Karrey's story: There's no typical joint-replacement surgery; a multitude of factors come into play
- on July 13, 2011
Editor’s Note: My firsthand account of joint replacement in a three-part series. This is part two: Surgery.
At 9 a.m. on May 19, I checked into Kansas University Hospital to have my right hip replaced.
I needed the replacement because of congenital hip dysplasia — my hips didn’t form correctly. The surgery I had at age 2 lasted for nearly four decades.
Dr. Kelly Hendricks, my surgeon, said: “The surgery bought your hips more time, so you didn’t need a replacement when you were 25. That’s good.”
But now I needed new parts.
I showed up for surgery in the recommended baggy clothing — sweats and T-shirt — and no makeup. I hadn’t had anything to eat or drink since midnight.
As soon as my husband and I made it to the second-floor waiting room, a person in scrubs called my name and escorted me beyond the double doors and into a holding room near the operating room. He asked me to change into a hospital gown and to put a tight, white stocking — called a thrombo embolic deterrent hose, better known as a TED — on my left leg to prevent blood clots.
The preparation before the operation — hooking me up to an IV, putting in a nerve block, marking my right side, visiting with Hendricks — are all kind of a blur. Before I had time to think about it — which was good — I was rolled into the operating room and then it was lights out.
It was about 11 a.m.
Surgery for a knee or hip replacement generally takes between 90 minutes and two hours from first incision to last stitch.
Dr. Kelly Hendricks predicted my surgery wouldn’t take that long because I am a healthy and fit person, something that also would benefit me during recovery, he said.
Some doctors won’t do a joint replacement on smokers and/or people who are obese. It’s for the patients’ safety, they say, because they’re at greater risk for complications.
During the operation, I was placed on my left side, along pegs to hold me in place. Then, Hendricks and his team basically took out the worn parts and replaced them with artificial ones. That meant making an incision along the joint, moving the muscles aside and removing the damaged bone and cartilage. He dislocated my leg during the procedure. Then, he fit the remaining bone with a prosthesis.
There’s great debate among orthopedic surgeons about the best implants to use. Some are made of ceramic and others of metal. Some say ceramic parts last longer and others say they don’t. Some say the metal ones release ions into a patient’s body and others deny it.
There’s even debate about the best technique to do surgery and the use of cement.
Dr. Richard Wendt, of OrthoKansas in Lawrence, said today’s implants typically last 15 to 20 years. He doesn’t anticipate any big advances in the technology being used.
He said the outcomes for joint replacements are better today because:
• Orthopedic doctors are sub-specializing in one or two joints instead of all of them. For example, Wendt specializes in knees and hips, while his partner, Dr. Doug Stull, specializes in shoulders. So, doctors are getting better at what they do and are doing more surgeries in their specialty.
“It makes patient care better — no question,” Wendt said. “Studies have shown over and over again: The more volume, the better the results.”
• The materials — plastic, metal and ceramic — used in the implants are better.
• The implants are fitting better because more sizes are available.
Wendt advises patients to trust their doctor when it comes to picking the implants.
“Let the doctor put in what he’s comfortable putting in and don’t ask about something that he’s never used,” he said.
For me, I trusted Hendricks, his methods and his decision to put in a ceramic implant.
For hip and knee replacements, the biggest risk is infection.
It’s because the artificial parts don’t have their own blood supply, as the natural parts do. So, if bacteria get on the parts, they can live there. Antibiotics won’t work because there’s no blood supply to get them to the joint.
If the joints become infected, doctors have to remove the parts and replace them in a separate surgery, after the infection has cleared up.
“It’s at least two more surgeries,” Hendricks said. “It’s usually fixable, but it’s a tough fix.”
Other major risks include anesthetic complications, blood clots, and blood loss requiring a transfusion. For hip replacements, there’s an added risk of dislocation and a change in leg length.
Minor risks for both replacements include nausea, constipation, persistent pain or stiffness, and nerve injury.
Surgeons also vary on their methods of preventing these risks from happening. For example, one risk is blood clots. Doctors vary on the type of medications they have patients take, and some recommend TED hose and others don’t.
The methods used to control pain also differ among hospitals and doctors.
My surgery took about an hour. I woke up about 1:15 p.m., and soon my family came to greet me.
I asked for water, warm blankets and lip balm. I wasn’t nauseated. I hardly felt any pain because a peripheral nerve catheter pushed a numbing solution into the major nerve near my hip.
Once I was in my room, nurses put massage devices on my feet to assist with blood flow and circulation. These little air pumps felt so good I wanted to take them home.
After my family left, I mostly slept except for when nurses were giving me pills, checking my vitals or taking blood.
At 10 a.m. the next day, I had physical therapy and made it down the hallway on the first trip with a walker. An hour later, I had occupational therapy, where I learned to put on my socks and shoes without bending past my waist. When you have a hip replacement, you can’t bend more than 90 degrees for about six weeks because, if you do, you can dislocate the hip.
That afternoon, the day after surgery, I walked a loop around the orthopedic area with a walker, the urinary catheter was removed, and IV fluid was stopped.
I felt like I was well on my way to recovery.
Tomorrow: The recovery.