As the number of baby boomers reaching middle age increases in the United States, so does the annual rate of artificial hip replacements. The Centers for Disease Control and Prevention in its FastStats lists that number at 332,000 annually, and this year, Murrells Inlet resident and my husband, Al Nicholas, found himself a part of the statistics.
On May 5, he underwent a total joint-replacement procedure on his right hip.
While doctors say there is no specific age or weight that points to replacement of one of the body’s largest joints, Dr. Thomas J. Chambers, who performed Al’s surgery at Grand Strand Medical Center, said “the measure of what is the right time is when you have an appropriate X-ray and symptoms that affect your quality of life.”
A doctor of orthopaedic surgery and sports medicine with Strand Orthopaedic Consultants LLC for the last 19 years, Dr. Chambers said the decision to have joint replacement comes when a patient says, “I’m hurting and I’m tired of hurting and I can’t control that hurt anymore.”
For Al, it was when he could no longer take long walks or enjoy a full round of golf without experiencing a lot of pain.
“I didn’t want to continue not being able to enjoy the simple things in life without being in pain,” Al said.
His decision was a long time coming. In fact, it was more than 10 years since he had begun to experience hip pain. That began after a home renovation project where he upgraded our home with new flooring and tile, and spent a lot of time on his knees.
“It got progressively worse so in 2008, I went to see the doctor for some back pain, and after an X-ray, they noticed the avascular necrosis in the right hip,” he said.
Perhaps not as commonly a cause for hip pain as various forms of arthritis, avascular necrosis of the femoral head is an interruption of the blood flow to the bone, causing eventual bone collapse. Caught early, there are some treatments to help avoid surgery; however, Al’s was too far progressed by the time it was diagnosed.
Dr. Chambers said while there are some factors known to increase the risk of avascular necrosis, most commonly it is idiocratic, meaning they simply do not know why it happens. He called it simply bad luck.
Maybe just bad luck caused Debbie Lombardino of North Myrtle Beach to need a total hip replacement. She had suffered with hip pain for close to three years before an MRI revealed the avascular necrosis. A retiree from Virginia, Lombardino chose to return to Anderson Orthopaedic Clinic in Arlington to have her surgery April 22 and to an area where she could count on a network of friends to help her during recovery.
She said her doctor chose to perform the newer anterior approach (front entry), releasing her after a one-night stay in the hospital. After home physical therapy for a month and a successful follow-up report from the doctor, she had a friend drive her back to North Myrtle Beach, where she says she is in “zero pain” and no longer taking four medications prescribed for her during her years of pain.
As anticipated for most hip-replacement patients, Lombardino is already enjoying a variety of low impact activities.
“I’m not running at this point, but I’m back on the elliptical at the Aquatics Center, riding my bike and swimming,” she said. “And as soon as the doctor clears me, my goal is to train to walk the Myrtle Beach half marathon in 2016.”
Preparing for surgery
Making the decision to have total hip-replacement surgery was just the beginning of a long list of activities that had to occur prior to Al’s surgery. Those activities began with a mandatory patient education luncheon, where an orthopaedic RN explained to the patients attending and their assistants what to expect before, during and after surgery, and provided a guide to follow. Our educator explained in detail all the steps involved in preparing for a successful surgery and for a recovery void of blood clots (the most common complication). He stressed the importance of managing the pain early and often so as not to hinder rehabilitation, which he said could start as early as the day of surgery.
We learned that Al would need to perform some special exercises during the weeks leading up to surgery to help build the muscles in both legs. He was to begin taking a multivitamin and iron supplement and told to continue for at least a month after surgery. If he wanted to donate his own blood for the surgery, he would need to arrange that through the Red Cross at least three weeks before surgery. We heard the pros and cons of anterior and posterior (side or back) entrance surgical procedures and learned that the surgeon would ultimately choose the best approach for the patient.
The educator shared a list of special equipment that would assist during recovery. Although some items could be provided through Medicare before leaving the hospital, we chose to prepare early. Al installed a locking, elevated toilet seat with handles in our master bathroom, added a safety bar in the shower and ordered an ortho bed wedge designed to elevate the extremity above the heart while sleeping. (Before leaving the hospital, Al was provided a walker, a cane, a gripper for picking things off the floor without bending more than 90 degrees and a dressing stick for putting on socks – that works incredibly well.) We also purchased an extended shoehorn so he could slip on his shoes without bending and without assistance.
Next steps included a series of doctor visits to obtain medical clearance from Al’s primary care physician and cardiologist. He underwent a battery of tests that included an electrocardiogram, blood work and urine sample, as well as a physical examination and X-rays to determine the extent of damage in the hip and condition of bone and soft tissues.
The surgery itself took less than two hours from start to recovery room. Dr. Chambers recommended the posterior approach to surgery for Al, inserting a titanium alloy tapered stem, zirconium oxide ceramic femoral head and polyethylene cup using tools similar to a carpenter.
With a successful first year and no falls or other complications, Dr. Chambers said Al could expect his implant to last up to 20 years.
By now, we both understood why our pre-op information stressed the need for having some in-home support after surgery. It was very important Al not fall or overstress the healing hip, which was covered with an aquasel bandage. He had a 5-inch scar that was closed with glue – no stitches or staples to remove – and frequent icing helped alleviate swelling and bruising. It was also important he continue rehab that was begun almost immediately in the hospital.
Like Lombardino, Al needed to be able to count on having help by his side during recovery at home.
“It’s important to have someone really caring at your side to get you especially through the first two to three weeks after surgery because it’s not a cake walk,” Al said.
In addition to me, Al could count on in-home therapist Eden Hibionada from InCare Home Health & Hospice, who provided three weeks of assistance three times a week. He helped Al through a series of exercises to regain use of his hip and leg, leaving Al with this advice once he is released by the doctor, “Go back to your life; enjoy your life.”
There are a few important rules to remember after having your joint replaced:
▪ You are not going to be driving for a few weeks, depending on your recovery rate, and you will have to rely on someone to get you to important appointments.
▪ Once healed and ready to travel by air, you will need to alert airport security to your new body part, as it may set off the metal detector. Your doctor can give you an identification card to carry with you.
▪ You should also advise your dentist and family physician about your joint replacement before having any dental work or future medical procedures. To prevent against any complications, you will need to take antibiotics.
As for Al’s progress five weeks after surgery, he is feeling pretty encouraged.
“The therapist felt I was moving along really well, and the doctor felt the hip looked great during my follow up,” he said. “I guess the biggest question is now how soon will I be able to swing a golf club.”
ANGELA NICHOLAS is a freelance writer and can be reached at email@example.com.