How is hip replacement performed?
There are multiple approaches (positions we approach the hip in surgery) —> Anterior, Anterolateral, Direct Lateral, Posterior and posterior lateral. At OJRCA, we do our hip replacement through a new muscle sparing, tendon sparing, ultra-minimally invasive posterior-lateral approach. For a standard total hip replacement surgery, the main steps are pretty much the same; however, they can be done in a different sequence and every surgeon does the procedure a little differently. After sterilely prepping and draping your leg and the surgical field, we make an incision that will allow us access to the hip joint. We make an incision through the skin and move muscles out of the way. Once the hip joint is safely and appropriately exposed, we remove the femoral head (top of the thigh bone). At that point, we can begin preparing your acetabulum (hip socket in the pelvis) and the femur (thigh bone) for the implants that will be put into the bone. There are many companies that make total hip implants and each one is similar yet different. The implants we use at OJRCA do not require cement to be held into position. They have a material on them which allows for boney ingrowth. We also replace the ball part of the joint (the femoral head) with a ceramic head, the cartilage is replaced by a plastic liner that goes between the socket and the new ball of the joint.
Before the real implants are put into the patient we have practice parts that we use first, to make sure the components are the correct size, that the hip joint is stable, and that leg length is correct. Last, but not least, an appropriate closure is then done; not only to secure the hip joint, but to close the wound. This is a very broad overview of how a total hip replacement is done. If you would like to hear more specifically how we perform a total hip replacement at OJRCA, please feel free to call us and set up an appointment today.
How much pain will I feel following hip replacement surgery?
This is a very common question for patients. It is also one that varies from patient to patient. This is a difficult question to answer because every patient is different, not only in how they tolerate pain, but how their brain and body respond to pain. That being said, each patient who has surgery at OJRCA will receive our “pain cockatil” to help decrease their pain in the post-operative period. We also will have you up and walking as soon as it is safe to do so, to get you up and moving! Moving quickly after surgery not only helps prevent blood clots but it also helps prevent you from feeling stiff. The vast majority of patients say their pain after surgery is minimal. They describe it as soreness around the incision and some swelling. It is most common described as “I feel like I’m sitting on a fat wallet”.
How much time is needed to recover from total hip replacement or total knee replacement?
Every patient and every case is different. Each person has a different experience and handles and tolerates pain differently. We typically say the recovery period for a total hip is 3-6 weeks and the recovery period for a knee is 6-10 weeks That being said, we have several patients back at work in as little as a few days or more typically within 2-3 weeks for hips and 3-4 weeks for knees. That being said, the “global period” for post-operative patients is 3 moths, and it can take even more time for your new joint to feel “normal”. Remember, this is not the joint you came into the world with. It will be warm, it can swell, and it may ache. These are all normal sensations that can be expected.
Who is a candidate for partial knee replacement?
At OJRCA, we are very selective on who should and should not receive a partial knee replacement. This is not because we do not want to do them but rather because if you are not the appropriate candidate for the surgery, you will not have a good outcome. If the whole knee is worn then a complete replacement is best. We screen our patients thoroughly so that they have the best outcome possible. There are multiple companies who have partial knee replacement implants. We choose to utilize the Makoplasty system due to its bone conservation, its computer guided system to allow for the best alignment and the ease it is to perform. The Mako uses a precisionbur to allow for bone conservation.
How often should you walk after a hip replacement?
Walk as much as you can SAFELY tolerate! We fixed your joints so you can walk and live your life with minimal pain. You will not hurt your knee or hip implant by walking. This is one of the best exercises you can do for your rehab! Not only does it help with your motion but it also helps decrease your risk of blood clots. You will notice swelling after walking and doing exercises. It’s important that you take time to ice and ELEVATE your legs after doing exercises and walking. Elevate as high as you can tolerate, above your HEAD not just your heart. Recliners do not elevate adequately. Again, make sure you’re being safe when walking. For the first few days or weeks, patients use appropriate assistive devices, such as a walker or cane as instructed by your therapist.
What if I am overweight?
The majority of hospitals and ASC’s in the US have implemented a BMI limit for elective total joint replacement surgeries. Most commonly seen is a BMI restriction of 35-40. This is because the risk associated with a high BMI skyrockets after 40. This includes, but is not limited to, wound break down and delayed healing, fracture risk, infection, etc. Each hospital and surgeon is different with their BMI limit. At OJRCA our BMI limit is 40, but some hospitals we operate at do have a limit of 35. We work closely with bariatric surgeons and fitness coaches to help patients who need/want a joint replacement to lose weight, if that’s an option they are interested in.
My doctor said I am bone on bone. What does that mean??
There are different levels of osteoarthritis. Treatment options vary for each patient, at each grade and is based on their symptoms, limitations and medical problems. The majority of times patients should try ice, activity modifications, oral anti-inflammatory medications such as Tylenol, Advil, Aleve, etc, physical therapy and cortisone injections before proceeding with surgery. These options vary based on symptoms and other medical conditions.
Grade one: There is slight damage to the cartilage and slight narrowing of the joint space.
Grade two: The space between the bones continues to narrow but to a greater extent
Grade three: The damage to the cartilage has progressed, the gap between the bones has narrowed significantly. As osteoarthritis progresses, the cartilage will continue to thin and break down. The bones will respond by thickening and growing outward to form lumps called osteophytes. The tissue that lines the joint will become inflamed, and it may produce extra synovial fluid, resulting in increased swelling. The lining swelling is called synovitis, and the free fluid is called an effusion, commonly known as “water on the knee”.
Grade four: This is the most advanced stage of OA, and the symptoms are very visible. The space between the bones in the joint is gone and we have “bone on bone”. X-rays will show bone on bone, meaning that either the cartilage has completely worn away or there is very little left. The individual will likely develop more bone lumps and experience pain that is often intense during simple activities, such as walking. In severe cases, the bones may become deformed and angulated because of asymmetric loss of cartilage.
Can I have both hips or both knees done at the same time?
Bilateral knee and hip replacements are NOT common any longer. Years ago bilateral knees were frequently performed. The risk of doing one knee at a time has fallen so much that bilateral surgery carries more risk than doing one at a time and assessing the total risk of the two procedures. When we do bilateral joint replacements we have to divide the medication we put into your joint, to help with pain immediately post operatively, in half. So instead of getting ALL of that medication in one joint, you get the same medication divided into two. We cannot give more because of toxicity levels. Also, therapy and relearning your gait is hard enough for one joint, it’s even harder with two. We need you to focus all energy on getting your one operative joint back to 100%. Bilateral knee and hip replacements are done, but very rarely. It is usually done with the angle deformity of the joint is so bad that it will make ambulation difficult if the other joint IS NOT fixed as well. This is a case by case discussion and other medical problems play a factor as well.
Are you able to perform joint replacement on younger patients?
Dr. Clifford has performed total hip replacements on younger patients. This is usually due to trauma, avascular necrosis from certain medications, or hip dysplasia. We are happy to see and evaluate any person, of any age. Obviously, we do not want to rush anyone into a total joint replacement, because there is nothing like the joint you were given when you were born. But sometimes, things happen, joints wear out and you might need a new one. We can evaluate you and see if you are an appropriate candidate for joint replacement surgery. The same thing goes with patients that have been told they’re “too old”. If you’re healthy, active and still busy living life, and the one thing holding you back is a bad joint, come in and we’ll talk to you about options. A bad knee or hip should not be holding you back!
How is the recovery after total knee?
Recovery after a total knee is hard work. Don’t let anyone tell you differently. You will be in physical therapy 3 times a week for at least 3-4 weeks, and then it decreases to 2 times a week for another 2-4 weeks. Ideally, patients will be bending their knee to 95-100 degrees by TWO WEEKS after their surgery, and will be getting their leg very close to full extension. By six weeks we love our patients to be fully straight in extension and bending to 120+ degrees. If patients have difficulty bending because they are not pushing hard enough in therapy and are not doing their home exercises appropriately they may need to be taken back to the operating room for what is called a manipulation under anesthesia. At that time, patients are sedated and their knee is pushed, so scar tissue is broken up and motion will hopefully get better. After MUA you will go back to aggressive PT. This isn’t a “do over” because the scar that has already formed can markedly effect the future of the knee. So it’s IMPORTANT to do your physical therapy as directed. Push as hard as you can from the start.
Can you tap dance after hip replacement surgery?
Only if you could tap dance before!
The is one of our favorite questions. Yes, we want you to be able to dance as much as you’d like!
Why Choose Us
We have perfected our treatment protocols over the last 5 years and now are able to perform total joint replacement surgeries in an outpatient setting. This greatly reduces our patient’s risk of infection as compared to having surgery in a traditional hospital.
Our experience in having performed over 14,000 procedures has allowed us to shorten the duration in which that our patients are under anesthesia. Additionally, our postoperative pain management has been refined to get our patients up and walking as quickly as possible.
Our postoperative rapid recovery protocol has our patients up and mobile shortly after waking from anesthesia. This increased mobility shortly after surgery puts our patients on a path to healing much faster than typical joint replacement surgeries.
Real Patients – Success Stories
The reason I was putting it off is because I did not want to be in the hospital for 3 days. He promised me that I would be out that night…
I did have surgery. At 3 o’clock in the afternoon I was up and out walking. I was home that evening. Never used a walker. I took pain medication for 2 to 3 days. The post-op and physical therapy, I had no problems. In 4 weeks, I am back to 100%.
Jack H. – Dr. Flip Clifford patient
Real Patients – Success Stories
“It was a wonderful experience. If you are able to have a hip replacement and go home the same day, you know mentally, I think it is better for you to be in your own environment than it is to be in a hospital… it’s a lot to say for somebody that had a total hip that goes back to nursing in 2 weeks!”
Trish W. – Flip Clifford Patient
“I had my surgery first thing in the morning, and was home by early evening, already walking”
“The entire experience from beginning to end was wonderful. I feel like 10 years have been added to my life and to be pain free is fantastic. I’m back to exercising, driving my car and playing full blast with my grandchildren!”
“Within 14 days after surgery I was walking with a little assistance from a cane and now am fully mobile and ready to start swinging a golf club 45 days after the surgery!”
“Dr. Clifford is an excellent surgeon, but also has a way to talk to and discuss the issues and concerns with his patients. I continue to tell everyone that asks, and some that don’t, how great it was working with him and what excellent results I had. I am very grateful I had him in my corner while going through these surgeries.”
“Dr. Clifford also insisted that I recuperate at home but that I go out for physical therapy. He said that he wanted his patients to “get up, get dressed and go out for physical therapy”. I believe that’s what saved me!”
“Dr. Clifford performed the second surgery with a fairly new and less invasive technique. What an amazing difference. I had the surgery or a Monday around noon and was home around 8pm the same night. ”
“No way! Was my first reaction to the idea that a hip replacement could be done as outpatient surgery. But now, having had both hips replaced six months apart and having returned home the same day for each, I am convinced, pleased, and walking around without pain for the first time in years.”
“I have never met another surgeon that truly loves what he does, cares about his patients and listens to what you have to say.”
Have you been suffering with the debilitating symptoms of arthritis of the hip? You may want to consider conservative treatment options that might be able to put you on the path to relief. If you have tried conservative options and you feel that total hip replacement surgery might be the right option for you, contact us today