I'm hip!

I'm hip!

My hip replacement surgery was Wednesday, January 6^th and everything is going well.

I was in surgery a little over an hour and left with a 3 ½ inch vertical incision in my left groin.  That's it.  No stitches that I can see.  The skin is held together with glue, so I don't have to return to have sutures or staples removed.

I chose a non-traditional surgery for my hip replacement called the direct anterior approach. 

The anterior approach differs from the traditional posterior hip surgery in that no muscles are cut during the procedure.  It's a minimally invasive hip replacement procedure. 

I watched the entire procedure before making my decision to proceed.  If you're interested—and watching an actual surgery doesn't bother you---you can access the video I saw at ORLive, Inc.: Anterior Approach to Total Hip Arthroplasty Anterior Approach to THA: Performed by Joel Matta, MD

Just Between You and Me

Most of the information I'm going to share with you is the same thing I'd tell friends over coffee.  They know I'm not a doctor.  Don't even play one on TV.    I'm just someone who---like many of you---has been looking for answers to this pesky hip pain.

Much of what I've learned in the past months came from people who had "been there, done that."

I'm grateful for their taking the time to answer my questions and for letting me know what worked for them and what didn't.  And, most importantly, for giving me enough background information to be able to ask the right questions when I had appointments with medical professionals.

In fact, it was fellow Oklahomans who had undergone the anterior approach hip replacement surgery who first told me about the procedure. 

The advantages to the anterior approach seemed significant:  no restrictions on movement following the surgery, less recovery time, less post-operative pain, fewer problems with leg length discrepancies and virtually no chance of dislocation of the new hip.

It was based on the experiences of those who had already had the surgery---and hours upon hours of my own research---that convinced me to head to Santa Monica, CA for the first of two hip replacements by Dr. Joel Matta at St. John's Medical Center. 

My Experience

I'll be happy to share my personal experience with the surgery---both the highs and lows---later in this blog.

But for those of you who want to "cut to the chase," here are several sites that will give you basic information about the anterior procedure and hip replacement in general:

Dr. Joel Matta and the Anterior Approach to Total Hip Replacement

Hip and Pelvis Blog Spot

Anterior Hip Replacement

http://www.johnshopkinshealthalerts.com/reports/pdfs/JHHAGuidetoHipReplacement.pdf

Understanding Minimally Invasive Hip Replacement Surgery

http://www.hipsforyou.com/index.php

Your Orthopaedic Connection

So, here we go.

The Big Adventure

At least that's what my husband, Will, called it.   We arrived at St. John's Medical Center just before 7 a.m. for pre-surgery blood tests and paperwork.  

It's a beautiful facility, only opened a couple of weeks ago.  State of the art.  And, designed to withstand the earthquakes that had shaken the foundation of the old hospital.

Each surgery patient is assigned a number by which family members can trace his or her progress around the hospital on television screens.  Will knew exactly when I was in pre-op, when I was moved to the surgery suite and when surgery ended.

Dr. Matta visited with Will after the surgery and said everything had gone just fine.  He said he'd lengthened my left leg because arthritis had worn away the joint to the extent that I was a little shorter than I had been.  He said when he replaces the right hip and lengthens that leg later this spring, both will be even.

So, What Hip Implant Was Used? 

After discussing the options with Dr. Matta, we decided to have use a ceramic ball and cross-linked polyethylene for the replacement.  There are any number of good options that range from metal on metal to ceramic on ceramic to a combination of both.  All options have their own unique advantages and disadvantages---which makes the decision even tougher.

Much has to do with how old you are and how you intend to use the joint.  Someone who intends to jog is going to need a harder weight bearing surface than someone who is content to stroll.  

As I was advised, the bottom line is that you want the components that will give you the best chance of maintaining your lifestyle for decades to come.  With the information I had available, ceramic and cross-linked polyethylene seem to do just that.

Recovery

The first thing I remember was opening my eyes in recovery and seeing a huge clock on the wall at the end of the gurney. 

12:45 p.m.

I'd been in recovery about thirty minutes.   The spinal block was still strong so I felt no pain from the operation. No nausea---which had always been my biggest foe in prior surgeries.  I felt great, which was a pleasant, unexpected surprise.

I was in recovery for an hour or so and then taken to my room.  One of the first people who came to visit was Deb, a physical therapist, who had me out of bed and walking across the room on a walker within two hours of the procedure.  

 

Frankly, the first day was probably the easiest one.  As the day progressed, I could certainly tell that something had been done, but it wasn't an overwhelming pain.  More like an ache or a feeling of pressure.  

In fact, on a scale of 1-10---with "1" being no pain and "10" being the worst---my pain level never went over a "4" during the entire 48 hours of hospitalization.    That's in marked contrast to times during the past year when the hip pain itself could sometimes top "8".

I had special stockings on both legs to help prevent blood clots from forming.  They'll be my constant companions for the next six weeks.   I also had compression devices on both legs that massaged my calves to keep the circulation strong---another anti-clot measure.  And, as a final precaution, I'll be taking two aspirin a day for the next month to keep clots from forming.

Ice Is Your Friend

In fact, my best friend. Nurses brought me several ice packs immediately after the operation and throughout the day.  I felt like a polar bear on a glacier.

But, it did what it was supposed to do:  it kept the swelling down.

Although Dr. Matta doesn't cut muscles when he replaces the hip, the soft tissues around the joint are manipulated and become sore.  The ice minimizes the build-up of fluids in the area around the joint replacement. 

(I made a crude measurement of the circumference of my left thigh, and it's swollen about two inches more than the normal.  That's not a lot, so the ice worked.   The nurses advised me to ice the joint as often as I want in the next couple of weeks, particularly if I've been exercising or standing for a long time.)

The Morning After

Deb, the physical therapist, was back bright and early.  She showed me how to use a walker, then a cane before we headed to the hallway for a walk up and down the corridor.

I'm able to put full weight on my new hip and there are none of the movement restrictions commonly associated with traditional hip replacement.   There's virtually no chance I'll dislocate the hip.  And there's no multi-week physical therapy required after the surgery.  Deb is there to make sure I get up and start using the joint as quickly as possible.

Our next challenge:  the stairs.

I thought it would difficult and perhaps painful.  But, she made it easy.  Deb said, "Just remember when you're walking up a step or a curb, your 'good' leg goes up first followed by the other. "

It's just the opposite going down stairs or down a curb.  Your operated leg goes first and then your "good" leg joins it on the same step.  

"Your good leg takes you to heaven (up).  Your bad leg takes you to hell (down)," she says.

Easy to remember.

Peaks and Valleys

I was warned that recovery would be marked by big steps forward and sometimes a few back.  The anti-nausea medication they were giving in conjunction with the pain medication worked well until the second day.  Then, my stomach rebelled.  I also felt weaker on that day than previously.

Although the anterior approach is classified as "minimally invasive," hip replacement is still major surgery.  I think on that second day I was feeling the results of blood loss.  (Some patients donate 1-2 units of their own blood prior to surgery in case a transfusion is necessary.  It's not likely but can happen.  The choice to donate is left up to the patient.  I decided not to bank blood because the donation had to be made in the month prior to the surgery and the timing simply didn't work out.) 

By Friday---just 48 hours after the operation---I was ready to be discharged.   Their standard protocol requires a leg ultrasound to check for blood clots. It was the last thing we had to do before we could walk out the door.  It was clear.  I was out of there.

Rest and Relaxation

It's suggested that out-of-town patients spend a night or two in the area to make sure they're strong enough to travel home.  I'm glad we did.  

I found that I tired easily.  A block-long walk was enough to make me want to nap.  My pain level, however, remained surprisingly good.  I took no prescription pain medication after leaving the hospital.   There was stiffness and swelling, but none of the pain that had been my companion for so many years.

One Week Anniversary

Seven days after the surgery, I remain surprised at at how well I'm doing---and grateful.  I used crutches for the first four days but then found, if I walked slowly, I could manage without them.  (I've thrown a cane in the trunk for any "just in case" moments that might pop up, but I'm very happy with the recovery so far.)

I'm driving, running errands and getting on with every day life.  I rode a stationary bike for a mile this afternoon with no discomfort from the replaced joint---although the right hip continues to talk to me.

The most discomfort seems to come from sitting for a time and then standing up.  It takes a moment or two to convince all the parts to work together.

In six weeks, I'll have x-rays taken locally and sent to Dr. Matta for follow-up.

In the meantime, I have very few restrictions.  I can sleep in any position that's comfortable.  I can put full weight on my hip.  I can resume any activities that I feel up to doing.

And, I guess that includes returning to work.

I'm really looking forward to seeing you again.

Questions? 

If there's something I've failed to cover, feel free to e-mail at linda.cavanaugh@kfor.com

Time For Surgery

Time for Surgery

I’m hours away from the surgery suite. I’ve gone through all the pre-operative exams and tests and all look good.

They use a system here where a physician who specializes in taking care of those in the hospital follows your progress from pre-admission to discharge.

My hospitalist will be there before surgery and later to coordinate pain management and whatever other issues arise.

On the advice of the surgeon, I’ll have an epidural instead of general anesthesia. The epidural will be similar to what many women use for childbirth.

It numbs you from the waist down. The surgeon says an epidural reduces the complications of surgery and reduces blood loss during the hip replacement procedure.

I like the sounds of that.

What I didn’t like was the thought that I’d hear the buzz of the saw and the bang of the hammers as the body carpenters set about their work. But they assure me I’ll be under a light sedative in addition to the epidural and will wake up in recovery remembering nothing.

The Operation

I’ve watched a total hip replacement on the internet and it’s fascinating. It lasts about an hour and twenty minutes. Having seen it from start to finish, I’m convinced orthopedic surgeons are engineers, artists and physicians all rolled into one.

In the beginning, surgeons were concerned with finding materials to replace the human hip that wouldn’t wear out and would function as well as the original joint.

They’ve made such great progress in that regard that now attention is being focused on the operation itself.

Depending on the surgeon and the procedure he or she uses, the incision can vary from three to twelve inches. Recovery can be a matter of days or a matter of weeks.

Some procedures require physical therapy, others don’t.

What To Expect

If all goes as planned, I’ll be in the hospital two nights and released on Friday.
They tell me I’ll be walking on the day of the surgery and will quickly move from walker to cane to needing nothing.

I can’t wait.

You can reach Linda at Linda.Cavanaugh@kfor.com

New Year. New Hips. New Me.

That’s my mantra for 2010.

The hips Mother Nature provided me have exceeded their warranty. They’re shot. Worn out. Or, as they say, I’m on my last leg---or legs in this case. Now, like many Oklahomans, I’m destined for hip replacements.


What Happened?

The first hint of trouble came about 15 years ago. I noticed when I’d begin my morning jog that my right hip had problems getting with the program. It would protest with small stabs of pain. I ignored the discomfort because it tended to go away as I ran. I just figured the hip needed a little time to warm up.

But then, it started hurting even when I walked. At that point I knew something wasn’t quite right.

The Diagnosis

I headed to a local orthopedic specialist who slapped the X rays up on the wall and said, “There’s your problem.”

My hip sockets aren’t normal. Simply put, they aren’t shaped the way they’re supposed to be shaped. It’s a condition called hip dysplasia and it was there from birth. Turns out to be a hereditary problem in my family.

Now What?

The surgeon told me I’d likely eventually need hip replacements. But, he advised me to hold off as long as I could. He said the implants they had available at the time would last only eight to ten years---which could possibly mean I’d need multiple hip replacements in my lifetime. That wasn’t a good option.

So I Learned to Live With It

For more than a decade, I modified my activities. I gave up jogging and began to walk for exercise---until that became too painful. Then I switched to an elliptical trainer, which is a good weight bearing exercise without the impact of taking steps. When that became uncomfortable, I started riding my bike around Lake Hefner. Now that hurts.

Are There Alternatives to Surgery?

You bet. And I’ve tried most of them. From acupuncture to chiropractic, from medication to physical therapy. But the bottom line remains the same: the cartilage is gone from my hip joints. That’s what’s causing the pain.

As it was explained to me, my hip joint should have a smooth surface, similar to the rounded top of a light bulb. Mine look more like popcorn balls. Early onset arthritis---fueled by the dysplasia--- had eaten away the surface.

Even knowing that, I still resisted hip replacements following the earlier advice that I wait as long as possible before having surgery.

In the meantime, I watched advances in technology and knew the lifespan of the implants themselves had improved. I also knew that the surgical technique was changing. So, I waited.

The Final Straw

My discomfort has continued to worsen. During the past six months, normal, everyday activities became a challenge. I could no longer bend over to pick up things from the floor. I couldn’t sleep at night because of the pain.

At work, it was sometimes so uncomfortable that when I’d have to stand to anchor in front of a set, I’d sit on a stool during the commercial break until it was airtime.

It was on one of those days that I realized that I wasn’t going to be able to walk across campus for my son’s graduation from law school in May.

The time had come.

Surgery

When the decision was made, I began researching surgeons, techniques and even the material used in the implants. I want mine to last the rest of my life---which I hope is several more decades.

Today, on my 35th wedding anniversary, my husband, Will, and I are celebrating by starting the steps to get the first of my two hip replacements. You know the drill. Pre-surgery exams and tests. Blood work. Insurance forms.

The surgery is scheduled for mid-week.

Instead of a traditional anniversary gift, Will told me his morning I could have my choice: a ceramic hip or metal.

What a romantic.

You can reach Linda at Linda.Cavanaugh@kfor.com