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Revision THR Hip revision surgery

PugMumma

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Hello, I'm so glad to have found this forum!

I've actually joined on behalf of my mother. She is 69 and due to have hip revision surgery next week. She had the initial hip replacement about 15 years ago, and the stem and cup have both become loose. She has a big difference in leg length and a frequent audible clunk from the hip - I can hear it if I'm next to her! The surgeon has said the op will be complex and take 4 to 5 hours to complete with 2 surgeons present. She has loss of bone density so will also need a bone graft.

Just looking for a little support and reassurance really, I'm so worried that something will go wrong and so is she.
 

Celle

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Hello @PugMumma - and :welome:

Please will you tell us the full date of your mother's hip replacement revision and which hip it is, so we can make a signature for you? Also, if you can remember the month and year of her original hip replacement, that would be helpful. Knowing the exact dates will help us to advise her appropriately in the future.
Thank you.:flwrysmile:

Your mother's original hip replacement did well to last for 15 years, as the expected lifetime of THRs then was expected to be about 10 years. That's now expected to be at least 20 years, so the new hip shouldn't need to be replaced again.

It's natural for you and your mother to be anxious, but successful hip revisions are done quite frequently now. We have several members who've had a revision done, with a successful outcome.

It's not that unusual to have two surgeons at the operation. Joint replacement is hard physical work for a surgeon and having a skilled colleague assisting at the surgery helps to spread the load.
I've had both my knees replaced and there were two surgeons at both of my operations.

Here are the BoneSmart recovery guidelines, to help you and your mother through her recovery:
Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. Try to follow this

6. Access these pages on the website


Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Pumpkln

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@PugMumma
Welcome to BoneSmart, glad you joined us on behalf of your mother. :welome:

Sorry to hear you mother requires a revision, she should be a lot more comfortable once all is said and done.

I also had two surgeons present at my uncomplicated knee revision, it is not an unusual arrangement.
Sounds like your mother's surgeon is being extra careful to insure a successful surgery and outcome so that this new implant lasts her the rest of her life.

All the best to you and your mother for her upcoming hip revision. :flwrysmile:
 
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PugMumma

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Thank you both ❤

She is most worried about not coming round from the anesthesia. I'm worried about this too although I'm trying to keep positive for her.

I'm trying to get a list together of questions to ask the surgeon when we see him on Tuesday. Her surgery is scheduled for Wednesday.

She has a 3cm leg length discrepancy which has given her an awful limp, I know this is what bothers her the most. We are hoping that this will be much better after the op, the surgeon said it may not be spot on but will be greatly improved.

Her primary hip replacement was right hip in March 2002 so actually 18 years ago
 

GimpyGal

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One of the questions you need to ask is about anesthesia if that's a major concern, is what is planned for your Mom. For my hip replacement (not a revision so not as lengthy an operation) I was given a spinal and sedation. Never intubated, and was always breathing on my own. Sedation isn't as deep a sleep so you can avoid some of the adverse reactions that take place with a general.

Of course, as far as I was concerned, I was totally 'out' and had no awareness of the procedure. If your Mom is a candidate for sedation, she might be more at ease. And if not, I'm sure she'll be in good hands, as well.
 

Pumpkln

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PugMumma

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Thank you Pumpkin, the date of surgery is 16th September
 
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PugMumma

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Unfortunately the surgeon said that spinal and sedation is not an option for my mum due to the length of the surgery
 

Jaycey

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@PugMumma Everyone facing surgery is anxious. Your mother will be able to speak to the anaesthetist before her surgery. She should tell them her concerns.

The anaesthetist will be at her side for the entire procedure - watching her very carefully and relaying any issues to the surgeon. Remember, although this is a big day for you and your mother this team does this surgery everyday, several times per day. Your mother passed all the pre-op assessment so she should be fine on the day.
 
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PugMumma

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Thank you Jaycey, I know you're right but the worry is still there.

Unfortunately we have just found out that mum has been in contact with someone over the weekend who is now unwell and suspect for covid. We are trying to contact her surgeon as she is due to meet with him tomorrow because now we don't know what this means for her surgery. It's been impossible to contact anyone at the hospital but we will keep trying
 

Jaycey

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Oh dear - this is not good news. They will probably postpone the op as I don't think she can be tested and get a result fast enough. I would call the surgeon's office.
 

zauberflöte

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Oh @PugMumma what a nasty twist, I'm sorry! However, much better to have to wait a little and know that the covid risk for herself is nil, than to go ahead and have an awful surprise during recovery.

If it were I, (I'm 68 and had a medium-sized but out-patient surgery in June), I would if at ALL possible see no-one between now and surgery. And same after-- sticking to immediate household. I was very strongly encouraged to "stay put" for a month following that June surgery, and also had had to stay in for the 4 days between my Covid test and the op.

As to the anaesthesia... yeah, I really understand her (and your) fears. Between the ages of 25 and 38 I had GA six times for GYN surgery . The first two I was too young to know to be scared, the next one was major, and I was terrified especially of not waking up, the next two were D&Cs to clean up during miscarriages (so I had no time to worry and more important things to think about), and the last one, another major one, I was worried but not terrified. 23 years later, for the first hip, I was very nearly blasé! My hysterectomy had gotten rid of a body part which had caused nothing but pain since I was 11. I knew the reward for THR would be equally life-changing!

All that said, GA is even more sophisticated now than it was 18 years ago, and as others have said, mum will have the anaesthetist right at your head throughout the entire surgery. And, these folks are at their day job, so they know exactly what they're doing. And, mum has passed all the pre-op check-ins, so that also should inspire confidence. Tell her I'm thinking of her!
 

Celle

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I think that almost everyone experiences the fear of not waking up from an anaesthetic. It's the thought of completely putting your life into someone else's hands and having no control over it.
It's something your mother should be able to discuss with the anesthetist before surgery.

An anesthetist is a highly-trained doctor, who has done several years of additional training after his/her medical degree, so he/she knows exactly how to administer anesthetics safely.
He/she will be with your mother throughout the operation and will monitor her vital signs and condition the whole time, until she is safely awake in the recovery room.
 

GimpyGal

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Sorry about the need for a general, but you have the information and can move on. If they had major concerns they would tell you both. Sorry about the Covid scare, too. No one wants a surgery on the calendar to be delayed (I had FIVE dates myself) but dealing with Covid and recovery both would be miserable. I too, was quarantined both before and after. After is no big deal because I didn't want visitors anyway, but before was hard because I had a million things I thought I had to do. I had to 'let go' of that list.

Let us know if surgery goes forward as planned.
 
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PugMumma

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Jaycey, yes that's what I was thinking.

Mum is feeling very uncertain about the surgery now. She's still not feeling 100% and feels the whole thing has been rushed. She felt pressured by the surgeon to agree to the op last Friday. She didn't feel mentally prepared when she agreed to it. The surgeon's secretary called on Thursday to tell her the op was this Wednesday and sounded surprised that mum didn't know about it. A couple of months ago they told her she would need to isolate 2 weeks before surgery, she hasn't had that opportunity. She was meant to have a covid test 3 days before surgery, that won't happen until tomorrow, one day before surgery. This surely raises a risk to staff and other patients at the hospital and if they're taking that risk with her, are they doing that with everyone? If so, that's a huge risk surely?

On Thursday the surgeon called mum himself and said he would call her on Friday between 1 and 2 for her final decision. He called her Friday morning and said that if she didn't go ahead £15,000 of equipment would be wasted. She felt she had to say yes.

I'm unhappy with this. I don't want to say this in as many words because I don't want her to refuse the surgery, then regret it and blame me. But I don't want her to be at any more risk than necessary.

We tried to contact the surgeon and his secretary today but with no luck. Eventually we got through to the schedulers and explained the situation but all we were told was if you you feel OK then come in. The schedulers don't even have her on the list for surgery on Wednesday!

So we will go tomorrow and discuss with the surgeon, I don't know what else we can do.

It all seems so badly organised that it doesn't really give us much faith in going ahead.

Mum is awfully stressed by the whole thing and so am I
 

Layla

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Not sure what the program is for today after reading the last post. Wishing your mom all the best either way, surgery, or no surgery yet. Please keep us posted.
@PugMumma
 

leejaa

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I hope you received the answers you and your Mom need to fully decide and you are both well.

I had general for all four of my joints. No issues and with the last one, I was eating lunch with no nausea after surgery. They have better drugs now and better anti nausea meds they give at the same time especially if you stress that part.
 
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PugMumma

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We saw the surgeon today. Mum still isn't feeling 100% and has decided to postpone the surgery.

The surgeon said that she must go with her gut feeling and if she isn't sure then not to go ahead.

He said that the revision will be major surgery, her femur will break due to the thinness of the bone and that she will need a bone graft in the acetabular. He expects the surgery will take a minimum of 3 hours and that she will be in hospital for upto 2 weeks depending on how she recovers. He said that there's a chance that she wont come through the surgery.

He has given us his email address and asked us to contact him when she is ready to go ahead. When we do, we can expect surgery to be scheduled withing 2 weeks to a month.

I'm really upset, I think hearing him say that she could die during surgery has hit me quite hard. I don't want to loose my mum and I don't want her to continue to suffer with the hip so we're stuck between a rock and a hard place
 

leejaa

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I am sorry that your surgeon was so blunt even though honesty is important. Not coming through surgery is always a risk for anyone due to unexpected events. However, did this surgeon say why he was concerned about your Mum not coming through. Normally if there are other issues there are clearances with other specialists like cardiologists to help everyone make an informed decision.

Of course you do not want to lose your Mum and you want her to have a pain free life. Have you considered a second opinion with another surgeon? Maybe getting more information will help both you and your Mum with the decision.
 

Layla

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I'm really upset, I think hearing him say that she could die during surgery has hit me quite hard.
It is my understanding we’re all told this. The surgeon has to disclose this information. This is nothing new. I’m sure your mom heard the same for her two prior hip surgeries. This is extremely rare and the odds are in your moms favor that she‘ll do just fine. The anxiety is real, most all of us deal with it. I recall the thought of not waking up was my biggest fear. The recently retired BoneSmart forum nurse once shared here that she never experienced the loss of a patient during surgery in her 50+ yrs as an Orthopedic nurse. I looked for the post where she mentioned this, didn’t find it, but if I do, I’ll share it here.

There are no guarantees in life. None of us are promised tomorrow, nor do we really know if we’ll return home on any given day. Sometimes we take a chance for a better life and brighter future. Since the odds are in your moms favor that she’ll do well she should give surgery serious consideration and schedule it once she’s more comfortable with the prospect. Possibly your moms surgeon is not the perfect fit for her and you should consult with another one, or two?

Wishing your mom comfort, strength and peace of mind. I hope you’re able to persuasively support her when the time is right. She needs to feel confident that she’s making the right decision.

Stop back whenever you need advice or encouragement. We’re here for both of you.
 

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