Saturday, May 30, 2009

The Replacements

I have written about this before. But here I go again.

A little background about my hip surgery. About five years ago when I finally saw the handwriting on the wall, I researched the internet and discovered anterior hip replacement surgery. To make a very long story short, it was brought into this country about thirty years ago from France by an American orthopedic doc named Joel Matta, whose practice is in Santa Monica, CA.

He actually listened to a Frenchman living over here who came to him needing a new hip. Monsieur Le Patient asked Dr. Matta to learn how the French did their total hip replacements, because he thought their method was better. He'd already had one hip done the French way and Matta must have been impressed by what he saw, because he went across the pond for a couple of years to study with the frogs.

Google him.

It is worth noting that the French and Germans have been doing anterior surgery since the forties. For some reason [because we hated the Germans and don't trust the French?] most American hip docs use the English total hip procedure developed in the sixties -- a posterior incision with a big, sometimes foot long cut, longer recovery, and a risk of dislocation so high you are forbidden to cross your legs, turn your leg certain ways or bend your knee more than 90 degrees for the first six weeks. And in some cases, forever.

Since Dr. Matta learned the drill, he has trained a multitude of other docs to do this operation. One of them is my surgeon, Michael Stover. With true anterior hip surgery, which requires a specially designed table, a small incision of approximately four to five inches is made at the top of your thigh in front of your hip. For those of you keeping score: anterior = front; posterior = back; lateral = side. Instead of cutting across major muscles, the surgeon spreads them apart. This procedure helps prevent dislocation afterward, helps insure that one leg won't be shorter than the other, and it means I have no restrictions on movement while I rehab. Did I mention that you can also expect faster healing?

Having no restrictions means that I am the only person in re-hab with new hips who is allowed to use the NuStep, a machine which is similar to riding a bike. Unlike the the other total hip patients, I am allowed to bend my knee more than 90 degrees. A couple of people here have had a newer, less invasive, lateral or antero-lateral surgery. Their incision is on the side of the hip and smaller, but patients still have all the old precautions to worry about. And just what is so good about that?

In the rehab gym, the other old folks are puzzled when they find out that I have no restrictions. Na na na na na. They wonder out loud why their doctor didn't do my kind of surgery. I've also learned that uninitiated orthopedic docs in this country think anterior hip replacement is new surgery. Untried and untested. Can't they read? Don't they go to conferences? You'd think they'd at least be curious enough to find out about it.

You can actually watch Dr. Matta perform the surgery online. The docs can too, but I've never met a more insular, not-invented-here-group in my life. They close ranks any time someone is doing something they aren't.

I also wondered why more docs weren't doing this surgery, because it sure seemed to promise a better result for the patient. One of my surgeon's residents told me, "Because it's more difficult surgery." Aha. No wonder. Usually if a medical center offers anterior surgery only one or two of the docs are qualified to do it. And the farther east you travel from Dr. Matta, the less docs are doing it. There's a Dr. Nakasone who is doing it in Hawaii, if you want a great place to rehab.

This time around, I have had two other doctors, one a radiologist and one an internist ask me about the surgery. One of them even wanted to see the scar and exclaimed, "It's so small!!" BTW -- eight weeks ago when I had my first surgery, I was explaining the procedure the best I could to a different internist who was curious. As if to pay me back for describing what I knew, he told me about the new, way less invasive gall bladder surgery -- no, not the laparoscopic version. That is so 2002. For this new procedure they remove the gall bladder through your esophagus -- not your abdomen. So no gut cuts at all.

At one point I wanted to videotape my before and after hips. Unlike most people who have one hip at a time go bad, both my hips were frozen at an angle, making walking normally very difficult. I also had severe ossification [extra bone growths], making things even worse. Plus a bad back. So I wasn't a really good candidate to do a before and after, since you don't want people with complications that could make a doctor look bad. Now I wish I'd done it. Dr. Stover had made it look easy.

I'm still not 100% -- but it hasn't even been two weeks. I'm almost off all my pain meds -- one 50 mg. Darvocet three times a day. It takes time, but I get used to my new body parts more and more every day. Balance is my biggest problem. I was used to being lopsided. But I got my sense of balance back about five weeks after my first surgery straightened out my left leg. I'm curious to see how long it takes now that both of them are normal.

Of course, I won't be normal. But there's no surgery yet for that.

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