No Ifs, Ands or Butts - Hip Replacement Surgery is better than ever
Hip Replacement Surgery
Advances in hip replacement surgery offer patients more options than ever.
When your mother needed a hip replacement 30 years ago, she probably stayed in the hospital for 10 days and then faced a long recovery at home. Today, new advances in pain management, hip replacement techniques and even outpatient surgery for some patients can get you back on your feet faster.
Post-surgical studies show that 90 percent of hip replacement patients are happy with the results three months after the operation.
Thirty years ago, if your mother was in pain after her hip replacement operation she would press the call button for a nurse, wait 20 to 30 minutes for the nurse to come and give her a shot, and then wait another 20 to 30 minutes for the pain medication to kick in. It was roller coaster pain relief, says Dr. Peter Jacobson of Virginia Institute for Sports Medicine in Virginia Beach.
In the early 1990s hospitals began using intravenous (IV) pain medication partly controlled by the patient, Jacobson says. Within parameters, the patient could get more pain medication in her IV. People took less pain medication because it was smoother and they got out of the hospital sooner, Jacobson says.
Now, during the surgery the patient can get an injection of pain medication along with an anti-inflammatory drug and a drug to stop bleeding, Jacobson says. The patients pain is controlled without leaving the patient too groggy to get moving and into physical therapy after surgery.
The components that make up artificial hips are much improved, helping the new hips last 15 to 25 years compared to 10 to 15 years, Jacobson says. In the past, prospective artificial hip patients sometimes were advised to delay surgery so they wouldnt outlive their new hip, but now patients could get new hips in their 40s and 50s, he says.
Some orthopedic doctors and their patients are excited about a new technique that enables the surgeon to replace the hip cutting from the front instead of the back. We dont cut through tendons and muscles to get to the hip joint, says Dr. Anthony Carter of Hampton Roads Orthopaedics and Sports Medicine in Newport News.
Carter performed the first such surgery in Virginia, in 2006, and has done about 1,200 since, he says. Since more tissue is spared, recovery time is cut in half, Carter says. Patients usually can put away their canes within three weeks and return to driving in seven to 10 days, he says. Thats compared to up to three months of no driving with the traditional approach.
The procedure is not universally accepted. Jacobson says the smaller incisions are not always done properly because the surgeon doesnt have the same visual field with a small incision. Its also difficult to replace a large hip using a small incision, he says. A lot of the people out there with worn out hips are not size 5s, he says. Theyre size 18s. Then you have a very large hip and youre trying to do a big operation through a tiny incision. Jacobson says, however, that a fairly new, special table he uses, called a Hana table, allows surgeons to get X-rays of the hip during surgery and position the hip during the operation to ensure the new hip is placed properly.
Finally thanks to that anterior approach, some patients are even having hip replacement surgery as an outpatient procedure. Dr. Mark W. McFarland of the Orthopaedic and Spine Center in Newport News performed the first outpatient hip replacement in Virginia in 2010. Weve had four patients go home inside of 24 hours, McFarland said in December. As with the anterior approach, surgeons differ on whether this is a good idea. Some worry that patients released too soon may suffer complications and have to return to the hospital.
Picking the right patients ones who dont have heart trouble, diabetes or other problems is important, McFarland says. Its also best if the patient is among the first surgeries of the morning. Patients who have the procedure done as an outpatient also need to have support and help at home for recovery, he says.
Patients are concerned about the risk of in-hospital infections and complications, he says. People also are much more comfortable in their own homes than in a hospital setting. This is going to be a significant savings to the health care system in the long run if we get to where we can transition patients home early.