Discussions that mention fragmin

Knee & Hip Problems board


I would encourage anyone who is younger, relatively active and thinking about hip surgery to look carefully at the possibility of hip resurfacing rather than total hip replacement (THR).

In my case I had both hips resurfaced (Birmingham) in one operation on 14 December 2005. I am a 54 year old male living in Melbourne Australia, and had osteo arthritis in both hips (right hip went first) for about 6 years. In the second half of 2005 things went downhill rapidly and I came to the point where I couldn't go on - painkillers did not work properly, waking up with pain every 1-1 1/2 hours etc.

I researched the internet on possibilities and decided that resurfacing sounded very promising, so got a referral to a surgeon that did them (very experienced - he has done about 500 over 7 years). He went through the advantages (retaining an intact femur, much more stable joint, more rapid recovery, greater range of activities following recovery, easy conversion to THR if the joint failed at some future time), but cautioned that bone cysts that could be seen in my X-ray could be deep enough to make resurfacing problematic - in which case he would need to decide in the operating theatre to do a THR. He also cautioned that whether I could stand both hips being done in the one operation could only be seen in the theatre, and he would do one hip and then decide whether I could go on for the second.

Given these caveats, the whole thing went off fine from my point of view. I coped with the operation well, and he was able to resurface both. I was in hospital for 8 days, standing two days after the operation, and taking steps with forearm crutches 4 days after the operation (those who only have one hip done do better than that). I found very little post operative pain, and the hospital was very good about offering painkillers on a preventative basis (they want patients pain free so that they are not detered from moving and starting the physio exercises).

By the time I went home I could get in and out of bed, walk around the hospital floor and give myself a shower. When I got home I needed to self inject a blood thinning agent (Fragmin) for 20 days, and wear TED stockings for 3 weeks. I took home exercises from the hospital physios, and expanded these when I went back 4 weeks after the operation. The surgeon and the physio were very keen for me to do hydrotherapy, so I went to the local indoor pool and saw an exercise therapist for a program which I have been following for the past 3-4 weeks, and that is really helping.

What makes me so keen is the visible progress!! Not only was there no pain from the start, but I sleep through the night (from a couple of weeks home), driving again (from 3 weeks at home), able to get out and about (went to the Quarter-Finals of the Australian Open Tennis 3 weeks after getting home). This is now my second week back at work (I'm not sure if that is all good!).

I know that resurfacing is still classified as an experimental procedure in the US, but it now has 7-8 years of history and I believe is clearly a better alternative for younger active patients who are able to sustain the operation. So it can be worthwhile looking into the possibilities. Don't leave it too late either, as the bone surface can deteriorate (cysts grow) and leaving it too late may mean that the surgeon will opt for a THR (which is not a bad operation - just not as good for younger active patients). Resurfacing is a technically more challenging operation than THR, and some surgeons could be reluctant to retrain to it. Keep looking..........

If anyone is thinking of hip resurfacing then the current best considered professional opinion is that offered by the UK National Institute for Clinical Excellence, in their Technology Appraisal Guidance No 44 "Guidance on the use of metal on metal hip resurfacing arthroplasty". This can be accessed at [url]http://www.nice.org.uk/page.aspx?o=TA044guidance[/url]

To see a sequence of photos taken during a hip resurfacing operation, look at [url]http://www.hipkneetumoursurgery.com/5_professional_area/hip_resurfacing_procedure.htm[/url]

Warning, these are close up photos of an actual operation and could be disturbing to some people.

For more information on how the different hip implants last over time look at [url]http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrrreport_2005.pdf[/url]

This is the latest annual report of the Australian National Joint Replacement Registry. Modelled on a Swedish registry which had a significant positive impact on the success rates of hip operations in Sweden (by allowing surgeons to see what implants succeeded over time, and which had problems), the Australian registry has recorded details of hip and knee operations in Australia since September 1999. Probably easier to understand than reports from the Swedish body (for non-Swedish speaking English speakers). The implants used in Australia are sourced from all round the world, and the information in the report would be relevant in other countries too, in discussing with a surgeon what he does and how successful it has been.

Cheers