Arbor Orthopedics

What to Expect

Surgical preparation: This is an elective surgery and we require a medical doctor to evaluate you prior to the surgery and ask that he or she be available to follow you while you are in the hospital.

Labs: There are numerous labs and tests that are needed to evaluate the risks of surgery. These include blood tests, chest x-ray and an EKG heart test. Sometimes other tests are needed for patients with a history of heart problems.

Pre-surgery evaluation:

Our Office: We will see you a few days prior to the surgery to go over the plan and make sure all of your questions have been answered.

Pre-op clinic: The hospital will need to see you to complete paperwork, to review labs and give you instructions.

The day of surgery: The instructions as to when to stop food and drink will be given to you at the hospital during the pre-op visit. Once in the hospital an IV will be started for medication such as sedatives and antibiotics. The skin will be prepared in the surgical area. The anesthesiologist will discuss the plan and answer questions.

The surgery generally is about 1-1/2 hours in length but the time in the operating room is much longer. First the anesthetic is administered then you will have a catheter placed in your bladder as it will not work well for awhile after the surgery. Next you will be positioned on the operating table. Your skin of the entire lower extremity will then be prepared with a solution that kills bacteria. The leg will then be draped with special sterile materials and, finally, an impervious sticky drape is used to cover the skin and prevent contamination of the instruments as they are used during the surgery. After the surgery a tapeless dressing is applied. Dr. Carn feels it is very important not to have tape applied to the surgical area as it is associated with blistering and pain. Therefore, you will have special wrap, compression type of dressing which holds the sterile dressing in place over the incision. Also, a cold pack will be applied as part of this compression dressing to minimize swelling and pain.

Once in the recovery room you will be made comfortable in your hospital bed. X-rays and laboratories will often be obtained to monitor your progress. The total time from holding area to recovery room is 2-1/2 or 3 hours.

After Surgery

Deep breathing and wiggling is very important to prevent problems even in the recovery room when the patient is first waking up.

Most patients are mobilized the day of surgery by getting them out of bed and having them walk at least a bit. This promotes circulation and improves bowel and lung function.

As the days go on the confidence in the use of the operated extremity quickly increases and within a few days patients are able to take care of themselves. Those who have good help at home can go directly to their normal living environment. Those who do not have sufficient help or have other factors such as multiple joint arthritis, age or medical problems may be best treated in a rehabilitation facility for another one or two weeks.

It should be noted that Medicare protects the right of Medicare patients from early inappropriate discharge. Dr. Carn has always respected the patient's rights as well as when it is appropriate to discharge the patient and does not feel it is appropriate in only very few selected patients that they be discharged within the first day or two after surgery. The average length of stay is anywhere from 2 to 4 days averaging about 3 (Medicare patients will be given a form by the hospital describing their rights as a patient as it relates to discharge from the hospital). (See section on “Standard of Care”).

Dr. Carn will evaluate you every day while you are in the hospital and once you are discharged or transferred, then he will see you at about four weeks after the surgery for the first set of x-rays and to evaluate your progress.

Controversies in Total Hip Replacement

The United States traditionally has an excellent level of medical care compared to anywhere in the world. Part of this excellence is the ability to advance medicine. Until recent times, advances in medicine were done without patient consent and with the patient not understanding the options. In the last 20 years this has been corrected and the standard of care in hip and knee replacement has been firmly established.

The controversial areas in hip replacement include the type of surfaces that slide across each other (bearing surfaces) and the way that these parts are fixed to the patient (with or without bone cement). The vast body of knowledge in orthopedic surgery supports that the cup or acetabular side be placed using a non-cement technique. On occasion if the patient has abnormal bone such as for a tumor, for very soft bone or for infection, bone cement may be used in the cup side.

The method of fixation of the thigh part of the hip replacement has excellent documentation that both cementing the stem and using cementless techniques of fixation of the stem are very predictable.

The greatest controversy is regarding the type of surfaces that actually move against each other (bearing surfaces). The tried and true standard of care is a metal called cobalt chrome that moves against a very specialized plastic called ultra high molecular weight polyethylene. Ceramic surfaces and metal on metal surfaces do not have the same multitude of literature available as the standard metal on polyethylene bearing surface. There have been some early failures in some types of ceramic surfaces and there have been measurable increases in metal ions with the use of some designs of metal on metal articulations. Even though these have been extensively used, Dr. Carn does not feel they represent the standard of care.

Not only do controversies exist in the type of hip replacements but also in the surgical approaches. The long-term accepted concept of surgical approach was that of an extensile (large enough to see everything) exposure. The amount of damage from the surgical approach has lessened in recent years with the surgeon’s skills improving and allowing them to do the same surgery through smaller and smaller incisions. The overwhelming principle is that the surgery be done correctly in order to have the best long-term result and studies of both long and short incisions show no difference in the long run as far as quality of result as long as the parts are placed well. Dr. Carn generally uses a very small incision, minimally traumatic to hip replacements, but this is based on many years of experience in doing total hips. Regular length incisions absolutely are still appropriate and standard of care.