How I Spent My Summer Vacation
I had some great plans for this summer. Instead I ended up choosing a hip replacement surgeon. Although my friends told me this was an easy surgery, that it was like going to the dentist, that everybody is doing it, I had to find the best hip replacement surgeon in the world.
What I discovered is that there is tremendous variance in the methodology employed by surgeons. The standard protocol is the posterior approach, which cuts through the gluteus maximus. It also involves detaching 2 of the 4 external rotators of the hip, and reattaching them.
The newest protocol is the anterior approach, which does not cut through any muscles. The posterior approach remains the standard of care for most surgeons in the US. On the surface, that doesn’t make sense. But realize that changing protocols involves a learning curve, and many doctors don’t want to change what has worked for them for many years.
The recovery for the anterior approach is shorter, and eliminates the need for movement restrictions inherent in the posterior approach, including not bending more than 90 degrees. With the posterior approach, you might dislocate the prosthesis because of all the healing that the stabilizing muscles have to do after this type of surgery. And the recovery takes longer.
The anterior approach involves the risk of damaging a sensory nerve in the front of the thigh, the lateral femoral cutaneous nerve. The symptoms of damaging this nerve involve burning and or numbness in the front of the thigh, and occurs in 30% of the surgeries of this type. The nerve usually grows back completely, but this can take 3 months to a year. You may be left with one small spot of numbness at the incision.
Your doctor may not make a point of telling you which approach he takes. You need to ask. It was pretty obvious to me that I wanted to work with a surgeon who employs the anterior approach after I read the list of physical restrictions I would have to adhere to for 3 months. And after I talked to my physical therapist and several patients.
I had a very quick onset of hip pain. In April I started having some pain in my thigh. By mid-May I had to use a walker or crutches to walk. I decided to get a cortisone shot. My physiatrist did not bother to mention that most surgeons will not perform surgery for at least 3 months after the shot, due to increased infection risk. Since the shot only worked for 3 weeks, I have had to be on a walker for 2 months now. I have to use the handicapped cart at the supermarket. I discovered that most handicapped parking spots are pretty far from your destination. I learned a lot about being handicapped and how this supposedly ADA oriented world is working. It isn’t working very well. Going to temporary events, like our local rodeo, was virtually impossible unless you could find someone with a cart to take you to the venue. Let’s not even talk about what it was like to try to attend the opera in Central City, CO. The parking was 1/2 block from the opera house, down a steep hill. The seating was almost 30 across, making accessing your seat quite an ordeal. They took my walker away from me, as I could not have it near my seat.
This is major surgery and hardly like going to the dentist. You have to go through a very thorough physical. I am diabetic, but completely under control with an A1C of 6.4. Still, I was subjected to the ignorance of at least one surgeon who said I was at greater risk of an infection. No, I told him, my endocrinologist said that with my A1C I did not have a higher risk. “She doesn’t have to operate on you.” That is completely misinformed, not to mention irresponsible, and I complained to his office. As it turns out, when I had my physical, the Apgar scale of my combined risk was extremely low because of the way I maintain my health conditions. Still, you are subjected to the ignorance and arrogance of these surgeons. It’s not fun.
I’ve also spoken to people who were literally in wheel chairs whose doctors told them their hips were not bad enough for surgery. That is ridiculous. The prostheses last between 20 and 30 years, the success rate for surgery is very high, 98%, and anyway, why would you want to live with all that pain?
So, I had several fun camping trips scheduled for this summer. Also, I was planning to go to St. Croix for a Pickleball clinic in the fall. All had to be cancelled. Instead I spent the last 2 months dealing with an ever escalating level of pain and consulting with surgeons.
Well you would think those are all the decision points you have to consider. But there’s more. The latest leading edge technologies are a smaller prosthesis, computerized positioning of the prosthesis, and robotics. There is not one surgeon in the entire state of Colorado who is using these technologies. Dr. Dennis in Denver uses the computerized positioning, but is still using the posterior approach. Dr. Kim at the Steadman Clinic in Vail dismissed robotics and computer positioning as unnecessary gimmicks, and told me the smaller prosthesis would fall out. I did not ask him where he got his data. He was clearly being “creative” in his analysis because the data does not support his conclusions. The “mini-hip” procedure removes less bone than the standard prosthesis, even less invasive and allows for revisions in the future if necessary. Ordinarily revisions are a major deal on a full size prosthesis. These state-of-the-art methods and technologies involve more training, more skill, and more investment in expensive equipment.
Dr. Stefan Kreuzer in Houston (http://www.stefankreuzermd.com)/ is employing all of these state-of-the-art methodologies. He has done over 2,000 in the last 6 years. He was highly recommended by patients as well as other orthopedic surgeons. Most amazing of all, he still takes Medicare, unlike many surgeons at the Steadman Clinic in Vail. So, in August I will be flying down to Houston to get the best of the best.
I’ll let you know how it works out in my next posting, but I’m excited to be on the leading edge.
August 2, 2017
I decided to take human growth hormone for the next 3 months, at least, to assist in the healing process. I have a friend who did this for his knee replacement and he said the healing was greatly expedited. To get this you have to go to a hormone replacement doctor, and I chose Dr. Brandt of ThriveMD.com (Edwards and Denver) because I know him and know of his reputation. Needless to say, this is not cheap.
I ran into someone at Whole Foods yesterday whose husband had a hip replacement with Dr. Kreuzer and they said it was a breeze. He’s hiking mountains after 6 weeks. That seems a bit too aggressive, but apparently he’s not having any problems.
August 4, 2017
Pain has gotten a lot worse and even walking on the walker has become difficult. It’s a good thing I’ll be operated on in a few days. I’m actually wheelchair material at this point. Percocet does little to alleviate the pain. How lucky we are to live in this time when this things can be fixed.