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Dear Surfacehippies

This may turn out to be a long message/post, so I'll divide it into various

headings. I’ll be posting snapshots as well – check the Photos link on the

left side of the surfacehippy home page.

Facts

I had my left hip resurfaced on Monday, 16th February 2004, at St. Cross

Hospital in Rugby, Warwickshire, United Kingdom. The operation was performed by

Mr. Krikler. The procedure was done on the NHS (National Health

Service), or free of charge.

Chronology

Sunday, 15/02/04 Checked in St. Cross's Cedar Ward; met Harry who is

also a 53-year old with a left hip due for resurfacing by Mr Krikler; Harry is

very fit) I carry some 8 pounds of excess weight round my waist)

Monday, 16/02/04 Agreed with anaesthetist to have spinal anaesthetic

(like epidural for women in birth); Mr Krikler was happy to provide a " running

commentary "

At approx. 12:00 taken to pre-op theatre room where spinal was applied

Apparently was taken to op theatre where Mr Krikler started the incision and I

mentioned that I could feel it - he asked the anaesthetist to apply general

anaesthetic. I do not recall this exchange. I understand that the op lasted 1

hour and 45 min. Mr Krikler said that the hip was very stiff and that I had

very hard bones. It appears a bit more work than usual. He fitted a Cormet

device with a 48mm cup on femoral head.

At about 16:30 I was awake and back at the Cedar ward.

A couple of hours later Mr Krikler saw Harry and me (Harry was operated after I

was and his op lasted 1.15, I understand). By then the small of my back was

quite uncomfortable and I asked Mr Krikler if it would be OK to turn on my

'good' side (non-operated right). He said that'd be OK (many nurses were later

surprised by this - I guess they are still more familiar with the THR

post-operative procedure which prohibits sleeping on your side, or crossing

legs, for months, I understand)

Spent the night mostly awake; did not use PCA (Patient Controlled Analgesia) -

morphine pump to you and I - as the discomfort was bearable (I have to stress

here that I was not playing macho, but that I have extremely high pain threshold

and went through years of OA with bone-on-bone and a cyst without ever taking a

single pain killer); passed water 4 times (nearly a pint each time?!?) and

sat-up on the bed to wee (I could never do it using the 'goose' bottle lying

down in bed); constant sitting-up and fidgeting led to some leakage and oozing

from the incision which got redressed 3 times that night; all-in-all not too bad

a night.

Tuesday, 17/02/04 Day 1 - is how the hospital staff refer to the day

after the op; given a 'Zimmer walking frame at about 08:00 (after breakfast) and

told to apply full weight bearing on the operated leg/hip

Walked round the Ward and to the main corridor all the way to the lifts where

use of mobile phones is permitted; phoned friends and loved ones to inform them

that all's OK; couldn't find a place to connect my laptop (rather found a

connector but the hospital switchboard could not enable it for external calls to

an ISP - however, this week a new cable system went live there and each bed will

have cable TV, telephony [outgoing only, I understand] and full internet

access); alternated the day between walking, laying in bed reading an obscure

book and talking to Harry and the other 4 patients in our room; had bowel

movement and used toilet.

Wednesday, 18/02/04 Day 2 - had a shower in the bathroom; no problem washing

both legs; could see bits of bruising on my bottom; very little swelling.

Told that I have a 9-10 " incision/scar (22.5 - 25 cm); not bothered by that; it

is healing beautifully.

Harry and I are given 2 walking sticks/canes each cut to our size; we start

walking with these; usual destination: outside the lifts in the main corridor;

spending a fortune on mobile calls; after an hour I drop one stick/cane and use

one only (I'd like to stress here - mainly for our Yankee friends - that one is

free to walk round and explore as we do not have the culture of suing the

hospital should we stumble, fall and injure ourselves; it is pretty much left to

the patient to be sensible; I always informed the duty nurse when I went for a

walk, especially at night when I couldn't sleep; but I appreciated the

unrestricted, yet caring, environment I was in).

The continuous walking, interspersed with periods of rest/sleep/reading appear

to have speeded-up the healing tremendously - both the bruising and the swelling

are fast disappearing.

Made a mistake of not asking for a sleeping pill and spent most of the night

awake but without any pain.

Thursday, 19/02/04 Day 3 - Physiotherapist gives us (Harry and I) the

steps (up and down) and the platform test (up and down) with one cane/stick - we

pass and are ready to go home.

Blood test shows our INR (International Normalcy Ratio) for blood coagulation is

too low at 1.2 and 1.4 respectively for myself and Harry; the hospital decides

not to release us until we reach the accepted INR window of 1.5 - 2.5

(apparently, if our blood coagulates faster that 1.5 times the blood of a normal

person, i.e. the range between 1.0 and 1.49, we are at risk of DVT of sorts

where a thrombocite can get lodged in our lungs causing sometimes deadly

pulmonary thrombosis; if, however, our blood coagulates slower than 2.5 times

that of a non-operated person who moved round normally, we are at risk of

suffering bleed which could be very difficult to stop and even fatal if internal

and unobserved); at St. Cross's hospital, or maybe even at that Health Trust,

the DVT is dealt with using Warfarin tablets (also known as rat poison as that

what it is commonly used for).

Mr Krikler visits us and I take snapshots - I hope I'll be able to post these.

Nicola, the occupational therapist, is moving heaven and earth to arrange all

the necessary equipment for me when I'm released - there are peculiar problems

as I am way out of my area (I live in North East London, some 120 miles

south-east of Rugby), and I shall be staying at my sister's place in Essex,

another 50 miles east from my home. Nicola is trying to arrange through the

local social services for raised toilet seat, bed mats, raised chairs, bath

boards (to enter a bath tub safely), grabbers, long shoehorns etc. to be

provided by one Health Trust, via another one where I live in the third one

where I'll be staying - ah the vagaries of bureaucracy.

Friday, 20/02/04 Day 4 - failed the test again; Warfarin dosage

upped to max.

Saturday, 21/02/04 Day 5 - failed again; only managed to get the ratio

to 1.49; Harry is allowed to go home for the night as he lives only 7 miles

away.

I continue my 15 min walks round hospital complex/park at least twice daily

without a cane or stick which I carry in my arms but do not use. I regret not

bringing my car to the hospital - I could have driven it already on Day 3 as it

is an automatic and given that in the UK the steering column is on the right and

I had my left hip operated, I could have driven my car without any problems for,

say, 3 hours.

Sunday, 22/02/04 Day 6 - finally passed my INR test (barely, with

1.51); in the afternoon my daughter and her boyfriend gave me a lift back to my

sister's place.

22/03/04 - 29/02/04 Daily - walks approx. 1 mile without any aides.

Bruising has nearly all disappeared; there's no swelling; once a day, usually

before going to bed, I take 2 Paracetamol tablets and 1 Ibuprofen tablet - these

are meant to be pain killers and anti-inflammatory in their actions; the latter

I welcome, the former I do not need, but I do want to be a 'good patient'

I can do most things without a major inconvenience - dressing and undressing;

using the toilet; walking; using the stairs; putting on/off left sock & shoe;

washing/drying left foot etc.

01/03/04 – 06/03/06 Moved back home; I’m using my bath shower now; I

no longer wear a dressing/plaster over the scar (Mr Krikler used subcutaneous

self-dissolving stitches – the 9-10†incision has fully healed).

I’ve been driving my car for the last 6 days – no problems in driving it,

getting in/out, etc.

Went to Central London – the usual Friday lunchtime drinks with pals – I

went there unaided (no walking stick/cane) using public transport (bus and

London Underground, or Tube as we call it). Again, no problems using any of

these means of transport.

Comments

Leg length

Mr Krikler explained the mechanics of the procedure in detail; my leg was 1.5 cm

shorter; once the bio-physics of the pelvis-to-foot is clear and the resurfacing

procedure is factored in, it is clear to me why the resurfacing procedure can do

very little regarding leg length (mine looks OK now, but I'll have to wait until

my gait and posture are corrected and straight before I can establish if

there'll be a discrepancy) while THR can be much more effective in mitigating

leg length. That's about the only advantage that I could see that THR may have

over resurfacing.

Mobility

Extremely high extremely early - I'm absolutely impressed.

Recovery / rehabilitation

Unbelievably fast and painless (for me at least). However, I realise now that

the operation is less than 50% of the solution - the larger part is

recovery/rehabilitation.

ROM

Could not have imagined that the range of movement would be restored to such a

high level so quickly. I said, probably too optimistically, to Mr Krikler that

I plan to come for a 6-week check-up on my Honda Hornet to Rugby (ha thought I

was mad and he is a biker too).

My final challenge – to tie the shoelace on my left foot/shoe. I hope I’ll

be able to do that in a few weeks time. Standing on my operated leg, with my

good leg in the air (crane-like position), I not a problem but I lack the

balance I have when I stand on my ‘good’ leg.

Blood coagulation risks & management

Probably the least impressive of the otherwise superb NHS (or, at least that

particular Health Trust). Two of us were kept in valuable beds for 3 days - the

only thing that happened throughout these 3 days was the dispensing of the

correct dosage of Warfarin in the evening and a subsequent INR test in the

morning. I'm certain that could have been done in the local surgery / health

centre where the patient is based.

Thanks & appreciation

Where do I start? Mr Krikler for his wonderful manner and style with patients.

He answered every question without ambiguity, without use of a patronising tone,

with the patience that professionals have to have when they're dealing with a

layman. The fact that he was nearly invisible and that he made himself appear

accidental in this process, helped reassure me, and I suppose other patients of

his, that this is a routine op. By the way, Mr Krikler has performed 330+

resurfacings using Cormet in the last 8+ years. If you ask him, he'll tell you

openly about the 3-4 cases that needed revisions and why. He does also perform

this procedure privately - I understand that the package costs £9,000.00

(US$16,200.00 at 1.8 exchange rate) all inclusive (of course, there's the added

travel costs for our USA friends). Considering that the Cormet device costs

some £2,000.00, I believe this is very good value for money. Admittedly, it is

slightly more expensive than DeSmet in Ghent, Belgium, but we might be splitting

hairs here.

I must mention Safi, a Ward Nurse who appears to be quietly running the show.

She is a perfect example of a person who gains respect through her actions and

deeds. Her dedication, application, thoroughness, devotion and professionalism

were a sight to watch. Luckily, she was given a student nurse to teach as well

- the student was in perfect hands and would learn the profession well by being

tutored by Safi.

Nicola, who joined this site and offered to help with advice, is one of these

people for whom no problem is unsolvable. One felt safe if she said she would

look into something. I can't thank her enough.

There were numerous staff that were ever so eager to help - I'll mention Ivan

(from Zimbabwe, if I remember correctly) and Riki (from Zambia, I believe).

These guys were there throughout the long night shift and would respond

immediately if you pressed the buzzer - you could have tea at any time of day or

night. Whatever you needed, they provided it.

Lastly, it would be unfair if I did not mention and thank all the other staff at

St Cross hospital. This is a nice hospital with diligent and conscientious

staff that look well after their patients. Even the food was nice.

I must finish by mentioning the NHS - this is for the Brits - and stress that

anybody who wants to abolish it or plans to privatise it is either insane or

deliberately criminal. We have institutions for both types. And for the

unfortunate Yanks who have to fork out personal cash for the op - consider

strongly Mr Krikler and St Cross in Rugby (although Mr Krikler may suggest

another hospital where he operates also).

I'll shut up now. I hope to have more good news in 4 weeks time when I'm due to

see Mr Krikler for a check-up.

3 +44 (0)7974 981-407

* +44 (0)20 8501-2573

@ dan.milosevic@...

* 1A Cypress Grove

Hainault

ILFORD

Essex

IG6 3AT

United Kingdom