As I mentioned in passing in Mik's birthday thread, Mr wtg is recovering from hip replacement. Steve asked if we'd be willing to share details, and we're happy to.

Mr wtg has severe osteoarthritis in both hips but the right one was basically bone-on-bone so he had that one replaced. He waited much longer than he should have.

He had what's called anterior hip replacement, where they come in from the front rather than the side/rear. Requires a special (expensive) table to do, and a lot of hospitals don't have the equipment.

For the posterior surgery, I guess they cut six muscles to get to the hip. The incision for the anterior surgery is in front, they cut no muscles, and it's about half the length required for the posterior method. Recovery time is amazing; more later.

There are almost no restrictions during recovery for anterior. Only ones are no lunges, squats, and one other thing I can't remember. There's much less risk for dislocation with anterior because all of the muscles that hold the hip in place are intact, as opposed to the posterior where they all have to heal. With posterior, you have to sleep on your back with a pillow between your legs and you can't cross them. Lots of hip precautions.

So Mr wtg's surgery started around 2 pm last Wednesday. Spinal anesthesia and sedation, surgery done and he was awake by 5:30 (spinal still wearing off). By 10 pm he was able to sit up on the edge of the bed, stand up, and take a few steps in the hospital room (overnight stay, though if you're the first surgery sometimes you can go home same day).

Next day PT and OT came in. He walked down the hall with his walker, over to the stairway, and did a full flight up and down to pass his "go home" test (we have stairs). Less than 24 hours after surgery.

Came home Thursday night and walked upstairs and went to bed. Pain relief at the hospital was Tylenol, Celebrex, the remnants of the spinal, and Dilaudid (which I think they gave him twice). At home it is just Tylenol and Celebrex, the latter of which is given to prevent bony overgrowths while the bone is healing. Only discomfort was a sore thigh muscle from when they were working on the leg. Incision is maybe 4 inches long.

PT is coming to the house for 2 weeks to teach him exercises and get him off the walker to a cane and then nothing. This surgeon doesn't believe in outpatient PT and wants people to make slow steady progress. He thinks therapists often push people to do too much too fast.

He has to raise his legs above his heart four times a day to keep the swelling down, and ice it for the same reason. Also has to give himself a shot of a blood thinner for six days, then he goes on one aspirin a day for two more weeks. Celebrex and Tylenol for three weeks total.

It sounds like a miracle, and it really is.

Here's a guy in Scottsdale that does the same procedure and seems to handle things a lot like Mr wtg's surgeon does. It's the best explanation I've seen of the procedure.

http://www.scottsdalejointcent...acement-precautions/

Feel free to ask questions. I also know quite a bit about the posterior procedure, as my Mom broke her hip late last year in a fall, and had to have partial hip replacement to repair the break. since hers was done on an emergency basis, she ended up going to a local hospital where none of the ortho guys do the anterior procedure. Not sure she would have been a candidate anyway due to her age.

WHAT an amazing breakthrough, wtg! Many thanks for posting the story and info. I'd imagine many of us will be needing such surgery sooner or later and if sooner, they might especially benefit from learning of this new approach which they might otherwise have missed out on.

Grrr. Just remembering decades ago, NOT being told about arthroscopic surgery by an incompetent local orthopedic surgeon who simply hadn't been trained to do knee surgery that way.

I narrowly escaped being sliced with an ordinary scalpel instead, after tearing a medial meniscus. Visiting my parents GP on a visit to my old home town (I decided I might need an antibiotic refill). Noticing my limp, he asked me about it, then sent me to an excellent sports medicine doctor nearby.

That (knowledgeable) doc ended up operating on it arthroscopically on a subsequent visit.
I limped into the hospital in pain, and walked out after only a few hours completely painfree!

I still remember with resentment that first doc's willingness to put me through unneccessary, excruciating surgery (ordinary knee surgery used to be infamous), just because he himself couldnt do the "new" kind. (His wife was a good friend too! )

Your updating us about this approach to hip joint replacements could spare one of us (or a friend) from much avoidable hell.

It is amazing. Good for him!

Mrs. M has finally decided to get this done in November. She is in tremendous pain and even so is reluctant to go through with it.

We know people who did the deal with very little difficulty and others who had any number of problems with recovery. Many of our friends who have had the procedure done have had a lot of trouble with the anesthesia. Mrs. M. has had anesthesia in the past and has no problem with it so maybe that part will be OK.

It’s all inspiring and all terrifying at the same time.

I'm so glad it's working well for mr. wtg. It sounded like it was a major life impairment for him, and this should be a big improvement.

One thing to consider is that the hip will only get worse and throw her body out of whack and create pain in new places.

Mr wtg was having a lot of pain in the hip and was starting to have major knee pain and the beginnings of lower back pain. The surgeon pointed out that the hip is a rotational joint and the knee is a lever joint. Because Mr wtg's right foot was turning out because of the hip he was putting stress on the knee, which was trying to rotate (which it's not supposed to do) because the hip couldn't. And he was starting to walk bent over and causing the back pain.

The surgeon's skill in doing this procedure is also really important. Our surgeon is a hip and pelvis guy rather than a general orthopedic surgeon. He described their program for hip replacement as a Henry Ford assembly line. They have a rigorous protocol for each step, from pre-op medical exam through surgery and rehab. He's in an orthopedic unit in a university hospital and works with the same staff (OR assistants, anesthesiologists, etc.) all the time. He said when he was part of the general surgery pool at a regular hospital they never knew who would be part of the surgical team. He thinks they get better more consistent results with their current program. Plus he's been doing this procedure for almost 20 years.

https://www.nm.org/doctors/103.../michael-d-stover-md

Any surgery has its risks. The patient just has to be at the point that they feel the potential benefits outweigh the risks.

Dr. Stover did my first hip replacement with much the same results, though protocol then was to stay in the hospital a few days.

After retiring with the subsequent change of insurance, I had someone replace the 2nd hip 6 years later with the same approach. Almost, but not quite as good - there is a difference between docs!

I pushed rehab too hard after the second hip, but that was me, not the PT... I have some lingering issues on that side, but it is also the side that I had a knee replacement, so that could be part of the issues.

Women often have bone density issues which complicate the surgery - I remember the second doc saying all of the approaches have pluses and minuses and need to be considered with what the patient presents.

One thing I always recommend for those considering lower joint surgery is to spend as much time as possible leading up to the surgery working on upper body strength. It makes manipulating walker, cane and crutches so much easier!

As the ability to walk declines, getting in the pool or biking if possible maintains some lower body muscle tone which helps after surgery.

Knocking on wood.
Hope I never need a hip replacement.