A View From The Other Side
written by Jan Judge used with permission
Most therapists enjoy their orthopedic patients. They have a problem; it is fixed surgically and then rehab back to their full potential. I have had a degenerated left hip for about 10 years. I was treated first for an iliopsoas strain for over a year without significant results. An MRI revealed a mass on my right iliopsoas muscle. I was referred to an orthopedic-oncologist and thank goodness it was ruled benign. The pain persisted and then it was thought I had a labrum tear. The orthopedist wanted to do arthroscopy surgery at the time when a few surgeons were beginning to use the technique. I sought another opinion and another MRI was done with dye, which did not show a labrum tear but showed there was no cartilage in the joint. The orthopedist said to come back when I could no longer walk, as I was too young for a hip replacement at that time. Not being a quitter, I tried anti-inflammatory and some alternative treatment such as wearing a magnet and continued playing sports and working full-time.
In my last article, “A View From the Other Side”, (PT Advance, June 23, 2003) I explained how I acquired pituitary adrenal gland insufficiency. Taking the prednisone in high doses over a prolonged period of time had eroded the hip further. The pain became worse as did the x-rays.
In January of 2003, I experienced severe debilitating pain in my right hip. I had to revert to using the walker as each time I landed on either foot; the pain in my hips was unbearable. I was reduced to tears. After seeing the doctor, it was determined x-rays and MRI’s were in order as well as a trip to a pain management specialist. The radiographic showed avascular necrosis of both hips. Structurally the left hip was worse as the head of the femur was collapsing. The more intense pain was in the right hip because I was now putting most of my weight on the right. It was finally time to make a life altering decision.
A visit to the orthopedist was made with a decision to go forward with hip replacement surgery. After viewing the films, it was determined that I needed two new hips. None of my doctors were looking forward to this operation because of my other complicating factors: Addison’s disease, asthma, paralyzed right phrenic nerve, morbid centripetal obesity, hiatial hernia and a generally deconditioned body. It was to the point that surgery was not an option it was a necessity. The orthopod was afraid that I would fracture the left hip if surgery was not performed as soon as possible. The doctor was afraid that an unplanned surgery from a fracture would present even a greater risk than a planned replacement surgery.
My first surgery was scheduled for July 9th. If things went well, then the right hip surgery would be sometime in mid- October. I had to resign myself to the fact that surgery was inevitable. I signed on for the surgery with a lot of trepidation. Sometimes being in the profession has its downfalls. I knew what the surgery would entail and all the complications that could result from it.
I had to get medical clearance from all my physicians. I worked extremely hard at making sure that I had all the doctors and their concerns addressed before the day of surgery. One of my greatest fears was the anesthesia. The orthopedist decided that spinal anesthesia with IV medication would be the preferred method. After feeling better that it was not going to be general anesthesia and therefore would not need to go on the ventilator, I then began to worry about being paralyzed from the spinal!
Things at pre-op went along smoothly. I finally got to speak to the anesthetist who was going to do my case about 15 minutes prior to surgery. He saw that I had an allergy to xylocaine. He announced that this was going to change things. He would need to do general anesthesia. I was not happy. He got in touch with my allergist and they agreed on a drug that they could use with the spinal. Back to peace of mind. Well, almost. Again, knowing too much, I could envision the doctor cutting through the skin and then using a saw, hammer and other barbaric tools that should not be in the human body. Then, after treating many hip replacement patients, I could already feel the pain of the kindly therapist passively ranging my hip and saying hold for a count of 10. Oh, the revenge.
After being rolled into the OR, I remember feeling a stick in my back and lying down. Next thing I remember I am being rolled into my room. First part of mission – completed. The day of surgery is a day of rest. No therapy and bed rest. Enjoy your reprieve.
I was given a titanium socket with a cobalt chrome stem. The prosthesis was not cemented but will allow my bone to stabilize the prosthesis as healing occurs. My doctor performs an anterior approach for the replacement as opposed to the more conventional lateral posterior approach. The anterior approach presents with less chance for dislocation. He explained that even though my scar is posterior, he positions the leg in external rotation and extension. The posterior muscles of the thigh remain untouched which allows for a quicker recovery. Hip precautions are taken away at 6 weeks post-op.
Day two in the hospital, the kindly therapist comes in to get me out of bed. Boy, did it feel good. I transferred from the bed to the chair and thought I was in heaven. No pain. Now wait a minute, I thought the saying was “no pain, no gain’. Later that day, therapy came in again and I walked. Still no pain. What is up with this?
I was receiving IV pain meds and high doses of prednisone to cover me for the surgery but no pain? Day three brought the PT in twice for walking and the OT once for dressing and adaptive devices.
Day four was the move to rehab. Now, I am thinking is when the pain comes in. But still no pain. Went to OT and PT twice a day. Worked on dressing and using the adaptive equipment in OT and worked on ROM and gait training with Loft strand crutches in PT. I also attended group therapy run by OT or PT. Group sessions were comprised of both upper or lower extremity exercises and gait training. You cannot imagine the joy I had being able to walk more than 200 feet with no pain.
Because of the Addison’s Disease, the endocrinologist saw me daily. He assessed how I was performing in therapy while trying to decrease the dose of prednisone. Some days he was able to decrease it and others he was not. I was in rehab for seven days. Prior to discharge I could walk over 250 feet with crutches, ascend and descend 8 steps with one railing and a crutch, was able to bathe independently and dress with minimal help.
At home, I continued with home PT for the next four weeks. We had to take it slow as I was weaning down on the prednisone, which interfered with my endurance. I am currently, six weeks post-op. I can walk almost a mile using one crutch, can ride a stationary bike for 15 minutes, and can do a straight leg raise. I have not been able to do any of these things for the past 3-4 years.
I had my six-week appointment with the orthopedist and he was very pleased. He said I was way ahead of schedule and he planned my next hip replacement surgery for October 15th. Here is hoping to another phenomenal recovery.
Jan Judge, who has been diagnosed with Secondary Addison’s Disease, began another taper from prednisone on January 7th, 2005. She gave up her position as a physiotherapist due to ill health. Jan is the coordinator of the NJ/PA Support Group and has written a number articles including this one that have been published in the “Physical Therapy Magazine”. Jan graduated with a Bachelor of Science Degree in Physical Therapy in 1978 from Temple University, Philadelphia, PA.
For additional information:
Please feel free to contact Jan at: JanPT@aol.com
Or the NADF at: The National Adrenal Diseases Foundation
505 Northern Blvd.
Great Neck, NY 11021
(516) 487-4992 NADFmail@aol.com