Independance Day = 10th July

Hopefully my personal Independence day will be in 30 days time. About a week late for celebration of the Boston Tea Party - but I'm sure a nice cup of tea on the ward will go down just fine all the same.

I have just returned from an afternoon at the hospital. I saw the surgeon and we discussed the 2nd stage operation and agreed on 10th July as the planned date for surgery. This means I should be admitted on Weds 9th July provided there is a bed available. With luck I should be standing and taking (some) weight through my right leg 2 days after surgery. Then it should be a matter of waiting for the incision to heal sufficiently to be discharged.

This afternoon I had a further x-Ray - this time it was a full length femur ( normally these have been done as 2 X-rays for the top and bottom ends of the bone. I think the surgeon wants a single X-Ray to work from because he needs to assemble a jig to ensure correct alignment and leg length. I'm sure this is normal practice but given the relatively small amount of remaining femur I got the impression the kit would need to be modified a little and perhaps this can be done in advance of me lying on the table.

After the X-ray I went on to the Pre Op Assessment unit to complete another canter through my medical history - guided by the one taken a few months back for the first stage operation.

So I was weighed and my height measured - the computed BMI was acceptable ( just!). My Blood pressure was taken and again OK although a little raised - well I had just made my way down a flight of steps ( on 2 crutches) rather than wait for the lift - so not surprising.

An ECG followed and I was provided with copious amounts of water to encourage me to be able to provide a urine specimen. Unfortunately I had waited so long in the Orthopaedic clinic and again in the adjacent X-Ray department that I had grabbed the first opportunity to visit the toilet just before setting off to go to the Pre Op Assessment Unit.

We deferred the visit to the phlebotomist for various blood counts and cross matching as I will be returning to the hospital on Friday to have a cannula inserted and some iron infused into my arm. This is a great opportunity for taking blood at the same time so once I have been cannulated I shall be in position to donate as many samples as required by both renal and orthopaedic units.

Its "OK 4 GO" in T - 2 months ( and counting!)

Just got back from the follow up Orthopaedic Out Patient Clinic.

The questions were answered after a brief hands on exploration of the right thigh confirmed no apparent infection remained.

A 2nd stage Operation was still on, there would be no need for prophylactic anti biotics leading up to the operation as the joint would probably be cemented and or bone allograft with a cement collar at the junction with remaining bone above the knee. Progress after the operation would be normal ( all being well) and if cemented I would be weight bearing straight away although assisted with crutches/ walking stick(s) initially.

The operation will be scheduled within 2 months in preparation for which I had some blood taken to assess current inflammatory markers (CRP and ESR levels) and will be invited to another pre-op assessment.

The advice about weight bearing was interesting - I was still to work on the assumption of no more than 20% weight bearing. When I asked how can I tell the answer was blindingly self evident - in retrospect - "Stand on some scales with both feet then place the good foot on the ground and put pressure through the bad foot until 20% of the previous weight registers" - Of course - but why is this technique not known more widely e.g. by physiotherapists. Even armed with the knowledge of how to measure a percentage of weight bearing my muscle feedback mechanism is not that finely attuned yet to assess the difference between 10% and 20% so it still remains a very subjective (touchy feely) measurement.

We tried to export the X-Ray image to a memory stick and although the software allowed for this and the consultant was happy to give it a go we only succeeded in setting up an empty folder. Plan B was to take an image or two with a hand held digital camera. You can see the result. Both my wife and I realised that there was significantly more of my own femur in place than we had been told. It now appears that I have just under half of my own femur in place. The surgeon said that they also thought they had been more radical and that it is not easy to judge in the heat of battle (my phrase not his!). I expect one other reason for the inaccurate estimate is that I have relatively long legs for my height another is that they would not want to peel away more tissue than necessary just to get an accurate assessment.

Having said that the x-ray shows the metal rod fixed into the remaining bone and around which a cement version of the head of femur was constructed, so I assume it would have been possible to know how much of this rod had "disappeared" into my remaining length of bone. All academic really I suppose. The metal rod is the important thing here. The cement being formed into a temporary bone was more to store the slow release gentomycin to fight infection and to act as a spacer to stop leg length shortening. It did not matter that the junction between cement and bone was displaced as pressure would be through the rod not the cement.