Claire's Shiny New Birmingham Hip Resurfacing

Background;  Claire had experienced increasing problems walking and biking since last Winter's trip.  We'd seen several doctors about her problem, and the diagnosis they all seemed to agree on was osteoarthritis of her left hip and right knee.  The recommended ultimate treatment was surgical replacement of the affected parts with artificial parts...with some permanent range of motion limitations to be expected, and an expected lifetime of 10 to 15 years before the artificial joints would  need replacement, referred to as "revision surgery", even more complicated than the initial operation since the old prosthesis must be removed ...  IF a patient is TOO active, it might wear out sooner.  Thus doctors typically advise patients to hang on as long as they can before getting joints replaced, so they do not overuse them, and they do not have so long to last. The Xray picture below shows a total hip replacement installed, with the femur head cut off and the metal spike inserted deep down into the femur (there is a screw holding the socket into the pelvis in this one too).

This was a BIG GULP for us....SCARY...   Neither of us was keen on surgery...but surgery with expected repetitions when one is 75 or 80, then again at 90 if we're lucky... is just....mind numbing.  There is always a small risk of mortality with any surgery....but as people get into their 80's and 90's with weaker immune systems and hearts, it increases greatly.  We had elected to try the "band aid" less radical treatments last summer...cortisone injected into the hip in the hospital with fluoroscope really accomplished little after a few days.  Synvisc injections in the knee helped more....but Claire was still not comfortable walking any distance.  We left on the fall RV trip late, and decided to head to Florida rather than west as we had initially planned.  We enjoyed this trip, visiting many friends and relatives, but it was only on good days that Claire would walk from the RV on the outer edge of the parking lot into a Walmart store to shop when we spent the night there.  Without sufficient exercise, she was quickly becoming less capable of even doing that.....  :-(

 We had heard of a surgical procedure developed in England that preserved the top of the hip bone, capping it with a metal ball, that fitted into a metal socket in the pelvis.  This large ball replacement joint left patients with a full range of motion after recovery, and the metal joint showed promise of resisting the normal wear associated with the metal ball on plastic socket devices commonly used in total hip replacements.  Since it was not approved in the US, we decided it was not going to be reimbursed by our insurance...and, although it looked like it would be ideal for Claire, we did not think we could go overseas for the surgery and pay the full cost ourselves.  We had no idea where to even START with this.....

November 6, 2006;   We were visiting friends in Florida, nearing the end of the fall trip in early November, when we received an e-mail from friends in Massachusetts who had seen Dr Daniel Snyder on a local TV show talking about the newly FDA approved Birmingham Hip Resurfacing procedure he had been trained on in England, and was now performing at Newton Wellesley Hospital....less than 15 miles from our home!  We heard about this TV appearance on Saturday, called Monday for an appointment, and received an appointment two days after our arrival home.....

From Dr Snyder's webpage, http://www.bostonhipresurfacing.com/patientEd.asp we could tell that this surgery was recommended primarily for active women 55 and under, with good bone density...no osteoporosis.  Claire had good bone density when scanned five years ago...but would she qualify for this procedure now, at age 64?

Saturday, November 18, 2006   While browsing the web looking for more information about resurfacing, we found a yahoo chat group called "Surfacehippy"   http://groups.yahoo.com/group/surfacehippy/  devoted to discussing the hip resurfacing procedure and its advantages, the doctors performing it, the expected outcomes, and the varied recovery rates experienced by many contributing patients; even the things that sometimes go wrong.  This group has been EXTREMELY helpful in preparing us for the procedure and helping us avoid some pitfalls along the road to recovery.   If anyone is seriously considering hip replacement of any kind we'd recommend this group highly BEFORE the decision is finalized.

Monday, November 20, 2006;   We first had an appointment with Claire's surgeon who had injected the Synvisc in her knee.  He is a really nice person, but early on had said he does not do resurfacing.  He did recommend a Total Hip Replacement, cutting off the top of the femur and running the rod down inside the leg bone to support either a metal on plastic bearing, or a ceramic bearing which is expected to last longer...unless it receives enough impact to shatter it, when it turns into a BUNCH of sharp shards...inside the patient's hip.  This was described by the doctor as a "mess".  This mess we could understand well, having twice cleaned up shattered Corelle ceramic dinner plates from inside the RV.  The sharp shards still show up in odd places years later.....inside her hip, UNTHINKABLE!   He also recommended that Claire donate two pints of her own blood a few weeks prior to surgery, to replace blood lost during surgery.  We excused ourselves to "think about it", knowing we'd meet with Dr Snyder the next day.  

Tuesday, November 21, 2006;  We were disappointed to find the referral that had been promised by Claire's primary care physician, a requirement of our insurance, had not arrived at Dr Snyder's office....but signed the fee guarantee and proceeded....after the PCP's office again assured Dr Snyder's office that it would be sent immediately.

Dr Snyder took more Xrays, (yes, she's had a LOT of Xrays and MRI's in the past year).  While we were waiting for the Xrays to be processed he showed us a real Birmingham Hip Resurfacing device.

The socket (to the right in the picture) has a rough cast back surface that is drug coated to encourage bone growth to attach to it when it is press fitted into the hole that is reamed into the pelvis to receive it.  The post on the ball is placed in a hole drilled with special tools into the femur neck, while the head of the femur is shaped to fit exactly into the back of the ball, and is glued in place. Dr Snyder spun the ball in the socket like a top...and it might be turning still if he had not tired of the game.  The ball and socket are lubricated in the body by joint fluids, but the clearance is very important to allow optimum lubrication to take place, and the surfaces are machined with extremely close tolerances.  We understand the device in the US costs over $12,000 (hopefully the insurance will take care of most of that!).  For that price it OUGHTA be shiny!  :-)

The Xrays came back, and Dr Snyder indicated that Claire's bones looked good for resurfacing, but said he always had a standard Total Hip Replacement prosthesis in the operating room too, in case resurfacing proved unwise given conditions that became evident only during surgery.  We asked what the probability of resurfacing was...after a short hesitation he said 90%.  He indicated that most resurfacing failures occurred within 6 months of the surgery, due to fractures of the femoral neck.  I asked if he had any idea WHY those early failures occurred.  After a brief hesitation, he said "I think it is the technique".  We asked how many resurfacings he'd done...25 was the reply...and they are all very happy.....BUT, there is a statistical possibility of around 2% failure rate.  There is a study reporting on failures at http://www.hip-clinic.com/en/html/results.html  .  We asked if either of us should donate blood ahead of the surgery...we are the same type.  Dr Snyder said Claire would not need blood....he was almost certain of that, and he felt that donating her blood ahead of surgery was counter productive to her best recovery.  I again asked if my donation would be helpful...and he repeated that she would not need blood.  Dr Snyder impressed us very favorably, and Claire decided on the spot to have the surgery; he said the scheduler in their office would set it all up, find an open date, and arrange for insurance coverage.  One point that was emphasized in the surfacehippy group is that hips deteriorate when under attack by arthritis, and it is NOT wise to try to put off resurfacing surgery past the point where it detracts from your life.  Eventually the femur head will be damaged beyond the point of resurfacing, and a Total Hip Replacement will be required.  Dr Snyder reiterated this, and emphasized that resurfacing is for people who WANT to be active; activity is necessary to the recovery, and to bone health after recovery.  He emphasized that Claire needed to be able to walk 30 minutes a day.  Claire admitted that was not possible now, but had been our style before the arthritis hit, and was our desire again.  :-)

Upon returning home, we called Claire's primary care physician about the referral....who now said they did not refer to Dr Snyder or Newton Wellesley Hospital since they were not in that practice's network...HUH?  You wait two weeks after we called for the referral, and after we were PROMISED a referral, to tell us THAT... AFTER we had the appointment and guaranteed payment based on a phone call THIS MORNING?    GRRRRRRRRRRR!!!!  A call to Blue Cross confirmed Dr Snyder was a Blue Cross provider as he had stated....and they suggested Claire change her PCP at the end of the month to someone who WOULD refer to Dr Snyder.  It took 2 hours on the phone, but we did just that....  You cannot be too careful about checking and rechecking insurance matters.  The insurance systems are DESIGNED with arcane rules intended to shift the insured cost onto the patient, and the various company's involved will NOT always be "open and truthful" .  :-((((

Later in the day Dr Snyder's office called with an available surgery date shortly before Christmas, followed by the next available one a month after that.  We were not too keen on Christmas with crutches...but waiting here through an extra month of winter was not a pleasant thought either.  We decided on the December 19, 2006 surgery date....at least we could expect to be HOME by Christmas.  :-)

Monday, December 6, 2006;   Scheduled preop visit with Dr Snyder's office and Newton Wellesley hospital, more  Xrays, and time with Dr Snyder's assistant who told us the operating room was booked from 7:50 AM until 11AM for this operation, and explained dietary restrictions starting a week before surgery (no herbals, vitamins, or vitamin K bearing foods like kale, lettuce or other green leafy veggies...a mainstay in our diet).   These restrictions would continue until the anti clotting coumadin blood thinner was discontinued weeks after surgery.  Also stressed were the common position restrictions for this surgery...no crossing centerline with the operated leg, do not bring the operated leg above 90 degrees to the torso, and do not twist the operated leg toes in toward the centerline...all to avoid dislocation of the new hip until the tissues could regrow to keep it in place, and Dr Snyder's special restriction against moving the leg outward from centerline for a time after surgery, due to his Ganz method of avoiding detachment of outer hip tendons from bone; he slices the bone away with tendons attached to allow the hip joint to be opened, then screws the bone slice back on at the end.  Bone heals better than tendons do....   We asked which type of anesthesia Dr Snyder preferred....the quick answer was "General".    Claire was happy with this, as she did not want to be aware of the procedure anyway, expecting grinding and drilling noise like she had heard with her emergency broken ankle surgery under spinal sedation years ago.  We emphasized our strong desire to have resurfacing, not the Total Hip Replacement. ...and were relieved that it was noted already in our records.     We met with the hospital anesthesiology department, then the physical therapy department where crutch measurements were taken, and suggestions for home aids (like raised toilet seats, pillowed chairs, reacher grabbers and sock tools to allow picking things up from floor and putting clothes on without bending over). The blood testing lab needed a few samples......  This was a BUSY day....   Nobody had any clue what our share of the bill might be either .....   

Tuesday December 19, 2006  This is surgery day.  We needed to be at the hospital shortly after 6AM...so we were up EARLY!  (I gotta confess, I did not sleep very much that night, although Claire said she did).  We could have slept a little longer had we realized how fast the trip to the hospital would be with no traffic.  :-)   We sure got good parking places in the garage!  Right on time we were paged to go to the room where Claire was to be prepared.  Lots of folks introduced themselves....several nurses, anesthesiologist, anesthesiology nurse, IV nurse.....   We discussed the anesthesia to be used, the standard version of which started with a bit of sedation before the trip to the operating room.  We agreed, then the anesthesiology nurse came in with a paper cup with a  number of multi-colored pills for Claire.  The IV nurse attached the IV,  then Dr Snyder appeared for a brief visit.    He indicated Claire's anatomy was ideal for the resurfacing....she responded to him, and emphasized again that she REALLY had STRONG preference for resurfacing if at ALL possible.  He smiled...then said she'd get a resurfacing as he left to prepare for surgery.  The anesthesia nurse put medication into Claire's IV.....then shortly after, right at 7:50 AM she was wheeled down toward the OR, and I returned to the lobby to wait.  I had been given a pager that Dr Snyder would use to tell me how it went after surgery was finished.  I rather expected the call to come before the 11AM time...but the clock kept moving, no call.  The lady waiting next to me had her husband undergoing Total Hip Replacement...at age 47.  I felt sad for them facing future wear out of that hip...but smiled and wished them a good recovery when her pager went off.  It was nearing 11AM when I visited the bathroom, and returned to find Dr Snyder in the lobby looking for me, smiling....no, he had not tried to page me, rather thought he'd speak to me personally.  He indicated the surgery had gone well, Claire was in recovery breathing on her own, but he'd found a lot of inflamed soft tissue he'd removed...that it was a difficult case, but since he'd removed it, he did not expect it to return, and expected Claire would get a LOT of relief from the surgery.  He asked if Claire had been walking on her own without assistance just prior to surgery, I said "yes, but with a strong limp".  He said "She must be a TOUGH lady...."   What could I say...she is!  :-)  He indicated I could visit her after she woke up in recovery, I should ask at the desk in half an hour.  When I asked, she was still asleep, to try again in 15 minutes.  The lady on the desk asked who our surgeon was, and volunteered that Dr Snyder's patients always seem to do very well.....  That's reassuring.... but then, we hoped that was so.  It would be good info for FUTURE patients though!  :-)  Next time, Claire was awake, but they sent me to her room to wait, as she was being moved there.  When I saw her, she was still VERY groggy, but when I told her she had the resurfacing she smiled weakly and nodded that she understood.  I was the first to tell her.....  :-)   Her leg was elevated in a "sling" suspended from a rail over the bed, and she wore pneumatic cuffs on both calves that  were periodically compressing and releasing her legs to prevent clots, over knee length elastic "TED" stockings.  Dr Snyder came in later, and said she should not be so groggy...asked if she had pain, she said "no".  He very carefully explained to her while I listened that she should be sure to tell the nurses she had no pain, and not to take the oxycontin pain pills when they were offered.   He reiterated that "Pain pills are not good for you....do not take them unless you really need them."    Hey, I like this guy...he tells it like it is!  :-)  I wasn't sure if I'd be asked to leave when visiting hours ended at 8PM, but nothing was said.   The evening nurse came in with the pills, encouraging the pain pill so Claire would be ready to start therapy in the morning, and indicating that two 325 mg entera coated aspirin daily was the prescribed anti coagulant, not coumadin as we had been told to expect.  She said the anti coagulant treatment varied.  As long as it worked, we both felt the aspirin was less risky for side effects, and we could go back to eating our green leafy veggies!  :-).  We decided I should go home when Claire decided to retire for the night around 9:30 PM.  I found the parking garage pay booth was closed with the gate open when I left....well, I guess being late to leave has it's rewards.  :-))

Wednesday December 20, 2006  Today Claire was expecting physical therapy to start in the morning...and I wanted to be there for that.  I did arrive as Claire was finishing breakfast...I played the role of "family dog" and cleaned up the food she'd ordered but could not eat.  She's still got some recovering to do if she cannot eat!  :-)   The physical therapists came in, bringing crutches, and got Claire standing, and I observed that she stood erect, not leaning forward as she had before surgery.  They had her take a few steps around the room, then out into the hall until she started to tire, then we returned.  She returned to bed to rest, the therapists would return in the afternoon.  Claire slept a lot after her exercise....but awoke for lunch.  Again she had ordered more than she expected to eat...but nothing went back wasted. :-)  The physical therapists came in the afternoon, more walking in the halls.  Claire reported no real pain, but was tiring VERY easily.  She was taught to pace herself, so she had the strength to get back to her room.  We had understood maybe only two nights in the hospital, but when we asked about discharge the reply was "maybe Friday if all goes well".  It did not seem like Claire was ready now, fer sure!  A few minutes of sitting in her chair had her feeling faint, her blood pressure lowered, and back to bed she went.  It was not likely that she would be ready to walk out of there by 11AM in the morning.  In the evening a delivery man brought in a BEAUTIFUL plant.....big, green and just radiating LIFE!  We found a place on the bedside table for it.....

It just took over the room, letting us both know that there were other forces out there we could soon rejoin.   It's easy to lose sight of real life when every step and trip to the bathroom is a chore requiring minutes of planning.  That plant was a HUGE pick up for both of us!  THANK YOU David & Marge!!  :-))  I'm wearing down early this evening, but when I take some excess stuff to the car to go home after visiting hours end, the parking lot has not yet closed.  I watch another TV show with Claire, but she is dozing and I decide to leave no matter what....I'm TIRED!   By 9PM the parking lot is open for free departure...  :-)

Thursday December 21, 2006  I am a bit later arriving at the hospital this morning.  The night does not seem long enough for sleep and I do not set an alarm.    Claire is already finished with morning PT, they had her climbing stairs on crutches.  She seemed much improved over yesterday, not so tired, is interested in when she can go home.  :-)  I ask at the desk...they say maybe tomorrow, as long as the PT people think she is ready to deal with her home environment, and the discharge coordinator has approved it.    I wonder what Dr Snyder has to say in all this...and they assure me he has the final say and must authorize discharge.  I ask that arrangements be made if possible.....  Afternoon PT time comes.  Claire climbs the stairs and I'm cautioned to stay behind her to catch her if she falls.  Falling on the newly implanted hip before bone grows into it could jar it loose requiring more surgery.  Dr Snyder is pleased with Claire's condition when he arrives at the end of PT, and thinks she is ready for discharge tomorrow.  He mentions that hospitals are not a good place to be, and she should be discharged as soon as she's ready...   I LIKE this guy!  :-))   We ask him how much weight Claire should put on the operated leg, as PT thought she should be weight bearing as tolerated, but we'd heard from the Surfacehippy group that Dr McMinn in England who developed the BHR had recommended reduced weight bearing for three or 4 weeks to minimize chances for hairline cracks developing in the femur head resulting in later failure.  Dr Snyder said Claire should be on 50% weight bearing until he saw her in 3 weeks.  The PT immediately changed the paperwork.  We asked if the 35 grams a day of ground flax seed we ate was a good thing to keep taking; he said "yes".  The afternoon is spent gathering things that can go home with me tonight.  It's always amazing how much STUFF accumulates in a few days.....   Claire's spirits are improving steadily as she gains strength and anticipates her return home.   Son Matt comes to visit....:-)))   It's nice to see him.  The nurse suggests I take the plant home tonight, to ease the move out effort tomorrow.  I find a plastic bag to cover it, and take it on the last trip to the car.  

Friday December 22, 2006  I arrive well before the 11AM posted checkout time.  PT comes in the morning, and practicing walking further is the routine.  Stair climbing is considered OK and there are no concerns for discharge.  I think about the need we might have for a handicapped parking decal if Claire must get around in snowy weather, and call Dr Snyder's office about it.  I am invited to pick up a signed form in 30 minutes, and walk down to get it.  We will have to carry it into the registry ourselves.  11 AM comes and goes....no motion toward discharge, although Claire is dressed and ready, and all the belongings are in the car.  I'm quite thankful we do not have to be concerned about the plant freezing in the car for all this wait time.  I did not understand that discharges proceed sequentially whenever the team gets to us.  It is after 1PM when they finally arrive, Claire is transferred to a wheelchair to be pushed to the door by staff, and I go to move the car to the discharge door.  It is busy, parking is scarce, but I find a place and we labor to transfer Claire into the back seat of the car in a safe position on top of cushions so she does not bring her knee too high and break the 90 degree rule.  She looks awkward and uncomfortable strapped across the back seat, but the staff person thinks it's OK, and we start.  The first turn caused Claire to moan as centrifugal force moved her leg in unaccustomed directions.  I slow in turns, and she learns to support the leg with her good leg.  This is not gonna be EASY.....but at least there is no snow for the crutches!  :-)))  We stop at Walmart on the way home for coated aspirin and some prescribed drugs.  Then we stop at the registry office to get her handicapped parking permit.  I go in, find that I must mail the request to Boston, and it will take over a month...geeze.  The lady agrees to send the form to Boston herself, and mark it "RUSH"...but that is all she can do.  "-((  Claire is quite content to stay in the car through all this, we use family radios to keep in touch while I'm inside places.  However, she is quite ready to get out of the car by the time we get home, and we walk carefully on crutches up the front stairs and into the house.  We have cushioned arm chairs ready, and she is ready to rest.    It is not long before she is ready to rest in bed....so we climb the stairs for the first time.  She does well, but it's tiring.   There are prepared meals Claire froze before surgery, and these ease the recovery a lot....she does NOT have to eat my cooking!  :-)  Also, I do NOT have to cook either... we just heat 'n eat!   :-)))  Dishes are another thing, but without really cooking I'm able to run the dishwasher only every other day.

Saturday & Sunday December 23 & 24, 2006  These days blur.  I know I'm busy.  :-)  A nurse visits the house, is pleased with Claire's incision.  A PT specialist visits and checks our home's readiness for Claire's recovery, and assigns exercises.  Matt, Carol, and her fiancee Jason come to visit for Christmas;  Claire had ordered our traditional lobsters for Christmas eve before the surgery, but I get to pick them up and cook them.  I check the cookbook for boiling time for lobsters...but find only steaming directions.    I know I prefer them steamed, but do not have pressure cookers for this many lobsters.  The cookbook recommends steaming in a closed pot, not pressurized, with time dependent on weight.  We have a LARGE pot with cover, and a steamer rack...The heavier lobsters go in first, with the rest following so they are all finished at the same time.  This is easy and MUCH faster than bringing a full pot of water to a boil, and all 5 fit at once.  The lobsters are also tastier than when boiled submerged in water.    Maybe I CAN cook?   Well, yeah, I did get the tater tots a bit too brown .  :-(  We open gifts tonight, as Carol and Jason are leaving early for Maine for dinner with his family Christmas day.

Monday December 25, 2006 It's Christmas!  We're up wishing Carol & Jason a good trip when Claire announces she really DOES want to go to the family Christmas dinner an hour away.  I ask whether she will be OK riding 2 hours in the car...she says she thinks she can fit in the front seat on cushions.   We load up her high seat commode in back, and off we drive.  Claire soon learns to trap her operated leg in turns to prevent painful sideways motion, and the trip is successful.  We enjoy the day, but leave a bit earlier than usual and are certainly ready for bed when we get back home.

Wednesday January 10, 2006 It is 3 week post op checkup time with Dr Snyder.  He takes Xrays, and removes the remaining pieces of steri-strip covering the incision.  

He is pleased with the position of the BHR prosthesis.  He shows Claire how to reach down between her legs toward her toes while sitting in a low chair.  He stresses that this position, while violating the 90 degree rule,  will not hurt  her as long as she keeps the legs externally rotated.  Now she can put on her own socks, and sit in a lower chair as long as the legs remain turned out!  It might be a while until she feels strong enough to get in and out of a low chair, however!   He suggests rubbing vitamin E oil into the incision to reduce scarring.  The incision looks pretty good already....

It's around five inches long and was positioned such that not much will show when covered by a bathing suit.   It was stitched, not stapled.  There are still a few small bruises, but they will fade....not much damage showing from a total hip dislocation, femur and pelvis shaping, and reassembly with a 2 pound metal ball joint 3 weeks ago.....  Dr Snyder does GOOD work!  :-)  It is apparent at this time that Claire's arthritic right knee is limiting some of the PT exercises; it is more painful than the new hip.....  :-(  Claire is pronounced ready to progress to full weight bearing with a cane....putting as much weight on the cane as necessary to avoid limping, and when she is strong enough to walk without limping, to give up the cane entirely.  Dr Snyder is very pleased with her progress so far, and we are quite pleased, as not all recoveries go so well.

 Some Time after the initial checkup we posted a message on the surfacehippy group about Claire's right knee problem impeding her recovery...and a woman responded with her favorable experience with the FDA approved BioniCare electronic knee stimulator.  We looked into it at http://www.bionicare.com/ and decided it would be worth a try, since we were not about to undergo knee replacement surgery before Carol & Jason's mid July wedding....the recovery period for that would guarantee no dancing at the wedding.  :-(((  BioniCare has study results showing far fewer users had knee replacement surgery at the end of 6 years than in the control group of non-users. ...but it does NOT work for everybody.   If it works well enough for Claire to allow full recovery of motion until next fall, we're ahead.  They work to secure insurance coverage which is granted on a case by case basis, and we can return it if coverage should be denied or it does not work, and payments will end.  We asked BioniCare to send all the information they had on the device, and called to see if Dr Snyder might prescribe it....  We were told by the office he would not do it  until he could see us...which was not until the Valentines day follow up appointment we had with him....nothing sooner was available.

Wednesday February 14, 2006  We'd been lucky so far this winter.   January was snowless, Claire was walking a lot outside, first on crutches then with a cane.  It did her recovery a lot of good.  However, February proved to be a return to REAL winter...and Valentines day dawned with snow falling.  We were not about to skip out on Dr Snyder and wait a month or more for another appointment.  I was out early blowing snow, sweeping the path Claire would have to walk on, and spread heavy salt so there would be no chance of falling.   The walking was easier than the driving, which was slippery and treacherous, but we allowed twice the time the trip would normally take, and used most of that in the slow traffic.  Dr Snyder asked Claire to sit on a low platform....knees in a "crouching" position....she got down easily, but had to reach around to the support to get up.  Dr Snyder was pleased that she could do this at all...  We discussed the knee, he recommended a new Smith & Nephew "Oxinium" total knee prosthesis as state of the art, and likely to not need replacement in Claire's lifetime even though it does have plastic parts.  The "Oxinium" finish is said to reduce wear on the plastic and extend life of the joint. http://www.mylifeinaction.com/knee/treatmentoptions/totalkneereplacement/index.cfm?lpos=content_area

 We had noticed a woman in the exam room across the hall...she had walked out with a slight limp, had left her single crutch in the waiting room.... but Dr Snyder said she had the Oxinium device implanted three weeks ago.  That is impressive; we've been cautioned that knee replacement recovery can be more difficult  than the hip.  We stated our reluctance to have more surgery before the wedding, he agreed, then we asked if he would prescribe the BioniCare knee device.  He said he'd heard of it, knew of someone using it with Synvisc to treat knee arthritis, and would prescribe it;  however, he was not exactly sure HOW to prescribe it.  We offered to call the company and have them get in touch with him.  As we parted, I asked Dr Snyder if any of his resurfacing patients had experienced a failure to date....he knocked wood and replied "No".  He said he had now performed around 100 resurfacings.

The BioniCare company in Maryland was closed for a snow storm in the afternoon when we called.  The next day we talked to Ernie, who did not impress us as knowledgeable, but agreed to tell their sales rep to contact Dr Snyder.  We heard nothing for a few days, then called again; Tabatha checked and the rep had heard nothing about us...THANKS Ernie.  Grrrrr.  Tabatha said she would return our call and tell us how to proceed....  The next day Carol called....she was following up on the mailed info from our initial contact, but when she realized we were READY to order, just could not get the forms to Dr Snyder, she stepped right up, e-mailed the prescription form to us, and faxed it to Dr Snyder's office with an explanatory cover letter.  We called Dr Snyder's office the next day, the prescription form had been faxed back to BioniCare.  WHOOPIE!  We called Carol back, she referred us to Charmaine,  the person who would process our order the rest of the way.  Charmaine was sitting right next to the fax, had not received the prescription....  :-(  We asked Dr Snyder's office to send it  again....Charmaine did not receive it again.  Charmaine agreed to call Dr Snyders office and work it out.  The next day we called Charmaine, found out the form that had been faxed had been signed but not filled in....no good.  Charmaine agreed to work this out with Dr Snyder's office directly too....BLESS her!  Meanwhile, she e-mailed us forms we needed to fill out and sign and return.  The forms were acrobat .pdf files. I opened them, filled them out, printed them, and e-mailed them to Charmaine.  I also attached photos of Claire's insurance card in a Word document.  The only file Charmaine could print was the Word file.....  :-((

Friday February 23, 2006  We were going to PT anyway, so we faxed the signed forms to Charmaine from Staples nearby.  Called Charmaine from the cell; she got the forms and was good to go.  WHEW!

Monday February 26, 2006  Received e-mail from Charmaine that she had shipped our device by certified mail.......maybe we're finally good to go back to the RV?

Tuesday February 27, 2006 Checked airline fares to Ft Myers.  We booked one way seats non stop for $104 each.....that is cheaper than renting a car to drive there by a BUNCH, and THEY buy the fuel!  We'll be back on the road in Florida by mid March!!  :-))  The hip saga is pretty much told; barring any disaster in the next 4 months, it looks like a steady climb back to normalcy.  Claire walked 0.7 miles outside today with almost perfect gait, and at a pace that was a normal walk for me.  

She still tires more easily than years ago, but is steadily building strength, and we expect to be able to hike & bike in Florida like we used to.  We're planning on the Mountain View AR folk festival in April.  We'll let you know how the knee saga plays out.....we're hoping that surgery can at least be delayed a year or two.....maybe longer?  If all goes as it has been, this is a huge success story for Dr Snyder and modern medicine...knock wood!  :-)

Monday March 5, 2006  We received the BioniCare knee device today.  The package had been addressed incorrectly, and delivered to the neighbor last week.  It worked as described in the manual and DVD video instructions, and Claire does not find it too uncomfortable to wear in bed.  The device keeps track of total use hours, and turns off if it becomes disconnected.  It seems easy to use.  Now we need to accumulate 750 hours of use to see if it actually helps....  at the 9 hour a night rate we seem to use it, that's 83 days.  Well, we oughta know before Carol's wedding if we can do a fast jitterbug.  :-)

Wednesday March 7, 2006    This is too good to keep under wraps until next time....so we'll modify the page.   The very first recipient of a Birmingham Hip, installed by Dr McMinn in 1991, posted her 15.5 year follow up results today.  For those in doubt about the long term durability of resurfacing due to lack of a long history, or the possibility of long term damage to the body from chromium ions in the blood, especially in women who plan to have children ...the "boogiemen" that always seem to come up when modern resurfacing is discussed, especially by doctors who do NOT perform resurfacing....this is a POWERFUL message.  Our first surgeon said the life of a THR would be 10 to 15 years, less if Claire were VERY active.  Here is a young lady raising a family...hardly a sedentary lifestyle if we are recalling those days accurately.  :-)  She's going strong 15 years later....  you GO Katie!  :-))

Subject: [surfacehippy] 15.5 years on
Date: Wed, 07 Mar 2007 19:55:42 -0000
From: katiebat69 
Reply-To: surfacehippy@yahoogroups.com
To: surfacehippy@yahoogroups.com

Hi to everyone.  I haven't posted on this site for a long time but I
had a check up today at the Royal Orthopaedic in Birmingham after 15.5
years of having had my resurfacing and thought I would post an
update.  My check up went very well and it looks like my hip is still
going very strong.  The xray showed no change since my last check up 2
years ago which I was really pleased to hear.  For anyone who hasn't
read my posts before, My kids were born 2 yrs & 7 years post op and
are now 13 & 8, they are very fit & well with absolutely no signs of
any ill affects from metal ions that may or may not have passed across
to them during pregnancy.  I am not a gym bunny and don't do any
extreme sports, instead I keep fit by walking (especially walking
around shops looking for shoes - I must do a ten mile hike doing that
on a saturday afternoon!!)


Katie
Lhip McMinn 1991

Reproduced here with permission.

Friday July 13, 2007

We're not quite 7 months post op.  It's daughter Carol's wedding day.  We've long looked forward to jitterbugging at this wedding, Claire's hip and knee willing.  The BioniCare knee device has seemed to help the knee, she's logged over 1200 hours of use since starting in early March, although the right knee is still far weaker than the new metal left hip joint which appears to be working flawlessly.  Claire is ready and willing at the first dance, and continues until the evening is done.  Yes, she gets TIRED.  Is she in pain?  I leave that decision to you, as she dances here with a friend.  :-)

This is surgery that WORKS!  

Monday July 16, 2007

This morning  we walked two miles .....and after the 4 hours of pretty constant dancing Friday there were no really "sore" muscles...certainly no joint pain.  We're back among the living and active ones, folks!  :-)))

Until next time....    Barrie & Claire