The oversexed among us might laugh at the term, but probably only until I add "bone saw" to the equation. Imagine this statement: "Scalpel - scissors - bone hammer - bone saw - how many units of blood on stand-by?"
I can only assume words like those are expressed before a major operation for a hip replacement, but I'm pretty sure seasoned professionals like the ones who worked on my left hip two weeks ago (12/06/07) are fully prepared without having to do an aural inventory of the necessary tools for the procedure. I can also only assume the events that took place, because I was already unconscious, my head resting on the shoulder of O.R. nurse Claudia, as she had instructed me, while a spinal block needle was inserted into my back by the anaesthetist, who - only moments before - had explained to me that he would be administering both an anaesthetic to make me sleep, plus the spinal block to help stay "ahead of the pain" in post-op. I didn't realize, however, that the drugs to make me sleep, administered intravenously, would have me out before I even felt the spinal block needle. It was also not like a general anaesthetic, where you wake up in the recovery room all groggy and (sometimes) nauseated. I woke up from the surgery like a shot - wide awake, fully alert, and well aware of the A-shaped hard foam slab that was strapped between my legs, keeping them angled in such a way that I couldn't do damage to the work recently completed by my surgeon.
Don't know if you're familiar with this process, known as the complete surgical replacement of the hip (my left one, in this case), and if you don't care to be familiar with it, it's best to stop reading - but it's more or less as follows:
After about a 10-inch-long incision has been made down the side of my thigh, the ball at the end of my left thighbone (femur) has to be dislodged from its resting place inside its cupped socket (acetabulum). In my case, It's not exactly a 'resting place', however. Years of osteoarthritis have the ball at about twice its normal size, and virtually jammed into the socket, restricting my movement, and causing constant pain.
Once the ball is dislodged from the socket, it is cut off with a bone saw, and a titanium shaft is hammered down into the femur (all our bones are hollow, which is what makes this possible). Then, a solid ceramic ball is attached to the end of the titanium shaft.
On the acetabulum (cup) side of the hip joint, the area inside the cup is smoothed out, and any leftover bits of cartilage (in my case, probably none) are removed, and a concave cup is inserted (banged in really tightly is more like it). Then, there's apparently some time and effort spent popping the ball in and out of the cup to ensure a proper fit, but none of the parts are cemented in place. There is a cemented version of this procedure, but my surgeon feels, at my age (which is young for a hip replacement) the non-cemented variety is the best option. The human body takes about three months to 'accept' and grow around its new parts, and there are quite a number of restrictions on movement which must be obeyed, or there's a serious risk of "popping the ball", which would cause a kind of pain I don't care to ever experience.
How did I get here, at 50 years old?
I was a candidate for this surgery many years ago. I've just been putting it off until I turned 50. I was originally diagnosed with mild to moderate osteoarthritis of the left hip joint when I was in my early 30's, when a series of x-rays had been ordered due to the pain and inflammation from which I was suffering. At the time, there were also signs of osteophytes and scarring in the right hip joint.
From the time I was old enough to walk, I loved to run. I used to win all the races in the schoolyard. I was always a second faster than any kid in my school. I could fly. I wasn't a focused or trained runner, however. I would just whip on the shoes and go. I oncemarked off 2.5 km with spray paint on the back road from our house, and I would run to that spot and return home, and would compete against my best time almost every day. I was the fastest halfback on my football team. I even ran a race on a cruise ship in the Caribbean (my only "international" victory), winning after many laps around the promenade of the luxury vessel on a very hot day at sea. Obviously, running was something I loved, because, let's face it - not a whole lot of people spend their cruise ship vacation running around the promenade deck at breakneck speed. They're usually too busy eating, sunning, or gambling.
Over the years, I also took my running to work. I had a sporting goods store sponsor on my race gear, and I even won a Canada Day road race at which I was also the master of ceremonies. It's funny, presenting a trophy to yourself.
Now, this is the time when the author is supposed to say, "Then, one day…"
Well, in truth, my "one day" moment had happened many years before many of these events. Early into my running, I had developed a 'click' over my left hip. A 'snapping' feeling occurred when I walked, caused by what is now known as "I.T. band syndrome"…The iliotibial band runs up the side of the leg from the knee to the hip. The main muscular feature of the iliotibial band is the 'tensor fascia lata' muscle (meaning "tense wide band"), and the connective tissue of the iliotibial band is what joins all of this to the knee and hip. Mine, simply put, had shortened. I did all the prescribed stretches from many physiotherapy experts over the years to increase my range, but they didn't help much - because I wouldn't stop running. Eventually, I had to get shots in my hips for the pain, and when you start using steroids (cortisone) to mask your pain, you're in deeper trouble. Continuing to run is the main reason why I am where I am today. Basically, the shortened I.T. band was pulling the ball of my femur tighter and tighter into the acetabulum, and, in doing so, it was grinding away all the natural lubricants and cartilage my hip joints were born with, until the surfaces were simply bone-on-bone.
The ball of the femur continued to grow by developing scar tissue and bone spurs on its surface, and therefore scarring the inside of the acetabulum, and things eventually came to a grinding halt - or should have, at least, but somehow, even with the pain, I managed to keep a small range of motion and the ability to walk (but not much else). I have spoken to a number of people (all of them older than me) who've had the procedure, who told me that their joint had actually fused before they got to surgery. Because I had chosen to keep moving through playing sports (I haven't even mentioned being a goaltender in hockey most of my life in this missive), I was able to keep moving, and I built up quite a tolerance for pain. However, when I could no longer move from a seated position to a standing one with my sleeping 27-pound baby boy in my arms, it was time to see my surgeon.
I'm already really sick of being in bed. See how happy I look?When he came in to see me on Saturday (16/06/07) morning to release me early from hospital, due to the rapid improvement I had made over the four days post-surgery, my surgeon told me he was surprised by the amount of damage and "trouble" he encountered the previous Tuesday morning. He called the ball, "very large", and stated that, "obviously, this made the procedure more difficult, but we were successful".
In layman's terms, I think that means that he had to take a few extra swings with the bone hammer.
