to:
- Laying: hip abduction and pelvic tilts
- Sitting (new position puts more weight through the hips): leg extensions and holds with ankle weights, hip adduction (squeezing a towel between my knees which works the glutes more sitting than laying, and standing from a perch position without using my arms (REALLY hard!)
Short bursts of reading, watching TV, writing, learning to paint :-)
It’s important to keep my brain busy. But I have to be super careful not to sit in one position for more than about 40 minutes. So things I can do in short bursts are good, where I can also switch position between my high seat chair vs. the bed with legs up. I was never an artist at school (I’m very literal, and my creative outlet was always music) but I’ve bought a small watercolour set and a book which is helping me learn to paint natural things like leaves and flowers. Don’t expect the gallery opening any time soon folks! But it’s a very relaxing thing to do.
Visits and calls from friends
I’m very grateful for everyone who has visited or arranged calls/zooms. It’s lovely to see people, hear about things other than my boring little daily routine, and just laugh and enjoy the company of people who I know well. It also adds some variety to my day and means I will still have some social skills by the time I go back to work or choir in the Autumn.
So these are the things, day-in, day-out, that stop me from getting too bored - which would lead to my doing too much, too soon. My surgeon has put the brakes during this initial period of post-op recovery for good reason. So I need to trust in that, until I see him in two weeks' time. Hopefully then I'll find out that everything is going OK and the new hip will have ‘set’ enough, with new bone forming to hold it in place securely. Then, hopefully, the handbrake will the released a bit to allow proper rehab to start - including hydrotherapy. And I'll be rewarded with a chance to see an Xray of my new hip for the first time - Xrays of my hips have always been how I understand and connect with my hip dysplasia.
So until then, thanks for reading this and for following my progress. Stay tuned for the next episode in a couple of weeks xx
Jill Pringle was born with bilateral hip dysplasia in 1971 in Sheffield, UK. She has had various childhood and adult surgeries on her hip and knee. She writes this blog to raise awareness of living with CDH/DDH and being a ‘differently-abled’ walker.