Ouida Dickey, 86, likes to stay active. “I don’t sit home in the rocking chair,” says Dickey, a retired college professor and former academic dean at Berry College in Rome, Georgia. But after retirement, “great pain” in her hips from osteoporosis was making it hard to walk and putting a damper on life. In 2011, after weighing her options, she had a right total hip replacement.
When your bad hip — from a medical condition or trauma — is working against you to the point of constant pain and disability, and you’ve exhausted all other treatment methods, hip replacement may be on your radar.
Where to Look
If you’re choosing a surgeon, consider his or her experience, level of specialization and outcomes (such as infection rates and need for surgical revision), and how well patients function soon after surgery and months and years down the road. Some orthopedic surgeons are generalists, while others specialize in areas like joint replacement. When deciding on a surgeon, don’t hesitate to ask these questions:
— How many of these procedures have you done in the past year? Overall?
— What were complication rates? What post-operative infection rates did you see?
— What if I need a revision surgery? How often does that happen?
— Six months after surgery, how is hip function for most of your patients?
— How are patients doing five years later?
— Have you measured patient satisfaction? How is it?
Look for a high-volume facility — one that regularly performs these procedures. Depending on your location, choices can range from major medical centers to facilities that concentrate on hip and knee conditions.
“You want to make sure you go to a surgeon that’s comfortable doing the procedure and does a lot of them,” says Mark Zawadsky, an orthopedic surgeon at MedStar Georgetown University Hospital. “It’s a routine procedure that should be done in a routine manner, and you should have systems set up to handle the pre-op clearances and the anesthesia and the pain management protocols and the physical therapy.”
Read: [10 Lessons From Empowered Patients.]
Matter of Approach
As you go online to research surgeons, you’ll notice many describe their surgical “approach” — using either a traditional posterior (rear) approach to reach the hip joint, or an anterior (frontal) approach, which is becoming more common. “My concern was finding the approach that was the least confining and wouldn’t keep me out of operation very long,” says Dickey, who had her hip replacement done by orthopedic surgeon Thomas Bradbury in Atlanta. He used an anterior approach.
Zawadsky explains the distinction: “One of the big differences [with anterior] is all of the muscles are still intact. We stretch them and pull them out of the way as opposed to cutting the tendons and repairing them to bones,” he says. “So when we do the replacements [posteriorly], we have to allow six weeks for the tendons to heal back to the bones — and that’s where your ultimate stability of the joint comes from.”
Joel Matta, an orthopedic surgeon in Los Angeles who specializes in hip and pelvic reconstruction, is a strong advocate for the anterior approach, which he’s been using since 1996. (He’s co-designer of a special surgical table meant to be used for that approach.) Matta believes the anterior surgery may reduce rates of post-op hip dislocation and help surgeons achieve greater accuracy in terms of leg length. But the jury’s still out on this issue, with large, long-term studies and definitive results lacking.
When it comes to deep infection of the hip prosthesis, Matta says infection rates should be less than 1 percent — regardless of approach.
A comparison study by Zawadsky found short-term advantages for the anterior approach: Patients had shorter hospital stays by about a day, reported less pain, used less narcotic pain medicine and relied less on walkers or canes.
The biggest plus might be not having to worry about dislocation precautions after surgery — things like not bending your hips more than 90 degrees or moving your knee a certain way, using an elevated toilet seat, sleeping with a pillow between your knees and not driving for several weeks. Zawadsky says with an anterior approach, these restrictions aren’t needed.
Cale Jacobs of Lexington Clinic in Kentucky is a co-researcher for an ongoing study of the two approaches. Early results also suggest the anterior approach allows patients to be active sooner, but on the downside, the researchers are seeing more wound complications with it.
Anne Gittelson-Leck, 50, of Long Island had both hips replaced, in separate procedures using the posterior approach. Four months after her second surgery, she’s doing well. “It really took a full year for my first hip to feel completely ‘normal’ although I could do everything athletically much sooner.” she says. “My right hip [the second replacement] seems to be the same way,” she adds.”I feel great — I have some soreness and stiffness — but that’s it.” She’s walking, riding her bicycle and even took a few Zumba classes, although she exercises “with caution.”
Read: [Choosing Between Partial and Total Knee Replacements.]
About Recovery
After you choose a surgeon, the National Library of Medicine suggests questions to ask about hip replacement and how it will affect you, including, “How well does this surgery work for someone my age and with any of the medical problems I may have?” Make sure your surgeon and other health care providers are up-to-date about health status — medical conditions, complete list of medications, allergies and other precautions — in advance.
Find out how side effects will be managed in your case. For instance, ask how long you’ll wear compression stockings after surgery to prevent embolisms (blood clots) and what sort of anti-clotting medicine you’ll receive.
Ask about activities — such as golf, tennis or hiking — and when you can resume them. (Most activities are fine after hip replacement, but many surgeons advise against running.) Also, ask how you can prepare before surgery to make the outcome more successful — such as learning to use crutches or a walker before you actually need them, and how to manage stairs. And talk to your doctor or physical therapist about how to get in the best possible shape before surgery, to make recovery easier.
Also ask about your surgical wound care and supplies. Matta says one of the few restrictions he gives patients is not to immerse themselves in water — a Jacuzzi, bathtub or pool — during the first few weeks until the wound is healed.
Read: [12 Questions to Ask Before Discharge.]
After Surgery
Following her hip surgery and three days of recovery in the hospital, Dickey was transferred to a rehabilitation center for physical therapy. When she left two weeks later, she says she was walking “very well.” (Some patients go straight home after discharge and get outpatient physical therapy.)
Within a month, Dickey was walking around the house without a cane, although she would take one outdoors if “surfaces were questionable.” But after a month, she was cane-free. She says if she had to do it again, she “would have had [the procedure] a year earlier at least.” Now she’s glad she can walk through her Rome neighborhood again and follow all her interests.
Read: [Exercising After You’ve Gone Under (the Knife, That Is).]
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Your Steps Toward Total Hip Replacement originally appeared on usnews.com
