Die Another Day PART 3: Total Hip Replacement - Ivan's Story

Forty-nine year old Physio Remedies total hip replacement (THR) patient Ivan describes how his knowledge of the modern day advances in hip replacement technology, famous sportsmen and women that had undergone THR surgery and the first class physiotherapy and referral advice he received from Sarah Lawson and Nick Smith of Physio Remedies enabled him to make the decision to have surgery early and start realising the benefits of doing so – PART 3, preparing for surgery, the operation, rehab and today’s update.

In Part 1 Ivan gave the background to his diagnosis, and in Part 2 Ivan talked through how he made his decision to have a total hip replacement (THR).

Preparing for surgery (Hint - Find a Buddy If You Can)

The date for my operation was set and I spent the preceding weeks preparing myself for what the immediate days after the operation would be like and also thinking through what my rehab plan would be like.

It is very personal choice as to how much information you want to know about any operation. For me though, I thought since I was going to have a new body part to keep me company hopefully for the rest of my life, I should find out at least what it was going to be. A visit to Professor Haddad’s clinic for my pre-assessment provided all the information I needed.

The femoral head (the round top of the hip bone) was to be cut off, shaving off the cartilage inside the socket. A titanium shell would then be placed into the socket and a titanium stem would be fitted inside my thigh bone. Finally, a plastic liner would be placed inside the socket, like a washer, and a ceramic head fitted on the femoral component. The stem in my femur would have special coating that would create a “biologic” fixation between my femur bone and the implant, which would prevent weakening of the bone in my femur around the stem. It all seemed very high tech and I was impressed by the apparent strength and robustness of the materials.

The other really helpful thing I did, again more through chance than real planned intention was that I found myself a ‘THR buddy’. I learnt at a work seminar that an old colleague of mine had only just been through a THR six months previously. Although ten years older than me he was a wonderful source of encouragement and advice in the weeks that led up to the operation on what to expect, what to take to hospital and what the immediate days afterwards would be like.

Finally, symptomatic with my nature and character I could not help myself writing down with the help of Sarah Lawson and Nick Smith a rehab plan (see the chart below). Maybe this sort of level of detail is not for everyone but having milestones and targets certainly helped me on the road to recovery post-op. They talked through the restrictions that I would need to adhere to to start with while my new joint settled down post-op, returning to a normal daily routine, taking up gentle sports and finally getting back to impact loading sports.

The Operation and Rehab Journey (Hint - prepare for small steps)

The details of the operation are beyond the scope of this article save for saying that I was unlucky to have some form of psycho-symptomatic shutdown of the muscles in my operative leg which slowed me to getting back on my feet in the hours and days following the surgery. It was also shocking to be on crutches and having to relearn to walk but the physios at Physio Remedies were absolutely brilliant. Nick Smith ‘absorbed’ my frustration at literally not being able to run before I could walk. Throughout the early part of 2017 he gradually guided me and supported me along my rehab journey from taking baby steps without the crutches, to isometric and proprioception exercises in their gym, to strengthening exercises using the multi-gym, to more advanced intensive work to rebuild the muscle bulk that I had lost as a result of the operation.

I will always remember that one day when my ‘Trendelenburg gait’ (an abnormal gait caused by post-operative weakness of the abductor muscles of the lower limb, gluteus medius and gluteus minimus) had disappeared and Nick saying to me in his broad Yorkshire accent “look at that Ivan, you have got your swagger back”. I certainly had.

Today’s Update (Hint - take the risk – millions have and will continue to do so)

As I conclude, the discomfort, pain and anxiety of those pre-op days are but a faint memory. So too are the nine months of rehabilitation. I can’t even imagine how I would be today if I had not taken the leap of faith to get on with it. I completed my first sprint triathlon on the 17th of September 2017, nine months after the surgery.

Since the operation I have kited in Mauritius, windsurfed in Maui, Hawaii, skied in Kitzbuhel, Austria and returned to a life of sport. The guys at Physio Remedies have recommended that I don’t ever run a marathon again – there are THR patients that unbelievably do as well as even ultra-marathons and IronMan triathlons – but I am ok with that.

Sprint Triathlon Nine Months After Total Hip Replacement Surgery, September 2017.

It is easy, having ‘come out of the other side’, to say this but the benefits far out weigh the risks of an operative nature.

My top five tips to aid a successful total hip replacement are:

1. Get the best advice.

2. Consult and work as early as possible with Phyisos who are deeply experienced with THR rehabilitation such as Physio Remedies.

3. Research as much or little as you need about the operation.

4. Find a THR buddy.

5. Set some goals to help you on the road to recovery.

Finally, with the recent arrival of my first child, Molly, it has become apparent that I made the right decision to have the THR early. As she grows up, although there is always a chance in ten to fifteen years’ time that I will need a revision to the THR, I can guarantee you that she will never know how the early onset of hip arthritis nearly killed me but I really have lived to die another day.

Ivan with Molly on the kite surfing beach at Hayling Island August 2018.

Words and images by Ivan. Ivan runs an IT professional services company, Snell Consultancy, and he can be contacted at www.ivansnell.com.

If you’re experiencing hip pain call us on 02030 12 12 22 to book an appointment with one of our hip specialists: Paul Martin or Alex Manos.

Die Another Day PART 2: Total Hip Replacement - Ivan's Story

Die Another Day PART 2: Total Hip Replacement Gives Physio Remedies Patient, Ivan, A New Lease of Life

Forty-nine year old Physio Remedies total hip replacement (THR) patient Ivan describes how his knowledge of the modern day advances in hip replacement technology, famous sportsmen and women that had undergone THR surgery and the first class physiotherapy and referral advice he received from Sarah Lawson and Nick Smith of Physio Remedies enabled him to make the decision to have surgery early and start realising the benefits of doing so – PART 2, making the decision.

In Part 1 Ivan gave the background to his sporting life and his diagnosis.

Making the Decision (Hint: look at what other THR patients are doing worldwide)

So the mind games began. There must be a mistake? I have hip osteoarthritis, that’s what my mother had that preceded her total knee replacement when she was seventy five. There must be a mistake, I need a second opinion surely? It is nothing that a few anti-inflammatory and pain killers won’t nail. I must have reached a threshold of discomfort.  Why don’t I wait a few years, let’s set a date? When I am fifty or maybe fifty five?

Mr THR Bionic

Sometimes in life you have to believe in fate, even if it seems that we ‘filter in’ events and information which will help us solve problems – events or information that in our normal life we would ignore. My turning point in making the decision to go ahead with the operation was one afternoon, following the consultation with Professor Haddad, at a water-ski lake outside London. I got chatting to another water-skier who happened to be an orthopaedic surgeon. Not surprisingly he knew of Professor Haddad and his excellent reputation but, of more relevance, he said to me “Did you see the guy before you mono-skiing on the lake?” I had indeed seen a guy, about mid-fifties, canning it back and forth between the water ski buoys like a pro but I had not paid him much attention. “That was so and so” my new acquaintance said adding with a smile, “by the way he has had both his hips replaced”. I could have cried for joy!

Once I understood, from seeing Mr THR bionic water-skier man in action, that a THR did not mean the end of the life as I knew it, I researched all I could find on sports after total hip replacement surgery. It blew my mind. I thought hip replacements were an end of life last resort to keep the aged in their eighties mobile with the aid of a walking stick. How wrong could I be?

Total Hip Replacements - The Statistics

There are now over 1.4 million total hip replacements performed globally each year, over 230,000 in the USA and 80,000 total hip replacements alone in the UK, 60,000 carried out by the NHS. And the trajectory of THR operations is expected to increase with estimates that they will exceed 575,000 in the USA by the year 2020.

In fact, the clinical improvement now achievable from modern total hip replacement surgery is known to be second only to major heart surgery, as the single most life-value adding surgery. The procedure is into its fifth or sixth decade of development. As surgical techniques and the prosthetic biomaterial and technology have improved in the past three decades, THR has almost become a standard, highly routine, procedure to deal with the pain of end-stage hip osteoarthritis.

The lifetime of the prosthetic has increased dramatically encouraging surgeons to recommend THRs to a younger and younger demographic of the population. For example, from 2001 to 2007 in the USA, the incidence rate of total hip arthroscopy (THA) in patients between the ages of 50 and 59 increased by 50 percent. This far outpaced the incidence in persons aged 60 to 69 (15%) and 70 to 79 (9%). But what would I be able to do after my surgery? 

Total Hip Replacements - A Who’s Who

I read up more and my research turned up some surprising ‘A’ list athletes who had undergone THR at relatively young ages and since returned to high level activities, including sports and physically demanding vocations. I am sure you may recognise some of the following (age of THR):

• Jo Durie – British tennis player (53)

• Andrew Castle – British tennis player (50)

• Mark Covell – British sailor, British Olympic Silver Medallist (48)

• Scott Mckercher – Australian pro windsurfer (46)

• Patty Lane - US triathlete (50)

A decision!

My mind was made up. I was through the mental anguish. I was going to do this to get back on the water, back on the bike and running again. And besides, I was desperately hoping to have a family one day, how could I ever imagine not being able to windsurf or kite or even run around with my children?

Words by Ivan. Ivan runs an IT professional services company, Snell Consultancy, and he can be contacted at www.ivansnell.com.

If you’re experiencing hip pain call us on 02030 12 12 22 to book an appointment with one of our hip specialists: Paul Martin or Alex Manos.

Next month – PART 3, preparing for surgery, the operation, rehab and today’s update.

Die Another Day PART 1: Total Hip Replacement - Ivan's Story

Die Another Day PART 1: Total Hip Replacement - Ivan's Story

Forty-nine year old Physio Remedies’ total hip replacement (THR) patient Ivan describes how his knowledge of the modern day advances in hip replacement technology, famous sportsmen and women that had undergone THR surgery and the first class physiotherapy and referral advice he received from Sarah Lawson and Nick Smith of Physio Remedies enabled him to make the decision to have surgery early and start realising the benefits of doing so – PART 1, diagnosis.

Introduction to Ivan

Every athlete, sportsman or woman dies twice: once when they take their last breath and once when they hang up their jersey or so the popular adage goes. No matter the level of competition or ability, once that part of someone's life ends it creates an unfillable void and an insatiable desire to play again. No real death is experienced obviously, but a major part of that person's life vanishes. This popular phrase played through my head on repeat as I sat in my orthopaedic surgeon, Professor Fares Haddad’s, office in dejected terror and disbelief in September 2016 trying to let his words sink in.

“I am afraid it’s bone on bone, there is no cartilage left. You are going to need a new hip. It is a simple as that” he said. “I am only forty-seven years old” I thought! But that was that. The camera, or in this case, an x-ray, never lies. This is the story of my journey from that day, now more than two years ago, to a happy place today. A place where my old life has returned. Not only am I hundred percent pain free but I am back to the same activity levels and lifestyle pre-operation.

A Life of Sport

I am a sportsman and waterman. That’s who I am. That’s what I do. At school I played every sport under the sun. County hockey, football, rugby, cricket, golf, squash, badminton, tennis, rackets, but real tennis was my passion. I was a British junior national champion in all junior age groups and I played for GB in the 1988 Bathurst Cup (the Real Tennis equivalent of the Ryder Cup). My first sailing experience was at fourteen months old in my father’s Swallow keel day boat. This led on to a lifetime of dinghy sailing, windsurfing from twelve years old, kitesurfing, water skiing, wake boarding, surfing, stand up paddling (SUP) and yacht racing. I have kite surfed and windsurfed in most of the best locations there are worldwide and I ski and snowboard in the winter. And I run. Nothing dramatically spectacular but I run. Cross country at school, ticked off the marathon sub-four hour on the to-do list and I have run my fair share of half marathons. In the last ten years, I have taken up triathlons. Add swimming and cycling to the list. You get the picture.

Physio Remedies Referral (Hint: get the best advice you can afford)

The pain started gradually at first. It was autumn 2015, three years ago. A post run deep sharp pain in my pelvis after I got up from my desk at work left me hobbling for a couple of minutes. This progressed from post sport discomfort to pain on a daily basis. I had to stop running. I developed a limp. Pushing down on the clutch pedal in slow traffic hurt. By April 2016 I was in real trouble. A walking holiday in the Atlas Mountains, Morocco proved to be a struggle. Despite ongoing release and mobilisation work from Nick Smith, Physio Remedies’ Senior Physiotherapist, the symptoms were getting worse not better.

After a tennis match in September 2016 I was not able to walk back home from a local restaurant without the supporting shoulders of my girlfriend and her mother. Not a good moment, believe me! I remember walking two minutes from a tube station to a work event and standing there, champagne glass and canapé holder in hand, grimacing at the shooting pain in my left hip.

Sarah Lawson, Senior Physiotherapist and Physio Remedies’ founding Director, was brilliant at recommending who I should be referred to see from her London network of top orthopaedic surgeons. She considered who would be the best match for my situation, taking into account many factors such as my age, the suspected pathology of my hip injury, my sporting needs and the specialisms of the surgeon. She recommended I should go and see Professor Fares Haddad who has a worldwide reputation for treating sports related knee and hip injuries.

Following on from my consultation with Professor Haddad he wrote to me with his diagnosis. I had hoped, like an idiot that it was not structural, maybe a lower back ligament or tendon issue? But there it was in black and white. I read his letter, ‘he (me) is now bone on bone on the left-hand side (hip), he will need to manage the symptoms but will end up with arthroplasty surgery (a total hip replacement)’.

Words by Ivan. Ivan runs an IT professional services company, Snell Consultancy, and he can be contacted at www.ivansnell.com.

If you’re experiencing hip pain call us on 02030 12 12 22 to book an appointment with one of our hip specialists: Alex Manos or Paul Martin.

Next month – Part 2 - Making the decision.

Client News: Toby Swims The Channel

Physio Remedies client Toby Davis planned to swim The English Channel at the end of July in aid of The Cystic Fibrosis Trust but the weather wasn't playing ball during his window. However, he did eventually get the call to swim and his Channel Swim Report follows.

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Finally, I'm off!

After a frustrating two week wait for the weather, at 11pm on Monday 7th August I finally lowered myself off the boat and walked up Shakespeare Beach (just around the corner from Dover Harbour) to clear the water feeling calm and relaxed, reminding myself to enjoy what might well be a once in a lifetime experience. Then the klaxon sounded to signal the start of my 21 mile channel swim from England to France and we were off - I dived in and swam out to my boat SUVA's spotlight in the water, which I would use as a marker over the next 6 hours of darkness.

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Ready for the off!

The first few hours

That first few minutes were exhilarating but I managed to control the adrenaline and settle into a decent rhythm fairly quickly. I fed every hour and my first feed was very quick - a quick roll onto my back, down the carb drink and confirm to my crew that I felt good, then off again. About 15 seconds, which was the plan. Over the whole swim it turned out my longest feed was 40 seconds and average time about 20 secs which I was very pleased with. 

After the first feed the next 2.5 hours flew by and I knew it was going well. Swimming in the dark was fun, it gave me the opportunity to solely focus on getting my stroke right and making sure I was enjoying the swim as planned. 

Hour 4

Around hour 4 it started to feel a bit more of an effort and, when I stopped for a feed I realised why - suddenly where before I had been floating on my back next to the boat, now when I did that I had to kick furiously just to stay alongside. That brought home just how strong the tide I was swimming in was, and ended any over optimistic thoughts in my head about the possibility of making it across in a super quick time.

Around this time I also got some jellyfish stings to my back, legs, shoulder and most interestingly across my mouth and nose - I didn't really mind these actually, they were a bit like an extra strong stinging nettle and helped jolt me out of any autopilot swimming. 

Sunrise

Around 5:30am we were treated to the most amazing sunrise which brought the darkness section of my swim to a dramatic end. To witness that from sea level in the middle of the channel was truly spectacular.

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I am a very dark shadow in the foreground in this one but quite rightly the sunrise takes centre stage!

Hour 11

I swam steadily and pretty comfortably until the 11th hour when my crew told me they needed a big push in terms of effort. So I sprinted at 100% for an hour, which felt like forever. The fascinating thing was that, despite having swum for 10 hours already, every time my brain told me I needed to slow down I could override it and just kick harder.

Unfortunately the spring tide turned out to be too strong for me to fight across it and hit land at Cap Gris Nez, which tends to be the fastest place to end a crossing. So I found myself being swept up the coast by a strong turned tide, which meant the sprinting had to continue as I tried to fight far enough through it to hit land.

Hour 13

Around hour 13 I got frustrated as France had seemingly disappeared from view (it was actually hiding behind the boat on my right as I got swept north past the Cap) and I asked for a marker to give me an idea of how close I was. Neil my pilot told me I was deep into French inshore waters, and shortly after that the coast came into view again seemingly within touching distance.

Despite being no more than a couple of kilometres out, I spent another 2 hours pushing across the tide to get in - that time actually went quite quickly as I knew that I would get in eventually and that it was just a matter of time. I had to stop myself celebrating in my head though as I knew lots of swimmers still failed to hit the shore from that close. But finally I got close enough to see the houses and beach on the shoreline and knew I was swimming into Wissant. 

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Me sprinting against the ferry

The final 20 minutes!

The last 20 mins were pretty special, just making the most of the experience and thinking about all of the people who had supported me through the months and months of training. It got slightly emotional. I could walk up the last 50 metres and had a great time running and jumping through the waves to stand clear of the water for the klaxon to sound the end of the swim after a total of 15 hours 04 minutes! 

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Channel Swimmer!

It felt incredible to have finished the swim and even better that physically I still felt pretty good. I could easily lift my arms above my head and hold up my 4 month old in celebration once we got back to Dover, which I think is a good result!

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The team - Neil the pilot, Toby the co-pilot, Kate, me, Alice and Tony the official observer

I was back in the water (with pain free shoulders) within 2 days which was a huge bonus and a ringing endorsement for Ray Gibbs' coaching and the technique work he has done with me, as well as the excellent physio I had received in advance of the swim from Sarah Lawson at Physio Remedies.

Now to relax a bit and work on my future swim bucket list with a cold drink in hand!

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Toby's Channel Swim has raised over £10,000 to date. If you're as impressed as we are at Toby's feat, you can donate to The Cystic Fibrosis Trust via his Just Giving page.

Words and images by Toby Davis.