Patient story - John’s hip replacement revision surgery
The first in a series of interviews with Complex Hip Surgery patients. Talking to those who have undergone these procedures helps us understand what it’s really like for them before, after and during surgery.
John had hip replacements in 2008 and, due to an infection, needed revision surgery in 2014.
He talks us through his experiences.
Tell us a bit about you and your interests?
I am now 77. I was an accountant by training. I was always keen on sports, particularly rugby and tennis. I have also undertaken some major DIY property projects.
How did your hip problems start?
In my 20s I suffered a serious right knee rugby injury. I recovered sufficiently to continue playing rugby for many more years, but the knee was never fully right and my sporting mobility steadily decreased.
In 2006 I started to experience pains in both hips – the result of wear and tear and some hereditary malformation.
Over the next two years the range of movement reduced in the right knee and both hips, particularly in the left hip.
In March 2008 I had a left hip replacement. In June 2008 I had a right hip and knee replacement in the same operation. Both hips were metal on metal.
What was the outcome of these operations?
Although my wife - who is a physiotherapist - was aware that I was having increasing problems with my walking and particularly going up stairs with the left hip, she was twice reassured by my previous consultant that there was no likelihood of metallosis.
Despite this assurance - and because she needed to keep up-to-date for other patients - she had booked to attend a conference at RNOH Stanmore on metallosis in May 2014. As far as I was concerned, however, the new hips worked well until May 2014 when, I developed a sudden onset of acute pain in the left hip which was so painful I was unable to weight bear on that leg. I was admitted to hospital by ambulance and diagnosed with a major infection in the region of the left hip.
On May 8 2014 a biopsy confirmed a diagnosis of metallosis.
How was the metallosis managed?
By luck and good fortune, my wife spoke to Prof Alister Hart immediately following his lecture at RNOH, four days after my diagnosis. He agreed to see me and give a second opinion on revision surgery.
Further x-rays and scans gave a diagnosis of metallosis with a pseudotumor adjacent to the left hip and marked osteolysis in the right femur, which was on the point of fracturing.
Prof Hart explained very carefully how serious the infection was. To avoid infection in the replacement hip, both hips would need to be removed as closely together as was possible and temporary hips inserted until the infection had been cleared. At that stage, new, permanent hips would be inserted.
What physical state were you in before the surgery?
In general terms I was fit and I did not have any medical issues beyond the hips, but as I was only walking as necessary with two crutches my mobility was severely restricted.
I was calm and not unduly concerned, though I had taken the precaution of getting my affairs in full order!
How did you feel after the first operation?
On June 16 the first stage left hip revision surgery involved a long femoral osteotomy to remove the old hip, clean out the infection, and insert a temporary hip. It was a lengthy operation and involved breaking the femur to withdraw the prosthesis. Following the surgery I was in ICU for two days as I was anaemic. I felt totally exhausted and tearful.
Because of this, the right hip first stage hip revision surgery had to be delayed by two weeks until June 30.
Although this was more complicated, due to the right knee replacement and femoral osteolysis, the recovery was much easier - possibly as I was given a blood transfusion.
The intention was to insert the permanent hips two months later, but as the infection had not been satisfactorily cleared, the temporary hips were replaced by further temporary hips just two days apart on August 26 and August 28.
How did the permanent hip surgery go?
There was a further three month wait before the infection was sufficiently controlled to allow insertion of the permanent hips.
The left hip second stage replacement took place on December 1, and the right hip on December 8. The second operation involved a long femoral osteotomy to remove the old cement. Because the femoral bone was so thin, Prof Hart was concerned it would splinter with the force needed to insert the new prosthetic femoral stem.
I spent 6 days in ICU and 47 days in hospital in total between June and December 2014. I was able to come home between operations, but was restricted to either a wheelchair, or minimal weight bearing on a zimmer frame. I was confined to one floor initially but, as my wife had expected managing stairs would take nine to 12 months at least, she arranged for a full lift to be installed in our house. This meant I was able to get between floors even when confined to my wheelchair.
At times there was significant pain and the inability to do things for myself was frustrating. The period from the first hip pain to feeling fully recovered was around a year.
How are things different since the surgery?
Since I recovered from the final surgery in Spring 2015 my hips have been almost perfect. I do not think of them. I do not play sport these days – a combination of age and my right knee which I have to treat carefully – but I am active and still doing lots of DIY.
What advice would you offer to anyone considering having a similar operation?
It needs some courage, a very determined attitude and someone to care for you away from the hospital; but the outcome makes it well worthwhile.
If I had not had the good fortune to be able to get both a second opinion and switch to Prof Hart’s care, I would very possibly not have survived the complications of the infection.