Nick's Story - Congenitally Dislocated Right Hip

I left that first appointment with high hopes for the future, and I almost booked that skiing holiday I had always wanted.

Nick (aged 23)

My name is Nick, and I am 23 years old. I was born with a congenitally dislocated right hip, which means that my right hip socket only covered the inside half of the ball of my thighbone. When I was a baby one of the muscles in my leg was cut and I was put in an A-frame (which held my legs out by my side) for months, in an attempt to encourage the socket to grow out around the thighbone. This seemed to work, and although late to start walking, I led a fairly normal childhood. However, when I went to secondary school I started to find that running and jumping during games left me sore later, and even the next day. It became clear that my socket had not continued to grow properly when I was younger, but at that time I was told that it would be best if I waited until I was fully-grown before any surgery. When I was 17, my doctor suggested the best course of action would be a new operation from Europe, called the Gantz Osteotomy. Similar to the Tonnis Osteotomy it involved my hip socket being cut out of my pelvis and repositioned on top of the thighbone instead of to the side. I was warned that there may be no improvement, and with a possible 3 months in a wheelchair and 6 months on crutches. When I asked what his success rate had been so far he replied he had never actually done that operation himself, but had seen it once on video. To show him my hip was not that bad I promptly ran away.

Pre-Operative Wait

I moved to Birmingham, and all was well until about two years ago when without warning my hip went very stiff and sore overnight. My GP made a referral for me, and about four months later I found I needed an MRI scan done before I could see a specialist. Another six months wait later and I had the scan results. These showed that although my hip was malformed, it was still in fair condition, and there were no cysts or serious arthritis – good news for me. Luckily, during this wait my hip had become slightly better and I could walk as far as I liked, but running was out of the question this time. I went to see Mr. O’Hara a little later still, and having had a fresh x-ray taken, the Tonnis Osteotomy was proposed. With such a high success rate, and such a quick recovery time I left that first appointment with high hopes for the future, and I almost booked that skiing holiday I had always wanted. I was keen to have my own blood for the operation, so in the month before the planned date I gave one pint a week – a total of four pints. It was quite difficult to arrange this, but I am told it should become easier, and in my eyes it was definitely wort

The Big Day

I booked into Ward 5 of the Royal Orthopaedic Hospital the day before the operation, with toothbrush, pyjamas, spare clothes, flip-flops, Walkman and a good book. From the outset I realised I would enjoy my stay there, as everyone was so friendly, and to this day I have not read more than the first page of that book. That first night I was woken at 12am, as soon as I had managed to get to sleep, for my last pre-op meal of a round of toast and tea. Although I would have liked to have declined this kind offering, I was warned that my operation may be postponed for any reason, and I would still have to continue to have nil by mouth. On the morning of the operation both the anaesthetist and then the surgeon came round to say hello and ask a few questions, usually the same ones. If you weren’t sure of your address before you go in then you will be by the time you leave. I did not think that I would be nervous, but as the operation time approached I felt like I did at my driving test.

The porters came to wheel me down to theatre, and I was shown my four bags of blood. When the anaesthetist came in it became clear that I was not going to be given a pre-med. (a mild anaesthetic before the main general anaesthetic) which previously I thought was standard. As I slipped into unconsciousness, the phrase “So which leg was it again, Nick?” swam around my mind.

Post-Operative: As an In-Patient

Day 1:I woke up in the High Dependency Unit (HDU), shivering under a thin sheet, with oxygen tubes clipped to my nose and morphine dripping into the back of my hand. I was quickly warmed with a heated blanket, and shown how to increase my dose of morphine with a hand-held button. It was with the help of this button that most of this day passed (although it is limited in order to prevent overdosing). One unfortunate side effect of the morphine is that it may act as an anti-diuretic (i.e. stops you peeing). In that afternoon I had, by way of saline drip, orange juice, water and even parsley tea (a mild diuretic), about 5 litres of fluid and still no pee. Only when I was told the staff doctor was on her way to fit a catheter did I manage. Still, I have been told even catheters have their advantages, and they only stay for a few days. I was still very groggy when my girlfriend came for a quick visit in the afternoon.

Day 2:I stayed in the HDU overnight, and in the morning returned via x-ray to Ward 5. I was pleasantly surprised by the edibility of the food during my stay in this ward. However, at this point I was beginning to experience the downside of lying down on my back for so long and I would have paid £10 for an indigestion tablet.

Day 3:The morphine ran out in the morning and was replaced by milder painkillers. During the whole experience pain has never been a real problem as the painkillers are very effective. As most patients in the ward are in their backs, a more real problem may be sleeping through the noise of snoring. Luckily sleeping tablets are provided if you want them. Laxatives are also available in order to counteract the various effects of the painkillers. A physiotherapist came to get me out of bed and rudimentarily mobile in the afternoon. I was shocked to find that my leg had been lengthened by the operation. Although it only measured 2cm longer it felt a lot more, and I was quite worried about it. Now I am used to it I don’t notice any difference in length. By this stage I was able to walk with crutches to the bathroom and sit up in bed and even sit on high chairs.

Day 4-7:Progress takes the shape of getting better at the exercises the physiotherapist sets, which are invariably those movements which hurt most, and practising walking with crutches. You may be interested to know that patients are usually allowed a glass of stout a day, although unfortunately this is not provided. By this stage in my stay I was becoming aware that rubber sheets on beds are not there for comfort, and I was looking forward to going home. Unfortunately, my house has lots of stairs and before you are advised to go home you have to demonstrate that you can go up and down them. This is done with the physiotherapist. By the time I left I was able to get about freely on my crutches, climb and descend stairs painlessly, have a shower and get dressed. In fact, most everyday activities are possible, but they may take considerably longer than they should. Eight days after I had arrived, Ambulance drivers took me home with fond memories, a weeks supply of painkillers and a hatred of daytime television.

Post-Operative: As an Out-Patient

Week 1:My first appointment with the physiotherapy department established what I was able / willing to do, what exercises hurt, and where they hurt. It also established that I could walk without crutches, if only for a short way in extreme pain. In my next appointment a different physiotherapist used these notes to devise more exercises, all of which were painful, but clearly designed to get me better more quickly.

Week 2:My first of six weekly hydrotherapy sessions started in the pool at the Royal Orthopaedic hospital. It was possible to practice walking and other difficult exercises in the body-temperature water, for half an hour before re-entering the harshness of dry land.

Week 3-6:By this time progress is noticeably slower, and it was difficult to maintain the daily exercise routine. I had gone down from two crutches to one at 3 weeks and was even back at work in a limited capacity at 5 weeks. Driving and cycling were not a problem, although getting on and off the bike, and in and out of the car, were difficult at first. By the time of my appointment with Mr O’Hara at 6 weeks I had stopped using crutches altogether. The x-ray taken here shows that the bone had grown to fill the gap left by the operation.

Now, at 10 weeks, there is very little that I could do before the operation that I can’t do now, like walk about 4 miles at a time, run for the bus, and I have even started to play badminton.