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Author Topic: Recovery Time After Surgery  (Read 4120 times)

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momzer2

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Recovery Time After Surgery
« on: July 14, 2007, 01:34:29 AM »
Pat - I am scheduled to have a 'birmingham hip' replacement in September.  I read conflicting information about recovery time, etc.  I am 48 and in very good health.  I have hip dysplasia which has accelerated the normal hip degeration process.  I have severe arthritis and can no longer jog, swim, etc. without pain.  So I am more than ready for my surgery.  Where can i research just how good my doctor is?  I know he was one of the first in the country, at least that's what I've been told.  >:(  I am a very active person and have a very demanding job (I'm an office RN) and I just don't know what to expect.  I was only planning on having my left hip done, but now I keep reading about those who have done both hips, either at the same time or a week or two apart.  Do you and anyone else have any ideas????

Karen

Pat Walter

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Re: Recovery Time After Surgery
« Reply #1 on: July 14, 2007, 02:17:47 AM »
Hi Karen

I put your question under a new post to start another new subject since you are asking some other questions.

I would first tell you that I can understand your pain and not being able to be active at all.  No matter your age, life is very difficult with hip problems.  You are lucky to have found out about hip resurfacing.

About doctors and their experience.  Just because a doctor says he/she is one of the first in the country to do a BHR, does not mean a lot.  You need to ask the question of the doctor or staff - How many hip resurfacing have you done to date? How many femur neck fractures have you experienced? How many revisions of your BHRs have been required? How many infections of your hip resurfacings have occured?

If you doctor is not willing to answer these questions in a pleasant and honest manner - I would NEVER use him/her.  A doctor should be open and willing to answer any questions you ask.  I have a list of the more experienced doctors on my website http://www.surfacehippy.info/listofdoctors.php  and a page with their statistics  http://www.surfacehippy.info/doctorstatistics.php   These are doctors that folks on the large Yahoo Surface Hippy Discussion Group talk about and have used.  Some of the stats are from the doctors themselves when they contact me and others are hearsay from people that have used the doctors.

I am a believer that if you have a difficult hip problem, you definitely need a very experienced doctor.  You only have 2 hips and if the doctors does not perform a proper hip resurfacing, you will be facing a revision to a thr.  THis is how I feel a person should choose a surgeon  http://www.surfacehippy.info/pcselectingsurgeon.php   Hip resurfacing is still a fairly new surgery and as my doctor, Dr. De Smet says, the instrumentation is not a available as it is for the THR.  In other words, a hip resurfacing is as much an art as a skill at this point.  Only a really experienced surgeon has developed the skill. I have a number of studies on my website talking about the steep learning curve of hip resurfacing.

What doctor are you considering using?

Your recovery will only depend on how your body reacts.  No one can predict how quickly you will recover.  I can tell you from experience of my own and several years of reading the experiences of hundreds of other hippies, that people that use the overseas, experienced doctors definitely have quicker recoveries.  Some of the more experienced US doctors have patients with quicker recoveries, but on the whole, the US doctors are much more conservative.  After all, if they have only done 100 hip resurfacings they just don't have the experience that a doctor like De Smet that has done over 2400 hip resurfacings. 

I was on one crutch at 4 days and no crutches at 4 weeks.  My energy level remained low for a long time.  It took me almost 4 - 6 months to recover my energy completely, but I was 61 and in very poor physical shape since I could not do anything for years.

I personally think your attitude going into the surgery also affects your recovery.  If you expect a quick and easy recovery - see it in your mind, you will proabably do better than if you are worried and afraid. Again, that is only personal opinion.

If you have both hips done at one time, your recovery will definitely be slower.  But you will only go thru surgery once.  Many people have done bi-lateral surgery.  More doctors overseas tend to do that than the US doctors.  The US doctors like to leave some time inbetween.  Having done only one hip, I can say that I would consider doing both at one time just so there is only one recovery and one stay in the hospital.  But again, that is a personal decision between you and your doctor.

There are a handful of bi-lat stories on my Personal story page http://www.surfacehippy.info/hipstories.php

I hope that gives you some answers and a lot more questions to think about.

Please let me know if I can help in any other way.

Pat
Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

momzer2

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Re: Recovery Time After Surgery
« Reply #2 on: July 14, 2007, 09:42:42 PM »
Pat,

Thanks for your thorough and quick response.  I am considering using Dr. Mark Barba of Rockford Orthopedics Associates.  I know several doctors in this group and have firsthand experience with their skills since a lot of the patients in the clinic I work in have been patients there, too.  However, I haven't actually asked him how many resurfacings he has done, etc.  But I intend to at my next visit.  I do not know anyone personally that has had a resurfacing.  I read about the new procedure in our area newspaper and it sounded like it would be the perfect choice for me since I am too young to have a total hip.  I do believe that I will have a fast recovery.  Being an RN I know how important rehab is and I work for a really good internal medicine doctor who has actually had surgery with this ortho doc himself (though not a resurfacing). 

Now the only real hurdle I face is getting this procedure approved by my health insurance carrier.  I hear they are notorious for denying this type of surgery.  Maybe now that this surgery has been approved in the USA for about 16 months now, they will see that denying me will prove futile!!  :-\
Have you heard about anyone else having this issue?

Karen

Pat Walter

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Re: Recovery Time After Surgery
« Reply #3 on: July 15, 2007, 01:16:38 AM »
Hi Karen

As I said in a previous post, many insurance companies are difficult to deal with.  My only suggestion is - keep fighting.  If you can't win the battle, consider traveling to India or Belgium to have your hip resurfaced with several of the very best surgeons in the whole world. 

I went to Belgium because I did not have health insurance.  It cost a total of $16,000 for the complete trip and medical costs for my husband and I.  Others have traveled to India to Dr. Bose for $10,000 to $12,000   I just did not want to fly 22 -28 hours to get to India.  I would have no problem using Dr. Bose.  He is also one of the very best in the whole world.

There are always options to get what you want if you are willing to spend a little money.  Battle the insurance companies. Sometimes it takes several appeals.  If you can't win with them, send emails to Dr. De Smet or Dr. Bose and take a trip to get a great new BHR.  Hundreds of us have done that and are very happy we did.

Good Luck.

Pat
Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

Vicky

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Re: Recovery Time After Surgery
« Reply #4 on: July 18, 2007, 10:24:16 PM »
Hi Karen,

I was 48 when I had my hip resurfaced.  There are too many variables involved to really be able to take a guess at how long one's recovery will take.  Each person is unique.  It depends on age, physical condition prior to surgery, deterioration of your hip, how long you have been limping so that your other body parts are all out of whack.  It also depends on your surgeon and the type of approach he uses, antirior vs posterior as well as the muscles he cuts, re-attaches or does not re-attach.  Some people that have had both hips done recover different for each hip, so it can even be different for the same person on each hip. 

If you have one hip worst than the other I would recommend waiting for the second hip unless the doc tells you that you really need the other hip done too.  My right hip was also really starting to hurt, but my doc told me to wait and see how it would be after getting my left hip fixed.  Now 20 months later my right hip is still doing fine.  I am just now beginning to have some signs of groin pain in the non operated hip, but hey, if I have already received almost 2 years without it being fixed and I get another couple years out of it, I am glad I did not get both done at the same time.  I also have dysplasia which caused my OA to advance at a young age.  My Mom had both her hips replaced but did not start having problems until her late 50's and my Dad in his 70's, he also had both his hips replaced.  My hips and legs were uneven so my doc lengthened my operated leg, which made my recovery longer.  But, even with the longer recovery, I have absolutely no limitations now and have all of my flexibility back, this picture was taken at 11 months post op

I love my resurfaced hip.  I took about 2 1/2 months off work to heal at my own pace.  I am usually a real workaholic, so I took this time for me for a change and enjoyed being off work.  I could have gone back sooner but really didn't want to.

Vicky
LBHR Dr. Bose Dec 01 05



« Last Edit: January 28, 2012, 03:24:46 AM by Pat Walter »

momzer2

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Re: Recovery Time After Surgery
« Reply #5 on: July 19, 2007, 12:02:48 AM »
Vicky,

Thanks for sharing your story.  I, too, have hip dysplasia and my left hip is bad, but at different times during the day I can still walk without a limp.  Depends how tired I am, the weather, yesterday's activities, etc.  I want my hip done BEFORE I become incapacitated.  I am sure that getting it done sooner than later will make my recovery easier.  I also have the same leg length issue you did.  My left leg is about 3/16" longer.  I'm hoping he can fix that, too.

My right hip is only achey at times.  I probably wouldn't think anything of it, but I now know that it will need to be done in the future.  I just hate the thought of TWO major surgeries.  Not that I haven't had any surgery before, I have, but if I could "kill two birds with one stone" as they say, I was considering it.  I'm seeing my ortho doc next week for a follow-up since I have lots of questions, and the two-hip surgery is one of them.  My mom and her brother both have had hips replaced.  My uncle actually had them both done TWICE!  Ouch.   Too bad 48 years ago they didn't know about hip dysplasia and how to diagnose it in newborns.  Neither of us would have this problem at our 'young' ages.  LOL. 

I do believe I will recover quickly since I have been in excellent health, except for these hips!!  And I have been running for exercise the past 2+ years.  Of course now I have had the all but retire my sneakers.  I still try to run about 2-3 miles a week.  Which is a joke!!  I used to run about 15-20 miles a week.  I'm not a marathon runner, I do it for me (and weight control).  I hate being so limited!!  I can't swim without pain, couldn't even begin to play tennis or hike.  It really is a lousy way to live.  Anyway.... I'll keep you posted on what my doctor and I decide about the two hip surgery.  I'll probably only do one now.  We'll see.  By the way, who did your surgery?  Dr. Bose?

Karen

Vicky

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Re: Recovery Time After Surgery
« Reply #6 on: July 19, 2007, 12:46:27 AM »
Yes Dr. Bose did my surgery.  I had trouble with my insurance, they only wanted to pay for me to get a THR and there is NO way I wanted limitations the rest of my life which I would have had with the THR the doc at Stanford wanted to give me.  I paid out of pocket and went alone to India.  It was quite the adventure and it turned out to be an incredible experience.  Where else can you get a top surgeon to do surgery on you, stay in a hospital for a week that gives you a large private hospital room, plasma screen TV, fridge, microwave and wireless laptop all in your hospital room, then recuperate after for a week in a five star resort, all of under $12k.  I was treated like royalty there and Dr. Bose is a fantastic and brilliant surgeon.  It definitely sounds like you are ready.  Keep in mind that you can go downhill really fast with this.  I did, I started seriously looking into different procedures in June/July and by the time I left for my surgery the end of November, I couldn't walk without a cane.  It only gets worst until you do have surgery.  I would definitely wait on the other hip, there is a chance it will get better and you may never need surgery on it after the bad one is fixed. 

Who is your doctor?  Here is a list of questions to ask your doc, that Pat Dukes put together from the Surface hippy site.

You’ve asked about questions that you might want to have for your doctor visit.  That question is often asked and here are some questions that various board members have suggested in the past. 


How many resurfacings have YOU done? (not observed or assisted with)
Where did you train?
How many complications have you had?
How many resurfacing failures with revision to THR have you had?
How many times during surgery have you had to change to a THR instead of a resurfacing and why was the change made?
What device (prosthesis) do you use, how long have you been using it and why do you prefer it?
Do you use cemented or uncemented?  Why?
Do you cement the stem?

What anesthetic do you use?
How long does the surgery take?
What surgical approach do you use?  Anterior or Posterior?
What is the incision length?
What is your post-op pain control plan?
What hospital do you use?
What is their infection rate?
Have any of your patients had infections that required IV antibiotics following resurfacing?
What drugs/methods do you use for anti-coagulation after surgery?
How long will I be in hospital?
How successful have you been obtaining insurance approvals for resurfacing?

What is the rehab protocol?
When will I be 100% weight bearing?
What assistive devices will I use for walking after surgery?
How long on 2 crutches, 1 crutch, cane?
What if any restrictions do you place on your patients after surgery
and how long do they last?
Will I be given any at home nurse or PT care?

How does my other hip look at this time?
If both hips are bad, how do you handle bilateral resurfacing?
Is there anything unusual about my hip that might present problems?
Do you have a resurfacing patient who you've done surgery on that I
could talk to about their experience?

What is your opinion of my returning to (whatever work or activities you do)
Have you done resurfacing for anyone who has returned to these activities?


Good questions to ask.   :)

Vicky
LBHR Dr. Bose Dec 01 05

momzer2

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Re: Recovery Time After Surgery
« Reply #7 on: July 19, 2007, 02:30:40 PM »
Vicky,

Thanks for all the good questions.  There were a few I hadn't thought of.  Most of the post-op and surgery questions were a no-brainer for me since I work for the major hospital system as an RN where I'll have the procedure.  I feel really comfortable about the staff, etc. since I actually know some of them.  Once everyone knows that you're 'one of them', things are so much easier.  Plus I know all the 'lingo'.  Having had surgery before, I know what meds work for me.  Until I was linked with this site, though, I didn't realize there were two ways to do this surgery.  Why is a posterior approach better?  Less messing with muscle and tendon groups?   I'm going to have my surgery with Dr. Mark Barba. I'm told that he was one of the first doctors in the US to be trained.  He didn't go into a ton of details at our first consult., probably because he knows I'm a nurse and he knew I had read up some on the BHR procedure. 

I'll keep you posted.  Thanks again  :)  P.S.  You are really brave to have travelled to India by yourself.  Wow.

Karen

Vicky

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Re: Recovery Time After Surgery
« Reply #8 on: July 19, 2007, 06:35:30 PM »
It was VERY scary at first but I thought of it as taking an adventure, and an adventure it was.  I loved India and went back recently for cosmetic surgery, I got a referral from Dr. Bose for a highly recommended Cosmetic surgeon there.  I was there in March and was able to see and stay in their new Platinum Ward.  Again a great experience, and Dr. Bose stopped by every day on his rounds to say hi to me.  I also met several other hip patients while I was there and I will remain friends with one of them for life.  I have actually made quite a few great friends from this whole experience which has been a wonderful part of what wasn't so wonderful, the OA, the pain, major surgery, etc.

Here is a good explanation from my doctor on the differences between posterior and anterior.  I personally would never go to a doctor that did the anterior approach for resurfacing. 
http://www.surfacehippy.info/surgicalapproaches.php

"There are two ways to look at approaches to hip resurfacing or any hip arthroplasty. One is to view it with the amount of muscle damage done. The other is to view it in respect to the blood supply or the vascularity. The post approach is traditionally known as the muscle sparing approach and the anterior and anterolateral approaches are the muscle compromising approaches. These approaches are known as Hardinge approach or London hospital approach. There are many more modifications of this with slight variations but essentially they are the same and they disturb muscles to varying extents. The muscle here refers to the Abductor group or the muscles which lift your leg sideways and is the most important muscle of the hip. The post approach spares this completely. Interestingly there is now an anterior approach which is getting to be very popular for mini -THR and this is known as the mini Watson Jones approach or the micro hip approach. This does not disturb the abductor though it a ant. approach. However resurfacing cannot be done through this approach. Even when one does a THR the head has to be sawed off in place and then delivered out separately. Or in other words the hip cannot be 'dislocated' through this approach which precludes hip resurfacing. However some muscle have to be cut in any approach to get access to the hip and in the post approach, one cuts the short ext rotators which are flimsy , small muscles in the back of the hip. These are stitched back. These muscles are relatively unimportant. It is largely accepted that the post approach is more conducive to early and complete return of function as it is muscle sparing. The ant approaches which disturb the gluteus medius will result in slower and incomplete return of function depending on the amount of muscle disturbed and the intactness of the muscle repair over long term. The younger and the more active the patient , the more would be the perceptible difference between the ant and post. approaches as regards function. Thus an elderly patient having a THR will appear to have the same result with either approach whereas a young patient having a resurfacing will have an obvious difference.

Michael Freeman , an English surgeon established in 1978, the fact that the blood supply in an osteoarthritic hip is different from a normal hip. In full blown arthritis the blood supply to a large extent changes to inside bone( intra-0sseus) from a pattern that is predominantly outside bone (extra osseus ).Therefore in osteoarthritis , any approach can be attempted without a risk to the blood supply. Hence in osteoarthritis, as the blood supply issue is taken out of the equation only the muscle damage is relevant and therefore post approach is better. In fact when Derek McMinn developed modern resurfacing , he first attempted it through the anterior approach and found so much of muscle damage that he decided to change to posterior.

However in non-OA indications like AVN , the situation is little different and the intra-osseus blood supply is not well developed. Increasingly it is becoming increasingly obvious that neck capsule preservation is vital in these non-OA indications. Hence we have developed the neck capsule preserving ( NCP ) approach where the end arteries to the neck and head -neck junction has to be preserved. We have been doing the NCP approach for the last 6 yrs in predominantly non-oA indications with excellent results.

Neck capsule preservation is not possible through the anterior approach and therefore the post approach is more suited for non-OA indications. The other benefit of the NCP approach is the fact the capsule is also repaired back completely so that the surgeon can confidently advise patients that there wont be any restrictions post-op. The repaired capsule will prevent the patient from doing any awkward movement even inadvertently. This is very useful in the first 6 weeks which is the time taken for a pseudo capsule to form when the surgeon does not stitch back the capsule . Therefore capsule repair is of relevance only in the 1st 6 weeks

The 3rd issue comes into play when a femoral component of a resurfacing is done uncemented. This is the situation where one has to be extraordinarily careful as even a little necrosis of the head bone would cause failure of the implant. When one uses cement, the cement converts the head into a 'composite' of live bone, dead bone and cement. Some bone unviablility is easily tolerated due to the presence of cement. Therefore in uncemented femoral resurfacing one has to use the Ganz approach or surgical dislocation where the blood> supply should preserved entirely. Although this appears to be desirable in theory for all resurfacing it has its own problems. It involves a trochanteric osteotomy and reattachment with screws. The pt has to be partial weight bearing for 6-8 weeks till the ostetomy unites. Prof Ganz from Berne developed this approach for non arthritic hips for pts in their 20s to treat femoral acetabular impingement (FAI). These patients have a completely normal pattern of blood supply (completely exta-osseus) and in spite of this, pts do not develop any problems. This technique is described as surgical dislocation and surgeons employ this for any condition that requires a dislocation of a normal ( non-arthritic) hips. The surgical dislocation is always done posteriorly.

Thus 3 different situations with regard to resurfacing need 3 different approaches and all of them are posterior! Anterior or posterior refers to which side the hip is dislocated and not on where the incision would be. Irrespective of whether anterior or posterior approach is done , the incision will always be on the side ( exactly lateral). So one cannot deduce approach employed by looking at the incision. Therefore the skin incision is same for both approaches.
Vijay Bose.
consultant orthopaedic surgeon
Chennai"

Vicky

momzer2

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Re: Recovery Time After Surgery
« Reply #9 on: July 20, 2007, 01:48:26 AM »
Vicky,

Now that was very interesting.  I wondered about the muscle group problem.  I'm sure Dr. Barba would use the post approach, but of course I'm still going to ask.  Thanks for your help.

karen

 

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