Dec 072009

Don’t ask for a new hip unless you really need one.  Part Two in a series.

The thing about major surgery is that you place yourself in the hands of others, most of them strangers, and become totally helpless.  I remember saying to the anesthesia guy that I had three requests: put me out before the surgery starts, keep me out while it goes on, and be sure to wake me up afterward.  For those used to being in control of themselves and the circumstances around them, this is a humbling and possibly instructive experience.  For those of us lacking battlefield type bravery, it is also frightening.

surgeryMy orthopaedic team provided an advance seminar to help us prepare.  I reported (pushed in a wheelchair by my attending wife) along with several others also scheduled for hip and knee replacements.  For two hours we were told and shown what to expect.  Much was made of how our pain would be managed and how we must become active and begin physical therapy almost immediately.  The discussion and demonstrations were certainly informative, but they were also like pre-living the experience.  My wife and I continued to discuss and go over every point until late that night, and my sleep became a rehearsal.

The three main risks of hip replacement surgery are blood clots, dislocation, and infection.  Blood thinner is taken orally to reduce the risk of blood clots.  In my case I stayed on the blood thinner for 6 weeks, starting the evening before surgery.  Blood is drawn and analyzed several times a week in order to maintain the correct amount.

Since the hip must be dislocated in order to perform the surgery, the muscles and ligaments that hold the hip in place are weakened, and the replacement is at risk of dislocation following the surgery.  The risk decreases as time goes on and the supporting structure becomes strong again.  But that process goes on for perhaps two years, so you have many precautions to observe in the beginning.  The seminar provided all these warnings.

The risk of infection is two-fold.  Infections can be introduced during the surgery itself, or they can travel to the new hip appliance afterward by moving through the blood stream from other body sites.  This was of special concern to me since the foot attached to my bad hip has been infection-prone in the past.  Infection of the artificial hip is a catastrophic event.  Once infected, the appliance cannot be treated with drugs and must be removed from the body.  You may spend weeks in the hospital receiving antibiotics intravenously.  And it may be a long time before they can give you another hip to start all over with.

In the late 1970’s I got to observe open heart surgery from inside an operating room.  I stood on a low stool right behind one of the surgeons.  Like them, I wore a gauze covering over my nose and mouth.  That was for infection prevention in those days.  Today, for my surgery at least, the team wore space suits that cover them completely and air-tightly.  The air they breath comes in through a pipe and the air they exhale goes out the same way.  After one surgery, an hour is spent purging the operating room of every trace and leaving it spotless and pure for the next procedure.  Not that I ever saw these things, of course, because, like I said, you do place yourself in the hands of others.

Actually I did see my operation, in a way.  After I came home for the hospitals I found a video of anterior hip replacement surgery and watched it from start to finish.  If you’d care to watch, you can find it here:

I reported to the hospital at some early hour, having abstained from food or drink since midnight.  My surgeon met and told me that he had three hip replacements to perform that day and mine would be last, perhaps soon after lunchtime.  His intern later revised the estimate to around 2:30 as things were running late.  It was actually about 4:30 when things were ready for me.  The last thing I remember was entering the cold, brightly lit, gleaming room with all the panels, gauges, cabinets, and tools laid out and ready.

The anesthesia guy put a small rubber cup thing over my nose and mouth.  He said to take five breaths and I would be asleep.  I began to count.  I think it was actually six or seven.

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