Getting Psyched Up for Hip Replacement

It seems that the bulk of the next year will encompass bilateral hip replacement surgery. That is with one big proviso, namely that someone is kindly willing to go ahead with the knife and the drill. I have already had pseudo-emergency hip surgery to mend a fracture in the neck and ball of my left femur. I had to wait three days morphed out of my head for the operation. There was an innate knowing that each day I waited the outcomes would be worse. To get prepped for operation in the morning and then to be told it is not going ahead is not the greatest of tidings to hear. In September 2019 I started my 55th year post-op with a titanium prothesis. I was awake during the operation which felt that someone was at my skeleton with an industrial grade civil engineering jack-hammer. Your whole skeleton resonates. I have an inkling and would prefer a general anaesthetic next time.

As can be seen from my April X-rays the situation with my left hip is complex.

There has been a bony growth {blue arrow} over the top of the implant. This will need to be chiselled off to enable the pin to be unscrewed.

We could be talking three operations. One to remove the metallic pin, one to fit the right hip and one to fit the left hip. It will be up to the surgeon to decide what to do. You can see from the X-ray images that I am bone on bone, so to speak, on both sides. My range of movement is very limited. My arthritis is classified as severe or to use a lovely turn of phrase, end stage.

In my mind it is not clear how easy or otherwise it will be to have a successful complete hip replacement on the left hand side. The right hand side seems more common or garden.

At the time of the accident, a fall from standing in the kitchen, I was not checked for any bone weakness such as osteoporosis. There was a lot going on. The age at which the major fracture occurred for a male was young given a relatively minor trauma. The GP has kindly prescribed a bone density scan just to check if there are any bone strength anomalies we need to consider. If there is weakness there are some further blood tests including testosterone and calcium levels etc. A weakened bone has implications for hip replacement.

If you search for hip replacement personal stories on Dr Google you are confronted with masses of marketing and PR from various outfits offering butchery and repair. They are nearly always upbeat and scant in detail on the downsides. There must be some horror stories out there but these are not easily found. Why not? Without being overly macabre I would like to read some to get more balance. They have been somehow redacted. I get it that in most cases the surgery is transformative. I am always a little wary of one-sided reporting. It irks and poses the question.

I have no idea as to how well I tolerate pain compared to most. My speculation is that I can tolerate and endure better than average. Thus, my arthritis has progressed this far without me whinging and moaning too much. At the moment the pain levels are boring and wearing. They do grind you down a bit just as the joints grind away. Movement can feel like a pepper mill at the end of the day or a long walk. The 3 AM pain and subsequent medication is a tad intrusive. We have a supply of mid-to-high level analgesia in the pantry {given to the wife} which I have not touched yet. The possibility of a “trainspotting” red carpet moment exists.

I do not imagine myself doing a pogo to the Sex Pistols post op. It remains to be seen to what extent movement returns and pain diminishes. If you read the glossy bigged-up articles and watch the videos my career at the Bolshoi can restart, soon enough.

I have enough upper body strength to use a Zimmer frame with ease whilst sporting my Crips gang colours. This strength is on the one hand enabling and on the other limits my need to do recovery leg exercises. A mixed blessing.

We will need to pay for a gardener to do the hard labour I once did. It looks like we will stay here for the next year. To attempt to move house in the middle of getting sliced would be lunacy.

On the one hand there could be enhanced movement and a “new life” or at least a better few years. More likely the improvement will not be step function but an obvious improvement.

I know that I can hack lying around post-op with sexy compression stockings and daily anti-clotting injections. I will lose weight because muscle mass will go. I will not eat much at the hospital. The biggest worry would be a Myeloma relapse for the wife. That would make things very tricky. Two ill and disabled people in the same house. We already have a well-used loyalty card at the local hospitals. We could write a “Michelin” guide to French health services.

I don’t really have fear, yet. I have had general aesthetics near half a dozen times. In a weird way I quite enjoy the coming to process.

Again, the district nurses are likely to be regular visitors chez nous.

Yup it looks like close on a year for two {three} operations and the recoveries therefrom.

Life will kind of be on hold…

Quality of life

Quality of life is defined by the World Health Organization as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”. Standard indicators of the quality of life include wealth, employment, the environment, physical and mental health, education, recreation and leisure time, social belonging, religious beliefs, safety, security and freedom.

Health related QOL (HRQOL) is an evaluation of QOL and its relationship with health.

In healthcare, quality of life is an assessment of how the individual’s well-being may be affected over time by a disease, disability or disorder.

Measurement

Early versions of healthcare-related quality of life measures referred to simple assessments of physical abilities by an external rater (for example, the patient is able to get up, eat and drink, and take care of personal hygiene without any help from others) or even to a single measurement (for example, the angle to which a limb could be flexed).

The current concept of health-related quality of life acknowledges that subjects put their actual situation in relation to their personal expectation. The latter can vary over time, and react to external influences such as length and severity of illness, family support, etc. As with any situation involving multiple perspectives, patients’ and physicians’ rating of the same objective situation have been found to differ significantly. Consequently, health-related quality of life is now usually assessed using patient questionnaires. These are often multidimensional and cover physical, social, emotional, cognitive, work- or role-related, and possibly spiritual aspects as well as a wide variety of disease related symptoms, therapy induced side effects, and even the financial impact of medical conditions. Although often used interchangeably with the measurement of health status, both health-related quality of life and health status measure different concepts.

Activities of Daily Living

Activities of Daily Living (ADLs) are activities that are oriented toward taking care of one’s own body and are completed daily. These include bathing/showering, toileting and toilet hygiene, dressing, eating, functional mobility, personal hygiene and grooming, and sexual activity. Many studies demonstrate the connection between ADLs and health-related quality of life (HRQOL). Mostly, findings show that difficulties in performing ADLs are directly or indirectly associated with decreased HRQOL. Furthermore, some studies found a graded relationship between ADL difficulties/disabilities and HRQOL- the less independent people are at ADLs- the lower their HRQOL is. While ADLs are an excellent tool to objectively measure quality of life, it is important to remember that Quality of life goes beyond these activities. For more information about the complex concept of quality of life, see information regarding the disability paradox.

In addition to ADLs, instrumental activities of daily living (IADLs) can be used as a relatively objective measure of health-related quality of life. IADLs, as defined by the American Occupational Therapy Association (AOTA), are “Activities to support daily life within the home and community that often require more complex interactions than those used in ADLs”. IADLs include tasks such as: care for others, communication management, community mobility, financial management, health management, and home management. Activities of IADLS includes: grocery shopping, preparing food, housekeeping, using the phone, laundry, managing transportation/finances. Research has found that an individual’s ability to engage in IADLs can directly impact their quality of life.

Importance

There is a growing field of research concerned with developing, evaluating, and applying quality of life measures within health related research (e.g. within randomized controlled studies), especially in relation to Health Services Research. Well-executed health-related quality of life research informs those tasked with health rationing or anyone involved in the decision-making process of agencies such as the Food and Drug Administration, European Medicines Agency or National Institute for Clinical Excellence. Additionally, health-related quality of life research may be used as the final step in clinical trials of experimental therapies.

The understanding of Quality of Life is recognized as an increasingly important healthcare topic because the relationship between cost and value raises complex problems, often with high emotional attachment because of the potential impact on human life. For instance, healthcare providers must refer to cost-benefit analysis to make economic decisions about access to expensive drugs that may prolong life by a short amount of time and/or provide a minimal increase to quality of life. Additionally, these treatment drugs must be weighed against the cost of alternative treatments or preventative medicine. In the case of chronic and/or terminal illness where no effective cure is available, an emphasis is placed on improving health-related quality of life through interventions such as symptom management, adaptive technology, and palliative care.

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Extracted from Wikipedia.