Hip and Knee Replacement Surgery-My New Hips
(6/5/17)- A Swedish study of
21,363 older adults with a mean age of 78 years and a follow-up period of
nearly three years showed a positive result in those prescribed bisphosphonates
after hip fracture with fewer hip fractures, even in those aged over 80 years.
In addition, there was no
significant association with risk of renal failure or subtrochanteric
or diaphyseal femoral fracture as previous studies
have debated.
Journal of the American Medical Directors Association (6/2017)
(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/
(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 June 5/2017
To e-mail: hrubin12@nyc.rr.com or allanrubin4@gmail.com