Day 97 Does Size Matter #hipreplacement

Archive, Arthritis, Health, Hips, Hypermobility, Hip replacement, SURGERY

Ever since I knew I could find out the size and dimensions of my implant (my hip replacement) I’ve been on a journey of exploring why? Is it large or small? Cemented or cementless?

Why do I want to know?

Well I don’t really need to know, as I trust my surgeon to know what is best. But I’m nosey and why not find out.

So I sent off the form to National Joint Registry here and waited a fair few weeks to get the results. And here they are.

Pretty much confirmed what I thought I knew already. That my hip is made of Ceramic on Ceramic and that #Symbios is the manufacturer. And that I’m cementless (1 thing I wanted confirming) and then the sizes of the ball (I was really keen to find this out)

So does size matter?

The size of the ball joint of the natural hip joint (name is femoral head) actually varies and usually ranges from 40 to 54 mm (with smaller sizes in females). During the initial beginnings of hip replacement, the surgeons tried to make the implants which would mimic the natural size of the natural femoral head.

Does natural size work?

However, it was soon realised that when a large metal ball articulates with a plastic cup, the plastic part gets worn out quickly due to “volumetric wear”. To decrease the “wear” of the plastic, Sir John Charnley (who was one of the pioneers in the development of modern hip replacements), opted for a smaller 22 mm metal head (which is much smaller than the natural femoral head) in the design of Charnley hip replacement. This design was the commonest hip replacement done in the UK until recently.

Studies have shown that with this technique, there were fairly good long term results in patients who are not very young and active. However, these came with some restrictions placed, limiting what the patients could do to avoid dislocations (this is when the ball comes out of the joint) and a high dislocation rate following hip replacement has been common with smaller “ball size”

Small or larger femoral heads?

Many surgeons over the past few years have started using slightly larger size femoral head (28 mm) which is still within the range of conventional metal on plastic bearing. However, still it is smaller than the natural femoral head. The problem of wear and dislocation is still a potential concern.

Concerns?

Dislocation still remains a major reason (17%) for revision of hip replacement (NJR data 2008). I don’t know any hip replacement patients that aren’t worried about dislocation.


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Dislocation is the main reason people need revision hip replacements. Which can result in loss of more function, which no of us want, we are all striving for more functionality.

While the cause of hip dislocations is from multi factors, it is thought using a larger ball could decrease the incident of dislocations. However, we’ve seen the size of the ball was limited by the material properties. So that was another thing that needed looking at.

How things have changed?

Also much younger and more active patients are being offered hip replacements now at much earlier times in their hip journeys. And the expectations of young and active patients are alot higher as they strive to go back to their active lifestyles and sports with little to no restrictions.

To improve the durability of the hip replacements, material scientists have come up with modern solutions (alternative bearings). As no longer could an implant last 7- 10 years, now they are required to last 30-40 years.

New materials give new dimensions?

There are essentially three types of alternative materials – cross linked poly (plastic), ceramic and metal. These alternative bearings mean they could allow larger ball sizes to be used 32 mm, 36 mm and even 40 mm. However, these sizes would be limited by the cup (socket size) and also some material allow slightly bigger ball to be used with the same cup size compared to other materials.

So to end here, size does matter.

From looking at my sizes 32mm I have a reasonably larger ball so it’s probably the reason I don’t have restrictions, it’s fitting into linear of 46/50 which they recommend for 32mm balls. Reading all this I see this hip is designed to give me as many decades as I can of activity, and more adventurous living. Obviously running would cause faster wear and tear, but overall it helps me appreciate the gift I’ve been given.

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I have a date…

Archive, Health, Hips, Hypermobility, Hip Arthroscopy, SURGERY, Triple Pelvic Ost, Femoral Ost, PAO

Well kind of, it’s a pre op date, and hip workshop date and they are far sooner than I ever imagined. It’s for the 15th November this year!!

I believe before this though, I need the 3d CT scan and that sending off to Switzerland to be made from a 3d printed model. So it’s all go go go.

Weirdly I assumed I’d have at least 5mths to 1yr for this process, so maybe that registrar really meant 4mths for the whole process?

I got this date 4 days after my appointment at the ROH which blew me away. Usually I don’t hear from them for 3mths before any dates.

So it’s pre op, so ECG and height and weight checks, probably bloods too. Hoping by then I can confirm I have RA or tell them it’s just OA (RA rheumatoid arthritis, OA osteoarthritis) as this will affect medication allowed and treatment plans.

The hip workshop I’m not entirely convinced I need, this isn’t my first hip rodeo. My couch allows a seat at 90degrees (why we bought it) my bed is high too. I already have perches, bath boards, crutches and grabber. But I will go as required and see what they say.

I’m 49 weeks post hip arthroscopy and embarking on a new journey. It’s been 9 and 8 weeks since steroid injections in hip and CMC joint. And since then I’ve fallen over onto my outstretched hand (left one) I use with a walking stick. This seriously hurts, landed heavily on my left knee, which hurt more at the time, but now it’s 3 days old it’s only tender to touch. Unlike wrist, which feels worse now.

So I’m feeling a tad stupid for falling and hurting myself, I can only hope I fix soon and can use my walking stick on Friday for Blackpool’s big switch on!!

And so it begins…..

Archive, Health, Hips, Hypermobility, Hip Arthroscopy, SURGERY, Triple Pelvic Ost, Femoral Ost, PAO

Here I am yesterday, at the hospital awaiting to find out my destiny. Nervous, sick with anxiety, yet excited!?! It all starts with this appointment.

Weird and eerily quiet, so unlike ROH we are seen quite quickly for there, about 40mins after my actual appointment time. Sadly no specific surgeon but a pleasant registrar no less.

Not familiar with symbios he gains an audience with another consultant that works more directly with my Surgeon to help explain the process. But he’s doesn’t do it well, he ignored my husband, who let’s face it needs the information more, as he’s living through it. And answered more like a politician than surgeon.

But not matter, we walk away being added to the waiting list and being referred for the 3D CT scan. How long this time frame is, anyone’s guess. Seen as he didn’t really answer. We got 4mths out of him, but 4 months to completion or 4mths to scan is unsure??

So moving forwards from that, it’s time to reflect on what’s ahead, read more, research more. Thankfully on Facebook there are countless supportive friends going through or been through the same process to help guide me.

Today was physio and I honestly walked in thinking we would revise the program in preparation for surgery, but instead she’s too happy with my progress and strength that as long as I do it at home, I’m fit enough already and muscles are strong enough to keep implant stable. So we’ve left it as an open appointment, to come back as soon as I can after surgery.

Bit disappointed in that I’ve left again, but I understand why. I do always do my at home physio and workouts, I am religious in doing it, so there isn’t a need to go in and show her each week.

Overall this year I’ve started to be unaided though it’s incredibly painful at times and not for long. It’s still a win.

I’ve also lost 12lbs since Jan. We are eating better, making better choices overall. And making so much more of an effort with physio, exercise and weights in general. So my physio is right, I’m in a much fitter stronger place than I was facing my Arthroscopy surgery back last Sept.

And if you facing helping me with buying a tragically hip tee, you can find the link here

And similar if you are a fellow zebra with ehlers danlos syndrome like me and my daughter, she designed a tee here she needs to sell 4 to start the campagin off.

*Disclaimer* we get a small commission from every one sold *

42 weeks post #HipArthroscopy

Archive, Health, Hips, Hypermobility, Hip Arthroscopy, SURGERY, Triple Pelvic Ost, Femoral Ost, PAO

 

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Well if I was pregnant I have now done a full term and then some… But I’m not. However I do feel more in a position to judge the arthroscopy surgery and it’s results so far.

Am I pain free? Quick easy answer is NO. but I’m coming to terms with its unlikely to be that painfree ever.

Am I more mobile? This is more difficult to answer, Yes I am doing more, but mainly because my mind isn’t as broken as before. And the realization that this may be as good as it gets forever, spurs me to make the most of it regardless.

Before my mind was truly broken, I didn’t trust my ability and stamina, I definitely didn’t trust the legs.

This past 9 months has been going to basics, working the muscles from absolutely nothing into legs I do trust to hold me up, they are stronger, I am fitter. (Sadly not lighter though)

It’s been 2 weeks since the steroid injection and it’s been ok, but it’s not been the magic pain free injection I hoped for. But I did have some improvement, so I can’t complain really.

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This week it’s been about getting into an exercise routine once more, though I needed Monday off completely to recover from our barmouth weekend.

Tuesday I did the basic post hip replacement physio exercises

Glute squeeze 20reps x 2

Quad activation 20reps x 2

Heel Slide 20reps x 2

Hip abduction (lying down) 20reps x 2

Short Arc Quad 20reps x 2

External hip Rotation 20reps x 2

Bridging 20reps x 2

Pull in stomach breathing 20reps x 2

Hip flexion (ankle weights) 20reps x 2

Hip abduction (ankle weights) 20reps x2

Hip adduction (ankle weights) 20reps x 2

Hip extension forwards (ankle weights) 20reps x 2

Hip extension backwards (ankle weights) 20reps x 2

Heel to buttock (ankle weights) 20reps x 2

Mini squat (ankle weights) 20reps x 2

Hip pendulum (on step ankle weights) 20reps x 2

Looks like a lot, but broken down in an overall day of physio. It’s done slowly and methodically, with resting at times. All its for is muscle activation and strengthening.

Wednesday to rest the lower limbs it was a weights day. I’ve read that if you have Arthritis you should try and lift between 5% to 10% of your body weight, so you don’t lift too heavy and speed the disease up. I use 7kg for my arms now, but I started slowly and light at 2kg at first. I don’t do much as hands and elbows are in a joint flare up today.

Bicep curl 10reps x 2

Shoulder press 10reps x 2

Lateral raise 10reps x 2

Bicep row 10reps x 2

Tricep kickback 10reps x 2

Chest press 10reps x 2

Tricep overhead 10reps x 2

Kettle bell swing 10reps x 2

Again it looks more than it is in reality, and the sets are broken up between morning and afternoon. It’s to lubricate and activate, more than anything.

Thursday I can feel a change in the air, my joints ache, mainly my fingers and elbows. Although hip is niggly too. Opt for a day of mostly rest, painkillers and hot water bottles. I discovered I can’t even lunge my left foot behind me due to ankle issues ( I rolled it in may 2017 and it’s still not right now. Perhaps I should see someone) I did try some compound exercise for physio though, only 5 exercises but they killed me off.

Goblet Squat 10reps x 2

Three point row 10reps x 2

One dumbbell reverse lunge 10reps x 2 (actually can’t officially lunge, it’s more of a step back, and letting leading leg take weight, super easy for most folks but for me it’s painful and very difficult)

Single arm chest press 10reps x 2

Supine marching 10reps x 2 (this really pulled operated legs glutes into action, but also hurt my groin. Don’t think hip is ready for this? It’s meant to work your core, but I felt it all in the hip??)

Friday I honestly feel bodily broken so it’s probably a curl up on the sofa, hot water bottle and Netflix kind of day. Frustrating as brain says go, body says NO. But I’m pleased I managed 3 days of various physiotherapy exercises, so if I don’t do anything today that’s still self care and productive in my healing.

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