May 22, 2021 / by Jon Bellis / No Comments

If you’re heading for a hip replacement of any kind, or you know someone who is due to have one, you may find this post contains some useful insights. It’s about the things they don’t tell you when you have a Birmingham Hip Resurface.

The hip I was born with had grade four osteoarthritis brought about by a misshapen femur. The head of my femur had a protrusion that didn’t fit in the socket properly. So, every time the head of my femur attempted to enter the socket, it wore the joint down a little. Over the course of 50 years, it eroded it to bone-on-bone.

But no matter! You can get a new hip these days. And that’s what I did.

I recently had an operation called a Birmingham Hip Resurface (BHR) at the Royal Orthopaedic Hospital in Birmingham.

Jon outside the Royal Orthopaedic Hospital. Birmingham Hip Resurface

It’s a particular type of hip replacement for ‘young adults’. It feels good to be categorised as a young adult. And it gives a clue as to the typical age of patients who require a hip replacement. If I wasn’t so young, at the age of 54, I’d have had to have a full hip replacement at Northampton General Hospital. And that would have been a more restrictive outcome; the BHR allows unlimited movement whereas a full hip replacement imposes movement restrictions. So, in some ways, I’m pleased my hip wore out while I was so ‘young’.


An entirely positive experience

The BHR ought to be a major operation. And it is, really.

Large scar and dressing from the operation. Birmingham Hip Resurface

But it felt as ordinary as having a tooth out, for two reasons. First, it’s a fairly routine operation these days, so the whole thing is pretty slick. I was in and out in 36 hours. Second, my recovery has been remarkable. Eight weeks on, I’m more capable than I was before, I’m back to squatting decent weight, and there’s very little I can’t do. The whole experience has been entirely positive.

Before the operation, I was provided with all the information I could possibly want. I knew precisely what was going to happen and when. I knew exactly what to expect. Or so I thought. There are some things they don’t tell you. Not bad things, you understand, just unexpected. And sometimes rather amusing. Maybe they weren’t funny at the time, but I have to chuckle now.

In this post, I share with you ten unexpected things about my Birmingham Hip Resurface.


It’s not a resurface at all

The name of the operation makes it sound like they simply smooth off the two surfaces and coat it with something smooth and shiny.

I discovered during my six-week follow up that, in fact, I have a big lump of metal in me. Rather like a full hip replacement, with the Birmingham Hip Resurface, they saw off the top of your femur and put in a new ball. It’s just that with the BHR, they saw off less of it.

I also found out something else that explains how strange it feels when I lie on it. The new ball they put in is bigger than the bony one they replaced. That means it sticks out further than normal. And that’s exactly how it feels. When I lie on my side, it feels a lot lumpier than the other side.

One consequence of having a bigger ball is that the tissues that extend over the ball are now in a more stretched position. And that explains some other weird stuff about this operation.


I was lucid immediately after waking

I’ve only had a general anaesthetic once before in my life, and I was sleepy for about three days afterwards.

How things have changed! Immediately upon waking, I was able to have an articulate conversation with the nurse. And about 3 hours later, I completed 90% of the New Scientist crossword. The unfinished 10% would have evaded me in any event.


I couldn’t pee

I drink a lot of liquid usually. And as soon as I was able after the operation, I rehydrated. Of course, it wasn’t long before I needed a pee. So I got my crutches and shuffled off to get some relief.

Nope! That wasn’t happening. Try as I may, I couldn’t get a drop out. It’s a bizarre sensation. Your bladder is full, you’re willing and trying, but nothing happens. The spinal anaesthetic had affected my ability to relax the appropriate muscles to enable the flow.

I’ll give it an hour or so, I thought; failed again. It just wasn’t going to happen. Two more hours of trying, and I was desperate. Eventually, I had to have a catheter fitted, much to my embarrassment. But what a relief!

Now, although it was a little undignified having it fitted, I have to say it was rather convenient. I didn’t have to get up for a pee once. And I had a great night’s kip because my bladder never filled up. I did have to get up once though, because my 2-litre bag filled up in the middle of the night, and I had to go and empty it.

A full bag!

Too much information? Wait until you read about my constipation!


I walked up and down the stairs six hours post-operation

You’re encouraged to move as soon as you can. Indeed, I was shuffling around on my crutches within a couple of hours. And later in the afternoon, the physios came round to see how I was getting on. Within 15 minutes, I had gone up and down the stairs with two crutches and then repeated it with one crutch.

From a physiotherapy perspective, they signed me off for release there and then. If I hadn’t been required to stay in overnight as a standard precaution, I could have walked out of the hospital six hours after the operation.

Walking up the steps in the garden two days post op. Birmingham Hip Resurface


I fainted

I have never fainted in my life. I’m not a fainter. But the morning after the operation, just after I had had my catheter removed and gone for a pee naturally, I went for a shuffle up the corridor. On the way back, it hit me very suddenly. I felt very odd, moved to the wall of the corridor to prop myself up and….. Well, the next thing I knew, I was surrounded by nursing staff who were trying to wake me up.

I came round, but I was flat on my back on the floor. They brought me a chair, and I used all my upper body strength to haul myself into it. And the effort of doing that made me faint again! It was only for a few seconds this time, but it was my second ever faint. Two in 5 minutes!

It never happened again. I figured I just needed some of that hospital toast and a bowl of cornflakes. But, according to the nursing staff, it happens all the time. They couldn’t tell me why, but it’s something to do with the anaesthetic and all the meds they pump into you afterwards.


My leg collapsed inwards going round a roundabout

I never saw this coming. With the Birmingham Hip Resurface, your glute max is cut through lengthways, and mine remained strong even after the operation. But other muscles are sliced in half crossways and, for me, were completely dysfunctional after the procedure. The muscles that open your legs – they were completely shot.

And so, much to my surprise, as I was being driven home the next day, my leg collapsed inwards when we went around the first right corner. And even with as much focus and effort as I could muster, I couldn’t prevent that collapse. I had to hold it in place with my hand.

Even now, two months later, I still have to remind myself to push my leg out to stop it from collapsing inwards going round a roundabout. My abductors and external rotators are getting stronger, but they’re still repairing.


I had to inject myself for 28 days

This was unpleasant. I feel sorry for people who have to do this every day for their entire life. What was it for? It was a blood thinner – probably heparin – to prevent clots. I should know what it was, but I just did as I was told.

The syringes came in little packs, already loaded and sterilised. I had to stick it in the fat in my belly and empty the syringe. Sometimes the needle didn’t go in, and I had to force it. And that was when it was very painful.

I grew to dread and hate this little daily routine. My stomach was covered in bruises, and I breathed a sigh of relief when I’d used the last syringe. They don’t tell you about this. Not that I would have declined the operation. But I imagine anyone with a phobia of needles might want the heads up at least.


I thought I knew what constipation was like

You’re given laxatives and senna to take twice daily. It’s to counteract the tendency of the pain killers to induce constipation. I have to pronounce that it didn’t work!

This experience actually scared me because, for a time, I couldn’t see a solution. I’ll try not to be too gross. I had a stool that was too big and too hard to pass. There was pressure from behind, and my body was trying to eject it, but it simply didn’t fit and was too firm for my body to squish into a better shape.

I called the doctor and was prescribed suppositories. But I didn’t get to use them. The pressure was so great by this time that I actually passed the offending stool. But it split me, and the pain was eye-watering. Never mind an epidural for the hip operation; I could have done with one to pass that thing!

I ditched the heavy-duty painkillers at that point and relied on paracetamol instead. And you know what? It was fine. And that was only a few days post-op. I never really experienced any pain in the hip. You have to applaud the medical team; they did such a neat and pain-free job on me.

The undressed scar.


I can’t put my right sock on

Two months after the operation, I can squat 65 kg for 12 reps, I can do walking lunges with 30 kg in my hands, and I can do 80 kg Romanian deadlifts.

But can I put my socks on? Not with two hands, that’s for sure. I have to use one hand to hook it over my toes and then pull it on. Reaching the end of the toes with two hands is impossible at the moment.

I think it’s caused because the Birmingham Hip Resurface results in a bigger ball for the hip socket. It’s tightened the structures in my hip that would normally yield to allow that action. I guess I just have to wait until those tissues lengthen. It’s getting better, but slowly.


I can’t lift my leg

This was unexpected. My hip flexor is completely inhibited. That means, if I’m lying down or sitting, I can’t lift my leg. Well, I sort of can, but not using the usual muscles.

It’s weird, this one, because they didn’t cut my hip flexor. It’s nowhere near the site of the surgery in a Birmingham Hip Resurface. Yet it’s dysfunctional. Apparently, they moved it during the operation. I guess that moving it has somehow damaged it or inhibited it. It’s very slowly improving. But in the meantime, it’s interesting to see how often that muscle is used in everyday movements that I can’t do properly. It’s not ruining my life or anything, and sometimes it’s amusing. It’s just a little inconvenient from time to time and, well, unexpected.



Having a Birmingham Hip Resurface operation has been an almost entirely positive experience. I now have capability that I didn’t have before, and I don’t have any pain in the joint. It’s miraculous. What would my life have been like before this kind of surgery was available? I’m so grateful to the smart people and slick teams who make this happen for people like me.

But it’s interesting to see just how many curious and unexpected things occur as side effects of such a life-changing operation. The good news is that they are all temporary. Some are already a memory. But even those that persist will eventually disappear. And at that point, I’ll be fully functional, very slightly bionic, but definitely better than before. How fabulous is that?


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