u/blockitorgetin

2-Week Follow up

Post-Op History: 50M / \~37 years of AS / on biologic for the last 10 years

This is my 2-week update on the left hip resurfacing. Second side, three months after the right, same surgeon and same hardware. Earlier posts covered the prep and the first couple of days. I am focusing this one on recovery outlook, the issues that came up, and how I am managing pain, since those are the questions I usually get.

Recovery outlook
Had my 2-week check today. Both hips look good on X-ray, the incision is healing well, and I am cleared to drive when I feel up to it. The 90 degree flexion restriction comes off at 6 weeks.
The PA told me this was one of the most difficult resurfacings he has seen. Part of that is the anatomy, fused spine, deformed joint, large osteophytes. But the biggest factor was probably that my muscles did not fully relax during the surgery. General anesthesia on its own does not relax muscle, it needs a separate agent for that, and it sounds like that piece may not have been fully dialed in. On an already stiff AS body, muscles that will not let go make delivering and reducing the joint a lot harder, which is where the hard pulling came from. It was good to have that confirmed, because it explains a lot about how the recovery has felt, and it is one more reason to take anesthesia planning seriously if you have AS. It is not just getting the block in, it is making sure the muscle relaxation is enough for the surgeon to work. He also said my hip flexion contracture has no mechanical block. It is all soft tissue, maybe some spinal restriction. For me that is the best possible news, because soft tissue is trainable. There is real range to reclaim, not a wall.

Issues
The biggest one is soft tissue strain. To do the surgery they dislocate the joint, pull the femoral head out, do the work, then force it back into place. On a stiff AS body that means a lot of hard pulling, and the PA confirmed that is where my early pain came from. I have felt it as a deep strain around the hip that refers down toward the knee. It is tissue pain, not joint pain, and it is slowly settling.
On swelling: it is down from about twice normal at day 2 to maybe 15 percent over now, and that drop is exactly when walking finally started to feel normal.
Pain management
Still no narcotics, same as the right side. I did not need them. I ran combined Tylenol and ibuprofen for the first two weeks and I am now tapering. Dropped the Tylenol, down to ibuprofen only, stepping it down over the next couple of weeks. I am keeping the ibuprofen going a bit longer on purpose because it doubles as heterotopic ossification prophylaxis. With AS I am more prone to HO than most, so I do not want to drop the anti-inflammatory too fast.

Overall
Two weeks in, I feel good about where this is going. Same lesson as last time. The early wins are small and it is a long game, but the small differences stack into something real over months. A difficult surgery with a clean result. I will take it.
I will keep posting as I get further along. Hope this helps.

This post is only meant to provide information on what early recovery looks like after hip resurfacing for an AS patient. It is not medical advice and should not be taken as one. This is a purely informational follow-up for those who may be interested or going through something similar.
Post-Op History: 50M / ~37 years of AS / on biologic for the last 10 years

A couple of weeks ago I made a post about prepping for my left side hip resurfacing. This is the follow-up I promised. I am now Day 2 post-op, and I want to share what the first few days actually looked like, since this is the kind of information I was looking for before my own surgery.

Quick recap: same surgeon as my right side (Dr. Pritchett), same approach, same hardware - BioCore 9 cementless, ceramic-on-polyethylene. I went into this one as basically a controlled experiment on myself, three months apart, same everything.

The anesthesia plan worked out the way I prepped for, but not the way I hoped. If you read my last post, item #4 was that I requested general anesthesia after my anesthesiologist told me to. But they attempted spinal block anyway and I was not opposed. Nonetheless, it failed this time after what felt like 20-30 attempts and simply could not get it. If you have AS with any fusion in your spine, please plan your anesthesia route BEFORE you are on the table. This was predictable, and pre-planning the GA accommodation is the single best prep decision I made because after the spinal block failure, they were prepared for GA.

Here is how the first three days went.

Day 0 (surgery day): Home by mid-afternoon. Pain was moderate, manageable. The whole joint was very stiff. The hardest single thing was going from lying down to sitting up. Started my staggered Tylenol and ibuprofen plan with tranexamic acid. No narcotics, same as last time. I did not need them.

Day 1: Stiff everywhere, with a mild fever in the early morning (last time my Day 1 fever was a measured 99.2, low-grade and harmless, so I am assuming this is the same band). The big limitation right now is that I have no active hip flexion yet, meaning I cannot lift my own leg using the front of my hip. So I rigged a belt around my foot and pull the leg along a straight track to move it. Did short walks and standing heel-to-knee bends to pump blood out of the glute and quad. Bowel function came back the same day, which is earlier than last time. Getting into bed is the worst part because of the pressure on the joint, so I isolate the left side completely using my upper body and my right leg, with zero muscle engagement on the surgical side. That trick comes straight from years of managing AS flares.

Day 2: More stiff today, and the swelling is now tracking down above the knee. But I hit my first fully unassisted bathroom trip at 2:30 AM, which felt like a win at the time. Ankle pumps and knee extensions to keep flushing waste out. Managing the GI side with MiraLAX.

Comparing the two sides at the same point: the left is tracking similar, maybe slightly ahead. Bowel function and walking both started a day earlier this time. Day 0 pain was lower. And the main limitation is milder in kind. On my right side I had a complete dead leg early on and could not lift it at all. This time I can move it, I just do not have active flexion yet, and the belt bridges that gap. Small thing, but it tells me the soft tissue trauma was a little less brutal this round, probably because of all the pre-surgery PT I did on this side. Supine to sitting is hard. I have forgotten how difficult it was. After reading back my journal from the first surgery, I realized that I had it harder the first time around.

Lessons Learned: This type of surgery benefits from pre-surgery prep. Had I not built my strength on my right side and flexibility on my left side, I will be complaining about my dead left leg. Instead, I can stand on my walker and can perform hill to knee…. Barely moving a few inches but it was something I couldn’t do on my right side.

This post is only meant to provide information on what early recovery looks like after hip resurfacing for an AS patient. It is not medical advice and should not be taken as one. This is a purely informational follow-up for those who may be interested or going through something similar.
Post-Op History: 50M / ~37 years of AS / on biologic for the last 10 years

A couple of weeks ago I made a post about prepping for my left side hip resurfacing. This is the follow-up I promised. I am now Day 2 post-op, and I want to share what the first few days actually looked like, since this is the kind of information I was looking for before my own surgery.

Quick recap: same surgeon as my right side (Dr. Pritchett), same approach, same hardware - BioCore 9 cementless, ceramic-on-polyethylene. I went into this one as basically a controlled experiment on myself, three months apart, same everything.

The anesthesia plan worked out the way I prepped for, but not the way I hoped. If you read my last post, item #4 was that I requested general anesthesia after my anesthesiologist told me to. But they attempted spinal block anyway and I was not opposed. Nonetheless, it failed this time after what felt like 20-30 attempts and simply could not get it. If you have AS with any fusion in your spine, please plan your anesthesia route BEFORE you are on the table. This was predictable, and pre-planning the GA accommodation is the single best prep decision I made because after the spinal block failure, they were prepared for GA.

Here is how the first three days went.

Day 0 (surgery day): Home by mid-afternoon. Pain was moderate, manageable. The whole joint was very stiff. The hardest single thing was going from lying down to sitting up. Started my staggered Tylenol and ibuprofen plan with tranexamic acid. No narcotics, same as last time. I did not need them.

Day 1: Stiff everywhere, with a mild fever in the early morning (last time my Day 1 fever was a measured 99.2, low-grade and harmless, so I am assuming this is the same band). The big limitation right now is that I have no active hip flexion yet, meaning I cannot lift my own leg using the front of my hip. So I rigged a belt around my foot and pull the leg along a straight track to move it. Did short walks and standing heel-to-knee bends to pump blood out of the glute and quad. Bowel function came back the same day, which is earlier than last time. Getting into bed is the worst part because of the pressure on the joint, so I isolate the left side completely using my upper body and my right leg, with zero muscle engagement on the surgical side. That trick comes straight from years of managing AS flares.

Day 2: More stiff today, and the swelling is now tracking down above the knee. But I hit my first fully unassisted bathroom trip at 2:30 AM, which felt like a win at the time. Ankle pumps and knee extensions to keep flushing waste out. Managing the GI side with MiraLAX.

Comparing the two sides at the same point: the left is tracking similar, maybe slightly ahead. Bowel function and walking both started a day earlier this time. Day 0 pain was lower. And the main limitation is milder in kind. On my right side I had a complete dead leg early on and could not lift it at all. This time I can move it, I just do not have active flexion yet, and the belt bridges that gap. Small thing, but it tells me the soft tissue trauma was a little less brutal this round, probably because of all the pre-surgery PT I did on this side. Supine to sitting is hard. I have forgotten how difficult it was. After reading back my journal from the first surgery, I realized that I had it harder the first time around.

Lessons Learned: This type of surgery benefits from pre-surgery prep. Had I not built my strength on my right side and flexibility on my left side, I will be complaining about my dead left leg. Instead, I can stand on my walker and can perform hill to knee…. Barely moving a few inches but it was something I couldn’t do on my right side.

This post is only meant to provide information regarding my upcoming surgery prep and outcome expectation. It is not medical advice or should be taken as one. This is a purely informational post for those who may be interested in what surgery prep looks like for AS patients.

Pre-Ops and History: 50M / \~37 years of AS / on biologic for the last 10 years
I recently went through my right side hip resurfacing surgery (12 weeks post-op) and came out with a decent outcome. I made a post about that a few weeks ago. I am still recovering, but I feel like I gained a lot and I will have a higher ceiling after the completion of my recovery. I had no internal rotation, no flexion, and no extension. I basically had no ROM: adduction and abduction, no flexion or extension. Post-ops, I have 60 degrees of side-to-side ROM and about 45 degrees of front and back ROM. Because of this improvement, I decided to go ahead and schedule my surgery for my left side.

My left side is in stage 4 hip arthritis, and I have osteophytes around my acetabular and femoral neck, preventing certain motions and resulting in limited ROM. Pain-wise, it is tolerable, but I have functional limitations such as bending down and grabbing things. It was a better side pre-surgery. Post-op, I am feeling the limitation imposed on that side. It is kinda funny because I forgot about how good my left side was before my surgery. All I can think about now is how I want it to be better.

Pre-Ops Planning: Surgery in two weeks

1. Stop Hyrimoz a month prior to the surgery. My injection date was last week, so I skipped it. Post-surgery, I will resume my shot 1 month after the surgery.

2. Control my infection exposure: I am trying to stay home and avoid public places. Getting a viral or bacterial infection and somehow that causing issues in my surgery site is the worst nightmare. Even though my surgeon and rheumatologist said the risk is low, I am just taking precautions myself.

3. Lots of PT to strengthen my right side for post-surgery support. I also specifically work on flexibility and strength training on my left side. One lesson I learned from my right side surgery was that dislocating a femur from a hip socket can be very traumatic to my soft tissues around joints, especially because of AS and how it stiffens our body. Doing as much work as possible to gain flexibility and strength around parts where surgery will cause traumatic impact on joints will help me recover faster and with less pain. So I am going through very specific PT to prep my both sides. I am also working on my upper body strength more to support both legs.

4. Ask for general anesthesia instead of spinal block. After the surgery, the anesthesiologist came to my recovery room and told me to ask for the general anesthesia. It will help my muscles relax fully and potentially help the surgery. It requires special tubing as my airway is not straight. So I brought this up and requested the accommodation.

5. Getting things arranged for the recovery - prepping for my post-PT schedules, supplements, equipment, and assistance will make my life easier. I already bought my walker and most of the assistive gears for my previous surgery.

6. Lowering the expectation - Prior to my first surgery, I saw YouTube videos and read blogs from many people claiming to get back to normal activities within two to three weeks after the surgery. After going through one myself, I know it takes much longer than that. Slow progress was causing frustrations during the first few weeks. I had to reset my expectations for my mental health. Knowing what I know now, I will just take this as a long-term journey. The initial win doesn’t matter. Each day, I feel the difference. Even though they are very small differences, adding those small differences will become meaningful improvement long-term.

Overall, I feel like I am ready. Heretic ossification concern was sufficiently controlled with anti-inflammatory. I need to monitor and manage that long-term, but I am doing quite well per my X-ray images so far.

I plan on providing updates post-surgery so that for those of you who need to go through a similar process, can see what it looks like.

Hope this helps.

This post is only meant to provide information regarding my upcoming surgery prep and outcome expectation. It is not medical advice or should be taken as one. This is a purely informational post for those who may be interested in what surgery prep looks like for AS patients.

Pre-Ops and History: 50M / ~37 years of AS / on biologic for the last 10 years
I recently went through my right side hip resurfacing surgery (12 weeks post-op) and came out with a decent outcome. I made a post about that a few weeks ago. I am still recovering, but I feel like I gained a lot and I will have a higher ceiling after the completion of my recovery. I had no internal rotation, no flexion, and no extension. I basically had no ROM: adduction and abduction, no flexion or extension. Post-ops, I have 60 degrees of side-to-side ROM and about 45 degrees of front and back ROM. Because of this improvement, I decided to go ahead and schedule my surgery for my left side.

My left side is in stage 4 hip arthritis, and I have osteophytes around my acetabular and femoral neck, preventing certain motions and resulting in limited ROM. Pain-wise, it is tolerable, but I have functional limitations such as bending down and grabbing things. It was a better side pre-surgery. Post-op, I am feeling the limitation imposed on that side. It is kinda funny because I forgot about how good my left side was before my surgery. All I can think about now is how I want it to be better.

Pre-Ops Planning: Surgery in two weeks

1. Stop Hyrimoz a month prior to the surgery. My injection date was last week, so I skipped it. Post-surgery, I will resume my shot 1 month after the surgery.

2. Control my infection exposure: I am trying to stay home and avoid public places. Getting a viral or bacterial infection and somehow that causing issues in my surgery site is the worst nightmare. Even though my surgeon and rheumatologist said the risk is low, I am just taking precautions myself.

3. Lots of PT to strengthen my right side for post-surgery support. I also specifically work on flexibility and strength training on my left side. One lesson I learned from my right side surgery was that dislocating a femur from a hip socket can be very traumatic to my soft tissues around joints, especially because of AS and how it stiffens our body. Doing as much work as possible to gain flexibility and strength around parts where surgery will cause traumatic impact on joints will help me recover faster and with less pain. So I am going through very specific PT to prep my both sides. I am also working on my upper body strength more to support both legs.

4. Ask for general anesthesia instead of spinal block. After the surgery, the anesthesiologist came to my recovery room and told me to ask for the general anesthesia. It will help my muscles relax fully and potentially help the surgery. It requires special tubing as my airway is not straight. So I brought this up and requested the accommodation.

5. Getting things arranged for the recovery - prepping for my post-PT schedules, supplements, equipment, and assistance will make my life easier. I already bought my walker and most of the assistive gears for my previous surgery.

6. Lowering the expectation - Prior to my first surgery, I saw YouTube videos and read blogs from many people claiming to get back to normal activities within two to three weeks after the surgery. After going through one myself, I know it takes much longer than that. Slow progress was causing frustrations during the first few weeks. I had to reset my expectations for my mental health. Knowing what I know now, I will just take this as a long-term journey. The initial win doesn’t matter. Each day, I feel the difference. Even though they are very small differences, adding those small differences will become meaningful improvement long-term.

Overall, I feel like I am ready. Heretic ossification concern was sufficiently controlled with anti-inflammatory. I need to monitor and manage that long-term, but I am doing quite well per my X-ray images so far.

I plan on providing updates post-surgery so that for those of you who need to go through a similar process, can see what it looks like.

Hope this helps.

This post had been removed twice already: First for no acknowledgement even though I posted some time ago so it was a surprise that it was a requirement; and secondly due to the NSFW label I used for my Xray picture. I am reposting it without any pictures so it won’t get removed again.

——————————————————————————————
Hi all. I’ve been lurking here for a while, asking questions a few times and commenting on some topics.
I want to log and share my journey for Hip Resurfacing surgery, as there is barely any information out there specifically for AS patients. If you are like me—a broken body with limited functionality but fighting to maintain a relatively active lifestyle—I hope my post gives you some info so you can make an informed decision.
(Disclaimer: Edited with an AI tool to help organize my recovery journal notes into a readable timeline).
\*\*The Baseline Specs\*\*
• \*\*Background:\*\* 50M. Onset at 13/14, diagnosed around 21. Treated with Sulfasalazine and NSAIDs until 39. On a biologic (Hyrimoz) since 2015.
• \*\*The Damage:\*\* Fused SI joints (both sides). Severe osteophytes (bone spurs) locking my right femoral head and acetabulum into a fixed position. Upper and lower spine damage forming a permanent hunched position.
• \*\*Activities:\*\* Speed skating, running (3-7 miles, 2-3x a week), skiing, bodyweight, and light weight training. Bouldering (paused for 4 years, but planning to return post-recovery).
\*\*Why I Opted for Surgery\*\*
After running, I started getting frequent, deep throbbing pain inside my right hip joint. I also suffered severe functional loss—I couldn't put on my own socks or tie my shoes.
I initially didn't realize surgery was an option and gave up on ever gaining back my lost functional ranges. I honestly feared that surgery would trigger massive AS flare-ups and constant inflammation at the surgery site. But after consulting with my rheumatologist and three different orthopedic surgeons, I realized modern medicine had an answer.

\*\*The Decision: THR vs. Hip Resurfacing (HR)\*\*
I was given two options:

1. \*\*Total Hip Replacement (THR):\*\* Recommended as the easier path to recovery. The caveat was permanent restrictions on the high-impact activities I love.
2. \*\*Hip Resurfacing (HR):\*\* Preserves the femur bone. Harder surgery, longer recovery, and more trauma to the body. But, the restriction post-recovery is essentially non-existent.
3. It was a no-brainer. I chose the harder option (HR) simply because I wanted to enjoy more of my life rather than be restricted.
4. \*\*Surgery Day (The Anesthesia Lesson):\*\* I had a Spinal Block and was able to walk out on my own power using a walker. \*\*Major warning for AS patients:\*\* A spinal block kills pain but doesn't paralyze muscles. My AS-stiffened ligaments fought the surgeon the entire time, forcing them to use massive sheer force to dislocate the joint. My anesthesiologist later told me that for my upcoming left hip surgery, I must use General Anesthesia (with fiberoptic intubation due to my stiff neck) so chemical paralytics can fully relax my muscles and prevent that extreme soft-tissue trauma.

\*\*Weeks 1 - 3 (Survival & The HO Firewall):\*\* Pain-wise at home, I was mostly OK, but getting in and out of bed was hell. Sleeping was tough, and using the toilet was brutal.
• \*\*Recommendation:\*\* I installed a bidet a few years ago. It was a lifesaver. If you are doing this surgery, get a bidet.
• \*\*Meds:\*\* Because AS patients have a huge risk of Heterotopic Ossification (HO)—where the body mistakenly grows bone into the surgical muscle—I was put on an Ibuprofen for HO prevention.
• By Week 3, I was walking half a mile with the walker.
\*\*Week 4:\*\* All of a sudden, felt much better. Transitioned to a cane. Started PT. Could walk a half mile faster.
\*\*Weeks 5 - 8 (Progress):\*\*
Slow but steady progress. I successfully dropped the cane after Week 7 and started riding the stationary bike.
\*\*Current Status\*\*
• I'm riding 40 mins of stationary bike with light to medium resistance.
• I still have a compensatory limp, but I found that gently stretching my tight hip flexors temporarily restores my normal stride.
If you are an AS patient looking down the barrel of this surgery, know that the bone heals great, but you have to actively manage your stiff soft tissue. I'm targeting early July to get my left side done. Happy to answer any questions.