I need advice...just found out I need bilateral hips

[bethschaefer]

Hi!
Gosh, I'm glad I found this site! Was just told by my ortho surgeon that I need bilateral hips done. Left - Avascular necrosis, Right - several OA. Both - bilateral hip dysplasia. I am scared to death. Not of the surgery (I'm a critical care RN, so I'm okay with all of that), but the recovery at home afterwards. How do you take a shower? How do you get in and out of bed? How do you get the mail? Right hip was injected two weeks ago, 50% better; can't do the left because there is no place to put the needle. Your advice would be soooo welcome. Thank you in advance.
Beth

 

[Josephine]

Hello fellow nurse - welcome to the forum. Hey, it's always different when it's yourself, isn't it? We can exude self confidence with our patients but melt when it's us. I know - bin there, dun that!

As for your questions, well,

You got a walk in shower? That should be cool then. Just make sure you get a shower stool and a bath brush or similar to reach all those important little places!

. Also a big towel so you can loop the ends around feet and legs and not have to bend.

The physios (PTs) should show you the correct techniques for getting into and out of bed. It might be a good idea to have one call on you at home and do a home assessment and advise you on all the aids you will need and/or find useful like the shower seat, the high seat for the loo and a Helping Hand or handy reacher. Do get one of those- invaluable!

 

[ripanco]

HI Beth,

I had simultaneous bilateral THR in May 05. Does your surgeon plan on doing yours simultaneously? If you are a good candidate for that, it is a great way to go since you have only one surgery, one recovery, little leg length discrepancy, etc.

If you are going to have both done at the same time, it would be in your best interest to start strength training right now and get as strong as possible before surgery. Made a huge difference for me! I was home from the hospital in 2 days and never looked back!

The hospital should provide you with lots of information, an OT will help teach you all the little tricks, and a PT will get you back on recovery. I really had very little trouble doing daily tasks, was even forgetting to use my crutches going room to room within 4 days. There are several handy gadgets that Josephine has mentioned that will be great little friends. And you will find things out that work best for you. I worked out my own way of getting in and out of my tub. Since you can lift your leg behind you, I was able to face the wall next to the tub and lean on it, then lift my legs up behind me and over the tub wall. First the leg closest to the tub, then a little side step followed by the second leg. It was also a big asset having a supporting DH! So I never used a shower seat, was able to stand in the wonderful shower. I was allowed to shower as soon as I wished as long as I covered the incisions with waterproof dressing. I also found getting out of bed by scooching down and off the bottom of the bed instead of the side was easier.

Every surgeon and every surgery is unique so do your homework. I had MIS posterior approach, uncemented. VERY experienced and skilled surgeon!! No muscles cut, so I was weight bearing the next morning, skipped the walker and on crutches that afternoon and by evening I had done stairs and was cruising the halls! That was when they decided to send me home the next day since I was beyond what they could do for me at the hospital. BUT, I was in very great phyiscal condition and strong as can be, so I am not the norm, but it does show what can be done.

I can't tell you not to be scared, I was too. But, I can tell you that I have my life back now. I would do it all over again in a heartbeat but not wait so long! If you work hard at it, your recovery will go by fast and soon you will living your life without all the pain in your hips. Be positive and get stong! Good luck,

Andrea

 

[mredick]

One option you could consider it to have both hips done thru a direct anterior approach. This is done on the front of your hip and while it isn't new it has been more popular recently. It may help you because you would have the surgery while flat on your back instead of getting operated on your posterior (through your buttock) or lateral (the side). Many surgeons do not do bilateral hips as its too much trauma, but it is only one surgery.

Another advantage of direct anterior is that it is easy to take an xray during the surgery to see if your leg lengths are the same. This is much harder to do with a posterior or lateral approach.

Other items to consider are the implants, new techniques for resurfacing (BHR hip) or a ceramic head. For younger people a metal on metal hip is the latest technique used.

Of course finding an experienced surgeon who knows his products and can help you is always the best.

 

[bethschaefer]

Hi....

Thank you to everyone who responded to my questions. Just got back from the Ortho, and he won't do my surgery, nor will he give me any pain relief. My weight is a problem (I weight 290 lbs), and he doesn't feel the risk is worth it. Once I get to about 220 lbs, he'll go ahead and schedule everything, but I was advised to take 2400mg of Advil daily until I can lose the weight. I'm sitting here in tears...the pain is horrible, my weight is definitely a problem, but not sure where to turn. Beth

 

[Jamie]

Beth....maybe you should consider getting a second or maybe even a third opinion. Common sense would tell me that it would be very difficult for a person to lose 70 pounds when they cannot move well enough to exercise. I certainly am not a medical doctor, but I would think you will need some type of pain relief to do as this doctor asked. Please continue to post, okay?

 

[Josephine]

Hi....

Thank you to everyone who responded to my questions. Just got back from the Ortho, and he won't do my surgery, nor will he give me any pain relief. My weight is a problem (I weight 290 lbs), and he doesn't feel the risk is worth it. Once I get to about 220 lbs, he'll go ahead and schedule everything, but I was advised to take 2400mg of Advil daily until I can lose the weight. I'm sitting here in tears...the pain is horrible, my weight is definitely a problem, but not sure where to turn. Beth

That is iniquitous to not give someone pain relief! My earnest suggestion is to go looking for a more sympathetic surgeon who will help you. I think your first choice has simply been unfortunate. I agree with Jamie - you go on a search for more user-friendly surgeons and don't give up till you find the one who'll help you.

 

[Josephine]

One option you could consider it to have both hips done thru a direct anterior approach. This is done on the front of your hip and while it isn't new it has been more popular recently.

Indeed not new - McKee was using this way back in the 50s and it was actually described and first used in 1917 by an American surgeon broken link removed: https://www.jbjs.org.uk/cgi/reprint/35-B/3/482.pdf who made the first steps to deal with hip problems of all sorts. IMHO, it is far superior to the posterior or even the posterio-lateral.

Many surgeons do not do bilateral hips as its too much trauma, but it is only one surgery.

Many surgeons do not do bilats because it has not been within their sphere of past experience (training) and/or because they are not prepared to put in the effort. Doing bilats is physically demanding upon the surgical team and well as the patient but so many are done, it argues the efficacy of the "too much trauma" argument.

Other items to consider are the implants, new techniques for resurfacing (BHR hip) or a ceramic head. For younger people a metal on metal hip is the latest technique used.

Opinions vary and the jury is still out on that one. Whatever the latest trend or development, for every ten surgeons who would say it's the best thing since sliced bread, there are another ten who would argue the opposite. That's life!

Of course finding an experienced surgeon who knows his products and can help you is always the best.

Finding an experienced surgeon who knows his products is CRUCIAL!

Another advantage of direct anterior is that it is easy to take an xray during the surgery to see if your leg lengths are the same. This is much harder to do with a posterior or lateral approach.

You have knowledge or experience of xrays being take during surgery to ascertain this? I would be interested to know as in all my years I have NEVER known an interoperative xray being taken on the table. However, xrays were always taken in recovery before the patient was sent back to the ward but to ensure the hip hasn't dislocated during removal from the table to the bed, nothing to do with the leg length.

So far as I am aware, the correct method of checking leg length is to compare the legs at the heels and ankle bones whilst the patient is supine. This is usually done all through the surgery and finally checked immediately the drapes are removed.

 

[BigDog Mom]

Yes, some are actually taking x-rays during the surgery to make sure they get the placement just right. That is part of the (selling);) point of the new tables.
If you have a broadband connection, you can watch a direct anterior replacement being done this way on www.OR-live.com. Pretty cool!

Donna

 

[Josephine]

A VERY interesting video, BDM. Thanks for the link.

I had actually heard of it before but never realised they were using Image Intensifiers for the procedures. Cool idea! However, I had to chuckle again about the table as all they are doing is reproducing exactly the same the technique and approach used by McKee back in the 50s! Only we never had the benefit of their upmarket table so the theatre technician had to sit under the drapes and nurse the foot in his lap throughout the procedure!

There's nothing new under the sun.

 

[beachlover2]

I had the anterior surgery. My incision was on the front of my thigh beginning just below where the leg bends and going above the leg bend on the front of the hip. The incision is 4 inches long and they did do an exray in the middle of surgery to adjust the leg length.