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*** 1 year update ***
I had my annual checkup a couple weeks ago. The doctor was very pleased, and said that not only could I continue my activities, but that as far as he could tell I have the hip for life.

There were only 2 down notes. One was the left hip. It is not really slowing me down yet, but the x-ray looks pretty bad - nearly bone-on-bone. At some point probably not too far along it will probably start being more noticeable, and then I will need to get that one donw too.

The other thing is more an inconvenience. The leg has been a little sore for a while: achy when I sit for long periods, requiring a day or two's rest after activity like ultimate - in fact, very much like before the operation. I was a little worried that it could be the hip failing, but didn't even have a chance to ask Dr. Brockwell. As I went on to see him he was looking at the x-ray, and said, "I see you have dug yourself a divot." Apparently I am flexing the leg more than the plan called for, and the metal head is digging into the thigh bone. This is putting a dent in the bone - nothing to worry about, the doctor says, but it will be a little sore until the process is finished. No problem, as long as I know it is not damaging, it isn't hurting enough to stop me from doing anything.

*** Original content: ***
For my 35 years as a runner and ultimate frisbee player, my knees have always been iffy. That was why it was such a surprise 4 years ago when it was not my knees but my right hip that blindsided me and ended my sports participation.

Maybe it should not have been that big a surprise. I have always been unusually stiff - my high school track coach wanted to turn me into a hurdler, since he thought a 6'2" quarter miler had potential. Even on the ground I could not come close to getting into hurdler's position. I recall a doctor at the time telling me I had some sort of "congenital hip condition" that made me stiff, but he gave no more detail that I recall.

The detail would be "femoral-acetabular impingement of the cam variety", according to Dr. Brockwell. Looking back, I can see symptoms starting over 10 years ago. I would notice myself limping slightly after frisbee practice or training runs, despite not having any pain. Walking up stairs I noticed I was naturally taking steps 2 at a time with my left leg but only one at a time with the right. I had what felt like a minor muscle pull in the lower back on the right side that never got better with rest or worse with use. And the right shoe was getting harder and harder to reach to tie.

It didn't occur to me this was more than normal aging. Many people find their arms too short to read as their eyes age, didn't it make sense that people naturally get stiffer as they get older? I was still playing ultimate at a high level (in 2002, at age 44, I was invited to play on an Asian at-large team at the Ultimate World Championships), running up to 60 or more miles a week, and bicycling to the Great Wall and back before Aaron returned from school.

In early spring of '03 I was at the doctor for some other minor thing, and as I was set to go mentioned I had been growing increasingly stiff. The doctor asked to check, and was shocked at what he found - I was unable to cross my legs, there was almost zero abduction (leg moving out). They took x-rays, and I overheard one doctor exclaim to another he had not seen a joint like that on anyone less than 80 years old.

They informed me I needed to quit all sports immediately, and would need hip replacement within 6 months. I went to the US for a second opinion, and it was slightly better: replacement would be needed eventually, and I could continue my activities as long as I felt I could, though the doctor said that would not be long.

That was winter of 2003. By spring of 2004 I started feeling the effects while running, and gave that up. I did continue playing frisbee even though I could feel myself deteriorating. My speed, quickness, and reach all suffered, and I found that limp that used to barely show up after 3 hours of practice now started after 15 minutes, and was more severe than before. It didn't bother me too much; ultimate is fun even if you are not a star, and at 46 years old I knew I would have to start slowing down some time. Others were having fun too. People I had been beating for years now had the chance to get back at me, which they happily did.

By fall things had continued to progress. Those who had been happily burning me in July were starting to hold off by September. Being a mediocre player is one thing; receiving pity is another altogether, so I stopped showing up.

Though the x-rays looked bad and I was unable to continue participation in sports, things could have been worse. My only symptom was stiffness and an accompanying limp, right to the end there was never any pain. The week of the operation I was still able to go for long (2-hour) walks, day hikes, and bicycling (though getting on and off the bike was not easy).

I also took advantage of the enforced retirement from competitive ultimate to pursue spreading the sport. Through a friend I got contacts at Beijing Aerospace University, and started coaching a team there. I looked forward to their weekly practices as a chance not only to teach and coach, but also if they were perhaps short a player to step on the field and jog through games.

During this time I also tried other treatments. Earlier knee injuries had been treated very successfully by the blind doctors at Beijing Massage Hospital. They were not encouraging - my doctor said they could help, but the best we could hope for was minor improvement after 4 or 5 years of treatment every other day, and certainly no resumption of sports. Through a friend I saw the head of Chinese medicine at prestigious Beijing Rehabilitation Hospital, who said there was nothing they could do - if there were pain they could address that, but for the mobility and stiffness nothing. Finally, I accidentally met a massage therapist who combined Chinese and western training, and was willing to come to my house 3 times a week. Under his treatment mobility improved slightly, but stiffness continued on a slow downward slide.

By the middle of last year things were getting worse. My jogging participation in Beihang practices reduced to walking, and 45 minutes of tossing the disc and walking would leave me limping badly for 2 days. When my therapist returned home to Luoyang in October things accelerated. Finally in November I went to AEA, to find what else I could be doing.

When doctors first discussed replacement with me, the situation was not ideal. Replacements lasted 10-15 years with limited activity before they needed to be replaced. That meant no running or ultimate, and revision surgery around age 60. Worse yet, further revisions could be trouble, so by mid-70s I could need another hip and find it difficult. Doctors agreed; in fact, they said hip replacement was meant to cure pain, and people were generally advised to put off surgery as long as a reasonable lifestyle could be maintained with alternative therapies (stretching, painkillers, and so on.) My research did show the technology was progressing quickly, with new alloys and ceramic replacements becoming available that improved on the state of the art. There was also something called "hip resurfacing" being done in Europe which sounded intriguing, but was considered too early to be reliable.

At AEA I found that they had progressed as well. They now regularly brought in an orthopedist from Hong Kong to serve the Beijing community, and it turned out Dr. Jason Brockwell specializes in hip resurfacing surgery. It took about 3 weeks for me to get in to see him, and after that about 90 seconds for him to recognize that I was the ideal candidate for this surgery: active adult with severe hip degeneration. He explained to me that with resurfacing there were no limits on the sports I could do, except perhaps bungee jumping. (One former patient now does full contact karate.) And, since the technology was only 10 years old they could not say for sure, but experience indicates this may be a lifetime fix: most people will not need any replacements.

That sure sounded good to me, so as soon as my insurance company agreed I set up a date with Doctor Brockwell: December 29, 2006.


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