2 Weeks of Recovery Insights — A Birmingham Hip Resurfacing Story

22 min readJan 29, 2021

BHR image, 2007. Graphic image. Med Device Online. https://bit.ly/3osNrMP

I wrote this article to help prepare others who are considering or planning the Birmingham Hip Resurfacing procedure. And if you’re not sure, I may be able to provide some helpful insights about the recovery process prior to your going through with the surgery. Before diving in, I want to present a couple important caveats:

I am not a doctor. The research I’ve done on the procedure itself was only to decide between a full hip replacement or resurfacing. I chose BHR because it seemed less impactful than full hip replacement and seemed to have a better recovery process. My decisions are based on my age, activities, and eventual possibility of having to do a full hip replacement anyway.
I required both hips to be replaced or resurfaced and began with only my left side so I wouldn’t require as much assistance during recovery.
Everyone’s recovery is different, both in time and severity of symptoms. Your body’s reaction to drugs, pain, and the effects of the recovery process will vary.
Regardless of what is written in this article, please do your own research! Know what you are signing up for and the effects/use of various medication.
I chronicled my own recovery challenges in hopes that you’ll be better prepared to handle them should they come your way.

Why did I need hip replacement?

I spent much of my life as an active athlete in martial arts, gymnastics, soccer and other high-impact activities to my hips. Through my 40’s, my activity began to diminish though I continued to play indoor soccer. This eventually waned as I would get more and more back spasms from twists, turns and even the most benign of activities (like picking up a sock from the floor). Later, I would connect the issues going on in my hip with the strained back issues I was feeling earlier.

Family life and work took much of my time and you tell yourself you’ll become active again when the kids are off to college. My wife and I, having been lucky enough to work at the same company for several years, would go to workout class together almost everyday. During one particular cardio class, we had been doing a high number of knee lift workouts. It was during this class, about 3 years ago, that I was exerting myself and eventually injured my left hip flexor. It was quite painful and I figured a couple weeks off would be fine. It never quite got back to normal. In fact, knots in my upper glutes and burning down the left side of my leg would turn out to be tell tale signs that my muscles were compensating for issues in my hip.

Fast forward 2 and half years and sitting straight down in a chair or standing straight up would cause my left hip to either knot up or feel like my sciatic nerve got pinched between my bones. The pain was excruciating and would put a halt to any activity I was doing until I could recover. I would often perform a special twisting move prior to sitting or standing just to avoid the possibility of feeling that pain. The month prior to my surgery, I had it down. I knew what stretches to do to decrease the possibility of knotting up. I had a high impact massager to target the muscles at the top of my glutes and down the side to my hip. Pain was manageable but the issues didn’t seem to go away.

Actual x-rays

My X-rays showed zero cartilage in both hips. The damage was so pronounced, the specialist didn’t even order an MRI. I had developed bone spurs due to the misshapen bones at the top of my thighs which aggravated the muscles and nerves. The ball joints on both sides were somewhat oval shaped and had been wreaking havoc on my hip sockets over the years. There was even evidence of calcification in my muscles which manifested in painful knots and burning pain in my hips, glutes, knees, and on bad days, down to my ankles.

“If this were in your chest. You’d be dead.”

The PA looked at my chart and stared at me directly. “Can I be real with you for a second?” he said.

“Sure?” I replied. Not sure what to expect. Until now, there really hadn’t been a lot of formalities between me and my caretakers.

“You see this?” He pointed at both of my hips. By this time, I had already memorized the rough lines and chunky white blobs on the screen and had been chastised multiple times about how badly past the point of treatment I was. So I braced for another lecture.

“If this were in your chest…you’d be dead.” He waited for my reaction.

“Jeez,” I replied in shock. I didn’t know where to take it from there.

“Men are trained to ignore pain all their lives, but you can’t ignore the pain. You’ve got to do something about it.” He continued.

The specialist interrupted us. He quickly verified that the PA had gone over some options of the surgery with me. I had not formally met him, but he had seen my charts. My expectations of sympathy and bedside manners were quickly dashed.

“No good news for you today, huh?” was his self-introduction.

The conversation quickly ended with a nod to needing both hips replaced and that I was a good candidate for hip resurfacing. The choice was mine. I quickly noted I wanted hip resurfacing and to not cut my muscles. Boom. Everyone on the same page.

At the time, we were planning on a double hip surgery. Get it all done at once, I thought. But a couple days before the surgery, I was informed that we were only doing the left first. Since the issues in my right hip were fairly mild and sometimes non-existent, we would start with the left and see how it went. I’m SO glad they chose to do that.

Surgery Prep

Your doctors will give you a full set of instructions in preparing for this surgery. 3 days prior to my surgery, I was asked to wash with anti-bacterial soap, dry with a new towel and change the sheets each night.

As for the procedure itself, there are videos about the surgery that you can watch beforehand. Warning: very graphic!

The McMinn Center, “Birmingham Hip Resurfacing (BHR) Surgery by Derek McMinn (Live Surgical Demonstration)”, 2008. Video. https://www.youtube.com/watch?v=QZGUrQYqk9Q

The surgery is about an hour and half but make no mistake, they open up your leg, contort your body, and drop a trailer hitch on that thing! I watched the surgery videos on YouTube afterward just to understand where and why I might be feeling pain in my hip area.

Prepare Yourself!

This is also a good time to get the supplies you need!

Grabber ($20) — great for pulling up sweat pants and stuff that falls on the floor
https://bit.ly/3csIhxU
Walker ($30) — The ones with the wheels on the front are much easier to get around, but I made due with the 4-peg version. Be careful! It’s easy to misplace your wait on the front and topple forward. Keep your hands to both sides.
https://amzn.to/3t6av7F
Cane that stands up on its own ($16) — You may find that you can let go of the walker after the first week. Initially, I found a cane with a really cool bird skull top. I thought it was cool and still practical. The most frustrating thing I found with that cool cane was that it was difficult finding a place to lean it or having to place it on the counter while doing small tasks.
https://amzn.to/3cxOlWj
Loose sweats — you’ll need this for several weeks since you shouldn’t be bending past 90º to do anything with your feet. Try to place the sweats on the ground where you can step into the leg holes, wiggle your feet through the bottoms so you can feel the carpet, and then pull up one side with your cane’s handle or use the grabber. At about the knee, you can reach down the non-surgical side and pull your pants up. 2 weeks after surgery, I still have my wife put on my socks and shoes.
Slip on shoes — This makes it very easy to get around without having to put on socks. Probably best used in the warmer months, but you can make due in the winter.
Pedialyte or Gatorade — You will get sick of water. In fact, the taste may even make you nauseous. It is important to have a variety of flavors because you’ll be needing to hydrate heavily during the first week and a half! Pedialyte provides you additional things like electrolytes that will help your body cope with dehydration.
Water or Pedialyte on the nightstand — Dehydration is real! I would wake up with my mouth completely dry, as if my salivary glands stopped working. Having liquid within reach in the middle of the night is a life saver.
Portable potty seat and toilet paper rolls ($30) — If you don’t have someone who can move the potty seat up and down the stairs each day and night, pick a bathroom you can get easy access to and leave it there. And take the toilet paper off the roll and have it available somewhere in front of you or with just a minor twist. You must not reach and twist behind you. Putting that one roll within reach on the sink counter or window sill makes it much easier to stand up and wipe! And have replacement rolls at the ready vs. in a basket behind your toilet.
https://amzn.to/3codGBI
BRAT diet items and Saltine Crackers — You can’t eat your regular food when you first get home. Bananas, rice, applesauce and toast (or saltine crackers) are very light on your stomach. Your body will be burning massive calories trying to heal itself, so you need to find ways to ingest foods, calories, and nutrition.

Surgery Day

My surgery was scheduled for 6AM on a Tuesday and I was raring to go. I wasn’t nervous and was actually looking forward to that moment when you simply wake up after all the magic has happened. I had been using cannibis gummies on a nightly basis to manage the pain for about a month. 24 hours prior to surgery, that and certain blood thinning medicines (i.e., joint pills with vitamin E) were halted. You are given a cocktail of medication during and post-surgery, so they want to make sure there is no conflict with those drugs. There’s not a ton of research done on cannabis use prior to and after surgery, mainly due to the varying laws around cannabis and people willing to divulge that information. For the most part, and you should look this up yourself, I found that cannabis CAN have an effect on the amount of anesthesia needed during surgery. It can also affect the ability of pain killers to do their job post-surgery. Those who smoke cannabis have also had longer recovery times with regards to breathing. Either way, always check with your doctor.

At the hospital, I was prepped and my wife waited patiently by my side. I remember asking the doctor if there was some silly juice I might be able to take before they wheeled me out so my wife could video me. No such luck. They inserted my spinal tap, which was par for the course, and fitted me with my oxygen tubes. I had also opted for anesthesia, noting an irrational fear of waking up mid-surgery.

In the operating room, a nurse entered with a small kit of cotton swabs and some other medication.

“We’re going to swab your nose with 5% povidone-iodine to decrease infection,” she said.

Povidone Iodine nasal application, 2018. Graphic image. PDIHC.com. https://pdihc.com/wp-content/uploads/2019/12/PDI-Profend-Nurse-Using-Swab-on-Patient-A_012518.png

Removing two long swabs from her kit, she proceeded to coat the entire inside of my nose with this iodine mixture. The liquid drips out of your nose as a blackish gray substance. It is used during surgery to greatly decrease the Staphylococcus aureus colonization in your nostrils. It’s also referred to as a nasal antiseptic and can ward off deadly infections at your incision site. I didn’t really notice the smell at the time and it dried quickly, however, it would later prove to be negatively impactful during my recovery.

Additional reading on the use of povodone iodine can be found here: https://bit.ly/39pGO9W

I said “I love you” to my wife and they wheeled me away.

The surgery room had been blasting country music. I didn’t think that was a thing.

I looked at the nurse nearest me and said, “Have you seen that movie, City of Angels? With Meg Ryan and Nicolas Cage?”

“Oh my,” she said. “It’s been awhile.”

“Yeah!” I was getting more excited at the thought of receiving subliminal music during the operation. “Do you remember in that movie, Meg Ryan played music while she did surgery? I thought that was made up. But it sounds like you actually get to do that!”

“Yep!” The nurse kept me distracted as the mix of anesthesia increased in my nose tubes. “It’s doctor’s choice. He likes country.”

Black out.

Recovery Day 1

2 hours later, I remember being gently nudged awake. The procedure was over and everything had gone swimmingly. I didn’t really feel a great deal of pain in my hip. If you review the videos for the operation, you’ll see that they add quite a bit of medication to the affected area before sewing it up. They also give you plenty of fluids to replace the blood loss, so keep that in mind with regards to your body needing to expel that liquid in some manner during recovery. The drain bag was clipped to my gown on the left with a drain tube feeding directly into my thigh. The IV was still connected to my right hand and would be the source of antibiotic and anti-nausea treatment.

OxyContin, 2013. Graphic image. NPR. https://media.npr.org/assets/img/2013/04/17/ap688498854190-1a854301544d2cd6c2fb4b56c22fa87633467c02-s800-c85.jpg

I remember distinctly asking to avoid any opiates in post-op. Oxycontin was the drug of choice and I knew my body’s reaction was to shake and make me feel like there was an impending doom. Luckily, I didn’t need it immediately and went with the anti-nausea medication, Zofran, fed through the tubes to counteract the two bouts of vomiting I just experienced. The smell of iodine lingered lightly in my nose but wasn’t bothersome.

Anesthesia

Here’s where the first symptoms of recovery begin. Apparently, anesthesia can take months to leave your body but is especially impactful that first night. It took me about a week to get through the waves of cold and hot spells. The heat sweats do not necessarily reflect a rise in body temperature. Keep in mind, any other medication they put into your body also needs to find a way out. Eventually, a focused pain in my hip that required me to take about 3 doses of oxycontin over the course of the night and the next day. I quite them cold turkey prior to leaving the hospital. In retrospect, it may have been better to ween myself from them, but I wanted any withdrawal issues to happen quickly. We did pick up a prescription for OxyContin after leaving the hospital, but I never used them.

Longest Night Ever

In the recovery room, I had been lying in my bed at about 2AM, over 12 hours since waking up from my surgery. I awoke suddenly, overcome with sweat. I was pulling covers off me but keeping them nearby in anticipation for the cold swing. I buzzed the nurse on duty and asked if they could please turn down the heat in the room. Perplexed, he took my temperature to see if I was experiencing any fever. Nothing. Just a soaking wet forehead. Upon inspection of the temperature control, he said, “It’s all the way down.”

Not knowing what to do, I asked if he could just leave the door and curtains open about a foot to let the air circulate. That seemed to help a great deal.

With everything going on in my body, I wasn’t able to eat much at the hospital. When my wife was there, she could eat a free meal and I could watch in envy. The intravenous Zofran helped greatly in removing the effects of nausea. Fruits were good, along with switching back and forth between juices and water.

Don’t take a bunch of electronic distractions with you! My wife was the wiser here, but I figured I’d have some down time where I could work or at least do some web surfing. In reality, with all the sleeping, nausea, bathroom trips, etc., I probably checked my phone twice. Total waste of space. I strongly urge you not to worry about entertainment. My room had a TV, but I could only watch about 15 minutes before passing out again.

Amazingly, you can walk on your leg within hours after surgery. In fact, they force you to take a couple strolls right after surgery and later as you’re resting. Eventually, you’ll need to get up and go to the bathroom. OxyContin can cause a hardening of the stools. If you go home and continue to take it, you will need a stool softener so you don’t get backed up! I opted not to take it, instead, sticking with Aleve and baby Aspirin (taken to avoid blood clotting). ALWAYS call your nurse when you’re going to get out of the bed. It’s difficult to maneuver at first, but you’ll get the hang of it. They’re there in case you fall. Just play it safe and have the nurse watching over you as you walk to and from the bathroom.

Physical Therapy

The next day, the physical therapist stopped by for a quick test of walking and stair usage. They led me to a dedicated room with a small stair set and some other strengthening equipment. Pretty straight forward rules.

Going upstairs:

you’ll want to use your weight bearing leg first. In my case, the right leg would step up first.
Then pull up my left leg or surgical side.
Use the railings and your cane/walker to steady yourself.

Going downstairs was just the opposite:

Surgical side steps down first
Followed by the weight bearing leg.

Now is a good time to talk about using a walker and/or cane.

With either a walker or cane, it’s very important not to drag the tool while stepping. Lift it and set it down. And not simultaneous with your step. The tip of the walker posts or cane can get caught on carpet or simply lag behind. It only takes a millisecond of lagging behind to be out of sync with your step support. If you’re setting your surgical side down at the same time as your cane or walker, there’s a chance of falling. Why? I found it very easy to try and time my walker with my foot taking the step, but on occasion, the cane would get stuck on the carpet and I’d find myself stepping with no support unless I had my other hand on a railing. This was especially true coming down the stairs. So I strongly suggest a conscious effort to walk in this pattern:

Lift the cane/walker straight up > swing it into place and put the cane/walker down > then take both steps.

This method allows you to ensure your cane/walker is set before moving forward. And since you’re not putting your wait forward while you place your cane/walker, you won’t feel off balance.

Back to Povidone Iodine

This was probably the most mysterious source of major nausea. Night two after coming home, I still had not been eating well (drugs still leaving the body) and had been going through what felt like withdrawal symptoms. That night, however, a new smell was becoming very distinct in my nose. I had forgotten about the povidone iodine because I thought it had just dissipated. No such luck. A sweet, rancid, medicine smell was permeating my nostrils. At first, I thought there was something in the environment. Things tasted strange so maybe it was a combination of reflux and whatever I was eating. Soon, the smell became a taste. Water, saliva and other non-sugary drinks tasted like the smell or were altered in such a way that it tasted disgusting to me.

I had taken my first dose of Meloxicam, an anti-inflammatory drug, that day. By bedtime, my stomach was burning and nausea was setting in. The smell of povidone iodine is difficult to explain, but once you smell it, it doesn’t leave your nose. It created a vicious cycle for the next 8 hours, forcing me to throw up (and I was only throwing up liquids for some reason), calm down, smell and taste the povidone iodine, throw up again, and so forth til the morning. I was basically waiting on the couch for the nausea sensation to subside in time for me to smell it again. Brutal. To note, I stopped with Meloxicam and switched to Aleve for anti-inflamation.

I picked up the phone at 6:00 AM and called in a prescription for anti-nausea medicine. The pharmacy was going to open at 8:00 AM, so at about 6:45 AM, I rushed upstairs to tell my wife we had to go to the hospital. It was a 20 minute drive, so she finished getting ready and we left around 7:30 AM, just in time to be there when the pharmacy opened.

It was a long 20 minute drive. Trying not to allow the slightest breeze through my nose, even with tissue jammed up in there, proved very difficult. Upon arrival, my wife rushed into the ER to find my prescription. Turns out, the office had accidentally sent it to a facility with a pharmacy that was another 40 minutes away. The facility I went to was much closer but did NOT have a pharmacy and did not know I had a prescription waiting to be picked up.

By this time, I was fighting against vomiting in the car and opted to just check into the ER. I thought, “At least I can get an intravenous dose of Zofran and take care of this pretty quickly.”

Be aware of what they give you in the ER and ASK QUESTIONS about it!

The ER technicians were stumped at what the smell could be and gave me a packet of alcohol swabs to sniff in order to replace the odor. This worked briefly and as soon as the Zofran kicked in, I was feeling much better. They were also replacing a lot of the fluids I lost throughout the night. I could still smell the odor but it wasn’t making me sick.

I had finally recalled that the povidone iodine in my nose had never been cleaned out. They said there was a distinct possibility that the concoction that had saved me from infection could be the source of my nausea. Getting a Netty Pot was next on my list to help reduce the amount of povidone iodine in my nose. I had done some quick tissue wiping on the inside of my nostrils but could tell I’d need the Netty Pot to reach the deeper areas.

Emergency Room, Unknown date. Graphic image.Stormont Vail Health. https://www.stormontvail.org/wp-content/uploads/2018/02/emergency-department.jpg

During my stay in the ER, 2–3 nurses or technicians were attending to me. I had received Zofran intravenously, but another technician had come in with a different medication in pill form. I took these upon offering, not thinking about the medication I was receiving already through the tubes. A little while later, a different technician came in and offered me a dissolvable tab for under my tongue. I took this as well. I asked them, if the nausea persisted, if I could take another. After a short pause, they said it might be OK since they do give us medication in 4 hour spurts during recovery if needed.

I thought, “Great! I’ll take this in 4 hours just to stem the nausea.”

In short, I had been given 4 doses of 3 different types of anti-nausea medication in the space of 6 hours. NOT GOOD. 4 hours later, I’m anticipating the drowsy effects of the Zofran and decided I should take another dissolvable tablet. The wife was in Costco picking up my anti-nausea medication and a Netty Pot.

After getting home, I laid down in bed to rest. This began the most intense set of border-line psychotic dreams I’ve ever had in the space of 2 hours. I was anxious, my heart was racing, and I couldn’t get these awful images out of my head. Only after getting out of bed and going downstairs to type something could I focus and get away from the effect. Luckily, the symptoms didn’t last long and a quick call to my doctor revealed that no, I should NOT have been given 3 different types of anti-nausea medication in that short amount of time.

Lesson learned:
Before taking medication, ASK about timing, dosage, and if it will interfere with ANY medication you’ve previously taken or are currently taking!

General Recovery Items

After recovering from this incident on day 3, the recovery process took a turn for the normal. So here are some general things to be aware of and prepare for.

6 Weeks of Healing

There’s a 6 week healing period, so don’t chance it. You may be feeling great by week 3. Don’t chance it. There’s no more pain in week 4 or 5? Don’t chance it. Stick to the rules they give you! The 6 week healing time is to let your muscles scar up and reattach to their connection points. Light walking is all that is needed during this period because it is the most risky. While you may feel well, the false sense of security you have could create monumental problems: falls, dislocation (which requires a call to 911, sedation, and probably re-operation), over exertion, etc.

Itching

It turns out, I have an allergy to adhesives. Leave a patch style band-aid on me long enough, and I develop a welt and rash exactly where the adhesive is. I went 2 weeks with annoyingly itchy bandaids. Luckily, at your 2 week visit, barring any issues, you can permanently remove that bandage! Your incision point may begin itching as well. Don’t scratch it!

Figure 2: Patch test showing marked reaction to a hydrocolloid dressing, Unknown date. Graphic image.Medetec. Woundsource.com https://www.woundsource.com/sites/default/files/patient-condition/medical_adhesive-related_skin_injury_2.jpg

Hydrocortisone was the goto medication for treating the welts and itching. You can apply to the affected area but NOT the across or on the incision!

Netty Pot that Povidone Iodine

I can’t stress this enough. If you can, Netty Pot that povidone iodine out of your nose AS SOON AS YOU CAN. I spoke with a different doctor about this after my bout with nausea and the ER and he said he had the same experience after his neck surgery. One thing to note, the Netty Pot solution can dry out your nose. You only need to do it once or twice. I found that using vaseline in my nostrils helped with the dryness.

Aches and Pains

They tweak and pull your tendons! Specifically, the band that runs down your outer thigh and into your knees. And they will be sore to the touch later. You may also feel weird little pops and clicks in your hip as your muscles readjust. Also, there is swelling, so things will be moving around.

Swelling

Speaking of swelling. Some of the liquid that doesn’t get reabsorbed into your body will behave like a sponge. You’ll be able to press down on your skin and leave an impression. This requires you to walk, move around. Get your muscles and joints moving to break up the liquid. If it moves to your lower leg like mine, put on the pressure sock they give you to help decrease the swelling. I only had to wear mine for about 2 days before the swelling went back down. Your mileage may vary!

Blood Clots or Deep Vein Thrombosis (DVT) — Dangerous and Life Threatening!

Blood clot in leg vein, Unknown date. Graphic image. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557

Look this up. Understand the signs and don’t be afraid to call up the clinic or 911. The baby aspirin helps to mitigate the risk of blood clotting, so take it everyday!

Here’s a quick reference on blood clotting symptoms and issues: https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557

Sitting/Getting Up/Sleeping

Follow the instructions about sitting for ALL 6 WEEKS! One way to bend over if you absolutely have to, is to keep your surgical leg straight and in alignment with your body as you balance on your weight bearing leg to lean over. This requires balance, probably a hand on a railing or cane, and slow, deliberate moves. I don’t suggest this, but there are little workarounds that you’ll discover.

When getting up from a sitting position, stretch your surgical leg forward, put your weight-bearing leg under you and stand up with your arms and weight-bearing leg working together. Always have your cane/walker nearby and easy to grab in front of you.

I’m a side and back sleeper. But you should avoid sleeping on your side in the first several weeks. Your surgical leg cannot pull across your weight-bearing leg. Damage to your muscles, connective tissue and even dislocation are very real. It may be uncomfortable, but sleep on your back during this healing period.

Anesthesia may still be leaving your body. Be ready for hot and cold swings in the first week.

Getting in and out of cars

This is very nerve racking at first, but here is an easy way to handle getting in and out of cars.

Getting in (left leg example on the passenger side):

Sit backwards on the seat. Make sure the seat is moved back and the back of the seat leaning back a little bit.
Use both hands to support your left leg in a sitting position.
Bring your right leg up parallel with it and scoot yourself back into the seat, swinging both legs to the left at the same time.

Getting out:

Supporting your left leg with both hands, swing both legs to the right so that you are facing the open door.
Let your RIGHT leg rest on the car floor edge while your left leg prepares to put itself on the ground.
Grab your cane or prep your walker
Scoot closer to the opening and use your right leg on the ground to stand up on. Utilize the car frame, walker, cane, whatever you can get your hands on that is stable.
BE CAREFUL in snow and ice!! Your right leg should be vertical, not angled back. Putting pressure on this leg while it’s angled could result in it slipping forward.

Closing thoughts

I hope this has been a helpful reference! As always, any questions or concerns should be directed to your doctor! Happy healing!