All's well that ends well ...

Over the last two years the osteoarthritis in my right hip had been causing increasing difficulties. My range of movement without pain was limited. I couldn’t put my right sock on without using a ‘sock assistant’. Anything other than very limited gardening was impossible. Instead of 5-6 mile hikes without a problem, I could manage only a couple of miles on the flat at a slow ramble. And worst of all, I had to quit walking football, which I had played for eight years since my early seventies.

On 5th April I had a total hip replacement. The following afternoon I passed the mobility test and was back home in the evening. The post-operative pain relief provided in hospital eventually wore off around three in the morning. I was grateful for the morphine I’d been given for such eventuality.

Apart from that first night at home the pain was never horrendous and could be managed with standard painkillers. I learned to take a stronger analgesic an hour or two before any activity that promised to be more strenuous than my usual routine of short walks, which were around the house and garden in the first week, progressing outdoors from week two. It seemed I was the average, straightforward THR recovery patient, improving my range of activities on a daily basis.

One day short of two weeks post-operation, I went back to the hospital to have the clips removed. The nurse expressed slight concern about the swelling around the wound and a small unhealed bit of the incision, and arranged for my return in two days for a check. In the meantime, fluid continued to seep from the wound and my wife had to change the dressing morning and night. Back at the hospital the nurse summoned the consultant, who thought that there did not appear to be any infection. Nevertheless, ‘to be on the safe side’, he prescribed a course of antibiotics.

Three days later, after more wound drainage and dressing changes at home, I was back for a further check. The consultant ordered the blood-thinning injections to be stopped and asked for another checkup appointment in two days. At this appointment, upon inspection of the still-seeping wound, he advised immediate treatment to minimise the risk of infection.

So the following day I was readmitted and for the next two days the wound was attached to a VAC (vacuum assisted closure) machine, a device that uses suction to drain fluid. On the second morning a different consultant was on the ward round. He was a little surprised that the wound was still draining. In the circumstances, he advised me to be prepared for further surgery. The wound would be reopened, the joint flushed out, and the removable ceramic parts of the prosthesis replaced. I learned that the procedure was called DAIR (debridement, antibiotics, implant retention). Operation Mark 2 was on 29th April, three and a half weeks after the first one.

Back on the ward in my side room, I realised that my mobility would be somewhat curtailed for a while. There was a drain from the wound into a plastic bottle; a Pico suction dressing replaced the VAC machine; I had a catheter for urinary purposes; and twice a day a drip provided strong antibiotics via a cannula.

Confined largely to bed or a chair for the next few days, I did some internet research (a mistake, most people say). Hip replacement is the most successful elective operation the NHS does, but occasionally there are complications. DAIR is necessary in about 1% of cases. I was one of those unlucky few. I didn’t regard myself as unlucky, though, because infection had been found and was being treated in the best way possible. Cultures from the second operation had revealed two types of staphylococcus bacteria. Once I was stable enough to be discharged, I would be on antibiotics for up to three months.

A week passed with the drain bottle remaining my constant companion. When I saw the consultant on his morning round, he explained that the full laboratory test results could take seven days, possibly longer as we were now into a Bank Holiday weekend. The drain might be removed tomorrow. (That’s what I was told every day).

The next night the drain removal question was violently resolved when I trapped the tube in the door on a visit to the toilet. It came adrift from the wound and I was patched up by the nurse on duty. On his next visit the consultant said that the dressing could be removed, together with the Pico pump. The lab results were in at last. A key infection marker called CRP (C-reactive protein) was moving steadily downwards. All that was needed to trigger my release was a plan from Infection Control.

Next morning the consultant arrived unexpectedly early to inform me that the CRP marker was down again. He briefly disappeared to phone his colleague in Infection Control, then returned with the news I’d been desperate for – home time! I simply had to wait a few hours before the hospital pharmacy sent my bagful of medicines up to the ward.

That first night back home I managed more than five hours sleep in total, more than any of the twelve nights I spent in hospital. On my second day at home, I started to feel really tired. Just moving around the house, up and down stairs, occasionally around the garden - my new hip was not used to this. As others have reported on this forum, it’s often a case of ‘two steps forward, one step back.’

Five days after release, I returned to the hospital for the removal of alternate clips and a blood test. My body was starting to adapt to the antibiotics. Sleep patterns improved - not normal, but definitely better. Social life resumed: a walking football friend drove me to our favourite coffee shop where the group meets after the weekly session. The banter hadn’t changed. I’d missed being verbally abused on a regular basis.

A week after the hospital visit, I returned to see the consultant, who said the blood results were good, and in particular the CRP score was down again. The remaining clips were removed - this time the wound had healed cleanly.

Tomorrow, four weeks after Operation Mark 2, it’s another Bank Holiday. I’m still downing the antibiotics, which seem to be having other beneficial effects, as well as fighting the bacteria. My taste buds are sharper. I don’t usually have a cooked breakfast, but today I have enthusiastically scoffed egg, bacon and black pudding. My mobility improves day by day. Around the house I manage without a walking aid. Outdoors I use a single crutch and try to walk at least a quarter of a mile every day. On the physiotherapist’s advice, I’m not obsessed with increasing the distance too quickly. I try to keep up the daily exercise routines. Most importantly, I’m pain free and almost back to a full range of movement of the hip.

If you are awaiting a THR and have managed to read this far, I hope my story has not caused undue alarm. I was the one in a hundred THR patients for whom things didn’t work out quite as planned. Yet here I am, only about four weeks behind where I had hoped to be at this stage, with the summer ahead and a targeted return to walking football in the autumn.