How I wound up in this mess

If this blog endures, I'm hoping it will be more about climbing and less about hip surgery. At this point I'm thinking it could be of interest to someone who climbs and is facing the prospect of hip surgey. Or anyone  who might be curious about the outcome of my attermpt to mix revision surgery with rock climbing. Perhaps there could be something to gain from learning about my failures and successes. Who knows, maybe I can come back strong enough to make this blog of interest to anyone who climbs, or at least enjoyable to someone who wants to read a travelogue of climbing in Argentina. However, this story starts with a pair of hip surgeries.

My problem was osteoarthritis. It was pretty much symmetric in both hips. I'd known about it for years but it wasn't exactly killing me. I mainly experienced it as a leaden discomfort, decreased flexibility, and occasional low level pain after intense activity days. But it just kept getting worse and there's no going back. I had a tendency to favor my left leg when climbing because it was more flexible. Could this be what caused it to degenerate faster? At one point, after a compressed high-step move finishing a boulder problem, I was left doubled over in extreme pain for more than a week. I needed do something about this.

One year and nine months ago I had my left hip resurfaced by a local doctor. A guy named Sixto Vilicich. I didn't know it at the time but he was a rank amateur. There's no way he should have been doing my hip surgery, yet somehow his convincing sales pitch, together with a strange set of surrounding circumstances, led me to believe he was a good choice. One of my prejudices, one that ended up costing me, was the misconception that it was somehow important to have the surgery done near home. Traveling, I thought, would be too difficult and complicated. Boy was I wrong.

Vilicich plodded through my surgery for almost four hours. An experienced surgeon can do the job in less than one. I didn't know it at the time but he had bungled the results in classic amateur style. The real calamity was that he didn't even seem to know what he'd done wrong. Ten months later I would discover on my own that the acetabular component had been put in way too steep. This problem caused the femoral component to lever against my hip bone when I walked. Maybe that was the reason I had reoccurring pain. Or maybe the pain was caused by the way the misplaced cup stuck out on the back side and grinded against tendons and muscles. Or perhaps it was a result of one of the other problems I would learn about later on. Most likely the cause was a combination of all that. Like an orchestra of complications, the consequences of my hip surgery played against any chance of recovery. Each time I thought I was improving, it was like I would get hit by a freight train.

In the end I decided to have revision surgery with Dr. Koen De Smet, in Gent, Belgium. He is without a doubt one of the world's most experienced hip resurfacing surgeons and also a specialist in revisions. This meant traveling. Since my health insurance does not cover procedures done outside of Argentina, I had to pay from my own pocket. This doesn't change my opinion that choosing De Smet was one of the best choices I made in this whole mess. I'd hoped he might be able to replace the acetabular component, leaving the femoral part intact. "Cup revision", they say. However, I agreed the final decision should be De Smet's call, based on what he found, after he'd opened me up. The day after surgery, he told me what he'd found. He seemed impressed by the amount of what he called "debris" inside my hip. I imagine it's not easy to impress someone who's done more than 6,000 hip surgeries (including several hundred revisions). The acetabular component was so loose it had come out with a tap. The bone above the cup had been poorly and unevenly worked. The placement of the femoral component had been "less than optimal". The kicker was the previous surgery had left me with a staph infection in the bones, further weakening the whole structure. I would need to submit to a massive, two month long treatment of antibiotics. Because of these complications, De Smet decided for a complete revision, utilizing a ceramic on ceramic THR. He placed a screw to fasten the new cup. This entailed the use of a smaller head size, but he said the 40 mm diameter ball should do the job. In the next post I will write  more about medical tourism in Gent and my immediate recovery, but let me just say now: had I gone to De Smet for resurfacing in the first place, I would have saved myself 6,000 euros and a second operation. So you might call this a cautionary tale.

But actually, the fact I'm even writing this blog is an expression of my optimism that I can, as the title says, "get back to it". A declaration of my belief that Koen De Smet is one of the world's best surgeons and an expression of my hope he's fixed my hip in a way that will work for me. We'll see how that goes.

The botched resurfacing

The revision surgery. Koen de Smet says it looks good