Bill Case
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billcase_preop.jpg (37368 bytes)This operation was done on July 9, 2001, by an ortho in St. Augustine Florida, the hospital was Flagler....

The prosthesis used was a bio-met, ceramic head, cross linked polymer cup and non cemented.


billcase_rtscar.jpg (26569 bytes)The right hip is healing nicely and is almost ready to get away from the walker. 

billcase_lftscar.jpg (24484 bytes)However, the left hip was just done the 27th of August, same doc, same hospital, interestingly enough, with the current information regarding the breakage of a few of the ceramic heads, my doc got in touch with the supplier who went to great lengths to find a set of prosthesis's from the same batch as the right side. He did find the same batch numbers in Houston, TX and had them shipped to the hospital here. He and I felt confident enough that with that precaution we would not have any problems. He did state if he couldn't find any from that batch, we would postpone the surgery till we did.

billcase_surgicalteam.jpg (39150 bytes)Operating Room Staff
billcase_oldhip_surgicalsite.jpg (37266 bytes)Diseased hip in place just before dislocation
billcase_prostheses_parts.jpg (64584 bytes)Tray of prosthesis components, Bio-Met
billcase_oldhiphead_out.jpg (42716 bytes)Diseased femoral head after removal
billcase_newprosthesis.jpg (46436 bytes)Prosthesis, femoral, prior to installation
billcase_newhip_surgicalsite.jpg (46069 bytes)Prosthesis in place, hip and acetabular
billcase_postop.jpg (34690 bytes)Bill, sitting up in the hospital, TCU post-op


Fri Aug 1 19:32:17 2003

On May 27, in Canada, at a remote lake three lakes removed from our cabin, while sitting in the front of a fishing boat, my right hip dislocated.

I was doing two things I should have known better not to do. One: sitting in a low seat with my knees slightly above pelvic level, and both knees together. Sort of wedged in the V portion of the bow of the boat.

A friend behind me had tangled his fishing line around his rod tip, and I told him to put it up to me and I would untangle it for him. Bad move, as I twisted around to get his rod tip over my left shoulder, I heard a grating sound and felt immediate excruciating pain. Another grating sound and I doubled over and just about passed out.

My friends came to my assistance and laid me down across the seat, with my legs still in the sitting position. As I looked at my knees, I noticed the right one was about 3 inches lower than the left, I immediately knew it had dislocated.

We had four other friends on the same lake in two boats, and we went to where they were and discussed what to do. It was decided to send one boat back to the cabin and call on the emergency radio to get a floatplane in to the lake we were on, and bring a body board since I knew I was not going to be ambulating at all.

The aircraft came about two hours later, and I was hoisted up into it, and taken to the local hospital. An ambulance met us at the floatplane dock and took me there.

The hip is now healing well. I was in an orthopedic brace for seven weeks; it limited my movement to 60 degrees at the hip and 10 degrees abduction. It was meant to restrict the movement to allow the capsule to heal well. I also slept with an abduction pillow and still do.

My ortho and I estimate it may take up to six months to get a total healing, and I am doing pt and exercises at home.

I will post more here next week and delve into the emotional battle I also faced, and more about the whole experience

Bill Case

Date: Fri Aug 1 19:43:45 2003


I had my right hip done and 31 days later had the left one. I am strong, and worked hard at pt in order to convince the docs that I could stand it.

It went well, but I can tell you after the second one, it took longer to get back on my feet again.

The problem is one of muscular tone and the pain involved, for up to three years, you will automatically and systematically lose muscle tone in the affected legs, your body does this to protect itself, and you help because of the pain. You tend to move less and less, further atrophying the muscles. What you end up with is a set of withered muscles and a new hip joint, and you have to literally rebuild those muscles back to their full strength. It is a long process but doable. You have to work hard at it, and keep working hard at it the rest of your life. But that is the trade off you make.

You can do it.
Good luck.


Subject: further war stories on the dislocation
Date: Sat Aug 2 12:39:41 2003

I last left you with my arrival at the hospital in Kenora, Ontario. Kenora is a busy tourist/floatplane base quaint town with about 20 plus floatplanes at the dock.

I can remember being offloaded from the floatplane and seeing quite a crowd at the landing, the outfitter and his wife were there as well, with support and let me know to contact them if I needed anything.

On arrival at the hospital, the attending physician looked me over and asked if I had a doctor in the states, so I gave him the number to call, he left to do so. The nurses were trying to make me comfortable, and removed the hard body board from underneath. My legs were still tied up with rope to stabilize them, and they left that in place.

The doctor returned and quizzed me on what I had had to eat in the last six hours, which really was just water. On hearing that, he stated "Well, we cannot possibly do anything if you have had water to drink.” I just told him, “Hey, it’s alright, I can wait another twelve hours in excruciating pain while you figure out what to do!“ his seemed to change his mind and he replied “Okay, guess it is alright if you just had water“. (I actually arrived with a water bottle between my legs, having a really dry mouth) I found out later from my orthopod in the states, that when the doc from Canada called him, he wanted to life-flight me back to Florida from Kenora. That would have been a disaster, in pain, and possibly injuring the joint even more. My doc talked him out of that and coached him through a closed reduction, actually being on the phone in the o/r when I was operated on.)

The next visit was from the anesthesiologist, who asked a couple of questions while they were putting a line into a vein on the back of my hand. I remember asking him if I could have something for the pain while they made up their mind if they were going to operate. He just smiled and said, I think I can give you something now and off I went into happy land.

When I awoke, I was flat on my back with my legs strapped into an abduction wedge with a nurse asking me how I was. I asked for water, and got some, then slowly returned from unconsciousness, with no pain in the hip. It was back in place, phew! After almost 4 1/2 hours in excruciating pain, it was over.

I was moved to a room, and the doctor came back in. (here we go again), and stated that I must leave for Florida immediately and must stop at a hospital every 12 hours for a blood thinner shot.

The enormity of that whole scenario was too much, I just told him flat out, I had seven friends on a lake for the next five days, and no way was I going to make one of them drive me back to Florida. (He insisted I wear the abduction pillow all the time as well).

I asked for my cell phone, and called my ortho in Florida and explained the situation to him. He said; “let me talk to the doctor again“. Eventually the doc came in, left the room with my cell phone and was gone for what seemed like an eternity. He returned, gave me the phone back, and told me he was going to put me in a Spica cast, since they had no orthosis braces available at the hospital. It was subsequently cast. I then spent the night in the hospital.

The next day, someone from social services came in and suggested some alternatives to staying in the hospital, one of which was the self-care hostel attached to the hospital, which I opted for. It was just 25 bucks, Canadian, a day. I had the cafeteria as well as the hospital handy if there were any complications. I was moved by wheelchair into the room and spent the next five days there while waiting for my buds to get off the lake.

The staff was wonderfully helpful, as were the outfitters, who came to visit every couple of days, and brought me stuff from the grocery store to munch on while there.

The next Saturday, my friends came off the lake, and came and got me. We stayed in Kenora that night and left for Winnipeg the next day, and our flight home. The outfitter had called the airlines ahead, and they arranged for bulkhead seats (my leg was cast almost straight out in front of me) and a wheelchair at each stop. Some ten hours later, I was back in Florida.

The next installment will be the visit with my orthopod, and the rest of the story.


Subject: rest easy
Date: Sat Aug 2 12:45:39 2003


Please try and be calm and don’t worry about the small stuff. I know what you are going through, and rest assured the staff at the hospital will take excellent care of you. I was the same way before the first THR, and after that, just sat back and relaxed for the next one.

The other post here says it all, I need not repeat all that, but it is right on the money.

Just have faith that you will be so much better for the THR, and the pain you have been going through for the last several years will be over. It is well worth going through, and it will give you a new lease on life.

All the small details will resolve themselves and your support group at the hospital, and here will help you through the surgery.

Hang in there.


Subject: dislocations.
Sat Aug 2 12:50:27 2003

My doc said that I was one of two dislocations he had had in over 400 THR's, do the math.

What I can tell you is that you must always watch and think about what you do with your body for the rest of your life. It has to be conscious thought, and you have to do it all the time. It was a small price to pay for the pain being gone.

I had my orthopod demonstrate to me, what my full range of motion was. It helped tremendously. He actually put my legs in positions that were all right, and showed me what not to do, demonstrating with his legs. Armed with that knowledge, you should be able to navigate successfully with out dislocating. You really can do a lot, more than you think.

Have that talk with your ortho.

Good luck


Date: Sun Aug 3 06:04:39 2003


It sounds like you went through pretty much what I did, although I was back to work within a week, but wearing an orthosis that prevented movement. Actually I would have liked to rest up a few more weeks but probably would have lost my job as well. So I can sympathize with you on that one.

I will post a further rambling on the emotional side of the whole thing, but having a dislocation, really changes things to a great degree. And yepper, you hit it on the money about younger more active people. It is much easier to dislocate than I thought, but if you observe the precautions you should be safe.

You went through your dislocation alone. I was lucky to have seven buddies right there to help. And you are a hero for crawling into your front seat. The pain you suffered had to be just like mine, and it was bad. Your recovery sounds like your orthopod really wanted you to heal the best you could. And I agree on that as well, but you shouldn’t have to quit your job over it. I am back at mine, which involves a lot of walking in an industrial setting. I really have to watch where I walk since there are so many ways I could trip, and the floor is quite oily and wet a lot of the times. But I have good shoes with no slip soles, and watch the floor all the time.

Like you, my doc put in a larger ball/socket combo, but one thing I did learn was that they now make a retention socket (you can find pics of it on the net, just search for retention socket), and if I dislocated again, that would be a strong option for me. Although they do restrict your range of motion, it would be an acceptable alternative to having it come out again.

Hope you are doing well,


Date: Sun Aug 3 06:12:46 2003


One thing that I have learned, and many others who have dislocated is that you NEVER should forget to use your 90 degree rule and knees together rule. That combo is deadly and will be with you the rest of your life. No, the chance of dislocation does not lessen as time passes.

You can do one major thing to lessen the chances, and that involves DAILY exercise of the joints, with leg weights, perhaps even in a gym. The stronger those muscles are, the less chance of them dislocating, but even at that, they can still do it. It is a mechanical process in which the prosthesis has a limit, if you go beyond that, it will just automatically lever itself out of joint.

Go to your orthopod, have him move your leg where you are allowed to move it, and show you with his leg, what you cannot do. It will help. And do not ever try and touch your nose with your knee! Forgedaboutit dear, ain’t never gonna happen again. :-)

Good luck


Side effects of dislocation
Sun Aug 3 2003 6:52:01 am

By now you have read the previous posts and the aftermath of the dislocations.

I am now at back at work and out of the orthosis and taking good care of the hip.

The main side effect was physical; in that I must now be ultra careful of how I place my body and use my legs so that dislocation does not happen again. Also, I am resigned to the fact that it will be a life long thing.

I think that when you recover from THR, that the relief from the pain is such a tremendous feeling that you feel invincible. Most of us lead very active lifestyles, and want to continue that. That is quite possible considering the broad limitations of range of motion in a replaced hip. I know in my case, dislocation had been way back there in my mind, two years out of surgery, and I was really asking for something to happen, forgetting about my precautions and just having a good time.

I had been on two canoe trips with no problems, and had been fishing in my own boat numerous times with no problems, and there I was, fishing again. Hey, I was having a blast. And bingo, out she came. I was doing all the wrong things of course, and not paying any attention to where I was or how I was sitting. Payback is hell.

The resultant emotional battering I took was literally hell. Some two weeks later, I was in a deep depression. It started coming on slowly as I began thinking about what I could not or did not want to do, and that was dislocate again. No way was I going to do that. It hurt too much.

So I began checking off things I would not do any more and realized that life was going to be a whole lot different from now on. No more fishing, no more canoe trips. What if I was two days downriver on a five-day trip with friends? It would mean that it would be a two-day canoe trip in pain, and all my buddies would have to cut short their trip. Not an option, so I won't go. Out fishing, bingo, dislocation. How am I gonna get back to shore, take the boat out, get home or to the hospital? Just ain’t worth it. I’m never going fishing again. May as well sell the boat and canoe.

The more I thought, the more depressed I got. I might as well just sit in front of the TV all day and have maid service bring me food, all just because I was not going to move anywhere I might dislocate again. The more I thought about it, the less I was willing to do in order not to dislocate again. Life was over for me. I may as well just give up doing anything.

Even thoughts of suicide worked their way in. NOT and option though, but you can think about it, depression feeds on itself; the more depressed you are, the worse it gets. You can actually work yourself into a deeper depression.

Talked to the doc about the depression, about getting on some meds. Nope, wasn't gonna help me there. Disappointed, I went to my other doc and asked for meds. Nope, no help there. So I went to book an appt with a psychiatrist, two month wait. Nope, no help there. So, forget it, I’m just gonna decide not to be depressed. If no one is gonna help me, forget them. I am tired of being depressed and it worked, anger is a great motivator. I just made a conscious choice NOT to be depressed any more. Kicked myself in the butt and got on with life.

I began to think of alternatives, and ways I could still enjoy what I wanted to do but behave myself with my precautions. I still have the orthosis brace if I really want to do something that might compromise the hip, I could just wear that.

Slowly, I began to get rid of the depression and started living again.

Thank God we humans are resilient enough to weather that storm.

What the bottom line is now, and I consider my self not depressed any more, is that I can continue my lifestyle. I must just be extremely aware of where my body is and what I do with my legs. I am certain that this is something you do not consider until you have your first dislocation. I think we all feel a bit overconfident after a year or two post-surgery, and tend to think you can just do anything you want to do. Think again on that one.

The main thing I learned is that you will never be able to do anything without watching what you do with your body, and will have to follow your 90 degree and knee together precautions as long as you live and breathe.

I wish I had talked to someone who had dislocated, prior to mine it may have helped.

I have been away from this board for a while; you can see my pictures taken during surgery on this board, Bill Case. I am going to the orthopod in a couple of weeks, and intend to get pics of the x-rays and post them here.

If what I write can help anyone to prevent a dislocation, I would feel like it has all been worth it. I know this board helped me tremendously during and right after surgery and I posted a lot to give back what I got, and hopefully in these posts, someone will be careful enough not to dislocate their hips as well.

We all learn from others experiences and this board is a godsend for being a forum to do that.


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