Erushka Returns!

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Erushka

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Hi y'all, I'm a 62 year old guy from North Carolina, USA. I'm scheduled for right THR on April 6. I had the left hip done during early 2012 and had an excellent result, but a rather prolonged and painful surgery rehab. But all's well that ends well, so I'm back for more.

My right hip has all the usual symptoms--pain & stiffness in groin and thigh areas, with some radiation into the knee. Can't perform many of my usual activities--long hikes, barbell training, Zen meditation, garden/lawn work--so it's time to TAKE CARE OF THIS. I figure that it's better to get the surgery while I'm still in pretty good physical shape. No point in holding out until one is barely hobbling around with a cane, grouching and grumbling at any and all.

My pre-surgery treatment is walking and yard work as tolerated, and hydrocodone when needed for pain. I can't tolerate any NSAIDS and paracetamol doesn't help, so there we are.

My surgeon has scheduled the THR as an outpatient procedure. Surgery first thing in the morning, then back to the hospital room, then PT, then lunch, then rest, finally more PT and discharge if I can walk 60 feet with the walker and climb up and down 4 stairs. Surgeon will use a posterior approach--he says it involves a smaller incision and less blood loss than anterior, also it spares more important muscles. I'll have outpatient PT starting the day after surgery. Talk about an aggressive approach! The doc seems confident (but then what doc doesn't seem confident), and says that his other patients have had excellent results with this approach. We shall see.

So that's plenty for now. Just wanted to introduce myself. Look forward to talking with you guys as time goes by.
 
Welcome to another April Rainbow. You must be superman! Good for you! I can not imagine being sent home the same day as surgery. I wish you the very best.
 
Thanks for your kind words, Kathy. I'm no superman, in fact I'm a bit more of a whimp with a pretty low pain tolerance.

My OS said that same day discharge is possible with excellent pain control. So he does a lot in that arena. He gives Lyrica (pregabalin) pre-surgery as it has been shown to reduce pre-surgery anxiety and post-surgery pain. He provides an intraoperative injection (I don't know the drug) that substantially reduces postsurgical pain for 2 or 3 days after surgery. He provides a TENS unit during healing. Finally, he uses oxycontin for pharmaceutical pain relief. He feels that his particular posterior surgical approach uses a smaller incision and spares specific muscles, especially the piriformis, that are particularly painful if cut.

So, according to him, all of these measures lead to superior pain control which results in a short hospital stay and a speedier rehab. I say, the proof is in the pudding. However I'm all for spending my first postsurgical night at home--goodness knows, the hospital is not a good place if you need rest. And there is a cost savings of about $1000, depending on your insurance. So we'll see. Of course I'll post the results.
 
@Erushka - I just wanted clarification,
my readings indicated that the posterior and posterior lateral approach is done with the
muscles cut and longer incisions and more precautions (no crossing of legs, no bending 90 degree rule).
While an anterior approach is less invasive, no muscles cut just moved aside and smaller incision
(no precautions, you can cross legs, no 90 degree rule).
Please verify if you can. You should get some feedback from other people with regards to their particular approach.
 
Yes, I've just been reading up on the nomenclature, and I've been wondering about it too.

This is an edit. Somehow I deleted a paragraph. My doctor described a surgery wherein all muscles are spared as he will access the joint through spaces between the muscles. There will be a short incision and a shorter procedure. He called this a posterior approach, but I think he meant posterior/lateral approach. I will ask him about this via email, and will post the response here in a day or two.

I had the anterior approach on the left in 2012. The OS said that not all muscles are spared in that approach, but there is more muscle sparing than in a traditional posterior approach. There were no specific precautions, but it was strongly suggested that I not cross my legs, just to be safe. My long term results were great, but I had a very painful and slow short term recovery, especially given my younger age (59) and my excellent fitness level. We are all different, and results are not always predictable.
 
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Per my doctor's email, the surgical approach: "per Dr. Clifford, it is "postero lateral' muscle sparing , piriformis sparing ."
 
@Erushka - So true, we are all so unique and heal differently. Also depends on what
the surgeons find when they actually open you up, sometimes they will change an approach.
I will be having pre-op with my OS next week and will confirm that his approach anterior has
no muscles cut at all. Supposedly go between the rectus femoris (part of the quadriceps group)
and tensor fascia latae (or also called ITB band/iliotibial band).
 
my readings indicated that the posterior and posterior lateral approach is done with the
muscles cut and longer incisions and more precautions (no crossing of legs, no bending 90 degree rule).
While an anterior approach is less invasive, no muscles cut just moved aside and smaller incision
(no precautions, you can cross legs, no 90 degree rule).
I will verify, @souldancer (again).
No muscles are cut during any approach these days. Used to many years ago but things have changed. What is done is that muscles bodies are split apart to gain access to the joint. The difference between anterior and posterior is that anterior is more superficial so posterior has farther to go. That's the only difference.

As for the restrictions, they are not indicated by the approach but by the surgeon's preference. I know surgeons who require NO restrictions at all and others who require restrictions for any approach. Some even demand them for life but that's just ridiculous! I doubt any patient told that actually adheres to them that long!
 
Getting ready for surgery on 4/6. Doctor still thinks this will be an outpatient procedure. According to the clinic's care manager, all of this doctor's THRs so far this year have been outpatient. He chooses carefully--younger age, generally fit with no major medical issues, demonstrated treatment compliance to date, etc. I'm enthusiastic about a one day hospital stay, but we shall see.

I'm very pleased with the hospital. They specialize in joint replacement/joint reconstruction, with a few patients there for ENT procedures. They have had zero infections there over the past 4 years, always a good sign.

So I've stopped shaving, stopped taking aspirin and fish oil, have completed all pre-op procedures. It's on to the hospital. See y'all on the other side.
 
Good luck!


Cindy, Sent from my iPhone using BoneSmart Forum
 
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