Fran's Story - Pelvic Osteotomy

I felt he had offered me a chance to be free of the debilitating pain that I had experienced for 23 years and the start to a new and exciting period in my life.

Fran

Since 1979, when I was 25, I have always had pain in my right hip. I gave up tennis and ten-pin bowling; whatever weight I was, walking became more and more painful. Several x-rays over the last 23 years all showed very little degeneration, or “arthritis”, in the hip joint and I was made to feel the pain was imaginary. I still maintained my right leg felt longer than the left and didn’t fit properly, somehow.

After a bad fall in February 2002, I was able to walk only with the aid of a stick and only a few steps at a time and yet another x-ray came back with the same diagnosis. Anti-inflammatory medication made me ill and Paracetamol gave only temporary relief. Life seemed very tedious. I had private medical cover from my employer and I asked my G.P. to refer me to a consultant for a second opinion.

The consultant offered me an anaesthetic injection, which again only gave a few hours relief. An MRI scan showed a cyst on the head of my right femur but it was felt that this was not necessarily the source of the discomfort. He suggested the x-rays be sent to a colleague of his in Bristol to ask for his advice who said a re-surfacing technique was not appropriate and suggested no other course of action. By now another six months of pain had elapsed. At my next appointment, my consultant told me he was to attend two international gatherings of orthopaedic surgeons and was hopeful of discussing my case further.

Meanwhile, I read an article on the medical pages of the Daily Mail which mentioned further techniques available from a team of surgeons based in Birmingham and researched this a bit further on the Internet. I filled in a questionnaire and an e-mail replied suggesting I made an appointment with either of two consultants. On telephoning one of their secretaries, I was advised of the protocol of swapping consultants, which was a further referral from my G.P. together with one from my existing consultant. I was beginning to feel exhausted by it all. Then out of the blue I received a letter from my specialist saying he thought it would be in my interest to see a Mr. J.O’Hara, Consultant Orthopaedic Surgeon whom he had heard lecturing in Ireland. He would be very happy to arrange this for me should I wish to proceed. Of course I did and when an appointment had not arrived within a week, I telephoned Mr. O’Hara’s secretary, Vicky, to check if she had received my records. It transpired these had been sent to another hospital for a National Health appointment. Vicky spent some time talking to me about her employer and what he had been able to achieve for patients with problems similar to mine and I began to look forward to seeing him on the 3rd. April this year.

Mr John O’Hara examined me and it became quickly apparent he had made a diagnosis from my ORIGINAL x-rays. He showed my husband and myself how the cup on my right hip did not cover the head of the femur and, as the load bearing surface was too short, how the pressure on the femur had caused the cyst. He explained all the options available to me, including the percentages of failure. I asked which procedure would give me the best chance and he explained using my own bone from my pelvis should give the best outcome. His usual patients were in their twenties, when the disformity should have been diagnosed! But the operation had only been available since, I think, 1986, well after I had first experienced the pain in my hip. However, he had operated on a lady in her fifties and had performed this procedure some 700 plus times in total. He told me it was a major operation with wounds in the groin and on my bottom, in effect putting me on a jig to turn the cut pelvic bone into a new cup, held together by screws and plates which would be removed perhaps a year after the original surgery.

Well! I didn’t need much time to make up my mind. Mr. O’Hara inspired me with his quiet confidence and it was only after the surgery that he told me he thought I had been brave to make a decision so quickly. I felt he had offered me a chance to be free of the debilitating pain that I had experienced for 23 years and the start to a new and exciting period in my life. One week later, April the 10th, I was scheduled for a triple osteotomy at the Priory Hospital in Birmingham.

Of course, I needed extra support from my husband, who had already been taking over chores I found too painful. We knew it was going to be tough going and a longer recovery time because of my age and because I was overweight but Mr. O’Hara didn’t seem to think they were insurmountable problems. Vicky gave me the name of a previous patient, Sarah, who was happy to talk through her experience with me and her help was invaluable. [I have included a list of my own hints and tips at the end of My Story, should future patients be interested.]

Two days before the operation, I had to go to the hospital for my blood to be matched for the operation. This involved taking three phials of blood and was painless. Sarah rang me the evening before my op. to wish me luck and mentioned that she had put off her operation for several months as she was anxious, but her recovery had been exceptionally speedy. I was not allowed food or drink after eight that morning.

I was taken through the admission procedure at eleven o’clock on the day of my op., when my personal details were double checked and a nurse assigned to take me to my room and complete extra details of my existing medication. A wristband was issued with my patient number and one to show I was allergic to anti-inflammatory medication. Mr. O’Hara visited me later and took me through the procedure again. Dr. Shinner, the anaesthetist, visited too and explained the epidural pain relief and I requested he ensured I would not be sick afterwards! He said he would do his best which was good enough for me, as I was NOT sick, the first time ever after a general anaesthetic. Excellent!

I was wheeled down to theatre on a trolley where Dr Shinner and Mr O’Hara were waiting for me. A large black arrow was drawn on the right hip [just in case!] and a needle was placed in the back of my hand through which anaesthetic, pain relief, antibiotics etc. could be administered. Ten seconds later I was under the anaesthetic. Then before the operation proper commenced, the epidural needle was placed in my back. This stayed in place for four days with the small tube taped to my shoulder so I couldn’t pull it out accidentally. I had been told to be prepared for the fact once I woke up, I wouldn’t be able to feel anything from the waist down and the feeling in my legs would return gradually over the next few days as the anaesthetic was reduced. When I came round I was actually convinced that my knees were bent, although looking at the bedclothes this was obviously not the case. I hadn’t had an epidural before and it proved to be a very effective method of pain relief. I was also given oxygen for four days, through a tube that clipped just inside my nose.

The next morning I saw I had extensive bruising on both hands and wrists, which looked more alarming than painful. The wound in my groin was approximately ten inches long and the one on my bottom about seven inches. Mr. O’Hara had stitched up my tissue in layers and I was relieved to know that no stitches remained to be removed at a later date. Waterproof dressings were used and I found the wounds healed quite quickly and I was able to remove them both within three to four weeks.

I still hadn’t peed very successfully, so day three post-op. a nurse fitted a catheter [what a relief] and the little bag became my friend for the next few days. I was given pain relief of Paracetamol and Codeine four times a day, antibiotics through the hand once a day for one week and a nightly injection to prevent D.V.T. The nurses gave me bed baths for three days then wheeled me to the bathroom so I could wash myself. Everything seemed very relaxed and I read or watched the T.V. On one of Mr. O’Hara’s daily visits, he thought I looked a little paler than I should be and ordered a blood transfusion; I had two packets, or units, given through the hand. Unfortunately, I became constipated, possibly because of the Codeine and lack of mobility. Nurse gave me two suppositories but it did take five weeks for normal function to return!

I do feel that the lovely, but oh so necessary, T.E.D. stockings deserve a paragraph of their own as they certainly have a mind of their own and I know my husband formed a closer relationship with them than I did. Bending over to put them on was too difficult for me until week four, but they came in handy for lifting the poorly leg onto the bed. They have to be worn for six weeks but be prepared for some swelling of the feet and ankles for a while afterwards.

The physio team visited me twice a day once I had the feeling return in my legs, say day five onwards. I was given a Zimmer frame to take my first tentative steps with and then I progressed to two elbow crutches. Some more exercises had to be performed on my bed. Every encouragement was given by these very patient ladies and gentlemen, but they were also quite firm about the benefits of the specialised exercises which must be performed religiously. I was given a printed sheet of the exercises on release from hospital, which take me 40 minutes first thing in the morning and at six in the evening. I have gradually increased these and the numbness around the operation site is now [week seven] starting to go. It is like learning to walk all over again. It is exhausting, especially as I am overweight but the benefits are the muscles developing in my shoulders camouflage the layer of fat somewhat! No patient is allowed to go home until up and down stairs has been perfected. Also, be prepared for little set backs; I developed a muscle spasm in my back. This was very painful and I had to rest for two days, which delayed my discharge. Mr. O’Hara had told me I would be in hospital for at least a week and in fact it was exactly two weeks.

I am lucky that I live only twenty minutes from Droitwich Spa brine pool and have been visiting the physiotherapist there every week. She feels that after my seventh half hour session I will be able to continue the exercises on my own and I have purchased ten more in advance as the cost is reduced. The feeling of weightlessness is wonderful but it does feel like someone has tied blocks of concrete to your ankles as you step out! I will continue these exercises weekly especially as I am now trying to manage with only one crutch. Both physio teams have provided continuing support over the telephone if I have had any concerns.

I found reverting back to the N.H.S. for post op. care was not as straightforward as I expected. If I had been an N.H.S. patient, all the home help aids would have been in place before leaving hospital. As it is, I am still waiting for my visit from the Occupational Therapist due 10th June, exactly two months after my operation. I hired an electric bath seat lift as at home I only have a shower over the bath and found it extremely difficult to lift either leg over into the bath whilst balancing on crutches, even with the help of my long suffering husband. I also put a chair at the side of my downstairs toilet to help me lever myself up and down off the seat. I was sent out of hospital with five days worth of painkillers and still have to visit my G.P. every 20 days or so to renew the prescription. Although most days I only take three quarters of the original dose, some days are more difficult than others and I revert back to the full amount.

My six-week post op. appointment came round very quickly. I was x-rayed again before seeing Mr. O’Hara who is very pleased with my progress. He said the new hip with the plate and screw in position was strong enough to bear my weight immediately post op. but, of course, his patients’ confidence comes back only over time. He also gave me some additional exercises to improve rotation of the hip and I am to see him in a further six weeks time. He may remove the metal any time after twelve months and will re-open the original groin wound to do so. This will involve an overnight stay in hospital. I am still not strong enough to drive yet and am really enjoying being chauffeured.

I am very excited about getting my life back. Thank you John O’Hara.