Surgical Alternatives to Hip Replacment for young patientsgreenspun.com : LUSENET : About Joints : One Thread
Discussion on surgical alternatives to hip replacement for younger patients. Specifically I would like to discuss Surgical Dislocation and Osteotomy.
-- Ray Biggs (email@example.com), July 15, 2001
I would like to comment on your question, but I need you to be more specific. What are your symptoms? What treatments have been proposed? What treatments are you looking at? How old are you? What is your medical status, etc.?
-- Marc W. Hungerford, M.D. (firstname.lastname@example.org), August 14, 2001.
i am 47 yrs old.i have had osteotomy done when i was 23 yrs old.since then i dont feel comfortable,the pain is most of the time there and as the years passed by it is increasing.by the way i have dislocation bilateralis,but after i went through my first surgery the post operative period was so difficult for me that i didnt want to go for second one.i am getting pains around my waist and from my hip the pain reflects towards my knee and lower part of the leg.i will appreciate very much if you give me some other ideas or the surgery is a must.thanks ardemis
-- ardemis massarlian (email@example.com), March 12, 2003.
March 5th and still no answer, I was told today that at 38 I need a hip replaced also. I wish the doctor you asked these questions of, would have cared enough to give an answer to you and us all. Typical huh??
-- Edward Vitale (firstname.lastname@example.org), May 21, 2003.
I have just undergone a total hip replacement at the age of 40 and it is the best thing I could have done after being born with a congenital hip dislocation and have suffered most of my life with pain only a person like you would understand. If you are offered a hip replacement go for it and evjoy the benefits while your still young enough. A little tip is, if you can possibly get as fit as you can before surgery. Tina
-- (email@example.com), August 06, 2003.
Friday , September 26th and yet still no answer to the above question. Very unprofesional website with no input from compident doctors. My surgery i soon and I had hoped to come back all these months later and see an answer!~
-- Edward vitale (Gamootz@aol.com), September 26, 2003.
I was contacted today not by a doctor but by this websites Web Coordinator,Debi Ross. She has not offered any help either. ashame
-- Edward Vitale (Gamootz@aol.om), September 26, 2003.
Hi everybody, I had my right hip replaced last Thursday and I am home already, I am not healed by a long shot yet but I want to tell you it went far better than I ever had anticipated. I am 39 years old and had many breathing issues but they never became an issue in the hospital during or after surgery. I opted to have my surgery with my being awake and having a spinal. what a good choice that turned out to be. I was in control and the surgeon and I were in contact thru the operation, He said my bones were strong and he choose to use a porcelain as the inserted part for the femur because of my age, he said the healing time is longer but much strong and would last much longer because the bone will knit into it. Chrome ball part and plastic for the pelvis cup were his other choices. It feels very strong already. They do not use cement for this type but the porcelain will actually grow bone through it because there is a bone type serum coating on it. I want to wish you all good luck on your surgery and tell you "If you pay attention, talk to your doctor/surgeon about any/all of your problems prior to surgery, he will take very good care of you. Look Up Surgeon Dr. Beauvais of Waterbury, CT. a great young doctor and very gifted surgeon. Don't be afraid of this operation, Eddie
-- Ed Vitale (Gamootz@aol.com), October 22, 2003.
Hi, I'm Eddie's mom. I am very proud of him. Despite all the the doubts and dread preceding his hip replacement, he has come through this major surgery with courage and a very positive attitude. Trust and faith in his surgeon and the entire medical team at St. Mary's Hospital in Waterbury, Ct gave him peace of mind and the fortitude to go ahead and have the much needed hip replacement. He had been in intolerable pain for well over a year,which interfered with his ability to do the things he loves to do. Now, he has a new future ahead and is confident that he can look forward to that while he recovers and he endures the discomfort and does his physical therapy with that goal in mind. He faces another hip replacement on the other hip in about a year and now does not fear or dread it. Way to go Eddie!
-- Margaret Tarbell (Tarbellmom@aol.com), October 22, 2003.
I think this was interesting enough to add for anyone cnsidering Hip replacment. Total Hip Replacement Surgery
The purpose of Total Hip Replacement Surgery is to remove the damaged and worn parts of the hip and replaces them with artificial parts, called prostheses, which will help make the hip strong, stable and flexible again.
At surgery, an implant, selected by your doctor to fit your hip, will be affixed to the area between the femur and the pelvis. In most cases, the implant will consist of two pieces: a metal shaft with a ball at one end; and a metal or polyethylene cup. These will replace the socket and ball of the femur, and will form a new hip joint.
For some patients, an acrylic cement called Polymethylmethacrylate (PMMA) will be used for the fixation. This cement has been used successfully by orthopaedists for over 25 years. It is a strong material, well-tolerated by the body and set or cures within 15 minutes after it is mixed. Before curing, the cement is pressure- injected and the implants are seated. Most patients are able to bear weight on the operated leg within several days of surgery.
For other patients, the implants are able to be affixed to the bones without cement. Special surgical instruments are used to precisely prepare the bones so as to enable a press fit. To supplement this joining, supportive screws or pegs are often used. Bone is a living and growing tissue. If an implant coated with metallic beads to form a porous undersurface is placed in very close contact to living bone, tissues can grow into the pores, further locking the implant in place. Porous-coated hip prostheses have been used for many years and have shown excellent results in many patients.
Preparing for Surgery Preadmission Exam Prior to surgery, you will receive several forms to take to your family doctor for a physical exam and for preadmission testing. Part of the exam will include a blood sample. Your doctor may suggest that you consider donating your own blood to save in case you need it during or after surgery.
Before Surgery 1. Do not eat or drink after midnight the night before surgery.
2. A sleeping medication may be ordered the evening before surgery.
3. In some cases, a blood thinner may be ordered a few days before surgery.
4. Generally, aspirin and nonsteriod anti-inflammatory medications should not be taken seven days prior to surgery.
Morning of Surgery 1. The nursing staff will take your temperature, pulse, respiration and blood pressure.
2. You may brush your teeth and rinse your mouth, but do not swallow any water.
3. A clean hospital gown will be provided.
4. An intravenous (IV) line will be started the morning of surgery.
5. Anti-embolism stockings (elastic) or a sequential compression device may be provided to promote circulation to the leg.
Going to Surgery 1. You will be asked to empty your bladder.
2. Remove all jewelry, dentures, contact lenses and nail polish.
3. Rings not removed will be taped.
4. Relatives and friends will be given instructions on where to wait.
5. A surgical orderly will take you on a gurney to the preoperative waiting area.
6. The anesthesiologist will discuss the type of anesthesia to be used.
7. You will be taken into the operating room.
What to Expect After Surgery When the surgery is completed, you will be taken to a post-anesthesia recovery room. When your blood pressure, pulse rate and breathing rate have stabilized, you will be moved back to your regular hospital room. You will also be instructed in breathing exercises to help reduce chest congestion.
For the first day or so after the operation, nurses will closely monitor your pulse and blood pressure. They will also make frequent observations of your affected hip and leg to check for drainage, circulation, stiffness and swelling. If, at any time, you experience discomfort or a loss of feeling, you should notify a nurse immediately.
For the first couple of days after surgery, you will be given fluids intavenoulsy. Once you can tolerate liquids, your diet will be increased accordingly.
If an antibiotic is prescribed as a preventative measure against infection, it may be given through the IV.
One or two small plastic suction tubes may be used to draw excess flued from the area around your incision. The tubes are usually removed within 24 to 48 hours when the drainage decreases.
A moistened oxygen mask may be used to soothe your throat and loosen secretions in your lungs. This mask can be removed for short periods of time. A trapeze attached to your bed frame will assist you in moving more easily and the side rails of your bed may be raised for your safety. While it is normal to experience some pain or discomfort after surgery, medication is available and ice can be applied to reduce swelling and discomfort. Let your nurse know if you are experiencing pain or discomfort.
Activity While in the Hospital Your surgeon will let you know when you can get out of bed to sit in a chair and when you can begin physical therapy. The nurse will help you out of bed and a trapeze may be used as an assistive device. A commode seat on wheels will help you to walk to the bathroom and use the toilet.
Time Most patients are hospitalized from four to six days. The surgery generally takes two to four hours to perform. Patients must use support in two hands for about six weeks after surgery while their muscles are rehabilitating.
Results Many patients are able to resume daily activities without restriction following surgery. It is important to remember, however, that the replaced hip is artificial and there may be occasional discomfort in the hip area, as well as some numbness in the skin around the surgical scar.
The results of total hip replacement are based on patient determination, the surgeon's skill and the bioengineer's well- designed implants and instruments. Continued advances in the field can be expected to result in continuing success in the future.
-- Ed V. (Gamootz@aol.com), January 13, 2004.
Hi Ed, I hope I find you well and well on your way to recovery. I would like to share with you my experiences and am hoping you will keep me posted on your further progress. It's rather a long winded story but here goes..... I am 23yrs old and was diagnosed with "Bilateral acetabular dysplasia of sublaxtation to both hips" when I was 15yrs old which was undetected at birth. I had suffered for many years with knee and foot problems on and off, as well as aching and throbbing legs. I was unaware I had a problem and as I didn't know any different but to experience this immense discomfort and pain, I believed that this was how everyone felt. It wasn't until I went out the house and as I started to walk I felt and heard this extremely loud clicking sound coming from my left hip. With every step I sounded like Robo-cop!!! Although it was "novel" at first, and soon became a party trick of mine due to the loudness of the clicking, I finally convinced my Dad that i wasn't a hypercondriact as he was starting to believe what with my endless x-rays on my knees and feet all coming back clear. He booked me in to see the doctor... who refered me to hospital to have an x-ray on my pelvis. After waiting weeks for the results I was called to the surgery where my doctor tried to explain something he clearly did not know anything about. More referals, three hospitals and several months later, I finally settled seeing the same surgeon. What an arrogant so and so he was too! This is where my nightmare began. He told me i needed to have a 'THR'on either side... no idea what this was at the time, i just nodded and tried to keep up with all he was saying. Over many months he would change how he was going to approach my condition. I felt so uncomfortable and with this very scared. I started putting on weight knowing the surgeon wouldnt operate if I was any heavier.... luckily I did the right thing by eating... this surgeon was a butcher and the only comfort he would give was telling me "how I didnt understand the implications of my condition.... and one slip of the knife and i'd be a cripple in a wheelchair for the rest of my life". As you can imagine... I went through a fair few clean pants that day! Years went by of seeing this surgeon and I got rapidly worse as it went on. He finally decided that he wouldn't even consider surgery until I was 21yrs old as that was when i would have stopped growing!!! I believed him. As I approached 19yrs he put me on the waiting list. 9 months wait max. he said. I don't recall how many times he took me off that list or fitted in numerous private patients for THR's. I was at my wits end. Lack of any mobility at times and the constant pain and throbbing... I could only pray for a miracle! Then one came... My ears pricked up as I caught the local news headline... my arrogant butcher of a surgeon had been sacked! He refused to operate with a spoon of all things during a routine hip proceedure! He literally up't tools and left, leaving his patient in theatre! I found myself making mountains of phone calls to see where that left me... more surgeons.... more hospitals... and then I was refered to a surgeon 400 odd miles away who was the nearest one who could do the operation I required. Within 5 days I had travelled to see him, and within four hours of being under his care he had done more in that time then the previous one had done in 7yrs! There was no having to wait weeks for x-ray results... he had me x- rayed and within 30mins i was sat down and he told me in simple terms that I was born with extremely shallow hip sockets on both sides which were becoming shallower all the time. He produced the very first x-ray I had and compared it with the one he just took... the difference was shocking! It looked as if I had no sockets at all in comparison! I saw him again the following week and he told me my options. He adviced strongly I should consider a Peri-acetabular Osteotomy. This way it would prolong my need for THR's and hopefully get many more years out of my hips just by breaking the bone in three places and re-orientating it all, utilising my own natural materials. I had so much confidence in all he said and I asked him to do what he thought was best. He gave me two lots of injections in my hips over the next 6 months... the first one was a god send! Although it was only a week of lessened pain, it was bliss! The second injection however didnt have the same effect. Apparently this is normal. I got the date through for my operation and I couldn't stop crying. Happy yet scared of the unknown. So, for the next four weeks I had to go and give a pint of my own blood at a time for use if I needed it after surgery. The big day came and I was put to sleep and whisked into the operating room. Unsure of which hip he was operating on as I told him to take his pick. The nurses were even placing bets as to which one it would be! I remember waking up thinking it was christmas... wrapped in layers of what seemed like tin foil. It wasn't how I thought it would be at all. I felt groggy and I couldn't understand why I wasnt in the slightest bit of pain. A nurse popped in and handed me the phone within minutes of waking up. It was my surgeon... He told me how the operation went, he said it was far more demanding then he anticipated and that it took twice as long as he first said it would. My bone was so thick that he had to break out the heavy duty tools... He told me that during surgery I had gained a fracture to the back of my pelvis, quickly followed be reassurance and the need to stay in hospital a week and a half longer then initially thought. That didnt bother me one bit... 3wks past and I still had the epidural in, I was like a dead weight.. couldn't feel my legs to move them one bit! Subsequently, I'm embarressed to say, I got one major pressure sore on my behind! That was the most painful part of the whole ordeal! They slowly weened me off the epidural and the pain got too much to bare. I couldn't cough... sneeze... and was to scared to move due to the grinding and grating I was feeling from within my pelvis. Numerous morphine jabs in my already bruised thighs didn't seem to ease the pain... although my own readily available supply of Entinox (gas) by the side of my inflatable bed helped no end! I was a giggling wreck! Even more so when I looked down at these "space boots" they had repetitively beating away at the soles of my feet. I could actually feel them now after so long. The next day I was sat up in the chair at the side of my bed. Took an hour of fussing on my part to get there but I did. I really didn't think I could do it. Every time I felt a crunch from my hip I panicked because with the crunching come sharp shooting pains through my pubic bone. The nurses were never on hand to help you and I found if I was having problems doing something one of the 70yr old dears from the next bed who'd days previous had a THR was helping me. The aftercare was diabolical. This has seriously put me off having my right hip done in April. I ended up discharging myself after 4 wks of it all. I missed my 3yr old daugther dearly and felt I would get far more care being at home letting my cat look after me! Besides, I was told I would only be in for two weeks and I was counting down the days until I could have a cigerette :) Shame on me! 400 miles of traffic and whinding country roads later, I eventually arrived home. I crawled up the path with my zimmer frame for all of sundry to see. I inched my way into bed and thats where I spent most of the last four months. Non weight-bearing on my operated leg for three months... I had no end of problems with me wound... the nurse came and took the strips off but she could only manage to take three of them off as it kept tugging. Within an hour of her leaving she was back again... my wound had decided to pour out tonnes of blood followed by orange watery stuff! It oozed for the next month - it just didnt want to heal! Tonnes of excerises later, emotional and physical tiredness, gallons of tears and still no sign of a physio... I slowly progressed off the frame onto crutches. I managed to get about using one crutch for the last few weeks but that soon stopped - it was too much. I went through a stage where I thought I was recovering well but 3 weeks ago I got up out of bed.. went to walk and I couldn't move my hips in their sockets. I couldn't even sit back down as when I tried I had shooting pains from within my bum cheek :\ It's agony! Once I get going the pain eases slightly but i'm noticing my gait getting considerabley worse then it ever has been. With each step I take on my operated leg I get this sharp shocking pain in my butt! My leg is even turning in and the only way I can get to the loo without too much pain is to walk with my thighs together trying not to move my hips what so ever! What with a huge scar which is messed up from where it didnt heal as the rest did I look like something out of "Resident Evil" and I have even been likened to Mary Shelly's Frankenstein. I can't get out... I cant do the things my little girl asks of me, and i'm lacking in adult conversation (hence the length of this message:) Not only that but I feel so alone with it and it lifts my spirits to see i'm not the only one out there going through the same mental and physical emotions perhaps. This is the first time i've sat down and re-lived it all so to speak. I've read some messages on the net this past week that has made me think how lucky I am! Most things can be fixed... and if they cant you adapt and learn other ways to make do! I hope if anyone else reads this post in years to come (looking back over it, it's going to take you all years to finish reading it)! and is faced with the same situation ahead of them which at the time seems daunting and never ending... I hope you keep your mind strong, as that is all you'll have to help you get through it all. Try not to forget the "you" you were before surgery. Afterall, our bodies are merely a mode of transport to make sure our hearts and minds get safetly from A to B.
-- Emma Jones. Cornwall, UK (firstname.lastname@example.org), October 18, 2004.
I forgot to add.... had op April 29th... still cant feel sensations in my thigh. Was odd to start with and hurt if anything even touched my skin. Still feels like its not my thigh! My surgeon said that the nerve was embedded somewhat which meant more stretching ... has anyone else had this and if so how long did it take to regain full sensation? Also... has anyone experienced bad effects of painkillers? I started feeling like my whole body was tingling hot.. like an electrical charge which started off as small twitches which would radiate from my armpits ... which progressed into jerking and my arms would fly out above my head with no control whatsoever! (lol.... odd symptons - I know) but it stopped to some degree when I was taken off "Tramodol" however I get faint twitches still, usually when i'm dropping off to sleep! grrrrr! Please tell me i'm not alone and i'm normal!!!!!!!!
-- Emma J (the essay writer) tee hee (email@example.com), October 18, 2004.
I've just been informed that my surgery has not been effective :( An x-ray taken shows my screws have bent considerably and that the bone which was cut in three places is not fusing together at all. Not only that but I have a fracture to the back of my pelvis! I'm not too sure if this fracture is in the same place as the fracture which I substained during surgery was. It would make sense if that was the case as the bone would be weak. A question for the surgeon when I see him again next week I think! As for the screws bending, I religously kept to everything the surgeon asked of me with non weight-bearing and I haven't had any falls. I do not understand how they could have bent???? He is talking of taking a bone graft from my right hip and placing it in my left after he has removed the screws, I'm also not sure if this means bone grafting to where he cut the bone to aid the fusing rate? Has anyone else had these sort of problems after having PAO surgery? If so I would be grateful for any advice with regards to this matter. Thanks in advance!
-- Emma Jones (firstname.lastname@example.org), October 26, 2004.