Hip Surgery Recovery

Have you ever heard of anyone who woke up from anterior hip replacement surgery with numbness on the outside of their thigh? It happens more often than you would think. With the new total hip replacement method being developed by Microport, numbness after hip surgery may be a thing of the past.

The skin nerves that run to the outside of the thigh are right in the way of the traditional incision for anterior hip replacement. Surgeons can easily cut these nerves when performing the procedure. While a numb scar our outer thigh is common, it’s really just a nuisance; however, a small number of patients have a more serious nerve injury. The femoral nerve, which is critical to walking, can be stretched during anterior hip replacement surgery. Researchers report the risk is usually less than 1%, but in some series, it has been as high as 3.5%. That doesn’t seem like much until it happens to you and you can’t walk for six months. Fortunately, most people who have this rare complication make a complete recovery, but it’s a risk. And risks are things we want to eliminate or at least minimize when having surgery.

Enter Microport. The company hopes to eliminate both numbness and weakness after anterior hip replacement and make the surgery easier for your surgeon to perform by moving the incision to a better location. The legacy skin incision for anterior hip replacement was selected to make it easy for your surgeon to see the cup of the hip. Anterior hip replacement was done in France way back in 1947. In the United States many orthopedic surgeons point to Dr. Joel Matta as an original champion. In his own practice Dr. Matta makes an incision over the cup. Dislocation allows the ball to be cut off easily. But the incision over the cup makes it hard to see the ball part of the hip during the procedure.

Dr. Matt Seidel in Scottsdale, Az presented the solution. Dr. Seidel has developed a cannula that is placed through a nick incision in the skin that allows the surgeon to perfectly clean out the cup without having the place the incision right over it. That means the incision can be placed more in the groin area.

There are several advantages to moving the incision:

• Lower risk of cutting the sensory nerves and causing thigh numbness
• Moves the procedure away from the femoral nerve that makes the already low chance of weakness even lower
• Reduces retraction during surgery, which means less pain and quicker healing
• A more natural incision means fewer wound complications

The new Microport approach has other advantages. The tools they have developed allow your surgeon to avoid dislocating the hip during surgery. The original reason surgeons in France tried the anterior approach to hip replacement was to preserve the muscles that prevent dislocation after surgery. In Dr. Matta’s technique to anterior hip replacement he typically dislocated the hip, then cut off the ball, before placing the implant. While there is no hard evidence that this is the case, many surgeons believe that dislocating the ball during surgery increases the risk of dislocation after surgery. Since reducing the risk of dislocation is one of the main goals of the anterior approach, your surgeon will do anything he can to lower that risk. The Microport approach avoids dislocating the hip during surgery entirely by cutting the ball off first, then removing it from the socket.

Surgeons are taking notice. “Microport had a session on November 7th in Dallas. It was a bad time, before the meeting really started, and we had 150 surgeons show up. The interest level has been so high its humbling” said Danny Metcalf from Microport.

Representatives from Microport were at Scottsdale Spine and Joint Surgery Center last Friday doing a cadaver lab. The goal was to perfect the technique and get the right material to present it to other orthopedic surgeons. A video of the lab is shown here:

The results were exciting. Great things are happening, people.

When Steve woke up from his superPATH hip replacement surgery he felt absolutely no pain. His journey to this bed started the year before when he realized he wasn’t going to be able to continue to fish unless he had his hip replaced. As his eyes regained focus, Steve looked around the recovery room and saw Tammy, his nurse, watching over him. He tried to smile.

“Surgery is over,” Tammy said.

Everything seemed perfect. Except for one thing. He couldn’t move his legs. Tammy saw him looking down at his feet and reassured him right away.

“Remember, you had the spinal?”

Steve nodded. In fact, both Tammy and the nurse anesthetist warned him ahead of time that he would be having a spinal anesthetic during the surgery. The block was placed carefully in the operating room after Steve was sedated. He didn’t remember it at all. Tammy and the nurse anesthetist warned Steve that he wouldn’t be able to move his legs until the medicine in the spinal wore off; most of the time that’s before the patient even wakes up after hip replacement surgery. But people are different. Some people wake up faster than others. A few minutes later Steve was wiggling his toes, and an hour after that Tammy had him standing up and walking around the Ambulatory Surgery Center with a walker on his brand-new hip. Steve was sporting a grin from ear to ear. He felt absolutely no pain. Including the pain, he had before surgery, which was completely gone.

Legacy hip replacement surgery using the posterior approach was so painful it required general anesthesia, which caused pneumonia and urinary tract infections. In general anesthesia, a breathing tube is inserted down your throat, and a ventilator machine breathes for you. Both the breathing tube and the ventilator require a level of sedation which is so deep it can only be achieved with high doses of potent drugs. If you are so sedated that you can tolerate a tube in your throat, then you are so sedated that you cannot protect your own airway. If you were to throw up while sedated and you are not able to protect your own airway, then there is a risk the vomit will go into your lungs. Aspiration of vomit into the lungs can cause pneumonia after surgery. Deep sedation can also cause urinary retention and the need for another tube in your bladder. Placing a tube in the bladder can lead to urinary tract infection. The superPATH and Anterior approaches are so much less painful than the legacy posterior approach that they do not require general anesthesia. That substantially lowers the risk of aspiration or urinary tract infection following surgery.

Today’s minimally invasive approaches, like superPATH and the Anterior, are so much less painful they can be done with a spinal instead of general anesthesia. Most people think of spinal anesthesia associated with having a baby. The patient is positioned bent over in a sitting position. By delivering the medications directly into the spinal canal there is little or no risk of stopping breathing and patients wake up faster and much fresher than they do with a general anesthetic. Pain relief with a spinal anesthetic is so strong a breathing tube and traditional general anesthesia are not necessary.

In rare cases, a spinal fluid leak causes headaches after spinal anesthesia. “It seems like every time they get a fluid leak doing obstetric anesthesia it’s significant, and requires a blood patch,” explained Chad Peterson, CRNA. Chad has extensive experience providing anesthesia for total hip replacement surgery. “The injection for the spinal block we do for joint replacement surgery is totally different. It takes only 30 to 60 seconds, and the needle we use is just thicker than four human hairs put together. The needle is so thin we almost never have fluid leaks.“ In the unlikely event, a fluid leak does occur, it can be controlled with a blood patch.

By the next day after surgery Steve’s spinal wore off, and he took medication to blunt the pain of surgery. Narcotics, non-steroidal anti-inflammatory drugs, and medical marijuana are all useful after hip replacement surgery because they work in different and complementary ways. Each has its own possible complications as well so that taking them requires specific precautions. Narcotics like Percocet, which Steve found very helpful off and on for a month after surgery, make pain feel much less severe. Narcotics are also highly constipating, so you must take a laxative with any narcotic pain medication. Non-steroidal anti-inflammatory drugs (NSAIDs), like Aleve and ibuprofen, reduce the inflammation which causes pain. For most patients, NSAIDs are the workhorse of pain relief after hip replacement surgery. NSAIDs also produce acid in the stomach, so you must take an acid blocker like Prilosec with them to avoid developing an ulcer. Narcotics and NSAIDs have been used by surgeons to control pain after hip replacement surgery for decades; more recently medical marijuana has emerged as a potent pain and anxiety reliever after hip replacement surgery as well. Today some hip replacement surgeons offer their patients medical marijuana to relieve the pain and stress of surgery.

The new superPATH and Anterior hip replacement approaches are less pain because they are less invasive. No muscles are taken down with the anterior approach. Most of us have experienced the pain of a muscle cramp; imagine the pain of having several muscles, tendons and ligaments cut and sewn back together. In the legacy posterior hip replacement surgery, the gluteus maximum, gluteus Medius, and tensor fascia Lata are often disconnected and moved to provide the surgeon access to replace the hip joint. Studies have shown significant weakness in the hip which may take two years to improve. If you’ve ever had it, you know hip dislocation is extremely painful. SuperPATH avoids hip dislocation entirely; the goal is to not only reduce the risk of hip dislocation after hip replacement surgery but to also make the surgery itself less painful. Surgeons who perform minimally invasive hip replacement surgery believe a less painful surgery leads to a quicker and better recovery.

Steve made a swift recovery with the help of the medications. He was up and walking right after surgery, ditched the walker after the second day, and continued to increase his walking every week after the procedure. He is hiking and fishing again and looking forward to hunting again when the season arises. Steve’s experience is typical.

The hip and groin pain people experience before hip replacement surgery is usually gone by the time they wake up. Surgery will always be painful, but with the minimally invasive superPATH and Anterior approaches, the pain is bearable and decreases dramatically over the first three days after hip replacement surgery. Most people report their pain is easily managed with the medications their surgeon prescribes and is largely resolved by two weeks afterward.

Ann knew she wouldn’t be able to keep up with her husband on their daily walks if things became any worse. She already had to make him wait while she stopped — several times if they went far enough— to let the pain drain out of her hip and leg before she could continue. Hip pain may make it miserable, but it wasn’t going to stop her. Ann and her husband had always loved to walk. She had been an avid walker herself for thirty years. Four years earlier, before the hip pain became severe, they hiked every day on their own property in Southern Alberta, Canada. The nearest big town, Medicine Hat, has several fantastic hiking trails in its parks as well. The only thing Ann loved as much as hiking is horseback riding. Her hip felt fine when she was on the mount, but afterward the back, groin, and leg pain was awful. After four years of thinking about it, she knew that she had no alternative. If she wanted to keep walking with her husband and riding her horse, it was time for hip replacement surgery.

It’s no surprise that arthritis, or rarely dysplasia like Ann has, makes the hip hurt when you walk. The hip joint absorbs tremendous stress when in use. With every stride your hip bends forward, extends backward, moves from outside to in, and rotates internally. The force of walking is 2-3 times body weight. For jogging or running its more than five times body weight. Researchers have actually measured the pressure inside the hip joint at 144 psi while walking; compare that to the pressure inside your car tire which is 30 – 40 psi when driving. A nice video showing how the hip moves during walking or hiking is shown here:

One of the barriers to hip replacement surgery for anyone, and in particular people like Ann who live in small towns, is finding the right Surgeon. An orthopedic surgeon in nearby Medicine Hat correctly diagnosed that she was born with hip dysplasia. But he was not trained in the superPATH or anterior approaches that other fellowship trained orthopedic surgeons who specialize in minimally invasive hip replacement are doing to make the surgery less invasive, with a quicker recovery, and also a lower rate of dislocation. Ann saw an orthopedic surgeon at the Mayo Clinic in Arizona for a second opinion who discovered she had a spine problem as well. Hip dislocation is a rare complication of hip replacement surgery; but having a spinal problem in the background, and horseback riding as well, put Ann at higher risk of hip dislocation after hip replacement surgery. She needed a minimally invasive option for hip replacement surgery that lowered her chance of having a dislocation afterward.

Ann decided to have the superPATH procedure after meeting with Dr. James Chow in Phoenix. Traditional hip replacement requires the surgeon to dislocate your hip to expose the ball and socket. Many surgeons today believe that dislocating the hip during surgery is not only harmful, its unnecessary. Dr. Chow and his colleagues developed the superPATH technique to avoid dislocation during surgery and thereby minimize the risk of dislocation happening afterward. For more information about superPATH look at: superPATH Hip Surgery. Eager to get back on top of the horse, and out on hikes with her husband, Ann chose superPATH.

Ann walked into the Phoenix Spine and Joint surgery center in Scottsdale at nine AM, and she walked out five hours later at 2 PM with a new hip. The surgery took just over sixty minutes. The thing she was most worried about ahead of time was the spinal; a friend of hers having surgery for another reason had a fluid leak after a spinal anesthetic. But Anne’s worries turned out to be for naught. She had no complications of any kind, and no uncomfortable memory of the procedure. Her husband drove her about an hour to her winter home in Maricopa, AZ. Some neighbors came over to check on her later that afternoon. She recovered nicely in her own home with her husband, and even took care of her four-year-old grandson at the same time.

The amount of time it takes to walk after hip replacement surgery depends of the surgical approach and the type of facility in which the surgery is done. Patients who have superPATH, direct superior, or anterior hip replacement approach in an Ambulatory Surgery Center begin walking an hour after surgery; they no longer require a walker after 1-5 days; and it usually takes them 2-4 weeks to build up to walking a mile in 20 – 30 minutes. Patients who have traditional hip replacement surgery recover more slowly. Most are kept in their hospital bed the day of surgery and walk a few steps with a physical therapist the next day. Once they can walk independently, usually three to five days after surgery, legacy patients who have traditional surgery in the hospital are discharged home and begin their own convalescence. That usually requires a walker for 2 weeks, six weeks of physical therapy, and gradual recovery over six to twelve months.

Ann started walking around the house the same day as surgery. She used a walker they gave her at the surgery center for the first five days, after which she knew she didn’t need it. She gradually built up her walking time in the weeks after surgery to thirty minutes. One of the first things she noticed after surgery is the pain she had walking upstairs was gone.

Nine out of ten hip replacement surgeries are done for arthritis. Ann’s case was unusual in that she was born with a mal-formed hip. This condition is called hip dysplasia. In her case she had a large cyst which will require more bone healing than is typical. Recovery from hip replacement surgery is slower for patients like Ann, but she has made steady gains. She is excited to already be walking with her husband and expects to be back on her horse next spring.

People considering hip replacement surgery are often concerned about how it will affect their golf game. We sat down with Kurt Brown, a PGA professional instructor and Director of Instruction at the Encanto Golf Course in Phoenix, Arizona to talk about playing golf with limited mobility. What he had to say might surprise you. It sure surprised us.

Encanto Golf Course was built in the 1930’s and designed by a world-renowned architect William Bell, whose legacy includes one of the most cherished PGA Tour stops of the modern era, San Diego’s Torrey Pines. But well before he broke ground by the ocean he made the Valley of the Sun his residence for a time in the 30’s and left his mark with some of the finest courses ever constructed. The enduring fascination with Encanto’s playability is evident when contrasting the coterie of older gentlemen who gather there for an eighteen-hole walk and a round or two after in the bar with the throngs of junior players who flood the fairways for junior events. Each enjoying the test only a timeless design can provide both scratch and high handicap golfers.

On this day the course was less busy than usual so we were able to chat with Coach Brown at length about what it is like playing with limited mobility and what players experiencing those difficulties can do to better their scores. Kurt went to Ferris State University which boasts the top-rated Golf Management Program in the United States. Upon graduation, he went to work at Camelback Golf Club in Scottsdale, Arizona. It was there and at the Titleist Performance Institute where he honed his skills as an instructor and furthered his education in the body mechanics of the golf swing. So, naturally, our first questions were about the body mechanics of playing with a less than functional hip that would soon require minimally invasive hip replacement surgery.

Golfers with hip pain swing to avoid excessive hip rotation. Coach Brown says, “we can always limit a swing away from pain, but we don’t need to.” The physical demands of a proper swing are not incompatible with an arthritic hip. “Pain limits speed and power… the reason people get hip replacements is to increase (their) range of motion and to decrease pain.” So, if you have been putting off minimally invasive hip replacement surgery because you are worried about what effect it will have on your golf game then you’ve been hurting your game. You don’t need a new shaft or driver when a new hip or knee will pick up an additional thirty or fifty yards practically overnight.

A traditional hip replacement surgery involved opening a patient with a large incision that would totally sever primary muscles. The patient would require an extended hospital stay and typically be on narcotics through a substantial portion of their recovery. Surgeons today perform hip replacement surgery using less invasive approaches such as superPATH and the anterior approach. These newer approaches have fewer complications and faster recovery. They both give surgeons access to the hip through incredibly small incisions that spare the muscles from major damage.

Typically, patients can walk hours after surgery and do not require narcotic pain medication during their recovery. If you cannot find a surgeon who meets our established positive outcome-based criteria, contact us and we will find one in your area for you.

Next, we asked Coach Brown about post-operative golf swing work, how do you get back in the game and how quickly can you do it? Coach says the first thing is to “listen to the people who the people who understand your body.” So, consult your surgeon and physical therapist before going out to the range. Coach also warned to be wary of “the early adaptation period.” When you come out of surgery your brain knows your hip is fixed and ready to play, but while your brain is good at telling your muscles what to do, your muscles don’t quite work at the same speed. So, they still think they’re compensating for your hip and end up doing harm while trying to help.

Use this period to work on putting and short game, really let the rest of your body catch up before swinging a club at full speed again, as Coach Brown says, “start small.” Your patience will be rewarded with renewed health and a newfound faith in your putter and wedges if you follow our tips from earlier in the week about how to recover like Tiger. If you absolutely must hit a golf ball down range again, we encourage you to work on your full swing as slowly as possible. Try hitting twenty golf balls thirty, sixty, then one hundred and twenty yards with a full swing in order to let the body relax and understand its new capabilities.

Coach says working from “the ground up in the golf swing” is the biggest factor in increasing speed. The footwork and weight transfers required to in an efficient golf swing with a high smash factor are best learned and absorbed at slow speeds. This is how the best players in the world learned these moves when they were younger. If you embrace the slow-motion drill you will develop better muscle memory, weight transfer and understanding of your swing in the process.

What surprised us most about our interview with Coach Brown was how overtly obvious it was to him that delaying a minimally invasive hip replacement surgery would harm a player’s golf game. From our familiarity with the research and relevant data we knew that would be the case going into the interview, but we somewhat expected the conversation to end at limiting the swing away from pain. Instead we were refreshed with a discussion about post-operative increased range of motion that allow for swing changes to bolster speed and can have players playing better golf than before they were injured.

For a long time, many people who absolutely needed a new hip were told they were too young for a hip replacement surgery. Times have changed. Today nobody is too young for a minimally invasive hip replacement surgery. Similarly, the old notion that some people were too heavy, and would wear out their implant, has changed as well. No one is too heavy for minimally invasive hip replacement surgery.

If you have been struggling with hip pain that keeps you from doing the things you would like to be doing in your life it is time to find a surgeon and seriously consider minimally invasive hip replacement surgery. Life is too short to spend any more of it suffering. If we have one more parting piece of advice it’s this, when you are ready to swing a golf club again, contact Coach Kurt via his website or on Instagram @bigkurt_golf