The Pivin's



My Hip Experience... beginning 10/17/06

10/17/07 - 1 Year -


still need to strengthen - but after years... after hike actually felt better and not sore! +4hr driving

now 2 bikes, 2 swims, pilates/golf... hiking --- see the hike --- next R2R2R.


8/17/07 - 10 Months - I'm doing 6 mile hikes with 1700ft. of ascent and 20mi. bike rides every week. Life is better. I get a couple twinges every now and then - the most recent was after I spent 2 hrs in the garage squating and deep-knee bending while working on a bike. Has taken about 2 weeks to come back to normal. Not sure what I did really; hope it goes away. I think I need to follow a nightly routine of quick PT refresh and stretching - just to make sure I don't plateau. In October planning a hike into Grand Canyon - who knows maybe a Rim-River-Rim. We'll see how it feels. I'm fit enough - but about the hip... should be fine. My life insurance tried to ding me because I had a hip replacement - but I had Dr. Amstutz write a note and explained about how this was due to an old injury and now cured - and I can work out and stay fit. Now I'm on the super-preferred plan. QLI = 9 - only because of the the aching after the bike maintenance.  Below is a typical bike ride - Red is 185bpm and green is ~120bpm heart rate. Garmin Forerunner.

Ok, yeah, I know - Floyd Landis had his hip done 3 or 4 weeks before mine and he finished second in the Leadville 100 8/11/07. An important lesson - if you couldn't do it anytime before the surgery, you're probably not going to be able to do it after.

5/17/07 - 7 Months - Now I'm about 95% recovered. Only thing is a bit of vague stiffness and awkwardness when standing on one foot to put on pants or something like that. I hike at brisk pace, bike - both for 1.5-2hrs no problem. Now also rare to have much soreness day after. Can actually jog a bit around - but waiting to get too agressive here - maybe pick up squash again soon. Can't say enough about how great a decision this was for me. Milestones for next month?: More golf; squash a couple times; hiking with pack; active flexibility - sitting criss-cross no problem. QLI = 9.25
4/17/07 - 6 Months - OK - so now my hip is definitely better than before the operation. Probably start only every 3 mo. updates now... Went for 1.5hr bike ride on singletrack dirt - wow. It was like I got back 7 years from my life! Doing at least one MtBike ride per week now of >1.5hrs. The baseline workout sched. includes 2 45min. swimming sessions; 2 recumbent/elliptical/treadmill sessions; and the 1 MtB ride. Now I'm having trouble just getting enough time to do all the things that this has enabled! Key exercise this month: Golf ball pickup and lunges with OP leg. Someone asked if I could hop on the op. leg --- I hadn't even tried it... I could, but it doesn't feel right yet - I'll try to have this done by 7mo. Running is another story - I haven't made a point to start running - so it's not natural; but I can jog here and there gingerly. I'm probably just babying it - but why push the running, it will come with time. Need to get out for 18holes of golf! QLI = 8.5 - just need to get better organized so I can work out more and take advantage of healthy hip!
3/17/07 - 5 Months - Milestones? Sitting cross-legged on floor! Putting on socks no problem - tying shoes. Need to work on my op-side lunges and reaching to pick things off floor (e.g. golf ball pickup). Slowly but surely the time that I can sit without discomfort is getting longer... Some minor numbness, tingling in foot after sitting too much - interesting.  I got an adjustable desk for work - nice! Highly recommended. First signs of starting to forget about hip: rolling on floor without paying attention to pain from site; waking up and not thinking about hip. Still can't really run - maybe I'm babying it. Tried a bit of running and was sore next day. Definitely don't want to overdo this - and I don't intend to make a habit out of running anyway. Will stick to golf, biking, swimming, hiking. Carrying daughter around on shoulders without problems - recall days when that was TOUGH - now fading memory. For 4 month ann. I thought I'd 'overdo' it a bit. One weekend: played golf (hit large bucket); short test on Mt. Bike; hiked 3.5 mi. on mountain trail; played squash game! Golf and squash probably pushed me too far - sore for 1 week. Need to ease into golf steadily and only play squash by myself for a few more months. Biking should start sooner. Hiking was not a problem at all - in fact I need to pick up more of this. Biking on pavement would be no problem at all - only problem might be the tenderness of my sit bones after a while off.
Talked to Dr. Amstutz today... Called JRI in morning then got call on my cell from from Dr. A in afternoon. Nothing remarkable to report (good news). I'll follow up at 1yr. mark. He said he wasn't planning on retiring any time soon. Asked again about device which was 56/50mm C+.
Oh - and I turned 37! 
2/17/07 - 4 Months - Today is the 4 month anniversary. I feel better than before the operation! I still have ups and downs and new pains. Slow period particularly around 1/28 - may have started walking longer distances a bit too fast. Groin pain on/off - need to take it easy for a few days - this is probably an adductor strain (gracilis, add. long.) as I'm doing more/more. Slow progress on flexion ROM and putting on socks... but I don't use the sock helper any longer. Did some hiking pushing stroller - felt great - walking faster than some people now... if I don't keep up on my ex. and stretch then I have trouble with socks. Need to re-up my focus on a sustaining plan. PT will end next week. I had a minor swelling of my foot after doing some hopping exercises - interesting - but went away. I can almost sit properly criss-cross/indian style on floor. 4mo xray looks exactly the same to me - yay. Shooting baskets. ... toying with idea of playing squash. Will ride my bike(s) on pavement soon. Here are the 4mo. x-rays plus others from before...
By the way- here's Floyd Landis' update for 4 months - he's doing better than me. :<
QLI = 8 (better than before surgery - need to work on being totally pain free and maintain my exercising)
1/17/07 - 3 Months - Stopped using the cane. I put on my sock without having to get into contorted position. Added few more exercises where one leg is involved - dynamic. Getting urge to golf and bike. Swimming with flutter and frog kicks. I'm getting fairly close to where I was pre-op. I had a pretty 'flat' week 13 - weak/pain rot/ab - need to work out more and sit less - but the next week was one of my best. This seems to be a pattern. Sleeping on op side now. Going to go on first trail hike. Now my daughter has strep and I'm feeling a little tickle in my throat - may need to go get some antibiotics...
Floyd Landis is a bit ahead of me :) - but we had the surgery within a month of each other. His 3 month update. I'm not exactly 'pain-free', and I bet he isn't either; but it's certainly a big improvement. At 3 months I actually feel overall better than before the surgery - maybe not in the morning, but on average. 
12/30/06 - 10+ Weeks - My wife had strep throat so I was nervous. I didn't get it. Doc. didn't recommend prophy. antibiotics. Had a trip from Phoenix to Portland on plane - about 2.25 hours. That took its toll. Also the lack of good exercise during the business trip set me back about 1 week. Xmas day - no cane around house - felt strong - next day sore though... Now sleeping and laying on op. side and also doing more free abduction (butterfly). I have about a 2 day time constant with pain and then improvement... repeat.. I went to a new PT this week (closer to my home/work). This new PT added more 'dynamic' exercises - which involve movement in more than one direction and twisting etc. These are really helping with my rotators/abductors for walking and gait. I created my exercise list on the web. I was able to tie my left shoe this week! QLI = 7.0 (7.5 on xmas day without cane).
12/20/06 - 9 weeks - Couple degrees better on my ROMs - slowwww going. Abduction is still weakest. I can stand on one leg for >30s now. Step-ups are the best exercise for whatever made me weak after the surgery. I drove my 4wd pickup with long clutch for the first time. Spent an entire Christmas party without my cane. Walked around an area at work where I'm not allowed a cane. I can touch my toes with straight legs on both sides. Leg press machine and 'reaching to tie shoes' exercises added this week. I actually tied my left shoe today - but not without a struggle. First flight (to Portland) this week - although I didn't need to go through security screening (Intel Shuttle flight). 2 hrs. of sitting really takes its toll - but I do notice that the sitting takes less of a toll lately...
By the way: Floyd Landis had his surgery about 1.5mo. before mine. He's planning on doing the Leadvill 100 (Mountain Bike endurance race) along with Lance Armstrong. People are doing Ironmans, marathons, etc... now I should be able to get my but out there and do my exercises routinely!
A Hip Anniversary Hike (AHAH!) planned for October 19-21 2007 (Th-Su) at Grand Canyon South Rim (Lodge/Cabins and who knows from there). QLI = 7.0 - little plateau this week with business trip and missing 1 PT.
12/13/06 - 8 weeks - Slow but steady progress. 75 degrees active ROM on flexion. I think this is where I was pre-op after years of compensation etc. Now my weak links are piriformis and abduction in general. Piriformis strengthening comes mainly with my 'step-ups' and standing on one leg. I can walk without the cane, but have an awkward limp that I need to work on. Typical exercise now is e/o day 5-10min. bike, 10min stair, 30 min swim. Then e/o day walking at least 1.2 mi. Daily stretching and strength exercises as prescribed - plus a few extra. I can now put on my pants and shoes without 'aids' or help. Still feels like a few weeks before I want to leave the cane. After sitting for :20-30 min. I get rather stiff and sore... need to concentrate on getting up and stretching often. When will this get better? PT is still at 3 days per week for a couple more weeks. Active stretching is helping me a lot. QLI = 6.5 and rising
12/6/06 - 7weeks - Started PT today. Lot more firsts. First time standing/balancing on op leg only. First walking without my cane; although Amstutz wants me on a cane until I don't limp. Went to gym and did stairmaster, cycling, and swam 1mi. My range of motion is horrible. Going to be going to PT 3x/wk for a couple weeks. Already after the first session I can tell that 'supervised' PT is going to accelerate my ROM and strength. My flexion is only to about 50/60 degrees! With all of this comes a lot of soreness and fatigue. Got some new walking shoes with more cushion and elastic shoelaces - so I don't have to tie them. Quality of Life Indicator QLI (stolen from MJ) = 5. Mood Factor MF = 5.
12/3/06 - 6weeks 4days - Started doing floor abduction for the first time. Walked 1.2 mi. in 30min. with a cane. First walk with cane of that distance. I can put my pants on without any assistance. Exercise then 3 advil and a walk is really a good recipe now. Weakest links now: Laying on side abduction and overall flexibility (only 50 deg. flexion and weak extension). PT in 3 days. Swimming tomorrow night..
12/1/06 – More ‘firsts’: Now rolling in bed. Really enjoying sleeping on stomach again – and then rolling over... Still not sleeping on OP side, but I didn’t do that before. First time on a recumbent bike trainer and stair stepper. The bike was interesting – no weakness, only clear lack of hip flexion flexibility. Need to work on that. I think now the main things I need to work on are the rotators and my flexibility. The rotators/extensors seem to be responding to isometrics in extended position and circumduction exercises. Also if I clench when I walk it helps. Still have the clicking on the back of stride, but I’m pretty confident they will pass with strength and capsule healing.

11/29/06 – Today was a bit of a bounce back… talked to doctor’s office today and had most of my questions answered. Particularly the ones about the surgical details were useful. Implant was a 50 mm femoral component and 56 mm acetabular. [>> Just talked to Dr. Amstuz's PA today about how he does it - and what she told me seems to match exactly what is described below (from Dr. Gross). The Glut. Max. is 'parted'/cut (some fascia is over this which is cut as well), that exposes the femur - however, to get the femur clear, they have to cut the external rotators (tendons). These tendons and their musculature help with abduction, adduction, early flexion and also stabilize the ball into the cup some that. The tendons are "sewn" back in place. Other than that I bet it's just a lot of stretching that goes on - which from my athletic experience can cause a lot of pain in/of itself. To get more detailed I think you'd have to read a description of the surgery from a journal or manufacturer and/or watch the surgery yourself. I haven't been able to bring myself to watch it yet! . but soon.. - Dave - Amstutz 10/17/06 LC+]

Some firsts today… laying on stomach in bed (ahhhhh!).. got down on my knees and knelt!... bent down with both knees… first day at work with one crutch and most of day… felt somewhat comfortable with cane and used it around the house… Going to call PT tomorrow.

11/28/06 – Little depressed today… This is my 6 week point (in a few hours). I was expecting to be off the crutches and with cane today. I can walk with 1 crutch or cane, but don’t feel real confident. The main limitation I perceive is an uncomfortable sensation when I extend my hip behind me in my stride. It should go far back – and when it does, at times, I get a ‘click’ sensation. Also I feel pain across the trochanter under the incision. It could be that I just have more healing to do and/or my strengthening/stretching hasn’t been done as much as it should. So I made a checklist for myself to go through my excercises 1-2 times per day min. and do 0.6-1.5 mi. walking. Every day or two there is a pleasant improvement – but yesterday I sat for a while at work after the long holiday week and felt very stiff/painful – went back to 2 crutches until evening. I would benefit from a visit to OS, PT right about now. I would even consider scheduling a phone or person visit with Dr. A to get some reassurances/advice… waiting for the office to contact me. I am getting stronger every day with my supine leg raises! Every day I can do more and hold longer – this was way weak for me.

Motivation for today: It is hard to put into words how my hip resurfacing has changed my life. The surgery and time in the hospital was better than I expected; I needed less pain medication than I was permitted. The recovery went faster than I had thought it would as well, but I took my rehab very seriously -- never missing any exercises, and slowly but purposefully increasing my workouts each week. Within the first year, I was back to snowboarding (no jumps that first year of course). Since I used a stationary bike during my earlier rehab efforts (after couch, floor and swimming phases), I began to enjoy the ability to spin a bike wheel. For the first time in probably 15 years, I was able to ride a bike without my foot slipping off the pedal. After spending a few months gaining strength on an indoor bike, I began to ride short modest rides outside. That was the beginning of a new "favorite sport".

11/25/06 – Had a baby girl 11/17 (Dana)… so things are very hectic around the house. Yesterday (11/24) was the first day that I felt like using one crutch the whole time – and did a fair amount. I can hold the baby and get around. Feeling stronger every day. I think the leg raises and isometrics that I’m doing more are helping. Now the biggest concerns I have are (a) feeling a little click/release when I have my op leg extended at the end of a stride and (b) getting stiffer all the time.. feeling like I may never be able to get my knee to 90deg or more and tie my shoes… need to look into the PT to work on this. Haven’t heard from doctor yet – had my x-rays taken at 4 weeks exactly and 6 weeks will be in a few days (tue – 11/28). I wish I knew that I would be talking with my doctor at a defined interval… I think I’ll try to find a suitable local doctor that I can actually get an appt. with and speak to without getting the runaround. I’m waiting to get OK for pool, PT and talk about my concerns. If I don’t hear from Dr. A’s office by Wed. of next week 11/29, then I’ll be disappointed.

11/16/06 just about 1 month – yesterday was 4 weeks. Feeling a little behind other people but I’m being conservative. I can walk with 1 crutch – and could probably just walk, but I’m sore and the doctor has not spoken to me or released for >50% load. I want to start some PT and swimming soon. Had x-rays done – no gross issues – but wondering why the ball head is rotated slightly in AP pelvis view. Rod looks centered in femur so maybe this is just my anatomy. Soreness and stiffness I can tell are going to be with me for a while. Can’t wait to get on some sort of regular PT and exercise. I think I’ve easily gained 5lbs of fat since I can’t do my regular swimming/biking. Holidays are coming, so it’s only going to get harder to keep weight off. I’ve been the same weight since high school, so I’m very concerned! My goal for this week is to do at least .5mi. focused walk every day – maybe up to 1mi. Also adding some iso/extension exercises. Sitting for a while makes me more sore/stiff, so standing whenever possible. My op leg is clearly getting stronger daily. Atrophy in quad is getting better. I can lift my leg in/out of bed and car – but this is clearly the weakest link. I have a hard time lifting the leg (as in laying down and just raising it) vs. non-op side. Also, this tends to come with some mild sharp pains along ASIS. I’m just going to chalk this all up to healing and the need for strength/stretch – I’m sure next week will bring a new outlook and set of symptoms! At this point I was expecting to be on 1 crutch all the time and raring to walk – but I just don’t feel that strong yet and I’m nursing the soreness to make sure everything heals well.

11/11/06 – almost 4 weeks – off coumadin – on aspirin only 2x daily for next three weeks. TEDS only at night. Now I’m struggling with the weakness of my quad and soreness in tendons around knee. I still feel a little ‘clunk’ every now and then, but not sure if this is the joint or tendons around the glut/wound. Slowly getting my posture back in chair – but it’s still odd, and hurts my back if I sit too long. Need to pick up the pace on my excercises to keep strength in my quads and other muscles. I think I’ll start swimming next week… need to check with Dr. again. Need to find somewhere that does the cross-table lateral hip x-ray… maybe my local OS? Will call Monday. Then I have a long list of questions etc. for my consultation. Still a little worried about what my local OS is going to have to say about all this. They tend to get defensive/ornery. Milestones recently? Can now lift my leg in/out of bed and in/out of car without lifting it. Still weak there. I can walk with one crutch or cane, but it doesn’t feel right and I limp, so still on 2 crutches. Atrophy in the quad – need to work on this. Went to work all 5 days this week; but I get antsy just sitting at my desk. I can’t go in the test floor with my crutches, so people have to do some work for me. Wife due in ~2 weeks! Busy. All in all, still on track…
11/4/06 – progress slowed a bit with muscle/tendon soreness – particularly at ASIS and above knee where lat.quad tendon attaches laterally. This resolves through the day but is worst in morning and sleeping. I get a little spasm every so often at night – very annoying. I can walk with 1 crutch and cane – but I’m not very stable. Still have 1 week on TEDs 24hr. and coumadin. 2 more weeks for 4wk follow-up. Starting to feel like I could use a talk with JRI… here’s a post:

Now that I'm 2 weeks out, I wish I had asked more questions and gotten more feedback from the doctor (Amstutz) on his first visit back with me after surgery - while things were still fresh in his mind. However, I wasn't prepared and I was just coping with meds etc. So I thought I'd compile a few things that you might want to have in a notebook to ask - or have your significant others ask immediately post op. This may be particularly important if you have to travel great distances just to speak face to face!

- Some surgeons take pictures of the critical components of the surgery, maybe you could ask for these?
- I want to get the details of the implant itself; like the size, lot, id etc.
- "Can you describe how the surgery went - e.g. the critical components?"
- When you were in there, what was the status of the fem. head and the acetablum? Did this cause any complications?
- How well do you feel the fem. cap and acetabular cup were set? Any trouble here?
- Any abnormal or extreme movement of muscle/tendon etc. required that might be felt later?

It might not hurt to have the x-ray or a picture of the hip there as an aid. I know this may start to sound crazy - but now I'm thinking that I need to be even more proactive about my visits/calls than before - since I have more questions every day.

I also refer to anatomy pages to understand the lingo better: e.g.:

For example, I'm feeling soreness and spasm where something attaches to the anterior superior iliac spine (ASIS). There are only a couple things attached here (heads), so I can be very specific when I have a phone consultation later. Otherwise it would have been very vague and ineffective.

Finally, as you may already have heard elsewhere, get copies of all documentation (e.g. xrays) on your progress. You may need this later if you have to see someone local.

Regards, Dave - Amstutz 10/17/06 LC+

For 4 week discussion:

- Need x-rays – get my copy
- Surgical report copy?
- Pain at top of knee where tendon attaches just above patella on left/outside/lateral – tender quad (lat quad tendon)
- More concerning – below ASIS tender – e.g. where sartorius or rectus femoris or tensor fascia lata attach – pain on flexing femur up without bending knee. Sudden sharp pain.
- - Some surgeons take pictures of the critical components of the surgery, maybe you could ask for these?
- - I want to get the details of the implant itself; like the size, lot, id etc.
- - "Can you describe how the surgery went - e.g. the critical components?"
- - When you were in there, what was the status of the fem. head and the acetablum? Did this cause any complications?
- - How well do you feel the fem. cap and acetabular cup were set? Any trouble here?
- - Any abnormal or extreme movement of muscle/tendon etc. required that might be felt later?
- Sensitive tooth – bad filling replace? When, protocol?
- Sore when I abduct – at asis – still sore at top of knee quad tendon – partic. When I squat
- What is flexion contracture – I did have limitations… now stiffness… need to work through
- Type of PT – posture, ortho, leg length – water, gait – talk to neighbor – how to get in/out of pool
- In 10 years who will I go to for followup?
- tender, pulling around trochanter/incision – where this goes back to glute... but not when weight bearing straight up – only walking after sitting really
- weakness in: raising leg from laying down; seated leg extension.
- soreness down lateral quad to knee. odd sensations in knee, like tendon stuff
- Why does AP pelvis show cocked ball vs. flush in some other pics I’ve seen. Is it ok that cup extends beyond? Are there notches on fem. head or just imagination. What to look for in these? Better lateral profile? How to fix this – rotate leg lateral. (abduct)
- Restriction in flexion to about 45… tough – is this contracture and do I need to work on it in PT.
- Now tender at trochanter – limits my walking; also tender where glute/ham intersect. These are deep pains so hesitant if it’s related to load bearing. However, I don’t feel pain when I stand straight up. Very stiff. Particularly on flexion and quad to knee. Had this problem before. Also having some spasm with my ASIS muscles – generally sore there. Had this spasm/soreness prior to surgery – actually one of the first symptoms – weakness when fast/sprint raising knee.
- Sore after/during sitting – muscles getting stronger. Really stiff to flex when waking. Pain on abduction at trochanter. Load doesn’t hurt much. One crutch ok. Cane wobbly. Get tired easy. Back to two. Diff. soreness now on ASIS/crest, seems like getting strongfoer. But still concenered that I had this before.
- How is device sized in situ? Was mine too large? Diameter of acetablum is defining? Any issues around my neck, bottom of cup? Buildup with cysts?

My 5-6 week update questions/comments:
- I would like to hear/see comments from Dr. Amstutz regarding how the surgery went. Can I get a copy of his surgical report? Any pictures that were used to archive the damage? I’m curious to know how the damage looked once in there – and if there were any complications (like filling cysts, sizing etc.) that I should know about.
- Specifically how well did the placement of the acetabular cup and femoral cap go? I noticed in the 4 week xray that a) the acetabular cup extends beyond my cup and the cap seems to be rotated slightly at 0 degrees. Is this anything to be concerned about?
- I would like to have the lot/id and sizing for my actual implant – so I can have this information handy in the future if there are problems.
- How do you handle sizing before and during the surgery? Do you have multiple implant sizes on hand in a kit?
- At 5 weeks I feel like I can walk for long periods of time with 1 crutch – and do. I do feel some minor clicking when I unweight at the back of my stride (extension). Also I have a lot of weakness in my flexion with leg straight laying down; can’t hold much longer than 8 seconds. I have a deep pain in my glute where it meets the hamstring. Sitting for longer than 20min. causes more deep pain. My trochanter is very sore – right under incision. This is the only pain that keeps me from feeling like taking baby steps without any support. Most other discomfort comes from taking longer strides or very quick motion. I have a soreness at the ASIS (or nearby) that is similar to pre-op – and spasms at night that keep me up at times. Is this just weakness and I need to work through it?
- Can you describe (name) which muscles/tendons are going to be weakest after the surgery – just from the way it was done?
- When I wake up in the morning I’m most stiff in the flexion (hard to bring to 45) and top of knee (lateral where it meets patella).
- Want to start water training and PT. Need prescription for the PT.
- Who will I be seeing in 10years? Who do you recommend? Should I find someone local that has done some? Duhon?
- Future restrictions? Sleeping, biking etc.?
- Do you return e-mails? Seems like good way to get in touch.
10/26/06 – almost 10days after surgery… experimenting with cane today for first time. First driving in auto minivan. Still some trouble sleeping. Incision healing nicely. Will be able to go swimming at 14days or so. Still on coumadin… still need to have blood drawn. Need to call doc. A. about release for driving. Recently sent some updates to friends and surfacehippy – attached now… Doing excercises and walking…

Jitters about “is it the right time”
- I think the anxiety even gave me some ill symptoms… My hip wasn’t going to get better and I just convinced myself that my quality of life will be better after this. Still I was nervous wreck. So I resorted to avoidance therapy – watching dumb/cheap comedies, sports, meeting with friends – to keep my mind off of things.

Worrying about anesthesia
- Trust the anest/doc and just tell them what you want… epidural+light general was OK with me and I’m a wimp.

Worrying about post-op pain and recovery
- Ok, so it’s a little depressing the first day after – since you really can’t do much with that leg; but as soon as the PT starts working with you, man, thinks start jumping. I find now that I have to hold myself back and listen to my aches. Every day I feel more and more ‘normal’. Yesterday was the first day in bed where – just for a second – I felt no pain and my hips felt perfectly normal; as if I could get up and run.

Little things about the first week after
- Sleeping – sleeping on my back kept me awake a lot the first week. Finally I can get into my own ‘tall’ bed – but can’t do much but roll onto non-op side with two pillows between legs. Even that feels a little odd – so I’m just getting used to sleeping on back – I crave sleeping on my stomach again!
- Driving (passenger) – give yourself lots of legroom for sweeping legs around – recline seat. Grab anything you can. Use the leg lifter or your arms to move your legs if you have to.
- Getting home (driving) – wasn’t as bad as I thought – left 3 days post op. Only took 1 rest stop in 6hr trip.
- Bathroom – besides sleeping this was an early challenge. Didn’t have BM for 3 days post-op – then it was tough to sit – even on the raised – toilet seat. Just now after 1 week getting used to sitting on the raised seat. Take the stool softeners. You should have BM 1-2/day on these. All the other meds might counteract some.
- Showering – I have a walk-in shower, so it wasn’t too tough. I also have a head with detachable sprinkler nozzle – so it’s great. I use a plastic lawn chair as a walker in the shower. I cover my incision with glad handy wrap and tape it down with mircopore tape.
- The incision – wow – it’s big, curvy and 10” long. PA for Amstutz did internal stitches with a lot of steristrips. Very low maintenance – nice work.
- Pain evolution/de-evolution – Had no problems with the pain – meds were avail. when I needed, but really I could have gotten by without it when I had a choice. Now the pain is more like constant bruised feeling (1 week)
- Stairs – easier than I thought with crutches – but go slow
- Sitting – Longer and longer on harder and harder chairs these days. My glutes are the most sore part.

JRI-LA-specific info
- Really do get the sense that this is old hat and they absolutely are world class. They are busy though! So don’t expect long conversations and shooting the breeze with Amstutz. This guy is doing 3 surgeries a day most days. They’re pretty good about answering messages etc. though. Just ask a lot of questions and take notes. Have questions ready when they pop into the hospital rooms – because you may be so out of it you can’t remember.

On the devices – MOM C+ etc.
- In the end I don’t see a significant difference; most significant is still the surgeon and the way they use the instruments etc. I figure that Amstutz has had the longest and most intimate involvement with all of this, so how can you do better today?

Things I purchased and actually brought along for trip:
- 4 leg raised toilet seat with arms that can stand alone or be used over the toilet
- leg lifter (norco)
- sock device
- gripper (one with peg and claw)
Surgery Week including 2-3 days after
[from my wife]

More walking around & less discomfort yesterday. Checkup by Dr.
> Amstutz yesterday went well, with exception of David's blood still
> being a bit thin. Vitamin K has been boosted to help, and another
> checkup today will determine release date. So far, things look
> promising for hospital release today & traveling back home tomorrow.
> Thanks everyone, for your well wishes & support! I anticipate any
> future updates will come from Dave Sr and/or David when he is back
> home this weekend.
> Lisa
> p.s. Read below for a happy testimonial from a former hip
> resurfacing patient! We're looking forward when David can resume
> his former life of mtn biking, hiking, etc. : )
Hello all, My husband had successful hip resurfacing performed by Dr.
Amstutz at Good Samaritan, LA on Tuesday. Everything went smoothly!
Yesterday (Wednesday) he was able to get up & walking with the
assistance of a physical therapist. I'm sure he will post more on his
experience when he is back home. (btw - I am not there with him as I
am 8 1/2 months pregnant - his dad is there with him though).

Question: He will be home this weekend. What can I do to prep for his
arrival? To help out when he is home? What are good things for me to
do or say to help him?


Just before - I'm on the epidural and some nice IV flow of something that will "make me feel like I had a beer". I think I asked them to make me feel like I had 3 beers.

After coming back from recovery. My hand never moved?

Walking a day or two after.

On the ride home. Look no crutches! Nice stockings.

The Day---

Surgery went smoothly yesterday. The part of the surgery that required Dr. Amstutz (the actual "resurfacing" part) was completed within a couple hours. See Dave Sr's pics to see the "after" pictures- looking good! I spoke to David yesterday evening. He was doing very well, no pain due to the epidural and the various painkillers. The only noticable side effect at that point was a dry throat/mouth from the breathing tube that was used during the surgery & no permission yet to drink liquids (ice chips only).

Click on this link to see a short animation of the "Total Hip Resurfacing"
procedure that David underwent:

The real challenge begins today, when the epidural is removed and he needs to actually try to move from the bed and around the room. As one "surface hippy" patient describes it:

"My first attempt to move myself out of bed was sobering. The trauma of surgery put my body in a primal conflict with my brain, which understood that the body has to move in order to repair. Because I felt so much pain upon movement, my instinct was to protect myself from further injury. I recall thinking that the discomfort was so great that I would not want to undergo another surgery in the future if the other hip were to go bad; I'd just have to live with it. But gradually I learned to "wrap my brain around the pain" and understand that although movement was going to hurt, it was not going to injure my hip any further. My comfort and mobility improved rapidly, almost freakishly well. By the next day I was walking with two crutches. I had gone off Morphine the day after surgery and was put on Percocet; by the next day I was down to Tylenol alone."

Day before----

Monday's appointments with the internist and the hip surgeon, Dr. Amstutz, went well. Surgery is a "go" for today! Check-in was at 8:30am Pacific time, and surgery scheduled for 10:30am. Our confidence rests with Dr. Amstutz, who is clearly an expert in his field, as evident through his successful surgeries & follow-ups over the past 30 years, his respect from his peers, his curricula vitae, and the many testimonials from happy patients.
Read more about Dr. Amstuz' credentials below.
Thanks to everyone for their well wishes! I'll keep you all posted as I get updates.

Before I left---

As some of you may know, David is scheduled for "hip resurfacing" surgery this week.
A description of the procedure, as described for Floyd Landis' surgery (Tour de France cyclist) is at this link:

David's didn't have the extensive injury that Landis did, but for whatever reason, his hip bone has severe damage (a "mean hip" as one doctor put it) putting him in quite some pain over the past few years, getting worse this year. When we found out I was pregnant, he realized he couldn't put off fixing it any longer, if he wanted to be able to walk around and play with the kids.

There are a couple choices for hip surgery: full hip replacement or resurfacing. The resurfacing, which David opted for, is a newer technique with not many experienced doctors in the area. After much research, David found one of the most experienced doctors in the country in LA. An initial meeting with the dr in LA a couple months ago confirmed this was the right doctor for him.

David left for Los Angeles, California yesterday morning with his dad (driving). He has a 10:30am appt with an internist today, for the final "go" for surgery, and a 1:30pm appt with the surgeon, Dr. Amstutz (no relation to Jenny, as far as we can determine!). He checks into the Good Sam hospital tomorrow at 8:30am, with surgery scheduled for 10:30am. We anticipate he will be in the hospital for 5 or so days, then come home next weekend.

I'll send more updates as I get them... Pls keep him in your thoughts!


10/14/06 – Day before – ok only positive thoughts from here on out. Had a lot of anxiety last night – but will work this out. Just going to take the ‘along for the rollercoaster ride’ approach now. Happy comedy movies, Scrubs, Chapelle, etc. will keep my spirits high. Went for a glorious trail walk (used to call these hikes) this morning. 1.5hrs. just to remind me why I’m doing this – man I’m sore. Seems like the exercise is helping to clear up my throat and keeping my mind off things. Going to do some last things around the house – like move furniture, cut trees – that I will not be able to do for more than a couple months… The baby is coming too, so get ready!!! This is going to be a fun couple months for sure. Definitely want to have a hip anniversary hike around GC next year!
10/11/06 – URI thing got much better, but still traces. Finally got the antibiotics prescription to Walgreen’s, but the course is beyond the surgery date by 1 day. Since things seem to be resolving, I probably shouldn’t risk it. Note: my appt. was 10/4 and took this long to communicate etc. with all the docs. Long story. Emma was sick today w/ 102 fever, vomiting, etc. – I hope this doesn’t catch up with me at the wrong time! Can you tell I’m getting nervous? 6 days to go. Have reservations at LA downtown Marriott Sun-Sat. Need to make sure I have a rigorous PT/Goal timeline when I return.
10/10/06 – Ok, I’m a bit worried about this URI thing that I’m fighting. Trouble sleeping and only minor improvement over 2 weeks. No antibiotics recommended or prescribed. I wonder if the stress of surgery could push this over the edge and make my recovery tough. Can’t reach doctors… argh.
10/7/06 – Next weekend we’ll be driving to LA. Had a respiratory infection of some sort the last 3 weeks. This has worried me – that I wouldn’t be 100% before surgery; but this is passing and I hope it will be fully resolved in a week. Still don’t have the test results from my pre-op appt. This would be the only thing (besides sickness or my wife going into labor) that would stop me at this point. I guess in the back of my head I’ve been doing some bargaining about how I might chicken out… Starting to imagine myself hobbling around and what it will be like not to bend my hip for a while – oh and the pain?
I keep telling myself to get pumped up about the way it will not hurt and/or limit my activities as much in the future…
10/2/06 – almost 2 weeks away now… very nervous, but reassuring myself… Concerned about work plans… Wondering what I will need for going to the bathroom, sleeping, etc. Also concerned that my wife will be giving birth 6 weeks or less after surgery! Looking for excuses to postpone I guess… Pre-op appt. 10/4 – final hurdle. Need to check with JRI on a few things (like typeA C+, sizing, THR options in situ). Should order all the stuff I might need this week and make financial arrangements. (10/3)


9/18/06 – t-minus 1 month… Insurance approval through. Scheduled with local internist 10/4 and have appointments pre-op in LA. Surgery scheduled for 10/17 at 10:30am. Plan to spend 10/15-10/20 in LA and drive back with Dad and Broseph (Jeff). Getting jittery and wondering (as many do) if it really is time. I keep reminding myself of the gradual decline, trouble putting on socks, trouble sleeping etc. etc. [Pain started way back before I can remember – maybe 1990(?), no soccer started about 2001, no running 2004, no hikes with backpack 2004, no squash 2005, no golf 2006, no biking 2006, just swimming now] It will be worth it. Hard struggle with the feeling of mortality that comes with losing an original piece of equipment that wore out. Starting to look at the rest of my body with more care/reverence. Thinking about which ‘aids’ I will need post-op – sock helper, toilet helper, etc. Wondering if I want general or local anesthetic. The mailing list can sometimes give you too much information to ponder – but in general it has been a big, big help. (surfacehippy on yahoo groups)
Surgery being done by Dr. Amstutz ( ) – renown in the community and developer of the protheses.
The bad hip – you can see spurs at the bottom; bone on bone at the top; cyst at the right.
One OS assistant said I had an “angry hip.” Most people notice my limp now and even strangers ask about it. [it’s my pimp limp]