HIPS
HIP ARTHRITIS
Hip arthritis can have a dramatic impact on patients’ quality of life. This often presents as low back, buttock or groin pain, and can make even the simplest tasks – putting on shoes and socks, getting in and out of a car – unpleasant. I will get a thorough history, perform a physical exam, and review X-rays of your hips and pelvis to confirm the diagnosis of hip arthritis. I will stick with you through the entire range of treatment options, which may include a combination of physical therapy, activity modification, medications, injections or surgery.
If you choose to consider surgery, I am specially trained in minimally invasive hip replacements using the direct anterior approach with a small bikini incision. My patients are up and walking the same day of surgery, and most will go home within 24 hours after surgery. 60% of my patients go home the very same day without staying overnight in the hospital.
If you choose to consider surgery, I am specially trained in minimally invasive hip replacements using the direct anterior approach with a small bikini incision. My patients are up and walking the same day of surgery, and most will go home within 24 hours after surgery. 60% of my patients go home the very same day without staying overnight in the hospital.
HIP REPLACEMENT
Although every case is different, a typical patient can expect:
- Preparation. After we agree on a surgery date, we will schedule appointments for you to meet the anesthesiologist and get pre-surgical clearance. There is also a personalized joint replacement class that will help you prepare.
- Anesthesia. You will come in to the hospital or surgery center on the day of surgery. Most patients will get spinal anesthesia, which means that you will be sleepy and numb from the waist down.
- Incision & approach. I perform most hip replacements using the minimally invasive and muscle-sparing direct anterior approach. Your incision will be about 8 cm long, or about the width of a hand. I place the incision in the groin crease, so it will be hidden behind a bathing suit or underwear. I will close your incision with a plastic surgery closure using dissolving sutures under your skin and glue. You will have a waterproof dressing that can stay in place for 1-2 weeks, after which you will remove it.
- Surgical procedure. I (Dr. Wasterlain) am the one who performs your surgery – I will have an assistant, but there will be no students or residents performing your surgery. The surgery will take about 1 hour, but it may seem longer than that to your family members because the anesthesia and positioning takes some time as well. I will inject a long-acting numbing medicine called bupivacaine into the soft tissues around your hip to reduce your pain after surgery.
- Post-op recovery. After surgery, you will go to the recovery room to wake up from the anesthesia. A few hours after surgery your legs will regain sensation and you will be able to move them again. The physical therapists will work with you to stand up, walk, climb stairs, and do basic self-care activities on the same day as your surgery. You will not have any restrictions or need to wear any braces. Although I do not recommend contortionist positions or extreme yoga, your hip will be stable and can permit most movements and activities without restrictions.
- Discharge home. Depending on how you are progressing with physical therapy you may go home the same day, or you may spend one night in the hospital. After you leave the hospital, almost all of my patients go home. Research has shown that nursing homes and rehab facilities are associated with more complications (such as infections, blood clots, and hospital readmissions). Therefore, we avoid sending our patients to nursing homes except in rare circumstances.
- Physical therapy & recovery. For the first week or two after a hip replacement, you will use a cane or walker. After 2 weeks, you may start doing physical therapy to regain strength. Some patients are doing so well that they don't require physical therapy. By 6 weeks you should be feeling much better and be able to walk comfortably without a limp or assistive device. The full recovery period can take up to 3 months, but many of my patients recover faster than that.