Stuart’s GoldWing Blog

My worn out hip, the cartilage space between ball and socket has gone; bone on bone contact is what hurts when you walk. The extra nobbly bits around the ball are extra bone growth - trying to be helpful but actually limiting movement.

This Article may be of limited interest to bikers, even to those GoldWing riders who might be approaching the age when arthritis creeps up on you.

But I’ve just had a hip replacement, so I can’t do any biking to write about at the moment, and this topic might at least be of interest to some of you.

Normal hip, you can see a gap between ball and socket where the cartilage keeps the bones apart and provides a smooth sliding surface for joint movement

The techniques and technology of modern surgery are pretty awesome stuff.  Infection control is especially important in orthopaedic surgery because if any infection gets going in bones it can be extremely difficult to deal with, even with antibiotics, so they operate inside a sterile tent.

The method of a hip replacement are also very impressive, although in some respects it still pretty brutal stuff.  It is major surgery, it cannot be done bloodlessly, so recovery from hip surgery does involve giving the body time to muster its repair process and deal with the aftermath.

Recovery does therefore take a number of weeks and it does involve a bit of effort on your own part – including the patience not to overdo it, especially during the first two weeks or so, when your skin and muscles are repairing the damage which, of necessity, the operation did.  Too much too soon can aggravate this damage.

Thereafter it’s a question of no pain no gain, so exercises as taught and an effort to mobilise yourself rather than settle for being a couch potato – although fortunately there isn’t much pain really, it’s more a question of putting in the work to overcome stiffness and discomfort, to get yourself going again and to rebuild rebuild the strength in your thigh and buttock muscles to give you the stability and confidence in your new hip that you will achieve.

You are encouraged to resume a fully active life, excepting only such activities as involve risks of high speed falls (like skiing) because a fracture near an artificial joint can be very difficult to deal with.  And, fairly obviously, things like bungee jumping.  The leaflet I was given advises that normal sex can be resumed “with caution” after three weeks, which begs the question of what is normal and presumably depends on what you were capable of before the operation!

No driving (or riding) is allowed until you can reliably perform an emergency stop using the foot brake, which is around six weeks.  There certain hip movements you are supposed to avoid, in order not to risk dislocating the artificial joint, so for example no extreme internal or external rotation and no flexion beyond 90 degrees – so no lifting your knee above the horizontal  when standing.  I asked about getting my leg over (the bike) and my surgeon wasn’t particularly concerned about that sort of manoeuvre as a way of dislocating the new hip.    With a heavy bike like a GoldWing, which has a high fixed top box (trunk) and rear seat back,  I will however be proceeding with care when the time comes.  A few practice mounts and dismounts with the bike safely on its centre stand on level ground will be my approach.  A friend who has a GL1800 told me he found it surprisingly easy to get back to riding, so hopefully it won’t be too bad.

The hip joint is, as most people will know, a ball and socket joint, the ball being on the bent-over upper end of the thigh bone.  The bone is angled to allow an upright walking gait and to allow enough room around the joint for it to cope with the incredible range of movement which you see ballerinas and gymnasts engage in.  Coping with this wide range of movement without the ball popping out of the socket is only possible because there is an elaborate combination of muscles and ligaments around the joint, supporting and holding it in place.  There is even a ligament which is attached the end of the ball and the inside of the socket.

Walking practice at home - wearing shorts makes it easier to hitch up the Nora Batties

The stability of a replacement joint depends on retaining as many of these attachments and supports as possible, so the surgeon’s job is to get the old joint out and the new one in with the minimum damage.  He can’t just open things up wide and then stitch them up afterwards, it has to be much more of a shoehorning-in approaching.  The technique for achieving this has been improved and refined over the forty years or so that hip replacements have been done.  Controlling the risk of complications of hip surgery (mainly infection and blood clots) has also been improved so that although it is still major surgery, hip replacement is now a very reliable and low-risk process.

During the past two years my hip had been giving more and more trouble and for the past year I have been limping painfully and the distance I could walk was getting more and more restricted.  I had been hoping that an X Ray would show only mild changes and I would be thereby galvanised into losing weight, taking more exercise and recovering my lost youth.  No chance, the X Ray confirmed that my hip was well and truly knackered.  I could either continue to put up with the pain and the handicap or face up to needing a hip replacement.

One of the perks of private health insurance is that you can pick and choose a bit.  So the date for my operation was set some months ago, timed to allow me to get the best out of the biking season and, hopefully, to get mobile again for Christmas.  The surgeon put me in his operating diary and the insurance company agreed to pick up the tab, so it was more or less just a question of turning up on the day.  I met the anaesthetist before the operation and was relieved to discover that he was a personable chap.  He explained what would happen very clearly and I gained even more confidence that I would be in good hands.

At the appointed time, more or less to the minute, I walked (or rather limped, hopefully for the last time) from my hospital room along the corridor into the anaesthetic room, wearing one of those fetching  backless gowns, fortunately with my own dressing gown on top of it.  As an added indignity I was also wearing one white, full length, elasticated stocking, on my “good” side, heralding the hosiery I would have to get used to wearing 24 hours a day for the next few weeks, to reduce the risk of deep vein thrombosis.

I sat on the edge of a trolley as instructed to have the spinal anaesthetic injection then lay down as my toes first of all started tingling and then went numb, as gradually did everything else south of my navel.    I did surreptitiously check down below that everything was still present and correct but I felt a completely different man, as it were, a most odd experience.  I was still wide awake so I could see, although not feel, the Anaesthetist sticking more local anaesthetic into my groin, this time to block the femoral nerve.  I remember it being explained to me what was happening as a group of people slid me across from the trolley on to the operating table and then the next I knew was waking up and being group-slid again, this time back on to my bed, which had been brought into theatre for the purpose.

I felt like I had enjoyed a really nice nap, no grogginess at all.  I still couldn’t feel my feet and was surprised when I looked down to see they were spread apart when in my head they were still ankles-together, where I had left them.  I couldn’t move them of course and I felt absolutely no discomfort of any kind, just this feeling that I had had a nice nap, which I suppose I had.

The aim of anaesthetics is to control pain as well as consciousness and while once upon a time one anaesthetic gas (originally chloroform) did both jobs, the gas putting you so deeply asleep you don’t feel any pain either.  But you have to be very deeply asleep in order not to feel pain such as major surgery can cause, so high levels of anaesthetic gas sloshing around inside you and lingering for many hours afterwards are necessary and not without after-effects.  Much better to control pain separately, so you can be put to sleep lightly and wake up without after effects, as I did.

The spinal block (or epidural as it is also known) provides very effective pain control pain by switching off the nerve supply to the lower half of your body.  In the case of hip surgery, to make pain control even more certain, a femoral nerve block (the injection near the groin) is added to supplement the spinal block.  Happily there was no way I was going to feel anything of what the surgeon was going to do to my bones.

In theory I suppose I could therefore have stayed awake but it didn’t appeal much. And with hip surgery they need to fix your pelvis in a stable position quite firmly so they can drill straight and  in the right direction, so it was best to put me to sleep as well – and I certainly didn’t argue.  They used the same stuff that finished Michael Jackson off, but in my case only one dose was necessary and of course I hadn’t been given the bucketful of other sleeping drugs which poor Michael had previously resorted to beforehand.  It worked a treat, I woke up feeling rested and refreshed and completely unaware of whatever had been done to me.

The mechanics of the operation are quite interesting if you are a practical sort of biker. In essence the surgeon cuts the skin and then works his way in towards the joint by pushing things aside as far as practical rather than cutting through them, in order to preserve as much as possible of the supporting muscles and ligaments around the joint.

Once he has access to the upper end of the thigh bone he cuts off the ball end, pulls it free and then discards it.  With the ball cut away the surgeon can get access to the socket, into which he pushes a special cutting device, like a cup-shaped rotary file.

This is used to enlarge the socket to the correct size to take the new metal one, which is then tapped into place using a mandril and a hammer. In my case he used a 57mm cutter to pave the way for a 56mm socket.

The thigh bone is then trimmed back a bit and hollowed out (with a thing like a reamer) to create space for the metal shaft which carries the new ball to be tapped into place, again with a hammer.  The new ball is located into the new socket and the surgeon then works his way back out, tidying up and stitching up as he leaves.

The surgical part of the proceedings takes about 40 minutes and together with the time you spend in the anaesthetics room and being observed in recovery afterwards, it’s about 2 hours before you’re back in your room.

I didn’t sleep at all that first night, largely I suspect because of the artificially induced afternoon nap I had had, but I was also required to stay flat on my back with my legs separated by a wedge-shaped cushion, the idea being to prevent me from turning over and crossing my legs, which at this early stage of settling in could easily dislocate my new hip joint.  I found it very difficult to get the hang of sleeping on my back although I did eventually manage it.

My son had undergone back surgery  a few months earlier and he told me that his hospital existence had involved sleeping at funny times and being awake watching TV at funny times too, so I didn’t get too bothered about not sleeping overnight and instead watched TV in the small hours and napped from time to time during the day.

I was on intravenous fluids (i.e. a drip) and it was fascinating to see containers of fluid flowing into one tube in my arm and coming out of another tube further down.  My kidneys certainly weren’t taking time out and it was clearly useful to be plumbed in;  it would have been quite a challenge keeping up with that rate of production using those papier-mâché bottles they supply as the alternative.  I wasn’t exactly feeling like getting up to go to the loo in the middle of the night either of course so one way and another the plumbing felt quite useful.   It occurred to me that there might be advantages to a biker in such a system because I can only manage about half the mileage my GL1800 fuel tank is capable of these days before a toilet stop.

So at this stage, although I struggled to sleep on my back and was a bit uncomfortable and restricted in being able to prop myself up to eat, it really wasn’t too bad.  I would have depended entirely on other people for help if the hospital had caught fire because the bed wasn’t drivable, but it had powered everything else and pressing all the buttons to see what effect they had was really quite fun. The daily routine in hospital involves getting you to stand up and, remarkably quickly, walk with a frame (very slow) then crutches (much better and much easier than you expect) and within a day or two you are able, with care, to get up and go to the toilet without help and to stand under a shower.  I was able to walk with two crutches and get up and down stairs on the fourth day after the operation, prior to being discharged from hospital on the fifth, which is par for the course.  Incredible really, but it happens.

I’m now two and a half weeks post-operation and walking really quite easily using one crutch.  The swelling and bruising in my operated-on leg has more or less gone.  I was stiff and awkward for a while, especially the first couple of days after leaving hospital,  which is not surprising; the surgeon did after all have to do quite a bit of digging and poking a round in there.  Pain wasn’t a problem at any stage;  such pain and discomfort as I suffered was far less than I expected and easily controlled with the medication I was given; I was much more concerned about getting constipated!

A worrying and dangerous episode did happen on the day after my discharge from hospital but it wasn’t anything to do with my hip surgery at all.   I went back to hospital with my friend Bill because he needed a last-minute specialist eye check to get clearance to go on his holidays the following day.  (I was his chaperone, to make sure he talked sense to the doctors, which would otherwise have been uncertain.)  We were dropped off at the entrance by our wives and we commandeered a wheel chair, so I wouldn’t have to do the long walk through the hospital to the eye clinic on my crutches, which I was only just beginning to get the hang of.  So far so good, this was becoming a bit of an adventure.

Hospital wheel chairs do however have rear wheel steering and it would be fair to say that Bill didn’t immediately take to this.  We weaved at high speed (Bill has never been one to dally) along the corridors.   Bill didn’t seem notice either my pleas to slow down a bit nor the people who were scattering in our path as we tore along.  Fortunately we got to the eye clinic in one piece and we had only hit the walls a couple of times and no one had actually been injured.  Terrorised maybe but not physically injured.  Bill had his eye check and was eventually pronounced fit to go on holiday, which of course he was greatly relieved about, ecstatic even.

Those of you who have had specialist eye examinations will be aware that they involve using eye drops to dilate your pupils, to help the specialist get a good view of  the inside of your eyes.  These make your eyesight distinctly blurred and you are advised not to drive for a few hours.

So as we set on our journey back through the hospital we had the additional complication of Bill’s blurred vision.  This didn’t slow him down at all, he was clearly keen top get back to our wives with the good news and he set off with gusto.  The eye drops must have affected his hearing too because he didn’t hear my screams, nor the sounds of collision and chaos we left in our wake as patients and visitors scattered from our path.  We got lost too, because the corridors were really quite confusing and Bill wouldn’t slow down to let me read the signs, convinced that he knew the way back.

Somehow we made it back to the main entrance where we abandoned the wheelchair as quickly as possible, in case Security were already hunting for us.  We made as casual, but hasty an exit as my limited mobility would allow.

Suddenly, as we emerged into bright sunshine, Bill got his comeupance and our roles were reveresed.  His dilated pupils couldn’t shut out the sunlight and he couldn’t see a thing; he had no option but to close his eyes altogether.  The only way he could find his way back to the car in the sunshine was to hold on to me like a blind man.  What we looked like to the motorists who stopped at the zebra crossing as I shuffled across on crutches and Bill followed, hand on my shoulder with eyes closed, I can hardly imagine. Like something out of Last of the Summer Wine I suppose.

So there are far more dangerous things in life than hip surgery, for example letting your biker mate drive you around in a hospital wheelchair.