The Second Part of Repairing Art’s Hip Fracture…
The focus of this blog is Hip Replacement. It’s the fourth part of a multi-blog article:
- Hip Fracture for Art: The Fall in Paradise
- Hip Fracture 2: An Inside View of Skilled Nursing
- And Hip Fracture 3: Recovery Worries, Insurance and Life Planning
- Also, Hip Fracture 4: Hip Replacement (this blog)
- And, yet to come: Hip Fracture 5: Physical Therapy
The previous blog in this series, Hip Fracture 3, dates from May 1, 2019, ten months ago, plus updates through November.
Following my fall in February 2019, Dr Lorrin Lee patched up my pelvis at Queen’s Medical Center in Honolulu. After eight weeks of therapy the docs pronounced me safe to travel. Nola came to Oahu to accompany me home to Michigan, as I bounced along on a pair of crutches.
This blog installment describes my most recent, hopefully final, surgical fix for my original hip fracture.
Hip Replacement, Light and Heavy
When I broke my hip, I didn’t appreciate that hip problems come in many degrees of severity. Roughly speaking:
- Quick fix: No bones broken. In this case, hip replacement may be the cure for constant arthritic pain. The patient leaves the hospital in 2 to 3 days – or even, the same day as the surgery! A typical patient can walk and take stairs unassisted after 4 to 6 weeks of rehab therapy.
- Months to repair: Broken femur. According to my doctors in Honolulu, this is the most common type of bone break resulting from a fall onto the hip. In many cases the bone can be spliced with a metal rod (intermedullary nailing). Healing requires 3 to 6 months.
- Over a year: Broken pelvis and broken femur (my situation). The Honolulu doctors usually only see these multiple fractures when the patient has been in a vehicle accident. Having this result from a “mere” fall like mine is uncommon. In my case, Dr Lorrin Lee opted to first repair the pelvis, in February 2019. Then, when the pelvis was sufficiently healed to serve as a solid foundation, my Michigan surgeon Dr Matt Schramski replaced the ball-and-socket of the hip joint itself, in February 2020. The two surgeries, plus healing time between and after them, can easily take over one year. (In my case, a year and a half because I took time out for a winter vacation.)
As it happened, I accidentally put myself into the third, most severe, of these categories. Here’s how I’m finding my way through it and out the other side.
Lifelong Value from High School Workshop
Following my pelvis repair and rehab in Honolulu, I returned to Michigan. My first step was to visit my bone doctor, whose name is conveniently Dr Henry Bone.
Dr Bone is an endocrinologist. As such, he is an expert on the many factors that affect bone strength, and how to make bones stronger. He has led major studies comparing bone-building medicines. During the last ten-plus years Dr Bone helped me recover from borderline osteoporosis to normally strong bones. Alas, not strong enough to prevent damage in a hard fall!
I saw Dr Bone and showed him my Honolulu x-ray, which I shared with you in my Hip Fracture 1 blog. And I said to him, what should I do next?
Dr Bone then gave me some instruction on the life paths of bone doctors. He said, fixing a broken hip is not my field. You need to see Dr Matt Schramski. He’s the go-to guy for hip surgery.
Dr Schramski is a partner in St. Clair Shores Orthopaedics and Sports Medicine, a broad-based orthopedic practice. Each of their doctors specializes in a particular body part, and Dr S only deals with hips. His schedule is so full that it took a text message from Dr Bone before I could get an appointment with him.
I had not realized the degree of specialization even among bone doctors. Dr Bone explained it to me this way: “In school, I was good in chemistry. When I became interested in medicine, that helped me decide to become an endocrinologist. The students who were good in shop took a different path – they became orthopedic surgeons.” He mused for a moment, then said, “If I had been good in shop, I would have become a surgeon. And I would have made a lot more money!”
A New Surgeon Enters My Life
Dr Schramski’s medical group occupies a large one-story building about twenty minutes north of my Grosse Pointe home. Dr S himself has his own entrance and a dozen or more rooms occupying the northwest corner of the building. When I saw him, I was newly arrived from Hawaii and restricted to a maximum of 50% weight on my left leg. So I was ambulating with a pair of crutches.
The x-ray technician took a few views of my hip and shortly thereafter, Dr S strode in to meet me. He flashed the x-ray views on a wall display and shook his head. “The end of your femur was badly broken by your fall and your hip joint is trashed. I’m amazed that you can even stand up, much less walk around with crutches. And without pain!”
Treat the Patient, Not the Condition
After further discussion, Dr S wrote me a prescription for outpatient therapy. Rather than limiting me to 50% weight bearing, he wrote the script for weight bearing AT, that is, “as tolerated.” However, the script also specified “no passive ROM,” meaning that the therapist should not force my joint to have a range of motion beyond what I could accomplish on my own.
He explained, “I was taught to treat the patient, not the condition. So it doesn’t matter that with this x-ray, you shouldn’t be walking. You are walking amazingly well, so your therapy should be based on that, not on the x-ray. However, I don’t want the therapy to cause further damage to this joint.”
He went on, “It’s only been 8 weeks since your surgery, and your pelvis is far from healed. After it knits, you will need hip replacement.” By this, he meant that I would require a new ball and socket to replace the barely-working broken joint. So I embarked on outpatient physical therapy, which continued for the rest of 2019.
A Jolt of T Builds Bones
During my hospitalization and subsequent rehab in Honolulu, the hosting organizations kept careful track of my health. Such careful track that I had an uncountable number of blood draw dots on my arms, and a matching number of blood test results.
One byproduct of these tests was the revelation that my testosterone level was below normal for my age. After returning to Michigan my urologist began injections to bring it up to normal. These accelerated the rate of my pelvis repair. Apparently in men, having a certain amount of circulating T is good for bone growth. (How things work in women must be completely different!) Subsequent x-rays by Dr Schramski revealed that my pelvis was healing and would be ready to support a hip replacement by autumn of 2019.
As it happened, Nola and I had planned a family vacation in Maui embracing Christmas and New Years, followed by a month of personal getaway. Dr S opined that if he replaced my hip in September, I might not be sufficiently healed by mid-December to travel. He preferred to defer my surgery until after the Maui trip, so he scheduled it for mid-February 2020.
Art’s Bionic Hip Replacement
I’m quite pleased with Dr Schramski as my hip surgeon. Not only is he lively and smart, but he has a wide range of tools at his disposal and can clearly explain them.
To be specific: A year ago, Dr Lee repaired my pelvis as the most urgent step in treating my injury. This entailed a six inch horizontal incision on my abdomen and he basically repaired the pelvis from its back or upper side. This year, Dr Schramski finished the job of hip replacement. He prepped me for surgery with a full set of x-rays, including the use of contrast to map out nearby blood vessels.
A Full Set of Surgical Spare Parts
When the fall jammed my femur into my pelvis, the top of the femur caused damage that enlarged the hip socket or acetabulum. Dr S mapped this out and laid out a plan to fill in the cavity, finishing with an artificial ball and socket. To fill the cavity he used a combination of ingredients:
- A piece of porous tantalum, visible in the x-ray as a pie-shaped wedge above the hip socket itself. My bone will grow into the pores, anchoring the tantalum in place.
- Some bone obtained by cutting off my femur to accommodate the stem holding the ball, plus a binder.
- Some cadaver bone, also with a binder.
Dr S set aside a full day for the surgery, which took 5.5 hours. He accessed my hip through a ten inch vertical incision on my left hip. When filling out the acetabulum he left just enough room for a tantalum cup to hold the hip ball and a plastic liner. The back side of the tantalum cup is porous, like the filler piece, and my bone will attach to it.
The accompanying image updates my collection of surgical scars. Most are described in my Heart Surgery 1 blog. The new additions are in green: Dr Lee’s pelvis repair and Dr Schramski’s hip replacement.
Hiccups: A Side Effect of Hip Replacement
Before the surgery, Dr Schramski had reviewed with me its principal risks. Of course death is a small risk in all surgeries, especially those involving anesthesia. However, for hip replacement the higher probability risks are dislocation, nerve damage and infection.
Fortunately, I have not experienced those common risks. However, I discovered another side effect, one that no one ever mentions but which is (according to my hospital nurse) not rare in orthopedic patients. Twenty-four hours after surgery the anesthetic had completely cleared my system. And it left behind a case of chronic hiccups!
When I say chronic: for one or several hours, I would hiccup frequently and regularly, typically one hiccup every 5 seconds. Then for several hours the hiccups would go away. This condition made it difficult to eat or talk, erratic to sleep, and generally seemed incompatible with my recovery plan.
Of course, I tried a wide range of home remedies, which mostly revolve around controlled ways of breathing and swallowing. All to no avail.
I had greater luck with ginger ale; if I would sip a little just as each hiccup was next due, the fizzy liquid seemed to block that hiccup. There might be a small burp of air, but not a full convulsion.
Meds for Hiccups? Maybe Not…
Naturally the doctors and nurses tried various medications. Not one of them helped! These included:
- Gabapentin: this med made the hiccups slightly worse, and caused a bout of acid reflux.
- Valium: three spaced-out small doses (2 mg each) had exactly no effect.
- Baclofen: a commonly used hiccup cure, which did nothing for my condition.
- Zofran: the hospital had given me a supply of this anti-nausea drug. It sometimes helps hiccups, but had no effect on mine.
- Reglan: this drug is used to fight many different conditions. Unfortunately, it comes with some scary side effects, among which is that it can give the patient a case of Parkinson’s disease! In my case, it did not help my hiccups; however, it caused me to throw up and to have an overnight attack of insomnia. So of course I stopped this drug at once.
No, I don’t still have the hiccups. They lasted for one week. What made them go away? In part, the passage of time. In addition, my chiropractor Dr Joel Hack adjusted my diaphragm, which was partly out of position. Presto, no hiccups!
What caused this attack? I initially thought that the hiccups could have been caused by my long surgery, during which a breathing tube was pressed against my epiglottis. However, I am told that the source of hiccups is generally the diaphragm, not the throat. During surgery I was lying on my right side. Moreover, Dr S clamped my abdomen, front and back, to keep my torso in a fixed position. My best guess is that the hiccups came from hours of off-center pressure on my diaphragm during surgery.