Rob Hooper is a University Lecturer whose life was becoming increasingly restricted by severe arthritis in his hip. At the relatively young age of 57, he made the decision to opt for Hip Resurfacing - a new type of hip replacement developed by a British company. The operation has changed his life.
I am a married part-time University Lecturer with an active enough lifestyle – principally walking, swimming, gardening and working out at the gym. For some years, my left hip had become more and more painful, and by 2001 my lifestyle had become severely restricted. I was limping permanently and sometimes had to literally crawl upstairs.
A change of diet and various dietary supplements did not seem to help. Steroid injections had an immediate but short-term effect and it was obvious the problem was not going to go away. My GP arranged for an X-ray which showed severe osteoarthritis of the hip joint. She was sympathetic, but said I would have to wait until I was in my mid-sixties before I could have a hip replacement. It seems that a conventional hip replacement has a finite lifetime before it needs a further operation, and that this was to be avoided.
My large group of student counsellor contacts became very useful. I spoke to them about my problems and was given information about a new type of procedure – Cormet Hip Resurfacing, a device developed by British company Corin Medical. The Internet provided quite a bit of useful information on this procedure and how it differed from conventional hip replacement. Less bone is removed, and the important feature is that the whole implant is made of metal, which means that it lasts much longer than the plastic in a conventional hip replacement, and is therefore suitable for younger, more active patients like myself.
I was referred to a local surgeon who has been using this technique for many years. Mr Krikler was surprised that the severity of the osteoarthritis was not disabling me more, and showed me the Hip Resurfacing device. We discussed this option at length, and although seeing a video of the operation did nothing to encourage me (I delayed for a couple of months), after discussion with my wife Helen, I finally decided I wished to go ahead. With the benefit of private health insurance, I was able to arrange the operation at a time that suited me.
The day of admission seemed to arrive quickly, and after frantic last minute preparations (including some urgent but painful gardening) I was booked into the 5-star accommodation at the Warwick Nuffield Hospital. Visits from the medical staff included the highly personable Mr Krikler, and the anaesthetist.
I was naturally nervous as I was wheeled into the operating theatre at about 9am, not just about the operation but because I had agreed to the whole procedure being watched by video link by about 50 visiting surgeons from around the world! I was “out” for one-and-a-half hours, but two hours after the operation I was back in my room and speaking to my wife on the phone.
It was an uncomfortable first night, but the next morning I had my first visit from the physiotherapist, who got me out of bed and had me walking a short distance with the aid of a Zimmer frame. My wife and sister visited, along with Mr Krikler, who told me the operation had gone very well – but I was tired, drugged up and grumpy that day!
The next morning I was feeling more comfortable, I was able to sit by my bed for an hour, and started walking on crutches. Day
three saw me tackling stairs and enjoying the friendly and attentive nursing care. From then on I went from strength to strength, showering, receiving lots of visitors, enjoying the sunny room and good food.
At last, six days after the operation I took a final stroll round the garden before packing my bags and heading home with my wife – great to be back only one week after the operation. The whole experience had been better than I had hoped for. Mr Krikler was reassuring and totally dedicated. The nursing staff and physios were excellent and the accommodation really very good. Very soon I was beginning to feel the benefits of the operation.
Helen took a week off work to help me in the first days at home, and with a bed downstairs and the spring sun shining, I was full of optimism about the future. Just nine days later I strode ahead of Helen on my crutches as we walked in the country for the best part of a mile. I was diligent with my post-op exercises and had plenty of rest, which I think was critical to my speedy recovery. But was able to do some University marking and work with visiting students. After
four weeks I took a long train ride to Devon to see my family, and a week later I was back at the gym and driving my car short distances – a week ahead of schedule! Seven weeks to the day after my operation, I was back teaching at the University.
A couple of weeks later I suffered from an infection around the scar which needed careful attention. Maybe I had rushed my return to normal activities a little, but antibiotics eventually solved the problem. Cleanliness is so important after major surgery of this type and maybe the Jacuzzi was not such a good idea!
Six months on, and with the benefit of a long relaxing summer, I feel almost back to full strength. I have been scrambling on rocks in Devon and walked for miles by the Italian lakes. I continue to look after myself with some care, but my progress is such that I don’t have to see my surgeon again for a whole year.
The NHS is now recommending Hip Resurfacing for patients under 65, and I would heartily recommend it in preference to conventional total hip replacement. I would have no hesitation in having a similar operation when my other hip eventually needs treatment – hopefully a few years away yet – and would ideally have it in the same hospital and with the same surgeon. Maybe Corin will have developed a new model by then, but resurfacing is my choice for an active life.
I have recently visited the Corin factory in Cirencester to see how they manufacture this amazing implant. And I still have to pluck up the courage to watch the film of the operation, and to re-live the one-and-a-half hours that changed my life.
The Surgeons View……
Total hip replacement, with a metal ball and a plastic cup, is a very successful
operation, which has being performed for over 40 years. Assuming the operation
goes well, most people do very well for many years, but after 10 to 20 years,
particularly in younger, more active patients, conventional hip replacements
tend to wear out or work loose. So, in patients who are active and are likely to
need a well-functioning hip for ten years or more, we need something better.
Metal-on-metal bearings should last much longer than metal on plastic. Also, as
the bone is resurfaced, much less bone is removed at operation, so if it does
fail after a few years, it should be much easier to revise than a conventional
failed hip replacement. I am not aware of any good evidence that the early
function is any better than a well-performed conventional hip replacement,
though I know of people who claim it is. My rationale for offering resurfacing
is simply that it should last longer, and if it needs to be redone, this should
be easier. I have been performing this operation since 1995, and most of these
patients seem to be doing very well. I have had some problems, but no more than
I would have expected in a similar group of active patients undergoing
conventional hip replacements. It will be interesting to see how well they do
over the next few years.
Mr S Krikler BSc PhD FRCS(Orth)
Consultant Trauma and Orthopaedic Surgeon
Coventry, UK
