A stubborn person's guide to hip replacement recovery

fossana

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Joined
Jan 11, 2018
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574
Looking NE on the ridge between Mt Holly and Delano Peak, Tushar Range


Mystery Ailment
In April of last year I returned from a short (and not atypically grueling for me) backpacking trip to Dark Canyon with odd symptoms. I had right hip pain in the trochanteric region accompanied by severe quad pain medial to the iliotibial band to the point that I had to manually lift my right leg when getting into my car. I am no stranger to hip flexor tendinopathy, which I've had a low level for over a decade, but the quad pain was unusual. I tried stretching and foam rolling without much relief after a month.

My sports medicine doctor diagnosed me with GTPS (greater trochanteric pain syndrome), a common ailment in aging women [sigh]. A cortisone shot provided no relief, so I started the
LEAP trial PT regimen, took occasional NSAIDs, and continued to hike. I was still able to hit the Tushars that summer, and in the fall hike into Scotty's Hollow from the Grand Canyon rim and Mt of the Sun in Zion.

But by late Dec my hip was very unstable. I was limping continuously, and I couldn't keep my normal pace on a winter holiday trip to the Supersitions. I could no longer bike, and the PT regimen was aggravating my symptoms. I continued to limp through local hikes, but I knew it wouldn't last. Had I not been distracted by a major house remodel and a major platform release at work, the injury would have taken a severe toll on my mental health.


Mt Holly, Tushar Range Scotty's Hollow approach, Grand Canyonramp to Mt of the Sun, Zion DSC02682.jpg

Definitive Diagnosis
In February I finally went back to my doctor and was insistent that there was something else going on. Despite my lack of typical symptoms, an x-ray confirmed that I had advanced osteoarthritis in my hip and I had been grinding down my femoral head for months. In 2007 I had a labrum repair in that same hip after an ultrarunning injury, so it wasn't completely unexpected that I had worn away the rest of the cartilage at a pre-AARP age.

I spent some time researching orthopedic surgeons and prosthetic material side effects. From someone who used to work on FDA regulated biologics, the lack of medical device regulation is appalling. I knew I wanted a
direct anterior approach hip replacement, as the recovery time is much faster. The downside is that there are only a handful surgeons in the States that are experienced at the technique, and UT has a stupid law that you have to be licensed in the state to do virtual appointments for residents meaning potentially multiple out of state trips. Traveling to the EU for surgery, where the technique is more commonplace, was unlikely in the near-term with the pandemic.

I cancelled my surgery with the first surgeon due to his sociopathic scheduler, who bragged about her propensity to wait until the last minute to submit insurance preauthorization paperwork (a potential $40K+ out-of-pocket surprise). Luckily I was able to find a competent in-network surgeon at the University of UT, and with COVID-19, the surgery queue was relatively short. I distracted myself with work and home remodeling projects until my April 23rd surgery rolled around.

My friend, Cindy (also an excellent PT), kindly drove me up to Salt Lake for my surgery. We both laughed during my pre-op interview when the attending surgeon told me that "I should have a 6-week endurance goal of 0.5 miles". I was told to "walk as much as I want" after surgery, but no running, climbing, mountain biking, or canyoneering for 3 months; I could live with that. The surgery was uneventful (minus the administration of fentanyl against my consent), and that afternoon I was released.


Before and after


Recovery
Some Bishop, CA friends and I had planned a belated group birthday party in 2 months, and I was hoping to be able to do at least some short Sierra hikes. I refused to take opioids, so I was able to go back to work immediately and drive within a few days. I was pleasantly surprised at the immediate stability in my hip. I used a pole for the first week on loose inclines, but I didn't need crutches. Within the first 9 days after surgery I had logged a slow, but steady 11 miles. I am thankful to my friends and neighbors during this time (and pre-surgery) for patience with my slowness on our hikes and the various food care packages.

Yant Flat, Cottonwood Wilderness my extended backyard

After doing my usual shorter, local hikes, I sought out long, flattish hikes (upper Hurricane Rim, Chinle Trail and Deer Trap Mt in Zion). For the first month, there was residual swelling and my quad would ache after longer hikes. As my friend who had a bilateral hip replacement put it, "What do you expect after someone hammered a huge titanium spike into your femur?" She has a point.

Hurricane Rim trail

Chinle trail, Zion Deer Trap Mt trail, Zion

I was anxious to add in steeper hills and altitude, especially with the rapidly increasing temps and my June trip. I started with a few trips to the Pine Valley Mountains, at times turned around by snow banks in steep sections covering fallen logs. I wasn't yet ready to risk a fall and hip dislocation. At 5.5 weeks I met with my surgeon, who was shocked at my rapid recovery. He advised me to "not overdo it", but as long as it wasn't painful I could continue on my trajectory.

Whipple Trail highpoint, Pine Valley Mts Whipple Valley, Pine Valley Mts

Finally the Pocket

At 6 weeks out, I decided that I was ready for the Tushars. I remember the comment from @WasatchWill on my prior Tushars trip report about how I had repeatedly skipped The Pocket, so this time I decided to loop it in even if it meant a lot of road walking. The Big John Flat gate was still locked, so at least I wouldn't be sharing the road with ATVs and 4x4s.

map.png elevProfile.png


I started out from Skyline trailhead, taking my usual SE route toward Mt Holly. It was still early for most of the wildflowers, but I saw plenty of elk throughout the day. Given the extra elevation gain I would experience later in the day, I used the Lake Peak saddle to gain the Holly/Delano summit ridge instead of dropping down to the south toe of the ridge first. It was quite windy, but pleasant when the sun was not obscured by clouds, and it kept the gnats away.

DSC02750.jpg

DSC02798.jpg DSC02782.jpg

After Holly I continued on to Delano Peak, thankful that the steep chossy section was free from snow and ice (although I had brought tent spikes for self-arresting). There was little snow on the summit plateau and the mountain goats were sparse today. Delano Peak was likewise deserted. I dropped down the South Fork basin, and encountered my first real snow. It was somewhat slow going, as I alternated between tiptoeing across suncups and postholing. I turned off at the 216 trail junction and was feeling the altitude on the steep climb to the Pocket. The views were beautiful, similar to the steep northern aspect of Mt Holly, but without the meadows. The forested trail down to Bullion Canyon was somewhat hard to follow. It was indistinct this early in the season, and was blocked in multiple places with snowbanks. I kept an eye out for cut logs and blazes.

DSC02810.jpg DSC02872.jpg DSC02893.jpg


At Bullion Pasture I cut up through the trees on what looked like an old mining road for a more direct line back to the dirt roads. The road walk back to the car took forever, with more climbing, mud, and postholing. It was nice not to have to dodge vehicles though. Finally, I made it back to the car.

As of today, 7 weeks out from surgery and with 2 weeks to go, I am feeling good about my recovery and upcoming Sierra trip. I'm hovering ~30 miles per week with on average 6800' of weekly gain. I guess my stubbornness in hiking up until my surgery date and ignoring the recommended recovery timeline paid off. I fully admit that this same obsessiveness has been the cause of prior repetitive stress injuries (as well as some major endurance achievements). This time I'll chalk it up to a win.
 
Last edited:

regehr

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Mar 28, 2012
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sounds tough, and sounds like you're dealing with it really well!!
 

Titans

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Aug 18, 2018
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Wow! Tough journey to get it properly diagnosed. Great to hear, that you’re recovering so well after the surgery, well done!
Have fun on your Sierra Trip.
 

scatman

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Dec 23, 2013
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I'm glad to hear your surgery was a success @fossana. It sounds like your recovery is going well too. Best of luck on your Sierra trip, and I'll be looking forward to your trip report. :)
 

AWR

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Mar 8, 2015
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Glad you're having a positive recovery! Quite a bit of OA for someone so young.
 

LarryBoy

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Jan 4, 2015
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Congrats on the successful recovery thus far! Whata great tripto celebrate with!
 

balzaccom

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Sep 30, 2014
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absolutely! You rock. Keep up the good work, and keep on hiking. I've been dealing with arthritis in my knee, and you've given me some inspiration!
 

Curt

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Feb 1, 2014
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Getting older sucks. I sympathize. Glad to read that surgery went well and recovery is progressing well. Hope the Sierra trip is wonderful and without problems.
 

Tim Valentine

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May 24, 2015
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Fossana, thanks for your inspiring post. I hope everything continues to go well for you. Keep us posted on your progress. I am particularly interested since I am on day seven of my own anterior approach right total hip replacement. (THR) Everything you said is spot on. For anyone starting down this path, if you start the limp or feel the hip or leg pain, go get the Xrays. Cartilage does not regrow so you are only going to get worse. The joint, unfortunately, does not heal itself. I would recommend getting the surgery as soon as practical while the other hip is still good and while the pain is not constant. I was fortunate to schedule my surgery before I was in a lot of pain but it was certainly impacting my endurance and enjoyment. I also was in and out of surgery the same day..... amazing. To discharge you, they require you to walk ( while you are still under hospital meds) with a walker to prove the joint is working. The follow on rehabbing and pain involved with it, is the body trying to heal the nerves and muscles that were dislodged that enabled the surgeon to get to the bone.
Fossana , good job on the balancing act between minimizing the pain meds and maximizing the exercise.

TV
 

fossana

Member
Joined
Jan 11, 2018
Messages
574
Getting older sucks.
Yes it does.

@Tim Valentine, I wish you the best with your own recovery. I had my labrum repair at Steadman Clinic in Vail, and they had a recovery plan for pro athletes and a recovery plan for everyone else. Not that I'm a pro athlete, but I know there's a lot more you can do beyond the everyone else plan to push yourself within safe limits. I tend to ask my surgeons what movements/incidents/activities would mess up the repair or otherwise significantly hinder my recovery, and I avoid those.

Let me know how your recovery goes.
 

zionsky

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Dec 23, 2018
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I've been fortunate to avoid any major/chronic pains to this point in my life but they are probably coming. When they do come, I am going to call @fossana for a pep talk :)
 

gnwatts

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May 19, 2012
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Great post @fossana . I had both my hips replaced in 2019, 6 months apart. I was up with a walker about 5 hours after replacement, and both times was out of the hospital 48 hours later. An amazing thing modern medicine. Thanks for sharing your experience and I wish you the best in your recovery.
 

TractorDoc

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Happy to see you've had a positive result and an amazing recovery.

Looks like the Sierras should be a walk in the park for you. . . or something to that effect!
 

fossana

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Jan 11, 2018
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574
@gnwatts Thanks, I'm glad that went well for you. Overall, most people seem to be happy with the surgery outcome, with exception of those that acquired metallosis from the CoCr implants (including a friend of mine). I heard from an ultrarunner, who was able to return to 100 milers after his surgery.

Thank you, @TractorDoc! Maybe a slow walk in Granite Park (see below), Sierra humor ;)

DSC02539.jpg
 

Rockskipper

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Jun 11, 2017
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@gnwatts Thanks, I'm glad that went well for you. Overall, most people seem to be happy with the surgery outcome, with exception of those that acquired metallosis from the CoCr implants (including a friend of mine). I heard from an ultrarunner, who was able to return to 100 milers after his surgery.

Thank you, @TractorDoc! Maybe a slow walk in Granite Park (see below), Sierra humor ;)

View attachment 99264
Great report. Very inspiring. Thanks for writing it up.
 

wsp_scott

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May 16, 2016
Messages
858
A friend of mine had a hip replacement in the fall and I was amazed how fast he was up and walking. It sounds like you have him totally beat :)

Glad your recovery is going so well. Where are you going in the Sierra? Climbing trip or just hiking?
 
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