Can you still play golf or go skiing with two artificial hips? “Of course”, says Heidi Rauch. She speaks from experience.
A report written by Heidi Rauch
When I tell someone today, at the end of 2020, that I have two artificial hips, nobody believes me. My gait is better than ever, I walk energetically, straight and upright. I may walk a bit to fast sometimes because I always want to get things done quickly, as much as possible at the same time. I’m completely pain-free and able to do my favorite sports without problems. If it does hurt, I go to my manual therapist or do some fascial fitness. My complaints mostly arise from muscular tensions around the lower spine.
2 Hip Operations in 2011
It wasn’t always like that. I used to be in great pain when walking and of course I always tried to delay the implantation of a new hip as long as possible, which is not at all a small operation. I tried everything to get rid of my always worsening pain – Alexander Technique, manual therapy, rolfing, shiatsu, yoga. At the end, I couldn’t even walk 9 holes as a passionate hobby golfer without feeling like I just ran a marathon afterwards! For non-golfers: 9 holes on an 18-hole golf course corresponds approximately to a distance of three kilometers which you can manage with a handicap of 16,5 on your own in one and a half hours; with one to three other players it takes longer.
Diagnosis after Osteoporosis Examination
I think all the mentioned therapies are useful, but not when the diagnosis is “advanced coxarthrosis on both sides”, which means arthrosis in both hip joints. However, I only got this final diagnosis after an osteoporosis examination. The radiologist and the doctor only recognized that both femoral heads were already more than affected on the x-ray image of the hip (and not of the pelvis or the spine) and the following CT. Thus, it wasn’t a blocked sacroiliac joint (which is the joint between the ilium bone and the sacrum, which doctors often suspect in the case of various complaints in the walking apparatus), not a sciatic problem. No, it’s a hip dysplasia, a malposition of the hip joint, which hadn’t been diagnosed as a child and which caused the abrasion of cartilage between the hip socket and the femoral head. If I would have been put into a position with spread legs as a baby for a few weeks, I wouldn’t have the problem now. But in 1957, the routine ultrasound examinations were still unknown. For me as a Prussian, who has been living in Munich since my studies and now in Erding near Munich, a woman from Bavaria once asked me whether I didn’t wear spreader pants as a child.
My poor mother was very unhappy due to my complaints and always asked herself if she did anything wrong at that time. But as soon as the butt cheeks of a baby lying on its stomach showed regular wrinkles, you supposed that everything was alright at that time.
Subchondral cyst makes walking hard
After walking “on the rims” for years – my complaints had been there for several years already – so-called subchondral cysts had formed which caused even more abrasion. No wonder that even Voltaren or Ibuprofen didn’t help anymore – they only caused gastrointestinal complaints.
Interestingly, my treating orthopedist was fairly impressed by my agility. Orthopedists perform certain leg movements on patients, try to brace and flex them. I probably still have this flexibility thanks to the Five Tibetans* that I’m doing every morning. I complemented his morning exercise with some Qi Gong exercises after two Qi Gong weekends on the Fraueninsel in Chiemsee and other exercises that my physiotherapist showed me. The goal was always to keep the joint smooth for as long as possible.
What caused my pain though was walking. Most of the time, I buckled after a few meters with this awful stabbing pain in the groin that hip patients know too well. My good thigh musculature always tried to balance out what the increasingly immobile joint couldn’t do anymore. Fortunately, I didn’t have this pain when sitting and lying at night. I never reached this “last stage”. I found comforting what many orthopedists tell their patients: “We don’t operate on the x-ray image, you are the one deciding on when the surgery takes place. As soon as your quality of life is too limited, you will know it yourself.”
Outpatient Rehab Before the Surgery
Kindly enough, my physiotherapist in Erding still believed in my agility and sportiness and recommended me to apply for an outpatient rehab at the (statutory) health insurance. My orthopedist supported my wish – and in the beginning of 2011, I found myself surrounded by spines, hips and knees, that is to say, among people with these problems, in the Outpatient Rehab Centre in Erding. Later during the rehab, everyone really only asks and answers with abbreviations: “Back? Shoulder? No, ankle”.
For three weeks, I trained with light weights on the equipment (it was about metabolism training, not about muscles), did group exercises on a vibration trainer and on Pezzi Balls (for better coordination), I was driven to a nearby hotel swimming pool to a so-called therapy pool where I did exercises in the warm water, learned relaxation exercises according to Jacobson – and I could even improve my non-existing cooking skills during a nutrition course. The clinic also offered psychological counseling, and now and then I had appointments with the orthopedist in the clinic. The general tenor: Oh, typical restrictions, but you are still doing well, aren’t you? Sure, as long as I only had to walk three steps from one apparatus to the other, my pain didn’t show. However, walking down the stairs to my car was already a problem and I had to hold onto the railings.
All in all, I can only recommend this kind of preparation for surgery and the subsequent rehabilitation. Like this, you already know what to expect. You also meet fellow sufferers who can give you valuable but also confusing tips.
My Hip Dysplasia friend shows me how it works
At that point, I didn’t look for a surgeon. I still had hope… My crucial experience was swimming in a warm thermal bath: the walking and paddling exercises were still doable without problems, but breast-stroke was impossible! The spreading movement were extremely painful. That was my “point of no return”.
I talked to my friend Susanne about that. She has a congenital hip dysplasia. The result: she had found an experienced surgeon who was willing to perform the complicated lengthening of her femur, the big thighbone within the context of the joint surgery so that she didn’t have to limp anymore. Thus, Susanne went – or limped – ahead and gained great experience in a clinic in Munich (here you can find an excellent clinic for hip surgery in Germany).
I visited her during her rehabilitation near Chiemsee, I was happy about her positive experience and also made an appointment for surgery. The orthopedist was short and sweet: he took a look at my x-ray images and asked me when I wanted to come. He didn’t care about which hip to operate first. They both looked equally bad. I took a deep breath and told him my preferred date at the end of May which he immediately confirmed. There was no going back anymore now. Which was good.
Get Aids in Advance
Thanks to Susanne’s experience, I already got the most important utensils of which most is paid by health insurance: ergonomic forearm supports (which have an additional support for your hands, very comfortable), a toilet seat raiser, a shower stool, a wedge-shaped bolster (which is not or only seldom paid by health insurance). In addition, I bought a long shoehorn and shoes to slip in: a pair of solid slippers for the clinic and a pair of sneakers with velcro fastening for training.
Later I realized that velcro fastening is really hard to fasten with tongs (you can lend them during the rehab). Right after surgery, you should avoid to bend your joint in a 90-degree-angle. Thus, I mostly slipped into my already worn out slippers. And as my rehab was during the warm month of June, I didn’t have to put on socks with the help of a stocking aid (which you can also lend during the rehab) at least during the day.
My tip for everyone who wants to undergo surgery: choose a date in spring. During the warm season it is much easier (and less dangerous) to go for a walk (which is important for the new joint) and you don’t have to worry too much about getting dressed. My second surgery was unavoidably in October and rehab was in November. But I was in luck: in the autumn of 2011, there was summer weather at Tegernsee while it was foggy and around 15 degrees colder in Munich!
Good Results for both Surgeries
I had a pragmatic approach to both of my surgeries: I have to do it, thus I toe the line, I don’t complain and trust the doctors. I didn’t really look at how the surgery works. I didn’t get the material that would be implanted with a kinesiologist (a fellow patient I met in rehab did that) and I didn’t watch the video of the pretty bloody surgery on Youtube.
I was a bit confused when some of my compassionate friends told me shortly before the surgery that it would be a very big intervention. Sure, I said, I know that. But nowadays, it is a routine surgery: more than 200,000 hip surgeries are performed in Germany per year! My pragmatic attitude probably wasn’t that bad. Before the first surgery, you could call me naive, but I was already experienced before the second surgery, but not less positive.
Hip Surgeries in Germany in 2018
At the hospital, I developed some characteristics which earned me not only admiration but rather amazement. Firstly, I didn’t eat anything after noon on the day before the surgery. I just didn’t understand why I should eat another meal and a later a soup which I didn’t like anyways just to get an enema in the early evening and get everything out again. Of course, after the surgery I didn’t get anything to eat until the evening. Doesn’t matter. It’s good for the figure. All I do is lie around anyways.
Secondly, I declared to be vegetarian although I’m not. I just didn’t want to have additional antibiotics in the form of meat from intensive animal farming. Unfortunately, for the first surgery, the Ehec virus outbreak messed up my plans for the first surgery: there was a ban on salad and tomatoes until it became clear that sprouts were the problem, and I got cheese platters in the evenings and fish with rice and without vegetables during the day or sweet dishes such as sweet dumplings or apple strudel with vanilla sauce. In the case of the second surgery, I was happy about salads and vegetable lasagna.
Finally, I started working again from the hospital. On the day of the surgery itself I was too weak of course. On the day after I was allowed to and should get up to get the circulation going and to walk the first steps with the “Maxl”, a construction that helps you walk. Later, I walked with crutches. As the physiotherapist already prescribes me some movement exercises in the bed on the second day after surgery, I didn’t see any reason why I shouldn’t use my brain as well. After I told all my relatives and friends on the phone how I was doing, I didn’t want to be mentally occupied with my state of health anymore. So I connected my computer to the internet (with mobile access, the clinic doesn’t offer Wifi) and thus connected to the world of work again – first on the table at my bed, after getting the catheter removed and was able to move better (I could finally go to the toilet alone again and take a shower!), I changed to the table in the double-room.
My neighbor first shook her head, later she was almost jealous when she saw how fast my days went by like that. Of course, I didn’t sit on my wedge-shaped bolster for hours without moving but I took short walks on the corridor every now and then, did some stretching at the window ledge, took some walks in the park of the clinic with friends (which is actually not allowed) and sat in the cafeteria downstairs with my visitors. I always had pauses for lying down, reading and sleeping – and I was so happy when I could change to rehab after ten days.
First Rehab in Bad Heilbrunn
For my first artificial hip, I went to Bad Heilbrunn for rehab. I was lucky that I got a freshly renovated beautiful single room. My fellow patient Christine who arrived a few days later only got a rather depressing “broom closet” which she was able to exchange for a less depressing room after some protest. The transition from the hospital to the rehab on one weekend however is problematic. In that case, it’s good to have a lot of visitors because on Saturdays and Sundays there is not a lot going on. Thus, time to explore – in my case we visited the very beautiful Herb Park right on the doorstep. A really nice experience!
Then I was happy about the food – I finally had some sausage, bacon and meat again. And all that with some nice fellow patients, far away from hospital smells. I was also really lucky to meat a former colleague from work, Hans, who brought another fellow patient, Hubert, to our table. Us four, Christine, Hubert, Hans and me, enjoyed our evenings playing the Bavarian card game Wattn, which they taught me as a Prussian. We laughed a lot and had so much fun!
Six Weeks of Partial Weights of 20 kg
All in all, the administrations in Bad Heilbrunn were good. However, I can only recommend to get enough appointments. In my case, I only had a few in the beginning, for physiotherapy and Medical Training Therapy, so that I had to protest vehemently. Kindly enough, the head doctor took care of my surgery report which I surprisingly didn’t get to see myself (for the second surgery, I requested it right away upon discharge).
The report mentioned the reason why I had partial weight-bearing of 20 kilograms – and had a correspondingly “soft” treatment”. When removing my subchondral cyst, the surgeon had filled the hip bone with Spongiosa, bone meal, in order to strengthen the thickness of the hip socket. This Spongiosa needs time to grow in and solidify. But in general, my surgeon had the conservative attitude to not recommend his patients the immediate full weight-bearing.
That was hard for me to understand at first, in the end, many hip patients walked without crutches after a few days at rehab. But I trusted the doctors – and I wasn’t able to do any different due to my weakened muscles. Thankfully, my physiotherapist supported me in so far that I was allowed to train with the apparatus not only half an hour but an hour per day.
Second Rehab in Bad Wiessee
I didn’t have that problem anymore during my second rehab in Bad Wiessee (here you can find excellent rehab clinics for orthopedic interventions). In the rehab clinic in Bad Wiessee, the patients can choose freely how often and how long they want to use the medical training therapy. I really liked this kind of self-determination.
In general, there is more sports program at the Hubertus Clinic. While in Bad Heilbrunn there are many patients that had a heart attack sitting in a wheelchair or patients with other neurological problems, the patients at Tegernsee are much healthier. There is an equal number of heart patients and orthopedic patients. Everyone is fond of the great location directly at the lake and meet at the “Aquadome” next door, the lake restaurant which offers fresh arctic char and has a little aquarium.
In principle, you can make great trips at both locations when friends and family are visiting with the car. The region around Bad Tölz, the neighboring town of Bad Heilbrunn is a beautiful part of Oberbayern just like the Tegernsee Mountains. I remain convinced that the amazing surroundings contributed significantly to healing. Finally, the psyche also needs healing after such an intervention.
Golfing and Skiing pain-free after three months
It was only with my two endoprostheses that my agility and sportiness really improved. When I only had an artificial hip joint, my body was still searching for the balance that wasn’t possible. After the first rehab, I swam a lot during the summer and took walks at the beach and the flat Adria.
The first games of golf were sobering. The left side just hurt too much. I was walking in a relieving posture and was increasingly frustrated. Thus, I let it be and decided to get the second surgery only five months later. I used the time until the surgery to build up muscles with the help of a personal trainer and my physiotherapist. Finally, the leg that already had been operated on, should be strong enough to support the one-sided full or double weight. My favorite exercise: standing on one leg.
After the second surgery and rehab, I waived the so-called Irena again, which is the outpatient rehab program which is paid by statutory health insurance. My surgeon also said: “You can do it by yourself.” He was right. I did my exercises everyday at home, including my beloved Five Tibetans, worked out on the Stil Fit-Ergometer in the living room and on my Bellicon-Mini-Trampoline.
With the confidence that I gained after the first surgery, I knew that I was able to do more after the second surgery. I think that I felt exactly what I could do with my new joints. Thus, I already played my first nine holes of golf after three months and went skiing three and a half months post-surgery. We were skiing for two and a half hours in relatively exhausting fresh snow.
After these “acid tests” in January 2012, I had a little break before I went skiing at the end of February, beginning of March for several days when I even went down a black run (!) and played my first 18 holes of golf afterwards.
Building a House and Moving
Today, eight years later, we are planning on moving. My husband and me are moving into an ecological community house in Munich Alt-Riem. We chose a 100 square meter ground floor apartment with a terrace with a view to the south on the community garden. The reason: We are not getting any younger! Among the 35 parties that we got to know from the beginning of 2018 during the three-year phase of planning and building, there are many young families with children. Will they care for us when we are getting older? We hope so.
We moved in several phases, including throwing out old stuff and packing. When you are over 60 and have two artificial hips, you don’t have to carry everything on your own anymore. I also don’t have to carry bottles of olive oil up and down the stairs anymore. Our cellar for olive oil is now in the underground parking lot right next to the elevator. I hope that my prostheses last for a long time, that I stay fit and enthousiastic about moving for a long time!
This report is a slightly changed excerpt from the book “Mut zur neuen Hüfte“. Text: Heidi Rauch, Pictures: ©private