The Birmingham Bible

Everything that You Wanted to Know About Birmingham Hip Resurfacing But Forgot To Ask

The below was written by an Australian patient in 2001, for years this has been around on the web as written by Author Unknown.  I just found out today, June 18, 2005 that the author is also a top Hip Resurfacing surgeon in Australia, David Young.

There is a lot of good info in it, but please keep in mind that everything can vary depending on the doctor you choose.  One thing that really stands out is the number of days in the hospital, what is listed here is true for many overseas hospitals but not so much for U.S. hospitals. Keep in mind that your situation will vary. This is not to replace medical advice, just a guideline written by a fellow patient.

Welcome to a step-by-step guide to the operation known as the Birmingham Hip Resurfacing. But if you think you're about to read a learned medical text, think again - this isn't it.

This booklet has been written by a patient for patients so that the whole process can be de-mystified and user-friendly. The author is now enjoying the results of a successful Birmingham Hip Resurfacing, along with hundreds of other Melbourne orthopaedic patients. You are about to join their number, so let's have a look at what's ahead of you on your journey.

Life Before a "Birmingham"
If you and your surgeon have decided that you are a suitable candidate for a Birmingham Hip Resurfacing, (from now on referred to simply as a Birmingham), you have probably been in considerable pain for a while. The pain may have varied from simple soreness and aching at the end of the day through to an inability to sleep right through the night due to the need to munch strong painkillers in the wee hours of the morning just to get a few hours rest. Where you are on that scale probably depends on how long you have been putting up with the discomfort of a worn out hip.

You may also have become frustrated at increasing limitations on your mobility. Whereas once you dashed around the tennis court or enjoyed 18 holes of golf, it may now be a daily challenge just to walk around the block. So most patients want two things from a Birmingham - freedom from chronic pain and the ability to do some of those physical activities that constitute a normal life for non-arthritic people.

You will have been given a separate booklet on the Birmingham prosthesis and your surgeon will have explained the operation to you. Whereas traditional total hip replacements have been around for decades, the Birmingham is a relatively new operation that can help patients for whom total hip replacements were not generally an option until later in life.

The Birmingham is designed for active patients with basically healthy bones but who are being slowly crippled by arthritis. Once recovery is complete, you can look forward to doing so many things that are no longer possible, such as a game of doubles tennis or a long bushwalk.

Mind you, if you think that you can use your new Birmingham to go jogging on hard concrete for hours on end, or return to marathon running your surgeon may disown you! None of us likes to think of our hard work going down the drain due to unrealistic goals and stupidity. So do discuss with your surgeon your expectations of what is reasonable with your new improved hip.

Preparing for Surgery
It's very normal to feel rather apprehensive about undertaking this major operation, especially if you have never been inside a hospital before. Many Birmingham patients have led very physically active lives prior to their hips wearing out, so there is usually quite a high proportion of patients who have never been near a hospital except to visit, or in the case of ladies, to have a baby - both normal activities that have nothing to do with illness!

One patient cheerfully remarked that hospitals are places where you check your dignity in at the door and pick it up on the way out! While there is quite a lot of truth in that, it is important to remember that the nurses are there to help you and you can feel quite safe and unembarrassed in their hands. Once a nurse has been around for a few years, there's almost nothing they haven't dealt with before. If you can keep this thought in your mind, you will save yourself a lot of unnecessary embarrassment.

You, the nurses and your surgeon are a team working on a very important project - your speedy recovery.

Preparing for surgery has much in common with getting ready for any big event in our life, be it running a marathon, a wedding, or having a baby. Firstly, get as fit as you can within the constraints of your condition. If weight-bearing exercise is difficult, which it usually is, you may enjoy cycling along quiet streets or the local bike path.

Swimming is another excellent form of exercise that won't put too much strain on your sore joints. Even an exercise bike in front of television will contribute to increasing your fitness level.

If your figure is a little on the generous side, now is a good time to be a bit more aware of good eating habits which could help you drop a few excess kilos before the day of surgery. The time it takes to perform the surgery and the length of the cut required is directly related to the amount of flesh the surgeon has to plough through, so give this some thought.

A dental check is another important thing to do at this point. After you have received the prosthesis you will always have to take a dose of antibiotics before you have dental work, even just a simple clean. This is a precaution against any unwanted bugs getting into your bloodstream and making their devious way to your new hip. Taking the antibiotics protects you from this unpleasant complication.

The case for bilateral or single "Birminghams"
Many people who have a Birmingham to solve an arthritic hip find that only one side of their body is affected, so only one hip needs the operation. For other patients, such as those with dysplastic hip disorders, the cartilage has worn out on each side, requiring Birminghams on both hips.

So, do you do one hip at a time or get it all over with by having bilateral Birminghams?

The question is for you and your surgeon to resolve, as there are different viewpoints on the matter. Generally, surgeons prefer to do one hip at a time, but sometimes circumstances dictate the necessity for doing both at once.

If you are in this specific situation, you will be in hospital several days longer than the patient with the one Birmingham. You will not be able to lie on either side for several weeks, and it does make moving in and out of bed more difficult. Your physiotherapy will also be harder at first.

The initial operation is much longer, (with the added risks entailed by that situation) but the eventual outcome is unaffected. The general advice is that if you need both hips "done" take them one at a time unless there are good reasons for bilateral Birminghams. Be guided by your surgeon on what is best in your specific case.

How long will I be in Hospital?
This seems to be one of the first questions potential Birmingham patients ask, as most of us have busy lives and may be at the peak of our professional careers. Therefore, spending time in hospital can be a very inconvenient prospect. The average stay in hospital for the Birmingham is 7 days. But this is only an average - some patients may be itching to leave after 5 days while others are only just ready after 8 or 9 days. The length of stay is variable because every patient's recovery pathway is individual. Another factor is your post-hospital plans.

If you are returning home to be waited on hand and foot, or going into a rehabilitation facility straight from hospital, your stay will be a little shorter than the average. If however, you are heading home to look after several young children with no-one to look after you full-time, then you need to feel ready for this an to get plenty of rest and get yourself as independent as possible before you leave hospital. Your surgeon and physiotherapist are the people who can help you make these decisions.

The Pre-Assessment Clinic
There are many people involved in your road back to full mobility. The team includes surgeons, anaesthetists, nurses, physiotherapists, occupational therapists and a wonderful individual called the Orthopaedic Patient Care Facilitator. He or she has the task of preparing you for surgery and co-ordinating all the things you will need.

You will meet her at the hospital a few weeks before surgery, and she will go through the whole process with you and measure you for the white anti-embolic stockings you may need (more on that later!). She
will go through a checklist of what you need to bring to hospital and explain why you need certain things.

She will show you a typical hospital room, so you know what everything looks like, and organise the hospital occupational therapist to talk to you about your post-surgery needs at home. Sometimes a home visit from the occupational therapist is organised so you can have a chance to re-organise your home and order any special equipment that will be needed for a little while when you come home.

The final part of the pre-assessment clinic is a trip to the hospital pathology department for a few urine, blood and ECG tests. The patient care facilitator is your link with the hospital, and the person to ring for the inevitable queries you will forget to ask on the day.

While there are these very important concrete details to sort out, the other role of the patient care facilitator is to reassure you and put a human face on the whole hospital experience that is looming before you. Never underestimate the importance of a friendly and knowledgeable face who is interested in your welfare. He or she will also pop in to see you at some stage while you are in hospital to see how you are getting on.

Red, Rich and Flowing - Yes, It's your blood…………….

Obviously, you can't do an operation without the presence of blood, but thankfully as an unconscious patient you don't need to know much about it. However, in the few weeks before the operation your surgeon may require you to make autologous blood donations.

This involves at least two visits to a pathology collection centre to donate two units of blood, one on each visit. Your haemoglobin levels will be checked and you may be asked to take iron tablets and iron-rich foods to assist recovery from the donations. It is a very simple procedure, with the reward of a cup of tea and biscuit at the end of it.

The first time it's a good idea to be driven and collected from the pathology centre, and the whole business takes between 90 minutes and two hours, which gives you lots of time to catch up on some light reading. The blood is then stored and used during your operation if necessary.

If it is not all needed during the operation, it will be gradually transfused back to you over the next day to assist you to a speedy recovery. The blood donation process is simple and has minimal discomfort associated with it, so there's no need to be nervous.

Many patients will have been living on anti-inflammatory medications such as Voltaren, Naprosyn or Celebrex prior to surgery. All these medications, including aspirin, must be stopped at least 14 days prior to surgery, or as directed by your surgeon. Paracetamol and paracetamol/codeine mixtures are generally allowed, but if in doubt, check with your surgeon.

This is one of the most important areas for you as the patient, because unlike surgery, much of the physiotherapy is in your own hands. It is important to start an exercise programme several weeks before surgery. The beauty of doing this is that you will keep your body as mobile as possible before the operation, and feel confident about doing the exercises once the operation is over and you have a rather "dead" leg to work with at first.

The hospital physiotherapist will visit you most days to teach you and assist with the exercises, which should be done twice a day. The nurses will help you organise the white board, support bolsters and heel supports - "donut rings" - that you need on the bed so that you can do the exercises.

While you won't always feel like bothering (after all, we're all human) try to remember that the exercise programme is your key to a quicker recovery and getting back to full mobility again. And it's one thing that you can have some control over and basically do for yourself, unlike most things in hospital.

The Big Day
Well, this is it. You have your affairs in order and today is the start of the rest of your active life. Your surgeon's secretary will tell you what time you should arrive at the hospital, and the time from when you will need to fast.

Many people are worried that they will get hungry during the seven hours before the operation without food or drink. There is no need to worry, because those hours are actually filled with all sorts of necessary little activities and people to meet, so your mind tends to be focused on what is ahead of you, rather than on any gnawing hunger.

You may wish to have a partner, relative or friend take you to the hospital and stay with you until it's time to go to the theatre. On arrival, you will be admitted and taken up to the ward, to the room where you will return after the operation. You will meet the specific nurse assigned to you for that day. He or she will carefully talk you through the day's procedures and allay any fears you may have.

The anaesthetist will also visit you, to discuss any previous reactions to anaesthetics and to put a human face on the day's events. Feel free to ask any questions that are worrying you - he or she will have heard them all before. Anaesthesia options vary from person to person, depending on your own preference and what your surgeon feels is best. There are three kinds of anaesthetics - general, spinal and epidural block. Some surgeons use a combination of these options to get the best result, and this will have been discussed with your surgeon or anaesthetist at a pre-operative meeting.

Your nurse will ask you to take a shower and wash thoroughly with an antiseptic solution and then put on a hospital gown and hop into bed. Soon after that, an orderly may arrive to give you a ride in a wheelchair down to X-ray if further, up to date, x-rays are required. Don't even suggest walking - remember, you are wearing a hospital gown now, with that famous slit down the back. Riding in the chair is definitely the most modest option.

By this stage, it's almost all systems go. You'll get back into bed and when the call comes the orderlies will wheel your bed upstairs to theatre, where you will meet MORE people - the theatre nurses, assistant surgeon and anaesthetist (very social places, hospitals) whose names you will promptly forget as you are wheeled into the operating cubicle.

It is usually quite chilly here, due to the need to provide a germ-free environment. If you are feeling really cold, the anaesthetist may direct a huge fan heater on you to give you a little warmth or in most cases the "bear hugger" is put over you to keep you warm. One short injection, and then you're off to sleep for a couple of hours.

Waking Up
When you regain consciousness you'll be in the Post-Anaesthetic Care Unit, known as the recovery ward, as one of a row of beds full of post-op patients.

There will be an oxygen mask on your face, a pulse monitor on your finger, a blood pressure cuff on your arm and a warm blanket over you. You will also have a drip coming out of your arm, a drainage tube leading out of your side and a urine catheter if you and your surgeon decide on this option. So you'll look "like an extra", straight out of Chicago Hope or All Saints. It's not as bad as it sounds, because you're really only semi-conscious. A nurse will be at your side doing what seems like a million blood pressure readings and you may be asked to cough a few times to get your respiratory system conscious and working again.

If in your pre-op discussions you are offered the choice of a urine catheter, take it. It saves a lot of hassle of needing to organise yourself onto a bedpan (ladies) or into a bottle (gents) when all you want to do is drift back to sleep again. It solves the problem of temporary loss of sensation that may affect the bladder area post-operatively and it will be removed after two days.

You may not be able to move your legs in recovery if you have had a spinal or epidural block. Due to the narcotics used during surgery, you should not be in any pain, and the nurse will keep checking that you are comfortable (well, as comfortable as you can be with tubes running out of you and a plastic mask on your face). You will stay in recovery ward for a short time, then you will be either transferred to a High Dependency Unit, if it is felt that you need very close monitoring, or returned to the ward.

On your return to the ward, the nurse assigned to look after you post-operatively will keep a very close eye on you for the next 24 hours. You will have frequent observations and blood pressure checks, usually when you just want to go back to sleep. You may feel very thirsty, so the nurse will bring you some ice chips to suck, also lip moisturiser or lip gel is very soothing at this stage, ask and you will receive! In the first few post-operative hours, the stomach is delicate, and the narcotics you rely on for pain relief may make you feel nauseous or vomit. For this reason, you start with ice chips and slowly graduate to water, some hours later.

If you are progressing well, you may even be offered the great treat of some lemonade, on the proviso that you sip it slowly. If you don't sip it slowly, you will soon throw it up. The first can of lemonade will taste as good as the finest French Champagne after what you have been through. If the nausea and vomiting does not subside quickly, the nurse will administer some anti-nausea drugs to help you get over this unpleasant time. But remember, it doesn't happen to everybody and you won't know how you will react until after the operation.

When you return to your room, your operated leg will be protected by a long foam gutter, to stop you moving it in the wrong way. Your pain level will be carefully monitored, and there are drugs available to help you with post-operative pain and nausea. Some people do develop a rash on their backs, often as a reaction to the narcotic drugs and aggravated by having to lie on it most of the time.

It's an excellent idea to take in a sheepskin to put under the bed sheet, and another to put under your ankles to stop them becoming excruciatingly sore from constant contact with the bed.

There's Got To Be a Morning After
The day after the operation is when the work starts. You may not feel much like food, and it's wise not to overload your system when you do start eating, so a light diet of soup and sandwiches may be a good way to go. Tea drinkers will relish that first cup of tea after the operation, which is usually wanted far more than food, as the drip in your arm will prevent you from starving.

You will still have tubes coming in and out of you everywhere, and you may still be on morphine or pethidine or you may have dropped down to panadeine or even just paracetamol. Everyone id different and individual pain perceptions vary.

You may find that you are wearing very fetching knee high white anti-embolism stockings. (They look as if they were the height of fashion in about 1895). No, the hospital is not trying a little cross-dressing for the gentlemen here, and it is acknowledged that the stockings are as much a fashion statement as that glamorous hospital gown with the rear "ventilation", but they serve a serious purpose, by helping prevent deep vein thrombosis developing as a post-operative complication.

The other part of ensuring that DVT does not occur is to give you a daily injection in the stomach to monitor your blood levels. Unfortunately, this will happen daily for quite a few days, until your blood tests say that you can change to the oral anti-coagulant therapy known as warfarin (starts 2nd post operative night).

If you're feeling up to it, the physiotherapist and nurse will help you to stand beside the bed, and you may start your exercises with a white board on the bed. Daily blood tests are now the order of the day, but they are over quickly and done by skilled pathology personnel with a minimum of discomfort.

And On The Second Day
By today it is quite likely that you will have had your first experience of standing out of bed. If it was agonising, remember - it only gets easier and better from this point. Some people find their blood pressure suddenly drops when they get out of bed, and this can slow up your ability and willingness to become vertical. As you do more of it, the symptoms abate.

If you have that famous red rash across your back, it will improve greatly if you can spend some time sitting in the chair rather than lying on your back in bed all the time. Your physiotherapist will help you to learn to walk to the chair with a walking frame. If you don't feel up to this today, you'll probably do it tomorrow.

By this time you will have been introduced to the wonderful "iceman". No, it's not a roving seller of Street's icy delights but a thing that looks like an Esky with a wide hose leading from the ice bucket and ends in a rubber cushion (resting against your operation site) through which icy water flows. You lay this cushion against your scar site and thigh and it helps enormously in bringing down the swelling, and is an adjunct to pain relief. It's worth using this machine as much as possible for comfort and to reduce the swelling.

You may have noticed that one leg looks normal and the other as if you have borrowed it from a large elephant. This is quite normal, as it's the body's reaction to a surgical invasion.

If you decide you would like to swap those awful hospital gowns for some underwear and day clothes, you may be in for a shock. Due to the size of the leg, your normal knickers or jocks will feel far too tight. So both ladies and gents may like to wear large or stretchy boxer shorts until the swelling subsides - this certainly makes dressing easier, as will be explained a little later.

It's a big day on the medical front today. By now you will have had your oxygen tubes removed, and today it's time to remove your drain tube and drip, as long as you are tolerating food and fluids. Removing the drip is fairly quick and only a little uncomfortable, but having the drain tube removed is painful for some people. But it all happens very quickly, so don't dwell on it - just take a few deep relaxing breaths and it will all be over very soon.

Your dressing will have had another night's sleep - are you getting used to sleeping on your back yet? That is the hardest thing for many people to adjust to. Some people find that a large "banana" pillow is ideal, as the height is easy to adjust and it cradles you so you don't have as much of a temptation to roll onto your side.

This is the time when the word "fantasy" conjures up a vision of being able to sleep on your side, just once! But hang in there - with a Birmingham it's only 3 weeks until you can try lying on your side, so that day will come. By midnight your last remaining tube, the urine catheter, will have been removed, and although you feel a strange "sucking" feeling for a moment, it doesn't hurt.

You will probably be slowly moving to the bathroom on your frame, and you might try sitting in the chair for your meals. Again, everyone does all this on different time frames, as your recovery process is individual to you. If you're feeling confident in moving around, the nurse will give you a shower, which you will take sitting on the elevated seat used on the toilet and in the shower. After two days of bed baths, the first shower is blissful but exhausting!

If you have been eating a light diet up until now, today you may feel like indulging in a full range of foods.

So Now That You're Used To This Hospital Routine
By today you may be feeling adventurous and wish to graduate to crutches, which are a lot faster than the walking frame. You will also be learning rapidly how to get yourself in and out of bed safely, which all adds to your sense of independence. And if you have decided to make the switch from 24-hour nightwear to loose pants and t-shirts, you will need to learn how to do it without hurting yourself or doing some damage.

So how does one learn to dress oneself?
This is where one of the essential implements you learnt about at the pre-assessment clinic is invaluable - the extension arm or barbecue tongs. The nurse or occupational therapist will show you how to negotiate putting underwear on using the extension arm. And you have no idea the sense of power that comes with being able to put your own boxer shorts on again! You will also learn how to use it to help you put trousers, socks and shoes on.

It's vital not to bend further than 90 degrees, and you won't feel like it either. The extension arm becomes an invaluable part of the move towards independence. One issue that usually causes problems post-operatively is your digestive system. While you are busy putting lots into it, the drugs you have been on have slowed the processing down to a snail's pace, resulting in constipation.

Make sure your diet has plenty of fibre in it and take something gentle like Nu-Lax to avoid having to take laxatives. This is a case where prevention is DEFINITELY better than cure, and you'll feel a lot more comfortable, even if you hate chewing the stuff.

Hospital Blues
Most people - yes, even burly blokes - suffer hospital blues at some stage during the post-op week. Nurses can tell loads of tales of walking into a room and finding the hitherto strong and competent individual in floods of tears for no apparent reason. Your body has suffered a huge upheaval, and it's going to react in ways you might not expect. You expend so much energy on simply coping with all the invasive medical procedure, the pain and strange environment that it's not surprising that all of a sudden the world collapses around you.

This is where a sympathetic nurse is just the person you need. When it happened to me, she assessed the situation in a second, mothered me, gently helped me into the shower and spoke soothing words until I had pulled myself together. Once I was showered and cosseted, I quickly regained my equilibrium and never looked back.

If you are one of the lucky ones that doesn't go through this, spare a thought for the person in the next bed who may not be so fortunate. And if it happens to you, it's normal and VERY temporary.

The Home Strait
Once you get to Day 5 or 6, you are over the worst and starting to learn the new skills you will need to cope at home. You continue with your exercises, and the physiotherapist will teach you how to ascend and descend stairs. The principle of "good leg to heaven, bad leg to hell" will help you remember which leg must always go first, depending on whether you are going up or down the stairs.

You may find that getting out of bed is no problem, but that getting in is rather more difficult, but it all becomes easier with practice. By this stage the nurse or occupational therapist will have shown you how to have a shower standing up without anyone to help you. You will continue to need help with drying, as you cannot bend sufficiently to dry your legs.

You will have stopped the stomach injections (hooray!) and be on a daily dose of oral warfarin. The physiotherapist will teach you how to get in and out of a car in preparation for your trip home.

Things You Need To Know
By now you will have become adept at using the special raised toilet seat that looks like it was designed for a large gorilla - fun isn't it? The occupational therapist will have told you the good news about needing one of these things at home for a few weeks. How long will depend on how your individual mobility is. But it is important to avoid bending beyond the 90 degree angle for a few weeks. Discuss this fully with your surgeon.

You may also wish to hire a kitchen trolley to enable you to transport a cup of tea and a sandwich from one room to another, especially if you will be largely on your own at home.

When Can I Ditch the White Stockings?
Sorry - you still have to wear them for 23 hours a day for a few weeks. You can have two half hour breaks during the day. After three weeks you may remove them at night and after four weeks you can kiss them goodbye. These are general guidelines, and you should check what specific rules your surgeon has.

What about those nice people in those little cars marked "Urgent Blood"?
They are the visiting blood takers from the Pathology laboratories. They are a very pleasant mob of people whose aim in life is to turn you into a pincushion, but it's all for your own good. You will probably have blood tests about twice a week and be advised of the changing doses of oral warfarin you should take until your surgeon decrees that your warfarin levels are sufficient.

As you can't drive for a few weeks, the pathology bods come to you - a bit like meals on wheels, except that you are doing the giving.

Brmm, Brmm - When Can I Have My License Back?
This is good news. Whereas total hip replacement patients are not allowed to drive for six weeks, most Birmingham patients are allowed to drive about two weeks earlier. So get through the next 3 weeks at home and you may have your wheels back.

While we're talking about mobility, you will go home on crutches and remain on them for a couple of weeks. Many people then use just one for a little while, or may prefer a walking stick for extra support.

You will know when you feel ready to walk completely unaided, and for most people it starts with walking around the house and just using a walking aid outside or in unfamiliar areas. It's not a bad idea to use a walking stick in busy areas such as shopping centres and schoolyards until you feel really secure.

Putting One Foot in Front Of The Other
Most Birmingham patients have found walking painful and difficult prior to the operation. It's important now to keep doing your exercise and putting yourself on a gentle training programme for walking. Don't overdo it, as you are still recovering from major surgery, but walk outside as far as you feel comfortable. You will gradually walk a little further each day, until you are comfortable walking for about half an hour a day by three months after the operation.

Once you are off crutches, you can strengthen your muscles and help your fitness with an exercise bike, and many people find hydrotherapy and swimming very good post operative exercise. But just being able to walk around the block again and enjoy other people's gardens is a major achievement for some of us.

Danger Signs

  • Most Birmingham patients have few post-operative problems, but it's wise to be aware of possible complications. Call your surgeon's rooms if you notice any of the following:
  • Draining with pus or drainage that is thick and bloody
  • An incision that is hot, intensely tender or bright red like sunburn
  • Fever or shaking chills
  • Swelling that gets progressively worse instead of better
  • Swelling accompanied by sharp calf or groin pain (this may indicate a blood clot)
  • Chest pain or shortness of breath (it may indicate a pulmonary embolism)

Keeping That Smile Brilliant
Remember, any trips to the dentist need to be preceded by a dose of antibiotics for anything other than an examination. You will have been given some information for your dentist, who can write you an antibiotic prescription for the purpose.

Things You Always Think of Later
Letting the Birmingham prosthesis and your body get to know each other is important. So don't complicate the issue by crossing your legs, rolling onto your side in the first three weeks, or bending the hip past 90 degrees until you have the OK from your surgeon.

Getting in and out of bed on the side of the operated leg is going to make life much easier for you, and you need a pillow between your legs when sleeping on your back, and initially when you start to sleep on your side. Some people find that their ankles become painful pressure points very quickly. The best way to deal with that is to always have a sheepskin under your ankles - this seems to bring relief.

In the first few weeks at home you may find that you wake during the nights with TWO very painful legs. Nothing has gone wrong - it's just a physiological response from your body to all the lying on your back. Try flexing your legs in bed to get relief, or even walking around (not a great way to get back to sleep, of course). Painkillers will help, but even better is the knowledge that this unpleasant symptom will probably disappear once you can sleep on your side, so hang in there - there is light at the end of the tunnel.

Long car trips are not recommended in the first few weeks, and you won't feel like them anyway. However, for your sanity, having a friend or family member come and take you out for coffee or a change of scene will do you a lot of good. It's all a matter of being sensible and minimising any long car trips.

Not Tonight Darling, I Have a Headache
Actually, what you've got is a leg-ache. You may be like one Birmingham patient who said "For the first six weeks, sex was the last thing on my mind". On the other hand, it may be just what you need as a pick-me-up. It's entirely up to the individual, and there are no real restrictions on sexual positions for Birmingham patients. (If you can swing from the chandelier, you are obviously progressing very well indeed…..)

Just be sensible and think about what you're doing - if your favourite sexual position requires more than a 90 degree bend, you may identify afterwards with the renowned Englishman, who had the following to say about sexual activity:

"The pleasure is momentary, the position undignified and the consequences damnable!"

But seriously, if you feel up to it, give it a go and see how it works out. And remember, if at first you don't succeed, try, try and try again. But not until you feel really ready.

Well, that's about the full run down on "having a Birmingham". Some of it is downright unpleasant, but the results are well worth it. The conventional wisdom is that your recovery is 80% complete by your three month check-up, but the final 20% will gradually take place over the next 12 months.

So, as a fellow patient who has had a Birmingham, would I do it all over again? You bet I would - next year in fact, when I have the other hip done!

David Young, M.D.
LBHR October 2001

David Young is a top Orthopedic surgeon in Australia