While discussing the prospect of a total hip replacement with a patient this month, I thought that it would be useful to detail a personal account of someone who had undergone the very same thing including how we helped and managed them along the way. Read on for Paula's story, first in my words, and then in hers.
"When I first met Paula in November 2011, it was the beginning of a journey together. As a fit and active woman, who looked at least a decade younger than her date of birth told us, she consulted our clinic complaining of hip pain which had become progressively worse, and was starting to stop her doing the things she not only wanted, but needed to do in life.
The first thing that an Osteopath does is take a thorough case history, including previous injuries, and what are known as aggravating and relieving factors. This helps us to build a picture of you as a whole person, and lets us know how your pain is impacting your life.
The next step is an examination which includes a lot of movement testing, muscle testing, reflex and power testing as appropriate, and joint range of motion assessment. It was clear from the first appointment, that Paula was displaying the signs of moderate osteo arthritis (OA) in her right hip.
In the first instance, we made a plan to start a combination of treatment and specific exercise to do our best to 'optimise function' and get Paula as strong as we could, then reassess how she was managing in her day to day life. There was some improvement, but I felt that we should request an X-Ray to determine the exact level of degeneration present, which would allow us to determine a more specific plan for the future. We wrote to Paula's GP with our findings, who was happy to assist and this confirmed our own diagnosis of OA hip - it was actually quite advanced at this stage but Paula's otherwise good level of health and fitness meant that she had managed well up until this point.
At this stage in her life, Paula wasn't quite ready to opt for a replacement, and so we spent almost two years working with a combination of treatment, and exercise therapy, liaising with her personal trainer, to keep her as good as she could be and maintain her strength and flexibility not only in the affected hip, but in the other hip, the lower back and in both of her legs.
Finally, the time was right and Paula underwent her total hip arthroplasty (THA). We made sure that she went into the operation as fit and strong as she could, and this paid dividends. She had a very positive experience at Pinehill and came through with a 'fighting fit' attitude, being religious with her post operative physiotherapy.
We still look after Paula now, with appointments every 5-6 weeks, sometimes longer due to her wonderful and active holidays which I always look forward to hearing about. Each individual patient has different needs and requirements, but this suits her situation well. We work to ensure the very best function in Paula's feet, ankles, knees and both hips - she now has orthotics to help with shock absorption and optimise her biomechanics - and she still undertakes a regular exercise program. This is monitored, updated and amended as appropriate to ensure that she is always the very best that she can be. We look at strength, flexibility, stamina and importantly also work on balance and proprioception which we know helps with injury prevention.
This sort of continued functional treatment, rehabilition exercise and management is seen commonly in professional sport but benefits patients such as Paula just as much as elite athletes! I could not be more proud when I see a patient take all of our advice and help over the years and then manages to achieve a goal. In Paula's case, a new hip and a new lease of life including walking part of the Great Wall of China." Hannah Walder
Read Paula's Story in her own words below:
"I first realised I might have a problem with my hip in 2011 whilst on holiday in Canada. Towards the end of some sightseeing one day, it became too painful to walk any further. At that time I had no idea my problem was due to my right hip. However it seemed to clear up and I was fine for the remainder of the holiday. However on my return home, it became progressively worse again and decided to visit Osteopathy First, who had a facility at the gym I belonged to and thus became one of Hannah’s patients. She very soon diagnosed the problem – it was my right hip. I continued going to sessions with her until she suggested I should get it X-rayed. She wrote a letter to my doctor and following an X-ray, her diagnosis was 100% proved correct – I had an arthritic right hip – and not just the start of one, it was already bone on bone.
Eventually in September 2013 I had a hip replacement at Pinehill Hospital (as a NHS patient) and all went well. Although I occasionally needed a stick prior to the operation, I was managing to walk OK and continued going to the gym right up until the operation. Once discharged, I religiously did the daily exercises as instructed by the hospital – up to 7 times a day, far more than required! I was “signed off” in November that year. However due to my husband’s deteriorating health (he died in May 2014), I was rather lax in going to the gym and seeing Hannah – possibly this slowed down my final rehabilitation. However once I was able to, it was back to the gym and also seeing Hannah.
I visit Hannah about once every five weeks – this is a “maintenance exercise” for me. She is so re-assuring and encouraging – my main worry is that I will have problems with my left hip, especially now that I live on my own. I know she will detect any future difficulties very early. I try to be vigilant with the exercises she gives me (!), I try go to the gym twice a week, I can run up my stairs at home, in fact most of the time I forget I have ever had the operation. Unless I have been standing for too long, and a gentle ache (which disappears after rest), tells me to sit or walk!
I lead a full and active life – indeed on a recent visit to China, I climbed a section of the Great Wall." Paula Downes