New Hip

[PoginyHill]

I had a new hip joint installed yesterday. Bad genetics, I guess to need one so young. Only one side was bad. The other looks fine on X-ray. My mother has had both hips replaced. But my 90 yr old father has had no arthritis - still walks in the woods ("retired" forester) and tails boards off my brother's Cooks sawmill.

Had the replacement done at the day surgery department where my wife is a nurse. They transitioned to total joint replacement being day surgery last year because of Covid. In order to continue elective surgeries, they could not be admitted, due to lack of beds - or at least the anticipation of limited bed space. And these surgeries are the lifeblood of small hospitals. That's where they make their money.

Arrived at the hospital at 8:30A, left at 2:30P. Anterior method (only method that does not require a hospital stay afterward) which does not cut any muscle; just moves it around a lot to pop the ball out of the socket to cut it off and replace it.

No restrictions whatsoever. Only what I can tolerate. Getting around with a cane as precautionary. But able to walk fine for now. There is still local anesthesia at the incision that will wear off in the next day or two, so I expect pain to increase a bit.

For the procedure, I was given a spinal and IV sedation. No general anesthesia. No breathing tube.

Rather remarkable experience. My wife works with an awesome team (she worked yesterday until I was released, but couldn't be my nurse - but was able to visit  )

[Raider Bill]

crazy how fast they get you in and out now.
may last total knee they wheeled me in the or at 702am and i was home at 251pm that afternoon.

3 weeks ago i had my wrist and thumb fused with plates, rods an screws.
this has been the most painful recovery i can remember between shoulder and 2 knees.

[YellowHammer]

Wow  with my total hip I was in the hospital for 3 days.  

I need a new knee, one of mine is quite painful.  I didn't realize it could be in and out in a day. 

Jeez, I ate too much for Christmas and it took longer to "get over it" than a day. :D

  

[WV Sawmiller]

   Sounds amazing but I am thrilled to hear it is going this well for you. My wife is going to have to have hers done at some point. I hope hers goes as good as you are describing. Please give us periodic updates on your progress.

[PoginyHill]

  Sounds amazing but I am thrilled to hear it is going this well for you. My wife is going to have to have hers done at some point. I hope hers goes as good as you are describing. Please give us periodic updates on your progress.

Two methods: Anterior and Posterior. (front or back entry). Anterior is the newer way, but not all orthopedics do it. I certainly recommend anterior. Otherwise it's 6 weeks of hip precautions and at least an overnight or two in the hospital. My mother had one hip of each way. Night and day difference. Really no comparison.

[Magicman]

Thanks PoginyHill for that awesome report.  My Dad had to have both of his hips replaced so it's always in the back of my mind wondering if or when?

[gasman1075]

I have had 1 done already ( arthritis ) by the posterior method and when I have to do the second within a few months to a year I am going for anterior. Thanks for the great report

[doctorb]

I have had both of my hips replaced. 2007 and 2011. They were not done through this less invasive anterior approach.  I spent a night in the hospital for each.

Several factors over the last decade have contributed to this outpatient total hip procedure.  1). The anterior approach for the procedure is less invasive, less bloody, and much less painful.  The caveat is that your surgeon should have done at least 50of these to get it right.  That's the learning curve.  So if you are planning to go this route, and it's an excellent choice, make sure your surgeon is experienced in this procedure. 2) Because there is no hospital admission, it's much cheaper.  So insurance companies are motivated to have it done this way. 3). The total joint specialists love it. They create their own pathways in these surgery centers that are super efficient, without all the trappings and inter workings of most hospital based operating suites.  They "flip-flop" rooms, meaning that they perform the procedure in one room, have their team close that surgery, while they start another procedure in an adjacent room.  The guys who are real slick can do 8, 10, or more of these procedures a day!  4). Many of the surgicenter are owned privately by the docs themselves, so the "facility fees" are captured by them as well.

It's become a really well oiled machine, and, if things go well, it's a nice advance for the doc and the patient.  One last thing aside, if you have a lot of medical comorbidities that make you a greater medical risk with anesthesia, or have a BMI > 40, you will be screened and possibly have your hip performed in a hospital setting

[peakbagger]

Hospital acquired infections can be nasty, far better to be out ASAP. 

[firefighter ontheside]

I'm happy to hear its going well for you so far.  I broke my left leg really badly 20 years ago and expected that I would need knee replacement at a young age due to the damage done to the proximal end of my tibia and tore my meniscus cartilage in half.  Well, I have no real problem from that, but my left hip gives me trouble and I think that will be my first replacement.

[Ed_K]

 You all are / where lucky with the short stays   . I just spent 2 1/2 days in the hospital, just to be told I had a tumor in my neck  >:( :( . And the chicken didn't taste like chicken  :D .

[doctorb]

Peakbagger-

You are correct that hospital acquired infections can be bad, and should be avoided if possible.  But, with respect to getting a total joint replacement, remember that in the vast, vast majority of cases, infection at the site of the hip replacement probably occurs at the time of surgery, and is not dependent upon length of hospital stay or whether the procedure was performed in an inpatient or outpatient setting. For most of these, we never know exactly from where the infection arose. Fortunately, these are uncommon.  You can get delayed or late infections after total joint surgery, but those are usually not related to the length of hospital stay.

[kantuckid]

Mine were both anterior and an easy PT thats ~ 1/2 the effort, pain and time of recovery as posterior where your butt muscles are cut through. The doc has to be trained that direction plus the surgery center must have the right table fort anterior, not all do.  There are highly capable ortho docs who have changed back from anterior after trying it or those that never went with anterior to begin with. Mine mostly does anterior but some peoples build (or lack of one :D) means they'll get posterior. Seems that fat folks the fold of blubber around the groin makes for infections during healing so I've read. My docs main hospital is a no-residents operate location and mine were observed but he did the cutting, not the watchers at that place. He's a U of KY doc so when done at the main hospital he usually has a resident cutting, also at VA residents mostly cut in his practice. My shoulder doc does posterior only so I switched docs for hips. He's also my knee doc, so I'll get him only with the knife. Might be this year?  
On his surgery days if your first or before say noon, you will leave that same day. Later you might be overnight. I was first on both hips and out of there early afternoon. My hip doc requires that you walk the hallway and climb up and down a flight of stairs while supervised by a PT person directly after the surgery-as in that very day! My doc has an RN do a class required for 1st time hip people so can ask questions learn about the joint.  
We have a family practice doc in my county who is maybe 45 yrs old. I suspect shes got rheumatoid arthritis? My doc did her hip too. 
The only time I really notice my hip joints is on certain occasions I'll have to adjust my body position while seated-on a farm tractor sometimes or a garage creeper is another. Sort of gets in a kink of sorts, otherwise I've never notice them since 2015/2017. Mine were combo of osteo and wear & tear. I went from being a hiker to a cane and tears to walk, then back to normal.  

[kantuckid]

Another important hip/joint thought- after my hips were done the dental college where I go would push me to take an anitbiotic prior to teeth cleaning. After a discussion with my hip doc, I was given a letter stating that the ortho docs professional organization does not see a reason for an antibiotic nor avoiding teeth cleaning or other dental procedures in otherwise healthy patients. Since then the dental college has taken the stance my ortho doc shared with them. I suspect there are still those who think it's a big deal to work on teeth with artificial joints as it's not been very long ago I was forced to take an antibiotic that I did not need!
My thinking is that somebody with a rotten mouth such as a Clint Eastwood western type of guy or homeless addict might need more concern with the issue? 

[doctorb]

Dentists didn't want the responsibility, risk, and blame for a total joint infection.  They were, and sometimes still are, very stern about pre-dental appointment antibiotics.  The American College of Orthopaedic Surgeons has a position statement about this, and they have helped stop the required antibiotics pre dental appointment.  On the other hand, the risk of a significant problem from a single dose of oral antibiotics is really pretty low, and many patients still take them as they have historically done, despite the newer recommendations.

[kantuckid]

Dental colleges tend toward far more conservative approaches than a modern dental practice (like mini-implants which they now do) which is trying to cash in on new services and another factor is that the faculty range from the very young and abreast of modern practice down to older ones that didn't get that newest training and it's a retirement gig. It became a quandary during several of my dental visits which that letter I took them, as you refer to, has now become the common practice they use at that dental school for most patients. 
On my first go around they were saying "eat this big antibiotic tab" ;D, that's a one shot fix, while I was saying that I've asked my hip doc about this and you need to call him now... I'd known his position on the antibiotics dating to before my 1st hip as I asked that question in the required class. Fact that I'd get a different professor over time and change students made it worse. A private dentist may do as they wish-my private practice dental surgeon I used during covid said he had no concerns at all.  

[Roxie]

Ed K the chicken never tastes like chicken in there. Are you going to be okay?  

[YellowHammer]

My dentist and hygienist keeps pestering me about it until I finally say "Got any?  Then give me the durn thing!"  The antibiotics don't bother me one way or the other.  

[kantuckid]

I'm not saying you should or shouldn't take the pill as my medical degree came from WebMD & Google :D. 
I thought it was commonly understood that taking an antibiotic when not essential is a bad choice-been written about for some years now how antibiotics have been overused? 
I guess the more common e.g. is the use for the common cold virus, which some docs still go along with. Not like that's a new idea as much has been written about our populations overuse of them which has resulted in less effective resources when a real infection like pneumonia or whatever, challenges our well-being.  
I'm hardly the expert but it's old information at this point to even bring this up. 
I've had that conversation with my orthopedic doc and several dental students and their professors. I've been advised by dental professors at U of KY that the colleges posture has changed on antibiotics to get teeth cleaned when you have a joint replacement. This is a fairly recent notion as my hips were  done in 2015 & 2017 and the college wasn't up with the change then. Fact is that many of their patients in the student clinics are seniors (or Hispanics or other students, or jail birds) like me with worn out teeth, and children of the pre-fluoride era, most of us have lots of silver amalgams and often joint replacements.
 

[petefrom bearswamp]

Poginyhill, glad all is going well for you.
I liken surgery methods to periods of history.
Dark ages, medieval and renaissance.
Unfortunately for me my hip was done in medieval.
1999 total, posterior, revision in 2006 again posterior.
Titanium prosthesis.
first time was about 97 percent as no pain or limitation of movement.
Revision not so much.
Cant walk very far without pain, so my still hunting days are over.
3-4 day hospital stays both times.
I have 2 10" scars on my left buttock cheek.
Bill, I hope it is not your throttle hand.

[kantuckid]

True, times change.
 My neighbor a home builder/contractor, fell off a 10-12' step ladder some years ago. He's a big guy around 6'4" or so and broke his hip. He had the old and the wear out versions too. I'm pretty sure he's on his 3rd hip joint. He changed jobs to be the school bus mechanic based on that hip. I asked the question at my hip class if they knew how long mine would be good for. The RN teaching the class was well informed and suggested that the newest ones outlast most folks who'll need one but not like I heard a year number either. I guess they avoid that sort of talk plus the newest ones aren't being re-done based on wearouts. I sat next tpo this guy in a waiting room at my hip docs. Guy was mid 60's and said he was getting a new 2nd hip and added that his hobby was senior weightlifting competitions so probably his own fault. 
Another factoid is that certain docs just wont change to a newer method. I had my CTS release surgeries in 2000 & 2001 and I worked with a HVAC teacher who's doc still did the cut your entire palm open style of surgery. mine was endoscopic and a 3/4" incision-his was like 4-6"!  

[Raider Bill]

Pete,
Worse it's  my clutch  hand. Got so I couldn't pull the clutch or hold a can of beer.
This recovery has been terrible. No movement in a month. Fingers swollen like sausages.
I'd rather of had another total knee done.
My ortho says if the dentist wants antibiotics then he can prescribe them which he does.

[PoginyHill]

The RN teaching the class was well informed and suggested that the newest ones outlast most folks who'll need one but not like I heard a year number either. I guess they avoid that sort of talk plus the newest ones aren't being re-done based on wearouts.

I was told new hips are expected to last at least 30yrs. Maybe longer as they don't have a lot of history yet to base it on.

[petefrom bearswamp]

Dang bill, sorry to hear this.
How is your cheese situation?
We miss our breakfasts with you guys to exchange cheese for social contact.

[Raider Bill]

We ate at that diner a couple months ago. 
Sue Ann asked if you were coming back down soon.