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Hip and Knee Replacement Surgery-My New Hips

(12/15/16)- With 150 000 knee arthroscopies carried out in the United Kingdom each year, and about five times that number in the United States,[1,2] arthroscopic partial meniscectomy—keyhole surgery for middle aged to older adults with knee pain to trim a torn meniscus—is one of the most common surgical procedures.

Considering the enormous volume, it is natural to think that there is compelling evidence for the procedure being beneficial. Remarkably, this is not so. (See British Journal of Sports Medicine at http://www.medscape.com/viewarticle/872137?src=wnl_edit_tpal&uac=120704ER for further discussion)

(6/24/15)- Danish researchers who reviewed nine randomized trials, including 1,270 patients ages 50 to 62, concluded that there is serious risks and no lasting benefits for those who undergo arthroscopic surgery for knee pain.

The patients had pain ranging from 36 to 100 on a 100-point scale. Surgery was compared to drug treatment and physical therapy. The studies involved only surgery for pain caused by degenerative conditions rather than traumatic conditions.

Surgery provided slightly more pain relief in the first six months, but no difference in pain level beyond that time frame.

The lead author of the study was Bloch Thorlund of the University of Southern Denmark, and appeared in a recent edition of BMJ.

(11/5/14)- Stryker, the medical device manufacturing company announced that it had reached a settlement with thousands of patient over lawsuits involving its all-metal hip replacement devices that is expected to cost the company about $1 billion.

In November 2013 the Depuys division of Johnson & Johnson agreed to pay about $2.5 billion to settle lawsuits brought by about 8,000 patients who claimed they were injured by its all-metal hip replacement devices known as the Articular Surface Replacement or A.S.R.

The all-metal hip-replacement devices were used in procedures until it was determined that some of the metal would “flake off” causing serious injuries to the patients.

The Stryker models used in the procedure were the Rejuvenate Modular-Neck or the ABC II Modular Neck, both of which were recalled by the company in 2012. Stryker said it had set aside $1.45 billion to settle the claims but that it expected the eventual expenses to be higher.

(7/4/09)- An analysis of a study, based on a computer model that used Medicare claims and other data, concluded that total knee replacement surgery provided about one year of better quality of life compared to that experienced by patients who did not have the procedure performed on them.

The average age of patients whose data were included in the model was 74 years.

On average the procedure cost about $20,000. The analysis which appears in the current edition of the Archives of Internal Medicine, found that the year of benefit cost about $18,300. To be considered cost effective, the threshold of $50,000 per year of better-quality life generally is required to be cost effective.

Elena Losina, an author of the study and professor of orthopedic surgery at Harvard Medical School said; "And as it often happens, the return on investment is less in the elderly population." For ethical reasons, it was not possible to do a randomized trial in which a control group would be denied surgery.

The researchers relied on data obtained through surveys, quality-of-life instruments and other measures to do their analysis. It is estimated that there were about 500,000 knee replacement procedures done in the United States in 2005, at a cost of over $11 billion. Other studies indicate total knee replacement to be 90% effective in relieving pain and improving bodily motions.

(6/13/09)- Editor's note- The following is an update on hip-resurfacing versus hip-replacement surgery:

A recent small study of hip resurfacing versus hip-replacement surgery indicated that the former was no better than the latter at helping patients resume an active lifestyle. In fact, some of the recent studies indicate that women are more likely to suffer complications, including a need for corrective surgery, following a hip resurfacing than a total joint replacement.

Martin Lavigne, a surgeon at Maisonneuve-Rosemont Hospital in Montreal, and Michael Mont, director of the Center for Joint Preservation and Replacement at Sinai Hospital's Rubin Institute for Advanced Orthopedics in Baltimore, were the lead researchers for the study.

The cost for both types of procedures is about the same, between $30,000 to $50,000, depending on the length of stay in the hospital. Hip resurfacing became widely available in the U.S. in 2006. According to the research data firm Millennium Research Group there were 270,000 first time hip surgeries in the U. S. in 2008, with about 5% of the procedures being hip resurfacing operations.

(Editors note: The following information was solicited by us as result of questions readers asked about hip replacement procedure. These are the verbatim notes/comments of a healthy individual who in his late 60's had one hip replaced and repeated the operation with his second hip two years later. This was done on a purely voluntary basis, and he received no remuneration from any source. We wish to thank him for sharing his observation with our readers. We will add appropriate comments from other readers of this web site.)

Eleven days in (an unnamed hospital in Miami, Florida, replacing my left hip
February 21st-March 2nd, 2005


(And December 2006 for the right one)

Day 1 - Monday, 2/21/05

The scenario began at 6 am at the registration desk in the rear of the hospital. Everything routine. I walked with a nurse into the prep room about 6:30 where an IV was inserted, in my left hand, an epidural plugged into the rear right base of my back, and my left thigh and hip was carefully shaved with an electric razor in anticipation of the coming incision. I endured a few rounds of questions (is it the left or right hip?) and discussed anesthesia options with the anesthesiologist who would hold my life in his hands in a few minutes. The surgeon assured me all would be just fine. Nancy was there until the time came for me to be wheeled into the OR which seemed to be just a few feet from the prep area.

The anesthesia must have been pumping really well because about the only thing I remember about the OR is peering up momentarily at what seemed to be a very low ceiling, the anesthesiologist peering closely at me before everything vanished into oblivion.

I had some slight remembrances of the recovery area but true clarity returned only after I found myself in a semi-private room with Nancy, Phil and Joy looking at me quizically.The time was about 10:30 am. I have pain but nothing very severe. I assume it's being controlled by the epidural. No solids today. Just liquids but there's no desire whatever for food. Catheda controls the outflow of body functions and this is no concern. No sensation of any connection and it's all rather convenient being able to drink whatever I choose without wondering how it will all get out.

Phil and Joy left early afternoon. Nancy until much later. Nurses all very considerate, attentive, caring.

My biggest problem and one that would persist throughout the hospital stay was sleeping. The first night was awful. No pain but an overwhelming awareness of time. Must have glanced up at the digital display every few minutes, in between the temperature and blood pressure checks. I expected
other problems but not this one.

Day 2, Tuesday, 2/22/05

My first full day as a patient and one that gave me a new awareness of the importance of sound medical/nursing care. Still mostly liquids. and Roger were here for visits. I'm starting to worry about what's going to happen when I begin having bowel movements. Don't want to use a bed pan, Who does? No problem yet though because almost no solid food.

Nancy arrived early afternoon and remained until nearly 6 when valet parking closed. Had a problem with a defective battery in the Cadillac which was solved only she waited for about a hour when someone from the dealership showed

Same problem sleeping although I did get a 15mg sleeping pill.

Day 3, Wednesday, 2/23/05

Solid food today although I'm only interested in perhaps half of the small portions that are offered.
Went to therapy for the first time, which consisted largely in making my way around the large activity room in the (deleted) to the right of the main entrance to the hospital. I'm using a walker, of course, and I'm hobbling from left to right as I lumber along, Naturally, I'm feeling soreness and tightness in my left leg and the area of the hip where the incision is located. But at least I feel I'm making the beginning of some progress. Therapist by the name of Jennifer seemed especially competent and helpful is getting the muscles in my very right left knee back into operation.

Bart was here for a visit as was Reina who last saw us Friday night at a performance of The Magic Flute.Calls from the kids and Victor. Made a tennis date for April 21st. Will I keep it?

Big moment when I was able to use the toilet seat by myself for the first time. It's amazing how the utterly commonplace becomes the extraordinary in a matter of days, but no complaints from me. So I never did use the bed pan.

Too bad I'm making no progress at night. More clock watching through the early AM hours even though the dosage on my sleeping pill was increased to 30mg.

Day 4, Thursday, 2/24/05

Switched today from the hospital to the rehabilitation facility where I may be staying for up to ten days. Ugggh! But I guess the longer I stay, the more intensive the rehab and the more complete my recovery. So I'm ready although I'd feel better about it if I didn't have such a sleeping problem.

I did have what I felt was sort of an epiphaney (that spelling isn't even close) late afternoon when I was able to get into bed, raising my left leg without assistance, somethat I have been unable to do. Horray!

More therapy. Walking. Stretching. Moving legs up and down, out and in while stretched out on a mat. I already feel I'm doing more than yesterday. Senior therapist here seems to be a lady named Haydee (I think) who has a dour expression but a sense of humor to go with it and a firm approach to making my muscles operational again.

Tonight's sleeping pill was a 5mg twin of the diazapan I take at home > although this was the brand name Valium. Tried watching a couple of the past Oscar winners being shown on TV this week in anticipation of the 2005 > Awards beng held this Sunday. Thought they might have put my in sleep mode. Didn't help.

Day 5, Friday, 2/25/05

Rang for the nurse at 5am and she agreed to let me take a shower at that strange hour. I haven't showered since Sunday night and I think my exhausted mind had begun to obsess on how filthy I had become as I lay awake during the night. In any event, she agreed and it was absolutely lorious to spray and soap myself in the early morning gloom while seated on the mobile toilet stand. I even slept for an hour or so afterwards before breakfast was brought to the bed.

More therapy during the day. More visitors including Bill and Joan who brought a beautiful bromiliad with a "get well soon" balloon attached. So thoughtful. It competes with Roger's artificial orchard, which is apparently so realistic that it has deluded a few of the nurses to come close for a sniff.

Therapy continues. Explanations of how to go up and down steps in safety, stepping on and off platforms properly getting on and off tables, plus more stretching or muscles that I haven't used recently because of my problem or were damaged during surgery. That's where some pain does erupt as the muscles are stretched and manipulated but it all seems relatively incidental to me.

I've become increasingly impressed with this hospital as the days wear on. The administrators really seem to have their act together. I could sense nothing but professionalism and care in the pre-op stage and - after returning to my hospital room - compassion, responsiveness and enthusiasm by the nurses and their assistants in their dealings with me. I always felt that they were truly interested in my welfare and genuinely enjoyed their work. I never felt for a moment (and I should not) that I was intruding or being a bother when I had any request, no matter how trivial. It seems to me that almost completely this was staff that genuinely enjoyed what they were doing and that their patients' needs were never an intrusion but rather, as it should be, the reason for their being.

The same holds for the rehab staff, first on the hospital side, and since yesterday in the Rehabilitation Center.

Day 6 - Saturday, 2/26/05

Bad night again with interrupted sleep throughout the early AM hours. But I felt much better after some breakfast. Brief visit in the morning from Leonard Hayet and later Nancy arrived with a new Acer laptop with which I am composing this epistole. Fun watching my DVDs on the screen and listening to the CDs which Nancy carried in.

Physical therapy limited to one session where I think I'm making good progress. Nancy sat in on an Occupational Therapy session with Iliana who uses sarcasm and humor to ingrain the importance of safety in my movements here and in the days to come when I'm set free.

Perhaps my favorite nurse was the one on duty for the week-end, Pat from St. Lucia, who tried so hard to convince me that I would sleep better tonight and in a very small sense succeeded.

Day 7 - Sunday, 2/27/05

Still little sleep last night but better than the night before when I really moved close to the edge.

Very little therapy activity and, as a matter of fact, the only activity at all was perhaps half an hour with the pleasant therapist (blond gal to fizzled hair) who walked with me and my walker and then supervised some exercises in my room. She was very friendly and pleasant.

Fred and Eva were (aside from Nancy) the day's only visitors. They're getting ready for a three-week trip with Joan and Leonard in a few days.

The big event tonight was the Oscar Awards ("Million Dollar Baby" won best picture) which was great for me because I delayed my trying to go to sleep until after midnight.

Day 8 - Monday, 2/28/05

It's the start my second week in the hospital, abet most of the time in rehab. Last night was he first during which I can say I at least managed a few consecutive hours of sleep. But even this was relative. Put my head down near 1 am but I did doze off rather quickly until about 3, when I rose to sit in the lounge chair for about half an hour. Then back to the bed until about 5 when Nurse Pat awakened me to draw some blood. Then back to sleep until about 8 when I was awakened for breakfast. That's a glorious difference from all the nights before.

Two sessions of Physical Therapy today with the usual stretching and more focus on training myself to walk without a hitch by keeping my left leg straight before my right leg swings past it. I'll do it, especially that now it is clear both my legs are the same length and there's no physiological reason why I need to limp when I walk. The therapist had insisted that my legs were the same length when I said yesterday that I had been told there was a difference so today she and Heyde actually measured each of them with a tape measure and confirmed that they were
identical.

Made me recall when I first brought up the subject of difference in leg length when I visited with (deleted), the anti-pain doctor, about a year ago. She foolishly accepted what I said and urged me a use sole inserts to raise one leg a bit. That was a bad idea. Have to remember that even good physicians have limitations - even someone like (deleted) who I've described in such glowing terms over the years. Maybe that it true but perhaps it should be limited to the cortisone injections she seems to handle so well.

Same gal also took me through the paces of climbing and descending steps and the proper movements getting in and out of the front passenger seat in an automobile. The latter exercise took place in a rather unusual location called Bachelor Village, a complex with storefronts, counters, a car, even a little beach where injured people have a chance to practice safe movements in a miniature make-believe world before they are actually reintroduced to the outside world. Quite extraordinary, I thought, and another example of the many things this hospital does right.

Anyhow, had two additional sessions with Therapist Ileana - one a group sessions featuring arm, neck, shoulder exercises, and another on dressing techniques using the "gripper". She and the others keep up the reminders about no crossing of the left leg, no turning of the left foot inward, no breaking the 90-degree line between waist and left knee - all safety measures to prevent any possibility of dislocating my artificial ceramic ball and socket. Annoying to be reminded so often but I probably need the attention.

Back in my room at the end of the day, my weight is still about 178. Talked with Glenn, Judy, Denise, Adam, Mary, Rachel and Bart. Told Nancy to remain at home and catch up on her sleep which she did. She sounded more relaxed when we talked about 7. Having this computer makes everything more manageable. Hope I sleep well tonight.

Day 9, Tuesday, March 1st, 2005

This will probably be my last full day here. Dr.(deleted), who is the rehab center physician, said as much this morning and confirmed it later in the day.

Which helped spark more enthusiasm on my part for the four sessions today. The two PC sessions seemed more advanced as my latest therapist (a lovely young gal who is actually a therapist in training) put me through paces to encourage me to straighten my left leg as I walk so I can return to a normal gait and also did some more aggressive stretching and muscle shaping, all of which is designed to strengthen my left leg and extend my stamina and get me back to normal.

The other two sessions with Iliana were devoted once again to safety at home (bathroom, kitchen and bedroom) with another group session focused on some simple experiences and more general safety considerations.

Nancy visited for a few hours in the afternoon. Bart called to tell me that he dropped by yesterday in late morning but, when he found me asleep and snoring loudly, decided to leave me be. Good idea.

So here it is nearing 10 pm and the end is near. Hopefully tonight will be the one where I lay me down and sleep normally. That would be grand but what seems even better is that it appears that what Dr. (deleted) promised is coming true. I do expect to return to whatever was normal before the arthritis consumed by left hip. Already, the type of pain I felt in my
left leg when I awoke each morning at home is gone. Hopefully, the rest of the positive scenario will play out during the next six weeks.

***************************************************
January 1st, 2007

Postscript: It is almost two years later, January 1st, 2007. First, the results of my left hip replacement in 2005, described on the preceding pages,were uniformly excellent. My rehab - three weekly one-hour sessions for four weeks - went well with full strength on my left side returning. Eight weeks after the surgery I was fully active, even to the point of
playing tennis once again.

But then came some bad news. Roughly a year later, in early 2006, I began experiencing some discomfort on my right side, with similar symptoms to those two years ago on my left, including discomfort when walking continuously for more than about five minutes. I ignored it for a while but then decided that if the problem was the same, there was no point in
delaying the inevitable. If my right hip needed replacement too, I decided to do it sooner rather than later. Who know whether my health would be the same in the future of if other unforeseen circumstances might intervene. It was never a matter of survival. That I could always do that although I assume the crippling effects of an anthritically affected hip would simply get worse and worse. In the past, there would have been no other option other than to curtail one's activities, take medication, grin and bare it But I was determined, as long as my health allowed, to take advantage of whatever modern medical science could offer.

So in the Spring I made an appointment with the orthopedist who had done the first implant to check out the possibility of a second implant. He took x-rays and concluded that the time wasn't right, that the anthritis, though evident, had not reached the point where surgery was an appropriate option. He wasn't about to be convinced otherwise so I assumed there was nothing to do but wait.

However, my opinion changed in September, when my wife, Nancy, was seeing another orthopedist named John W, about a problem she was having with her neck and shoulder. I mentioned my concerns about my hip to him and he agreed to take x-rays and render an opinion. He did that and, once again, the results were muddled. Yes, the arthritis was causing problems but he suggest we first try deep cortisone injections to the area followed by four weeks of leg strengthening therapy.

I agreed and we went through the process. First the injections under anesthesia on an out patient basis. The next day it was like a miracle. No more pain, not even a twinge of discomfort. But that lasted only a day or two. The discomfort returned, although not with the same intensity, and I undertook the second segment of the plan - the four weeks of therapy sessions at a (deleted) Center near my home. They seemed of some help but I still felt I was postponing the inevitable so, with the concurrence of Dr. W, I arranged for a second hip inplant (the right one) for December 14th, this time at (deleted) Hospital.

All the same procedures leading up the big day as two years ago: the EKG and chest x-ray, the pre-op examination and blood work by my family doctor, a dontion of blood at a community center to be used just in case, a final pre-op exam and registration at the hospital and finally - on December 14th - my admittance to the hospital.

Having reread my daily impressions from two years ago, the sequence of event s this time was remarkably similar. In and out of surgery, a painless couple of days and little food afterward. Much better, however, were my sleeping habits which, while restless the first couple of days, were relatively normal.

My rehab within the hospital began literally less than 24-hours after the surgery and within a couple of days I was managing some movement of my right leg and hobbling around the rehab center with a walker.

Four days later I was in an ambulance being transferred to the (deleted) Rehabilitation Center when I was to spend six nights passing time and participating in twice daily therapy sessions. Half of these, inexplicably, were spent on improving my upper body strength which, while I guess it is always useful, seemed to me to be a waste of time since my
right hip and leg is what needed the strengthening. But I had no interest in disputing the treatment. Instead, I looked forward to leaving the place as soon as possible.

Here is what I did on Sunday, December 24th, courtesy of a ride from friend Bart. The ride happily uneventful and a delight to be home. > Two days later,the day after Christmas, Bart also provided the transportation to (deleted)'s office where the operation was pronounced a success, the staples (stitches) were removed and the paperwork begun for a
series of rehab sessions at the )deleted) Facility on (deleted).

Today is New Year's Day 2007 and, almost exactly as I ended my account nearly two years ago, I am awaiting the start of the final rehabilitation program which I assume will conclude as successfully as the one two years ago.

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home

updated by editors on December 15, 2016

Original article by Daniel Greenberg
posted January 6, 2007
updated by editors November 5, 2014

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To e-mail: hrubin12@nyc.rr.com or allanrubin4@gmail.com

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