The Operation

This page contains photos, audio, and a description of the operation. If that is more than you want to know, skip this page.

OK. Now they cut. They cut right through the clear plastic membrane so none of my skin is exposed to the open wound. It takes them a while to cut down to the bone. They cut through some of the muscles and tendons around the hip joint. Then they cut around the ball at the top of the femur to release it from the socket in the pelvis. If you have ever tried to separate an undercooked thigh from the body of a turkey, you know it can be difficult. But they finally they get my femur disconnected from my pelvis. Many muscles are still attached, though, so they are always moving my femur around to get it in a good position or to get it out of the way.

The next step is to cut off the ball at the top of the femur. Here’s what it sounded like:
20130402 130457 saw

And here is Dr. Tomford showing me the ball and explaining that it is in fine shape but has no cartilage left on it:
20130402 130629 No Cartilage

I’m going on two week-old memory here since the partial video I got doesn’t have the first hour or so of the surgery. If I manage to get the entire video, I will revise the following if necessary.

The tool I hear Dr. Tomford ask for the most is a “bone hook.” It is one of several tools they use to keep my femur out of the way so they can work on the socket. The socket is down at the bottom of a surprisingly deep hole. I never got a good view of it because the camera was a little off to the side.

They use a rasp to clean out the natural socket down to the bone so the titanium socket will fit perfectly. The rasp is spherical and the surface is shaped like a cheese grater. The material they remove winds up inside the sphere. There are many different sizes and progressively larger ones are used until the socket is clean. In my case they started with a 52 or 53 and finished with a 61. I assume these dimensions are the diameter in mm. The tool is very quiet so I didn’t get any good audio.

Then the metal part of the socket is hammered home. It is a 62 being hammered into a 61 hole. The hammering makes noise but the shock of each hammer stroke travels up my spine, too, so I hear it two ways: over the air and by bone conduction. Here’s what it sounds like over the air:
20130402 133224 hammer cup
He really hammered it home, huh?

OK. We’ve got video from here on out so I am more confident of the details.

Next Dr. Tomford hammers a series of broaches into the femur to create a shaped hole to accept the prosthesis. The positioning of this hole is crucial to proper installation of the prosthesis. Here’s the meanest looking broach:
2013-04-19 134413

And here he is hammering it in:
2013-04-19 134558

And the sound:
20130402 134135 hammer broach

To get you oriented, my trunk goes down off the bottom of the frame. My hip is bent at an angle so my thigh goes off to the left. Dr. Tomford is on the right and Dr. May is on the left. But look at my lower leg! Dr. May has twisted it way up so the femur is rotated enough so Dr. Tomford can get to the inside of the top of the femur. Ouch. It’s a wonder I ever walked again.

Occasionally they flush out the wound with what looks just like a turkey baster:
2013-04-19 135501

Here Dr. Tomford is placing the plastic cup into the metal socket that he hammered into place earlier:
2013-04-19 135530

Here he is placing the prosthesis into the femur:
2013-04-19 140053
The shiny part is bare titanium. The white part is coated with a rough material that the bone can grow into. The top is hidden by his hand.

Here the prosthesis is in. You can see the shaft that will receive the ball:
2013-04-19 140135

Here the ball is being hammered on:
2013-04-19 140738

Here you can see the ball:
2013-04-19 140802

Dr. Tomford moves the ball into the socket and does a final check on its operation. Now it is time to put things back together again. A few holes are drilled into the femur to accept stitches:
2013-04-19 140939

And then a lot of stitching:
2013-04-19 141351

A cocktail of anti-inflammatory, antibiotic, and pain killer is injected in the surrounding muscle tissue:
2013-04-19 142838

Finally they peel away the plastic because they are ready for the top level of stitches:
2013-04-19 143300

Final frame of the video shows Dr. Tomford stapling one end of the wound while Dr. May is finishing the stitching at the other end:
2013-04-19 143825

Here is the sound of the staple gun:
20130402 143832 stapling
A total of 27 staples will hold things together for two weeks.

End of operation.