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Surgery Diary: Powerlifting Athlete Andrew Has Total Hip Replacement at 35 years old (Case Study)

Jun 20, 2024

My name is Andrew Ward, and I'm a young man who, at 35 years old, with a powerlifting background and a competitive spirit, found myself facing a challenge far different from any I encountered in the gym—a total hip replacement.

Osteoarthritis had been my quiet, relentless adversary, chipping away at my right hip until I could no longer ignore the pain and impact on my life. The decision to undergo surgery on 13th June was a turning point, not just physically but mentally. This is my journey—two weeks into recovery and the small victories that have kept me going. From the operating table to my first tentative steps, join me as I journey to reclaim my strength and mobility.

I hope you enjoy my diary of a hip replacement - Here is the start of my story so far!

Listen to a raw recording of me speaking about some of my experiences here
(26 mins. The article contains a lot more details, so it's still worth a read as well):

In This Article

Here are the topics I cover in this article (approximate order):

  1. A Message to Those Following a Similar Path
  2. Why I Replaced My Hip
  3. Background and Context of My Hip Replacement
  4. Recovery Documentation and Instagram Diary
  5. Pre-Surgery Fitness and its Impact on Recovery
  6. Detailed Surgery Experience (The Surgery Was Conducted at The Priory Hospital)
  7. Immediate Post-Surgery Activities and Progress
  8. Initial Home Recovery Steps and Achievements
  9. Physiotherapy and Exercise Routine Adjustments
  10. My First Gym Session Back (Day 8)
  11. First Setback (Day 10-15)
  12. Diary Entries Beyond Week 2 (ongoing progress and I'll update over time)
  13. Importance of Diet and Sleep
  14. Returning to Work Shortly After Surgery
  15. Support and Encouragement from the Community
  16. The implant and Surgical Approach (Why we chose Oxinium)
  17. Mindset and Recovery Philosophy
  18. Advice for Others Facing Similar Procedures
  19. Frequently Asked Questions

A Message to Those Following a Similar Path

If you are reading this as someone about to go through the process, then know that, above all else, it is crucial to maintain the right mindset throughout this process.

foam rollering tight muscles two weeks in

Foam rollering my inner thigh about 10 days post-op. Including here for the comical almost staged pose!

You are about to put your body through stress and challenge, and how you frame this can make all the difference. It's similar to the fight-or-flight response, where your mindset determines your body's perception of the chemicals at play. Anxiety can be reframed as excitement with a different perspective. The mindset of others around you may impact recovery, so surround yourself with people who will lift you up out of this and not pull you down.

The evidence suggested that psychological preparation may be beneficial for the outcome of postoperative pain, behavioural recovery, negative affect and length of stay and is unlikely to be harmful. 

So, as you read this article and as you approach your surgery, prepare mentally for what to expect.

While viewing experiences, pain, and setbacks negatively is easy, adopting a growth mindset can be incredibly beneficial. Viewing upcoming challenges as opportunities for achievement, akin to setting personal bests in the gym or climbing a mountain, is valuable. We undertake these difficult tasks because they bring meaning to our lives, and we derive satisfaction from overcoming them with the right mindset.

My Daily Diary

When I searched online for examples of people’s recovery, I couldn’t find anyone with my attributes and background who had a posterior approach hip replacement and was documenting their daily journey, particularly in the first seven days post-operation. So, I started keeping a daily diary.

You can see all of the day-by-day videos from 2 days before surgery all the way to seven days afterwards on my Instagram highlights reel here.

shows Andrews instagram reel location

I log how I feel leading up to the operation, during the surgery itself, and my recovery afterwards. This includes all the exercises and activities I've been doing in the weeks following the operation. As of today, my video diary on Instagram highlights covers up to day seven.

This article you are reading now is a summary, but I encourage you to watch the full diary if you have time!

You can skip through each day or watch specific parts that interest you. I’ve gone into detail on everything: my psychological state, daily pain levels, movement, and mobility. I also document the exercises I’ve been given, with video recordings showing my progress each day. This allows you to see the gradual return of strength and mobility.

Why I Replaced My Hip

Several of my friends were surprised to find out I'd had a hip replacement after it was already done and I was posting video updates. I've not complained about my hip much openly, come to think of it. I haven't posted about it on social media, other than close to the surgery date. 

I got so used to it that I wouldn't mention it unless someone noticed me limping. Quite a few of my friends had no idea, and I assumed they knew.

Andrew doing a roundoff flashkick trick outside

A backflip with a kick, called a "Flash Kick"

It was a gradual degradation from doing acrobatics. Think of it as having a lot of impact on the joint through flips, making the ball and socket bumpy due to the shock at the end range. This makes the joint space smaller, and the tissue degrades due to use, which makes it more likely you'll hurt the bone and cause more bumpiness and repeat. There was likely a genetic component to this, too, as a smaller, tighter hip joint might be more prone to damage and easier to shock with acrobatic movements, given they more easily put the joint at its end range of motion combined with the force of landing.

Watch my 2010 Acrobatics Tricking video, where you can watch me performing the moves that likely initially stressed the joint.

This bumpy joint, coupled with powerlifting, caused it. Until the last year or so, I could just ignore it, but recently, it's been affecting more aspects of my life.

If I went for a walk longer than 30-60 minutes, I'd be in pain, limping, and feel it the next day. I couldn't squat heavy anymore (140 kg max), and skiing was off the table, too.

I went to get a hyaluronic acid hip injection, and the radiologist said whilst performing the CT-Scan assisted injection, "This is very bad for your age. Whatever you're doing, stop. You must be in a lot of pain." This prompted me to get another MRI and see a surgeon in mid-January for advice.

My surgeon, Callum McBryde, said it was bad enough to operate on if I wanted, but it wasn't urgent. He discussed ways I could manage it and the surgical options. We had a much longer discussion than my summary here, talking about the clinical and statistical information behind different approaches, which I really valued.

When I came to the conclusion this wasn't a case of "if" but "when," it became an easy decision to get it done as soon as possible. 

You can see the state of my hip in January on this X-ray:

Xray of Andrews hip pre-op showing arthritis on the left side

X-ray from Jan 2024 showing progressed arthritis in the right hip. If you compare hips, you can see significant differences in joint shape and space. 

And an MRI scan of Andrew's hips pre-op

I also had an MRI before seeing the surgeon, which you can see here. This showed reduced tissue volumes and significant inflammation. 

I reflected on my decision for a week. Once I was sure, I scheduled the surgery for two weeks after Worlds so I could participate in the British Bench and World Bench and have the surgery in summer when the risk of infection is lower (13th June). This way, I could go into the surgery on a high note. I had won a World Bronze Medal last year and set a competition personal best at this year's Worlds. I knew I would feel content with the surgery's impact on my training and could focus on my recovery.

Before The Surgery

Andrew benching 175kg pre surgery

175 Kg bench press personal best at the IPF World Championships (I compete in the under 74kg Open Men's Class)

Coming from a powerlifting background, I was unsure how my healing would progress. Some people return to activity within a few weeks, while others are signed off work for four to six weeks. Running my own business, being off for that long would have been a nightmare for me. I didn’t know what to expect going into the surgery.

Anticipating how I would feel post-surgery, I had many concerns. There was the obvious pain and discomfort to consider, but also the mental load. Would I feel exhausted? Would I struggle with sleep? How would these factors affect my ability to work? These were the kinds of questions running through my mind.

I hope this day-by-day diary gives people an idea of what to expect if they are relatively young, fit, and healthy. For context, I’m 35 years old, a man, and I train three times a week at a high level in powerlifting. I compete internationally in bench press. Despite my symptoms before surgery, I could still squat 140 kilogrammes, which was light for me, though I had to taper back my deadlifts and adjust my training. Maintaining some degree of mobility and strength likely helped me going into surgery. I even competed in the World Bench Press Championships in Austin Texas just two weeks before the surgery, and lifted a new personal best bench press (gym lift) of 180kg (396Lbs).

I mention this because your fitness level before surgery can impact your recovery. However, remember this is just my story. Everyone’s experience will be different. It’s crucial to listen to the advice of your surgeon, physio team, and anaesthesiologist. They offer a unique perspective on what you should or shouldn’t be doing based on your specific situation.

Don’t beat yourself up if you’re not progressing as quickly as you’d like. The key is to push yourself to recover by following the prescribed training, but not so much that you risk damaging something and setting yourself back.

My diary entries begin with how I felt leading up to the operation. I discuss the emotional and physical aspects in detail, hoping it provides a realistic picture for others in a similar situation.

Leading Up to the Surgery

worlds comp leading up to surgery. Team 74kg at the Bench Press World Champs in Austin Texas! . Ivan Chuprynko, Kosei Yokoyama, Austin Perkins, Derek Logrande, Sakai Kazuhiro, Andrew Ward, Loc Nguyen .

Team 74kg at the Bench Press World Champs in Austin Texas! Ivan Chuprynko, Kosei Yokoyama, Austin Perkins, Derek Logrande, Sakai Kazuhiro, Andrew Ward, Loc Nguyen

I approached the situation with a positive mindset. I had decided to have this operation, taking control of the situation, and I viewed it as a journey to be experienced and enjoyed. Much like progressing in my powerlifting training, I wanted to find the same sense of progression and enjoyment in my recovery.

Reflecting on work, I ensured my affairs were in order, preparing for possibly needing several weeks off. I minimised the number of tasks left in limbo and enabled my team to manage things smoothly in my absence.

I was also touched by the support I received. Leading up to the surgery and in the days following, many people reached out to me. In the first three days alone, I received around 100 direct messages from friends and connections, all offering personalised messages of support. This unexpected outpouring of kindness was incredibly humbling and much appreciated.

The Day of Surgery (Day 0)

Andrew holding the surgical gown

The classic hospital gown that exposes the rear. Lovely. The pants to go with it were a spectacle to behold.

In the videos, I talk about my feelings leading up to the surgery, even joking a bit. Surprisingly, I felt no anxiety. On the day of the operation, they took me down to the surgery room, and I was ready to face the procedure with a positive outlook.

The surgery room itself has a distinct atmosphere, with an adjoining room where you first go. It was an interesting experience; I was on a bed with the team bustling around me. It felt almost surreal, like being in a VR video game, witnessing everything around me. It didn’t feel entirely real.

What stood out to me was the effort the team made to keep me relaxed. The anaesthesiologists and the surgical assistants were all very supportive. This effort to create a calm environment was genuinely appreciated. When the anaesthesiologist administered the anaesthesia, I felt relaxed and confident in the team's abilities. Their empathy and professionalism were evident.

I was asked to count down, but I didn’t even reach five before I was out. They gave me a light dose of general anaesthetic and also administered a spinal block. They gave me the spinal after the general anaesthetic. This combination allowed them to use a lighter dose of general anaesthetic, which is beneficial. The spinal block also reduces the risk of waking up during surgery. It’s similar to spinal plus sedation but with the advantage of being completely knocked out by the general anaesthetic.

Many people talk about feeling groggy after a general anaesthetic, but when I woke up, I felt surprisingly clear-headed. The team’s approach made the entire experience much more comfortable and manageable.

Immediately After Surgery

Andrew posing for camera just minutes after the surgery

(Not the most flattering picture! But here it is raw just for you)

I came to quite quickly after the surgery. I remember trying to get out of bed because they had put a warming device on me. A nurse assertively placed my hands back under the duvet, which confused me a bit as I had just woken up. It felt like I was dreaming, even though many people say it feels like nothing. I didn’t feel particularly groggy, though. I started asking the surgical team questions, although I might have been less cognisant than I thought.

Overall, it was a good experience. Once they were satisfied with my vital signs and I had warmed up, they wheeled me over to my wardroom. Then it was just a matter of waiting for the numbness in my leg to wear off and for Aimee to arrive. The nurses regularly checked my blood pressure and other vital signs.

Interestingly, even on the same day, just a few hours after surgery, I was able to get up and go for my first toilet break. You can see this in one of the diary entries I posted. They offered the option of using a bottle, but I wanted to take the opportunity to get up since my foot was no longer numb. It was a relief to feel my foot again. This allowed me to put some weight on it and shuffle to the toilet with the help of a Zimmer frame.

Andrew happy to be stood up for the first time

First Steps

You’ll see some amusing moments in my highlights stories as well. One funny incident occurred shortly after I had the anaesthetic, which I wasn't going to share publically, but screw it, why not (apologies to any colleagues reading this!).

I had an itch in a certain area but couldn’t feel anything when I tried to scratch it. I remember shouting to my wife Aimee, “Oh my God, I can’t feel my penis!” The nurse in the room, who I'd forgotten was there taking my blood pressure, looked quite shocked, and I quickly apologised for making her uncomfortable. It was a humorous moment, albeit a bit awkward.

The spinal anaesthetic can make you feel like you have itches in places where you actually don’t. It’s a strange sensation, scratching an itch that isn’t really there.

After the surgery, things moved quickly. I was given pain medication and spoke with various medical staff. They taught me how to inject myself with Clexane, a blood thinner, which I needed to do ten times at home. The first night’s sleep was rough, which worried me. I wondered if the rest of my recovery would be equally challenging, despite the extra painkillers.

I should also mention that the Priory Hospital food was exceptional! It was a quality restaurant, served on a literal silver platter, so there were no complaints. Thank you very much for that attention to detail hospital team!

The Day After Surgery (Day 1)

example day one bed exercises - seated abduction

First Exercises

In the morning, I used the opportunity to do some of the exercises prescribed to me. The first day after waking up involved a lot of activities. I had to get an x-ray, have my blood pressure checked, and undergo a walking test up and down the stairs with crutches.

You can see all of this in the diary entries. It was a busy and somewhat challenging first day, but documenting it helped me keep track of my progress and stay positive about the journey ahead.

Working with the inpatient physio team was quite enjoyable and kept me busy. Here is an example of the beginner exercises they programmed me to do four times daily.

The medication I was prescribed included paracetamol (known as acetaminophen in the US) and naproxen, a strong anti-inflammatory painkiller. While in the hospital, they also offered me Tramadol or Oramorph. I took some Tramadol the first night, but it didn’t really help. I wanted to avoid morphine, although it was available if needed. Upon discharge, I was given Clexane, paracetamol, naproxen, and the option of codeine, which I avoided as much as possible because I’m not keen on taking opiates. However, I kept it as a backup if I had trouble sleeping.

If, like me, you compete in a World Anti-Doping Agency-recognised sport, like Powerlifting, then you need to make sure to check the prohibited list to make sure nothing you've been prescribed is on the ban list. For example, at the time of writing, Tramadol is banned, but only in competition, which means I was fine to take it, providing there is plenty of time for it to leave my system before the day of my next competition.

I also saw the anaesthetist before I left. They play a significant role in the surgery and are as important as the surgeon. My anaesthetist, John, was lovely, caring, and clearly skilled. He kindly visited me not only before the surgery but also afterwards to check on my progress. He seemed genuinely happy to see that I was on the mend, saying, "Oh, you're looking good," which was very reassuring.

I thanked him for his care and attention throughout the process and asked him for any advice he would give others. He simply said, "Pick a good anaesthetist," emphasising the importance of having a skilled professional in that role, given its impact on your health.

I also asked John if he had to do anything differently for me and about his preparation for sedation and the general anaesthetic process. He laughed and said, "I could see that you were built like a brick shithouse, so I gave you a little bit more initially." This was amusing, especially since being described as a "brick shithouse" as 74 kilograms man felt like an achievement, similar to being called "big man" by the bigger guys at the gym. It was a nice ego boost.

The nurses also come to check your wound and replace the dressing. If you'd like to see this, then I took a photo which you can see here (WARNING: image contains blood and may be uncomfortable to look at to some people. Potentially NSFW).

They discharged me the same day after I saw the anaesthesiologists, members of the surgical team, and nurses. They decided I was ready to go, gave me my paperwork, and sent me on my way. I'd like to emphasise how amazing the care staff and team were in my visit. They were all attentive and caring, and did their utmost to ensure I had the best possible experience. THANK YOU.

Andrew being attended to by the nursing staff

(The staff consented to me recording and taking pictures)

A funny moment occurred when I was about to be discharged. The hospital had great food, and I had ordered a three-course meal for lunch. I got the starter and main course, but the pudding never arrived. Just as we were about to leave, a lady walked in and handed me a chocolate fudge brownie with ice cream. My wife, Aimee, said deadly seriously, "Oh, amazing, they give you a goodbye cake!" We still think of it as a goodbye cake, even though it wasn’t intended as such.

I was wheeled to the entrance in a wheelchair by a young man who looked strikingly like Michael Jackson (The young handsome version). Aimee drove us home, and I went straight to bed to start my recovery routine.

The First Days at Home After Surgery

first day home resting on the sofa

Sitting on my sofa relaxing and snoozing as planned! You can see I'm a bit tired here.

The days following the surgery have been a series of enjoyable mini-progressions. Each small step forward has brought a sense of achievement and has kept me motivated throughout the recovery process.

The first major win came the night after that rough first sleep. I slept soundly, which felt like such a relief. I found it easiest to sleep by taking a normal-sized bed pillow, having one half over the knee of my left non-operative leg and the other half under the knee of my right operative leg. This allowed me to keep my left leg straight and right leg slightly bent, which I found most comfortable and prevented me from accidentally rolling onto my right operative side while sleeping. As my leg got less sore, I also found this made it easier for me to switch from sleeping on by back to sleeping on my left non-operative side throughout the night.

I jumped straight into the standing exercises prescribed by the physio. Initially, performing squats and other movements was laborious due to the inflammation in the joint, but I enjoyed the process. I quickly progressed from walking with two crutches to just one, gradually improving each day.

Initially, I did squats while holding onto something for support. Soon, I moved to doing squats without support, starting with quarter or half squats from a chair. I then progressed to squatting to parallel using a stepper bench. Luckily, my wife Aimee is a pole dancer, and we have a pole in our living space. I used it for support, which was really helpful. You can see videos of all these exercises in my highlights reel if you’re curious.

Andrew doign supported box squats in the first days post surgery

Supported box squats in the first full day at home after surgery

For hip abduction exercises, I was able to move my hip wider and hold the position longer each day, feeling more activation through the glute. Each day brought noticeable improvements.

By day four, I attempted walking without crutches and managed to walk up and down my lawn a few times. This was a significant moment for me, as I hadn’t expected to be crutch-free so soon. The progress has been steady and encouraging, making the recovery journey quite satisfying.

By day four, I experienced a significant improvement, especially considering that on day three, I struggled a bit. I could walk, but it felt like I had to consciously think about every step, and my stabilising muscles were working hard. So, reaching day four and walking more comfortably was a big win.

Andrew walking unassisted on day 4

Feeling happy after walking well without crutches for the first time

Just to clarify, when I mention day numbers, day zero is the surgery day, day one is the next day, and so on. Now, I’m at day seven. To put it into perspective, around this time last week, I had just come out of surgery.

box squats day 7

Box Squats on day 7 without holding the bar

Hip Abduction

Hip abduction holds

Knee raises

Knee raises held for five seconds

This is really a whistle-stop summary of how my exercises have progressed. I found that things progressed little and often to the point you can see them in the above images. I've recorded myself doing the exercises every day of the first week on my highlights reel I mentioned earlier if you want to see how this improves each day.

First Physio Session (Day 7)

first physio at the rehab centre

Arriving at the Rehabilitation Centre

Today, I had my first physio appointment. Normally, the first session is scheduled for two weeks post-surgery, but I called them yesterday to request an earlier session, given my progress. They were accommodating and fit me in.

Interestingly, the physio I saw goes to my gym and has seen me around, which made for a nice conversation. He assessed my progress and spoke to my surgeon, who advised me not to push things too quickly—a piece of advice I definitely need to hear.

The physio then increased the intensity of my exercises. Previously, I was doing one set of ten for each exercise. Now, I’m doing three sets of ten, with added difficulty. For example, in my hip abduction exercises, I now hold my leg out for five seconds before lowering it. The same goes for leg raises; I hold at the top for five seconds and do three sets of ten. For squats, the physio suggested continuing with the box squats and, if comfortable, progressing to full squats without the box while maintaining tension.

This adjustment in my routine feels challenging but manageable, and it’s exciting to see such tangible progress in just a week.

I've also been given a resistance band. Over the next few weeks, I’ll incorporate banded exercises into my routine. Additionally, I've started walking around the garden more. I put down the crutch and walk up and down the garden, which has been going well. I’ve managed to walk up and down quite a few times without any issues.

I’ve been cleared to go to the gym for upper-body workouts, which is fantastic. Just a week post-operation, I can already do some gym activities.

First Gym Session (Day 8)

My first gym session back was always going to be a big milestone, as I didn't know when I could do it. I was conscious that the gym is a place where you constantly push yourself, and I didn't want to upset the injury, especially after reflecting on the physio's advice from yesterday. However, since the physio had given me the green light to go on day eight, I went to the gym, and the session went really well.

Before the surgery, I thought it would take me a while to get back to doing squats, deadlifts, and putting weight through my hip. But since I compete internationally in bench press, my main goal was to get back onto a bench and lift a semi-decent weight with enough reps and sets to get some volume without overstressing myself. Today was that day, and it happened on day eight. I didn't expect it to happen so quickly.

feet up larsen bench press

120kg x 6 Larsen Press at my first gym session back

I managed to do a Larsen press, a variation of bench press where you keep your legs straight on the bench, to avoid tensing through your lower body. I did 120 kilograms for three sets of six reps (watch video), followed by some close-grip bench presses at 100 kilograms for 10 reps. I also did supporting exercises like a chest-supported seated row, standing tricep extensions, bicep curls with straight legs, and lateral raises, as programmed by the physio.

It was a significant win for me, and I was pleased to complete the session. It marks a strong milestone on my road to recovery. This gives me a solid foundation to build upon. I need to be cautious and monitor how I feel tomorrow to ensure that the fatigue levels are acceptable. While this wasn't a very hard workout, it was hard enough to be meaningful, signalling to my body that it needs to retain its muscle mass.

Although I'm making great progress with my upper body, I need to manage expectations for my lower body. The implant needs time to integrate with the bone. The spiky part of the implant is inserted into the leg bone without cement, so initially, it relies on friction and the hope that the bone will eventually graft to it. After six to eight weeks, the bone should have grafted enough for the implant to be solid. However, the full integration process takes three to nine months. While it will have structural integrity, it won't be as strong as it could be immediately.

Additionally, the muscles around the wound need time to heal. They cut through the skin and muscles during surgery, and as these tissues repair, the new tissue bridging the gap is initially weak. It will take four to six weeks for these tissues to strengthen and tolerate any weight. No matter how good I might feel, I can't bypass these physical limitations. Good diet, sleep, and exercise are crucial during this period. This is why I feel like my collagen supplementation is particularly important.

Interestingly, you might expect the wound to be the area causing the greatest discomfort and the biggest limiting factor in terms of exercise progression or fatigue levels. However, I discovered through experience that it's often the inner groin muscle that fatigues the most. Many others online have shared similar experiences. The inner groin muscle is used extensively in stabilising exercises, not just in physiotherapy but also in everyday activities like walking, especially if you're challenging yourself to walk without crutches.

During surgery, to manipulate the leg and dislocate the joint for access, this muscle is likely bent and twisted, resulting in fatigue. This fatigue becomes apparent during recovery, leading to moments where I've had to rest because the groin muscle was tired. Interestingly, this fatigue doesn't require long periods of rest. A short break of around 30 minutes is often enough for me to feel refreshed and ready to resume light activities.

Andrews Magicgel ice pack

This is the ice pack I've been using to ice my hip. It's a great design and cost about £25 when writing.

I also want to emphasise the benefits of frequent icing. Like taking anti-inflammatory medication, icing helps reduce inflammation in the joint and can significantly aid recovery. I use an ice pack designed for the hip and leg, which provides good coverage and attaches securely. It’s recommended to ice at least every hour or two, especially after any activity. Although I haven't been icing that frequently, I've managed to ice around two to five times a day on average.

Now, I know some of you will be curious to see how the bruising and wound is progressing, so I will share this with you. Remember that a bit of bruising is normal at this stage, and the Clexane blood thinners increase the chances you'll pick up bruising. In addition to the pics, I also have a little but of bruising extending down the back of my leg to my calf.

Therefore, another WARNING: The images I'm about to link to contain bruising and partial nudity that may make some readers feel uncomfortable. With that out of the way:

  • Day 1: Again from earlier in the article for your convenience. Shortly after surgery.
  • Day 8: The wound and bruising on day eight were taken when we replaced the dressing. The full steristrip is still on.
  • Day 14: When the dressing first could come off for good (though some of the steristrip is still on)
  • Day 15: Exposed healed scar with full steristrip removed.

Again, my apologies to any colleagues reading this, but then again, you chose to click it!

Many people experience leg swelling after hip surgery, and though I had some minor swelling around my upper leg, this was minor. I did not notice any swelling in my lower leg or calves, nor did I wear compression socks outside of the hospital. 

First Set Back (Day 10-15 Groin Pain)

On day 10, I encountered my first setback. Progress had been going well, and I spent Sunday confidently walking around the house with no issues. However, all of a sudden, in the afternoon, I experienced sharp pain in my groin area, possibly from pivoting on my foot too aggressively. It felt like a potential pull, not a tear, so I had to take it easy that afternoon.

highlighting the area I get groin pain

Screenshot from a video from my highlights reels where I explain where I'm feeling the groin pain. This stretch feels like it targets the area of issue.

On Monday (day 11), I could still attend my gym session but noticed soreness in my inner thigh by the end of the day. The pain seemed to be coming from either the abductor muscles, the inner thigh muscle itself, or the hip flexor, though I suspect it is the abductor muscles. The pain worsens when I walk, especially when moving my foot from behind to in front of me, causing a twinge.

Today is day 15, and I've had several episodes where pivoting caused sudden pain, similar to a muscle spasm, requiring me to lie down until it passed. It doesn't feel like nerve pain. I had a physiotherapy appointment today, where I received a massage and some stretching exercises, which was helpful. The physiotherapist advised me to be cautious not to overdo it.

Examples of the various groin stretches

Examples of the stretches I've been doing to target the groin. The bottom one is the one that was programmed by the physio today. Careful copying me if you have restrictions set by the surgeon or physio, and if in doubt ask them if this is ok first.

This injury seems muscular. Post-surgery, there can be swelling that increases the risk of aggravation. Perhaps there is a correlation between this happening and me finishing my course of Naproxen and Clexane, but that is speculation and could easily be confirmation bias.

Although recovery is going well, I need to monitor the situation carefully over the next few days. I will continue with my programmed exercises, such as leg raises, abductions, and squats, as they do not seem to aggravate the injury. However, I will avoid prolonged walks or activities that might overstress the abductor muscles to allow them time to recover. I have been advised to use heat, ice, and stretching to manage the pain. 

Though I do have a groin pain life hack to share...

It can be demotivating to have something like this stop you from getting around so easily, especially when the solution is ensuring it gets enough rest to recover properly. Today, I found a ridiculous but effective way to still be able to get around in spite of groin pain.

Here is a silly video showing the technique. Let me know if this works for you, too!

This is an example of the silly walk. Be careful with this if you don't have good balance. If you are unsure if you can do it safely, either don't do it or try it with crutches.

The technique involves helping your thighs clamped together, almost like your knees are joined, and walking without activating strained groin muscles due to this position. So keep those knees tight together and try to walk by only separating your lower legs. If you pivot your angle, you do so on the spot, trying to avoid those knees falling apart. This allows me to still get around easily without pain and without aggrevating it even if my groin feels like it's going to twinge when walking normally.

My plan is to walk around as normal, doing exercises and stretches as programmed by the physio. You know, keep it working and moving as you should. But, if I feel a twinge coming on then it's time to rest, or if that isn't possible, switch it up to the silly walk. Maybe your groin pain is different and this doesn't help, or it's the same and this helps you to get about. Or maybe you just want to try the silly walk just for fun. Either way, happy silly walking!

Despite this minor setback, I remained optimistic and motivated. Setbacks are part of the recovery journey, but I don't believe this will significantly hinder my progress. 

Day 18 - Groin Update (04/07/2024)

By day 18, I felt confident returning to the gym and walking around without my crutch, though I still brought it with me just in case. I could see strength in the groin area returning well over days 19 and 20, and by day 21, three weeks post-surgery, I took a walk around the block to vote in the general election, having left my crutches at home. You can see the groin pain set me back about a week.

Day 24 - More Confidence Walking Around Town

On days 20 to 23, I felt confident and strong, having spent several days walking around the house without crutches. I experienced no pain walking around and managed to walk upstairs normally at home, alternating legs rather than shuffling. I often forgot I'd had surgery, going about my daily activities as usual. Though I've been to the gym without a crutch before today, it was a very stop-start, and I did not spend a prolonged period of time walking around other than between equipment. I'd also take my crutch with me, just in case, even though I had stopped using it.

Feeling good on day 24, I ventured into Solihull town without my crutch. We spent about three hours walking around, popping into various places and taking short breaks for food. Despite being on my feet for a considerable time, I didn't feel sore and maintained a normal gait. At one point, I even power-walked to find Wi-Fi to download my glasses prescription, and I managed fine. This experience boosted my confidence, making me feel optimistic about my recovery.

At 24 days post-surgery, I need to remember I'm still only just over three weeks in, and I shouldn't push myself too hard. I get fleeting thoughts like, "Hmm, I think I could load up the bar with 70kg and try a squat." It's the competitive side of me kicking in that likes to push myself.

The tissues and bone will take at least 6 weeks to heal well, regardless of how good I'm feeling, so I know I must wait until week six and get the go-ahead from my surgeon and physio during my six-week check-ups. I'm used to applying discipline to enable me to take action, but now I need to apply discipline to instead refrain from action!

Overall, I'm thrilled with my progress and relieved that my groin no longer troubles me.

I still don't have pain around the scar, although the skin from the incision to about an inch away on the underside is completely numb. I can feel pressure if I poke it, but the skin itself has no sensation.

I understand that nerves regenerate very slowly, at about 1mm per day, so I'm curious to see if I will regain feeling in this area over the coming months or if this patch of skin will remain permanently numb.

One Month In

Here are the gym exercises I was doing one month post-total hip replacement. I've been given adaptations to my exercises. I'm still not allowed to go heavy or add loads of weight, so it's predominantly bodyweight or banded exercises for lower body. Progressing weight for upper body is fine.

You can see here that I'm doing bodyweight lunges. I'm allowed to do bench presses because they focus entirely on the upper body. I am also doing squat variations and some dips. Although you can't see them in the video, I've incorporated chin-ups, lateral raise, and some other accessories into my workout that don't use the legs.

Overall, I'm really happy with my progress. Although I feel really good at this point, the tissues where they operated are still healing. My surgeon has advised me not to overdo it, so I'll listen to them and won't add more intensity until I'm greenlit by the physio or the surgeon after my next appointments in a couple of weeks' time.

Importance of Diet and Sleep

I'm extremely protective of sleep because I understand its benefits in recovery. My lifetime interest in sports has led me to research various aspects of recovery, and the same principles apply to recovering from an injury or surgical procedure. Sleep is the pillar that supports everything else. If you don't get good sleep, everything else suffers. It will hold me back if I don't protect my sleep and get poor rest.

Optimising sleep is a big reason why I was deliberate about how I used codeine as a painkiller. I avoided taking it during the day and saved it for the evening. I'm not sure if I still need it, but I'll probably continue for a few more days. Preventing soreness that wakes me up frequently means I'll get a much better recovery, improving my speed to get back on my feet. I stopped taking codeine at night altogether about a week after the surgery as I didn't want to build up a tolerance to it.

It's also crucial to ensure a decent protein intake. There's a lot of data on protein intake for recovery in sport, and I generally aim for two grams of protein per kilogram of body weight. For me, that’s about 150 grams of protein per day. For Americans, that's roughly one gram per pound of body weight. To ensure that my body has the building blocks needed for repair, I optimise my protein intake with every meal.

Example of the salads I have for dinner

This is an example of a typical dinner for me: a big bowl of salad (buried under there somewhere!) with lots of chicken, fish, and fresh pasta. Seeds on top add variety and flavour, and halloumi or avocado provides fat.

I also mentioned I supplement collagen earlier (Type 1 and 2); Collagen has been shown to improve wound closure speed and promote the repair and creation of blood vessels within the wound. It acts as scaffolding for the fibres within the skin and muscle, aiding the repair process. Studies on burn victims have shown that those supplementing with collagen were able to leave the hospital more quickly. This evidence suggests that collagen supplementation is a beneficial part of my recovery plan.

I also try to maintain a balanced diet, including plenty of fruits and vegetables. I take a creatine supplement, although I'm unsure of its role in wound healing. However, I know it helps with energy levels, which can only be beneficial (I'll give more details about creatine in the FAQ at the end). I also take multivitamins and supplements like omega-3 and omega-6 fatty acids.

It's essential to maintain a high-quality diet and protect your sleep. These are the foundations upon which your recovery will be built.

Back To Work!

Another positive aspect is that I've been able to get back to work. I had the operation on Thursday, took Friday off, and rested over the weekend. By Monday, I was back at my computer, working in one-hour intervals with breaks in between. It was a bit sore, but manageable. I made sure to ice the area afterwards, just as if I had been exercising. I've done a bit of work every day since then.

Andrew back at work

Getting back on with some work ASAP

Some might wonder why I’m pushing myself, but for my well-being, it’s crucial to focus on what I can do rather than what I can’t. Running my own software company, one of my concerns was falling behind if I took too much time off. Getting back to work not only helps me stay on top of things but also provides a sense of normalcy and achievement.

This approach has helped me relax. I know that if I need to take more time off, I can, but for now, staying active in my work and recovery has been beneficial.

To be honest, the idea of a backlog and a mess waiting for me would stress me out. By doing smaller tasks now, I prevent them from growing into bigger problems later. This approach allows me to work at my own pace. In my mind, I’m taking two weeks off, but I’m also allowing myself to do an hour or two of work daily if I feel up to it. If I can’t manage, I won’t beat myself up about it. But if I’m feeling well and want to work, I’ll do it. There’s no need to put up unnecessary barriers.

The Implant & Surgical Approach

In case you’re curious about the implant, I had an oxinium implant. It's a ceramicised metal that fits into a special kind of plastic, specifically 10 XLPE. I chose this higher-end option because, being younger, I wanted the best possible wear rating. Younger patients have a higher chance of wearing out the implant, and the Oxinium one offers superior durability.

Andrews hip xray showing the Oxinium implant

X-ray of the operative hip with the new Oxinium implant.

The Oxinium implant my surgeon recommended has very low wear. They test it for 45 million cycles under a 400-kilogram load. After all that testing, the plastic shows only 0.1 square centimetres of wear, and there’s no measurable loss in the oxinium material. If you take 3.6 million steps a year, that’s equivalent to 12 years of testing under a significant load, which gives a lot of confidence in the joint's stability. This was a critical factor in my decision.

Oxinum wear v.s. Colbolt Chrome

No significant loss in OXINIUM femoral head surface thickness was observed over 45 million cycles. Mean volumetric liner wear after 45 million cycles with OXINIUM femoral heads and 10-XLPE was 67% lower than with CoCr and 10-XLPE (p<0.05; Figure), and 80% lower than with CoCr and CPE after 7.8 million cycles (p<0.05). Source.

If you’re younger, I recommend researching the materials. Specialists debate other good options all the time, so it’s essential to discuss these options with your surgeon to understand the best choice for you. For example, some implant metals are strong, but have a high risk of elevating the amount of those metals found in your blood, or generate ions, which can cause health complication or in some cases rejection of the implant.

If you’re someone who likes to push themselves and finds activity and being active a core part of your identity, my recovery journey might resonate with you. When I looked online initially, I struggled to find relatable examples. Many people shared their experiences, but there were often small differences. For instance, in the US, the anterior approach is common, whereas in the UK, the posterior approach is more frequent.

There’s a lot of debate about which approach is better. Many advocate for the anterior approach because it supposedly has fewer restrictions. However, I had the posterior approach and the sugeon didn't give me any restrictions either. This highlights the variance in advice and experiences out there. The key takeaway is to trust your surgeon. Find a good surgeon you’re confident in and trust their expertise, as they understand the clinical data and variables far better than anyone else.

Mindset and Looking Forward

Andrew contemplating the future

At the moment, seven days in, I’m feeling pretty good and optimistic. I know that it takes four to six weeks for the tissue to heal properly, so I need to be cautious not to overdo it and set myself back. I’ll stick to the game plan and continue to move forward.

If you’re young, fit, and about to go through a similar procedure, hearing my story and seeing what I’ve been through might give you a benchmark for what to expect. Whether you recover as quickly as I have or take a bit longer, you’ll have your own unique journey. Hopefully, seeing my experience can help guide you.

But don't just take my word for it.

It seems like mindset and psychological skills can significantly impact performance and recovery. For example, A study published in Healthcare (Basel) shows the importance of Psychological Skills Training (PST) for athletes, highlighting various approaches like stress management, anxiety control, and coping strategies to enhance performance. This is particularly relevant for those recovering from surgery or injury, as adopting a positive and proactive mindset can facilitate faster and more effective recovery. Viewing challenges as opportunities and maintaining a growth mindset can improve your resilience and overall recovery experience.

To further emphasise the importance of mindset, a publication in JAMA explores how mindsets about treatment efficacy and the capacity to change can profoundly influence health outcomes. Mindsets, or the frames of mind that shape our expectations and motivations, play a critical role in recovery and overall well-being. For example, believing that a treatment will be effective can trigger physiological responses that enhance healing, much like the placebo effect.

This is why I strongly believe adopting a growth mindset (believing that your health can improve through effort and persistence) can lead to better management of chronic conditions and a more proactive approach to recovery.

As I approached my surgery, I decided to look forward to the training and rehabilitation journey. Post-surgery, although some moments have been challenging, I have genuinely enjoyed the small progressions and micro-wins along the way. These achievements have brought me great fulfilment, especially because I set my expectations low. Consequently, when I accomplished these milestones, it felt immensely rewarding.

Andrew wearing a cowboy hat talking positively about his experiences

 I got this Stetson cowboy hat in Texas for the World Championships this year. I wore it every day and had a lot of fun with it. I'll often put it on again at home in good humour, especially when the weather is good.

Everyone's recovery is different, but I had my first gym session yesterday, on day eight. I found plenty of exercises I could do using my back and upper body that didn't stress the joint or wound.

Even if your recovery takes longer, you can likely resume some activities within a few weeks, which isn't long in the grand scheme. It's not about being inactive; it's about finding safe ways to stay active within your limitations, avoiding setbacks. And, always consult your surgeon and physio. Don't just ask what you should avoid—also find out what activities you can safely do.

This advice applies to everything. Be careful the narratives you tell yourself, and don't let "I can't" become part of your identity; instead, ask yourself, "What can I do?".

Frequently Asked Questions

Frequently asked questions

Since writing, I've had a few common questions asked of me, which I'll answer here:

Why did you choose to document your recovery journey?

I chose to document my recovery journey because, when approaching the surgery myself, I was actively seeking content from people who had gone through a similar experience. Although I found some excellent content, like YouTube videos and blogs (Check out Peter Zierz's youtube playlist on his hip replacement experience), nothing quite matched my sporting background and age. This made it difficult for me to have a reference point for my recovery. By documenting my journey, I not only ensure I stay mindful of my recovery process, but also create content that could help others in similar situations.

What is the posterior approach to hip replacement, and why did you choose it?

There are several approaches a surgeon can take for a total hip replacement. Traditionally, in the UK, surgeries have been posterior, where they enter through the back/side, which can involve cutting through or even detaching a muscle. More recent techniques, like the anterior approach through the front of the leg, are sometimes preferred because they allow patients to resume normal activities more quickly and without movement restrictions, like squatting or crossing legs.

However, each approach has its pros and cons. For instance, while the anterior approach might offer a quicker recovery, it involves cutting through the quad, which can be problematic for quad-dominant lifters like myself. It also carries risks like potential nerve damage and requires a longer surgery with reduced visibility for the surgeon.

After researching and watching videos of both surgeries, I noted the increased complexity and potential for complications with the anterior approach. My surgeon recommended the posterior approach, assuring me that I wouldn't face the common limitations associated with it. Both approaches' Long-term outcomes are similar, so I decided to trust my surgeon's expertise, especially given their extensive experience with younger patients.

How did your fitness level before the surgery impact your recovery?

I was in excellent shape going into the surgery. I was still squatting relatively heavy weights, which, although light for me, were heavy compared to the average person. Competing at an international level in bench press meant I had exceptional upper body strength, within the upper one percentile. My body was like a well-oiled machine in terms of muscle recovery, consistently repairing and rebuilding after each training session.

This level of fitness was incredibly valuable for my recovery. I could differentiate between good pain and bad pain, and my body was accustomed to the repair process. I also maintained a growth mindset, viewing challenges as opportunities for improvement. This combination of strength, fitness, and mindset contributed to a relatively quick and pain-free recovery. I was able to resume activities quickly without overstressing myself, highlighting the significant role my pre-surgery fitness level played in my recovery process.

How did you manage pain and discomfort in the first week of recovery?

The pain I experienced felt more like muscle soreness rather than acute pain. It was more about weakness—my muscles weren't as strong as I wanted, especially during reverse abduction exercises (moving the leg inward while lying down). The hardest part was dealing with groin fatigue, which has been the main factor limiting my ability to move off crutches.

By day nine, I was walking around without crutches, feeling fine all day. But by the end of the day, my groin started aching, and I had to use a crutch again. Ironically, this discomfort wasn't from the surgical area. Throughout the recovery, I haven't felt much pain—just muscle soreness, which was different from what I expected. I thought I'd be in excruciating pain, affecting my well-being, but that hasn't been the case.

How have you managed motivation and well-being post-surgery?

Set the bar of acceptable progress lower and build up from that new baseline. Don't compare what you can do in the early weeks post-surgery to what you could do prior. You'll get there, but you need to reset expectations on how long that will take. This is a marathon, not a sprint.

Personally, I set my bar super low, so every little bit of progression felt like a win and was hugely rewarding. Even small milestones like taking first steps or going up the stairs without a crutch for the first time felt like setting new personal bests every day.

Try to reframe the experience as a challenge and play to win rather than play to not lose. If you can do this, you'll make better progress and be happier.

If you're struggling to gain perspective, book an appointment with your physiotherapist as soon as possible. Ask them to set exercises and provide a program with weekly targets that is safe based on your unique fitness level and stage of recovery. Most can do this, allowing you to see objective progress and regain enjoyment.

As mentioned in the article, get out in the sunlight every morning for ten minutes, eat lots of protein (2g per kilo of body weight), and prioritise sleep above all else.

What dietary and sleep habits did you focus on during your recovery?

Regarding diet, I’ve already mentioned some aspects, such as ensuring high protein intake and balanced nutrition, but focusing on sleep was equally crucial. I maintain a consistent sleep-wake schedule, going to bed at 9:30 p.m. and waking up around 6:30 a.m. To ensure good sleep quality, I avoid mentally stimulating activities before bedtime. We dim the lights and close the curtains and blinds to create a conducive sleep environment, especially important in summer.

I make sure not to turn on bright lights before bed to avoid disrupting melatonin production. I might listen to a podcast to wind down instead of having a busy mind. I also avoid caffeine after midday and even tea after 3 p.m. to prevent sleep disruption. Importantly, I’m abstaining from alcohol for at least six weeks as it’s detrimental to both physical recovery and sleep quality. So, if you’re considering a drink during recovery, I strongly advise against it.

How did you manage to get back to work without compromising your recovery?

I approached work with the mindset that I was officially off, only doing tasks on my own terms. This made work feel less like a chore and more like a choice. I ensured not to stay in one position for too long to avoid stressing the joint. I would work for about an hour, then take a break, maybe watch TV or do my exercises, and then return to work if I felt like it.

I scheduled meetings sparingly, limiting them to an hour or two at most, and only one per day to avoid mental fatigue. In the first week, this approach worked well. Howeever, when a meeting overran to two hours, I felt some discomfort, reminding me to adjust my position and take breaks.

Additionally, I bought a desk I could use while lying down, though I haven’t needed it. It’s a useful option for those recovering from hip surgery to do small amounts of work without putting too much strain on the body.

What advice would you give to someone young and active facing a similar procedure?

The data suggests that younger individuals are more likely to have a quicker recovery compared to older individuals. Similarly, being fit before surgery typically leads to a better recovery. If you’ve been dealing with arthritis or another condition for a long time, and your condition has worsened, your recovery might take longer.

I was fortunate to be very fit and young, and I acted relatively quickly, which contributed to my fantastic recovery. For setting expectations, consider these three factors: your age, fitness level, and how long you’ve had your condition. Additionally, focus on recovery habits like adhering to the program, maintaining a good diet, and ensuring quality sleep.

While you can't control all factors, aiming for optimal habits can enhance your recovery chances. However, remember that recovery is personal and varies greatly. My experience might not translate to yours, and even another surgery for me could yield different results.

It’s not a competition, so don’t beat yourself up if your recovery takes longer. My journey is an example, but yours will be unique. Prepare for the worst-case scenario, and if you achieve a best-case scenario, that’s fantastic. I prepared for a four to six-week recovery before returning to the gym or work, hoping for a quicker return, which luckily happened for me.

Any online resources you recommend?

Yes, of course, here are a few places I frequent:

  1. The Total Hip Replacement Subreddit
  2. The Hip Replacement Forum for Active and Young People Facebook Group
  3. Peter Zierz's YouTube playlist on his hip replacement experience

Are there any items you recommend people consider buying if they are about to have surgery?

Everyone's journey is different and will need different things, but to give you an idea, here are a few things I bought to prepare for my recovery:

  1. Surgery recovery set (Particularly the leg loop lifter, shoe horn, and shower scrubber)
  2. Laying down the laptop stand
  3. Wedge pillow
  4. Collagen Type 1 and 2 supplement
  5. High-quality protein powder
  6. Hip Ice Pack
  7. Creatine supplement
  8. Vitamin D supplement
  9. High-quality multivitamin
  10. Ibuprofen (Tylenol for our US readers)
  11. Paracetamol (Acetamorphen for our US readers)

Again, if you compete in a WADA-recognized sport, make sure any supplements you get are high-quality batch-tested ones, such as Informed Sport.

Why are you supplementing creatine post-surgery?

I've supplemented this stuff for decades.

I'm still taking creatine because it's not just for its benefits in sports performance and muscle building—it's a versatile supplement that offers multiple benefits, especially during recovery. Creatine supplementation may speed up recovery between intense exercise sessions by reducing muscle damage and promoting faster recovery of lost force-production potential. It significantly boosts cellular energy production, which is crucial for healing and helps my muscles and body work more efficiently.

Beyond the physical, creatine supports cognitive function, keeping me sharp and focused—a big help when balancing work and recovery. Creatine also has anti-inflammatory properties that help reduce post-surgery swelling and support my immune system. Essentially, creatine is like a multi-tool in my recovery kit, aiding in quicker recovery and helping me stay on top of my game.

I think of it this way: if something is cheap, safe, and has many possible upsides with few to no risks, why wouldn't I take it?

Conclusion

My documented journey provides a perspective on what recovery might look like for someone with a similar mindset. I hope watching my experience could help you understand what to expect and how to navigate your own recovery process.

I’ll continue recording my video diary over the coming weeks, and hopefully, my posts will provide valuable information.

Feel free to ask any questions, and please follow me on my Instagram, @andrewleeward, where I post daily highlights. This article provides a quick summary of the key information. As mentioned a few times in the article, I recommend watching my week one highlights reel videos for a more in-depth understanding and a realistic view of what to expect.

I hope this helps!

DISCLAIMER: I am not a medical or nutrition professional and am not qualified to give medical or sports advice. The information provided in this article is for informational purposes only and is provided "as-is". It should not be interpreted as medical, nutrition, or sports advice. Please make sure you do your own research and seek the advice of qualified professionals to guide your actions.