(Non aviation) Hip Replacement

[Let'sgoflying!]

What questions should be asked, issues looked into before a total hip replacement is done?

The surgeon has provided a good package of patient information, but I am looking for things the average person may not think about.

Thanks.
(No, not me - my hips still have their Shakira-like youthfulness.)

 

[AcroBoy]

You should ask about the risks of surgery, the length of time in the hospital, the length of rehab, how much pain to anticipate after surgery, how much time before resumption of activities, limitations following the procedure, and how long should it last.

You can do a search and see how many malpractice claims have been brought against the surgeon.

Best way to get the true story is to ask people who actually work in the operating room. Worst way is to get info from former patients, whose information would be purely subjective.

FWIW I work as a practicing orthopaedic surgeon and professor of orthopaedic surgery at a major university hospital specializing in joint replacement.

 

[Gary F]

You should ask about the risks of surgery, the length of time in the hospital, the length of rehab, how much pain to anticipate after surgery, how much time before resumption of activities, limitations following the procedure, and how long should it last.

A good place to start.

You can do a search and see how many malpractice claims have been brought against the surgeon.

This is reasonable but be careful how you interpret the results. Most physicians are sued at one time or another and not all lawsuits are legitimate.

Best way to get the true story is to ask people who actually work in the operating room.

Possibly true, but not very practical since it would be hard to track them down to ask. Ancillary personnell can be subject to various biases and are unlikely to have knowledge of long term results.

Worst way is to get info from former patients, whose information would be purely subjective.

I disagree, as long as you can get an unbiased population of former patients to query (which would be difficult). Patients are the best judge of results in terms of the peri-operative experience and subjective improvement in symptoms. Unfortunately, patients have no way of comparing the results of the procedure they had verses any other options.

 

[Bob Noel]

Additional: Ask about the different types of joints and materials that are available.

Also: suggest "your friend" check with the employer re medical leave (if applicable)

 

[SCCutler]

Additional: Ask about the different types of joints and materials that are available.

Also: suggest "your friend" check with the employer re medical leave (if applicable)

His friend has a real stinker for a boss.

 

[AcroBoy]

Depends on his job demands, but generally it's around six weeks off work. If he does some kind of manual labor could be longer. If he did heavy work, might be never.

 

[Let'sgoflying!]

SIX WEEKS?!?! No waay! (I am da boss if you were wondering abt my response)

Anyway, we had been told by everyone and their dog up until yesterday that all hip repl.nts are considered to be 15-20 years after which a second one will be necessary.
Yesterday the doc says the technology has the 'nylon' insert (the socket) lasting a lifetime.
As a backup; if they are proven wrong, the socket is a two part component The 'nylon' comes out and can be popped back into the part that grows into the pelvis, in a 15 minute (!) procedure.

The info they provided, the things we asked covered all the suggestions above, thanks for confirming.

 

[AcroBoy]

The insert is made of ultra high molecular weight polyethylene. It can be removed and exchanged if the X-rays show any wear. It takes around an hour, maybe more or less. A THR should last around 20 years. There is no data suggesting the plastic liner will last a lifetime, unless the patient's life expectancy is in the range of 15-20 years or less.

 

[Rob Schaffer]

PM GMascelli if he doens't chime in here soon. He's well experienced and can give you good timelines for duration between the replacements and the recoveries.

 

[patrick wentworth]

Find a Doc that does a lot of them..
By the way almost everyone I know that has one has the comment --" should have done it a year earlier" .. and they are right as it is a wonderful improvement.

 

[Let'sgoflying!]

ugh, sure are a lot of recalls/class actions against the devices.

 

[Gary F]

Find a Doc that does a lot of them..
By the way almost everyone I know that has one has the comment --" should have done it a year earlier" .. and they are right as it is a wonderful improvement.

This works only if you really need that procedure. A surgeon who has done a gazillion of procedure X may not be interested in discussing option Y which might be a better choice in your case.

If you are a hammer, everything looks like a nail.

 

[AcroBoy]

First, no one "needs" a hip replacement- it is an operation for pain and quality of life, but not a life or limb saving procedure. Probably the most important consideration is to find the key outcome factor of infection rate. This is now available publicly in most urban areas, but can be hard to find.

Volume does generally correlate with good outcomes, but on the other hand, there are surgeons who run big centers who want nothing to do with a patient after the index operation. They end up in my office with not so subtle x-ray findings of a sloppy and rushed job, as well as problems that could have been addressed with some thought and effort. Again, the best source would be to speak with the anesthesiologists and OR staff as well as nursing staff on the floors to get an opinion about the surgeon and outcomes. This can be hard to do without some inside knowledge or contacts.

There have really been only two specific implant designs out of many hundreds that have undergone recalls. There will always be a low percentage of implant designs and materials that come up with problems seen only a few years after introduction, and each implant manufacturer has had their own share of these.

Still, the overall outcomes in terms of pain relief and the low rate of complications makes a joint replacement a safe and effective operation for improvement in the quality of life

 

[Everskyward]

By the way almost everyone I know that has one has the comment --" should have done it a year earlier" .. and they are right as it is a wonderful improvement.

I have a good friend who would say the opposite. He wishes he would have waited longer. But I don't think he was as happy with the results as others seem to be but like someone else mentioned, he doesn't know what would have happened if he had chosen something else.

 

[AcroBoy]

Eighty percent of hip replacements are done by surgeons who do less than three a month. At the other extremes are surgical factories, where sometimes volume can outweigh results. You can ask questions of the surgeon regarding implant choices, but to develop a solid relationship, ultimately the decision should come down to what the surgeon feels is best for the patient. I've had patients ask for specific designs or brands, and after discussion they have gone elsewhere only to return with problems.

Likewise, at an academic center we deal with a lot of complex problems as well as surgical misadventures in judgement and technique.

Like any operation, there can be problems, and with joint replacement, these problems can be profound and have life long consequences. However, the vast majority of patients do well with the surgery, with decreased pain and significantly improved quality of life.

 

[Ghery]

My wife had a hip replaced this summer. Knee last year. The hip recovery was much easier, but advising the patient to take time off after the surgery is the right thing to do. Fortunately, my wife is a school teacher, so taking time off in the summer is easy.

 

[Doggtyred]

JimN's comments seem to be the ones that I have to give the greatest weight to here. Not much i've seen that I disagree with amongst the posts, just I like Jim's the best. Gary (the cardiologist) is a close second.

One thing that's not been addressed is the patient and how good of a surgical candidate. If they have poor lung function (COPD/Emphysema), poor heart function (Heart Failure) or poor kidney function (taking lots of motrin and aleve on a long term or high dose basis can cause that) then the patient may need consultation and prep before surgery by folks OTHER than the orthopedic MD. Anesthesiologists are good at what they do, and actually manage the patient and their body functions during the procedure, but sometimes "tuning up the patient" can take days in advance, not just minutes before going under.

Things to ask about in addition - what is the plan post operatively. When do they plan on getting you out of bed and moving (sooner is better), and how long will rehab last and how long will you be off work (for the type of work you do). Hospitals are under a mandate now to reduce blood clots from immobility, plan on being given low dose blood thinners while stuck in bed. And plan on not being stuck in bed for long.. literally hours, not days.

You will need to do breathing exercises in the post op period to help prevent pneumonia (something that happens when you go on a ventilator - the longer you are on, the more changes and deconditioning that occur - if you are healthy and have a 2 hour surgery its a non-issue... if you've smoked 2 packs a day for 20 years its a very very real concern)

 

[AcroBoy]

Agree completely with the previous comments. All of my patients undergo an extensive and comprehensive evaluation by our hospitalist internists whose sole function is to prepare patients for the operating room. They also follow them closely after surgery as well, as needed.

These internists know what we and the anesthesiologists need to know to go to the operating room safety, and provide risk assessment for the patients who have other co-morbidities, like heart disease, etc. It has cut down on our last minute cancellation rate by over 60%, and has provided us the best outcomes in our metropolitan area, despite having a more complex patient population.

So, a thorough physical exam prior to surgery, with EKG and lab work as needed, is key to getting a good outcome.

Hospitals are mandated to start antibiotics within an hour of the incision, and have them completed before incision as well. This information is also available by individual surgeons, and might be a fair indicator of their attention to detail.

Likewise, the post operative regimen for prevention of blood clots and the choice for anti-coagulation and duration are also key. Aspirin alone is not adequate, nor are external compression devices. Most studies would suggest either coumadin (a pill), or some form of daily injection (can be very expensive and has other drawbacks).

These are also important considerations in choosing a surgeon, at least in my opinion. This information would be a lot more useful than a glitzy office, as smooth sales pitch, or recommendations from friends at church.

 

[Let'sgoflying!]

Thanks, they discussed their perioperative antibiotics plan including pre-op nasal swabs for mrsi and mrsa, pain meds and anticoagulants so I think they are on their game.
I think they will enjoy this one, the patient is a young, good-looking, vivacious gal with wonderful health and a great attitude!