When my youthful 71-year-old mother-in-law admitted she'd been fighting hip pain for nearly two years, I was surprised. After all, she's the picture of health, enjoying biking, cross-country skiing and, until her early 60s, Rollerblading. But when she told us she was pursuing outpatient surgery to repair her hip, I was excited and incredulous. Clearly, I didn't understand a lot about hips. I also held outdated ideas about what a hip replacement requires. Advances in medical technology and surgical techniques give today's patient a very different experience.
Curious? I was.
Though my mother-in-law was medically cleared for outpatient surgery, Medicare required her to stay overnight at the hospital. To learn more about the experience of outpatient total hip-replacement surgery, I caught up with Tami Theide, who underwent the same surgery at age 55. Like my mother-in-law, Theide sought care at the Midwest Center for Joint Replacement (MCJR), a practice in Indianapolis established by orthopedic surgeon Michael Berend, who is renowned in the field of joint replacement and was named one of the nation's top 22 knee surgeons.
A physical therapist by occupation, Theide lives to move, enjoying long-distance cycling, scuba diving and, previously, running marathons. In her early 50s, she gradually watched her mobility diminish because of chronic hip pain. “You take the little things for granted until suddenly, you can't do them.” She lost her ability to cross her legs and touch her toes, and even gardening was difficult. “It was depressing,” she said.
MCJR surgeon Joshua Carter recommends that people seek treatment as soon as hip pain begins. “In general active, healthy, well-nourished people are motivated to recover because of wishing to resume their normal activities — get their life back. It's a life-changing operation for people.”
No patient is too old — or too young — for the surgery, Carter said. “Age doesn't matter — it's about the hip condition.” He recently performed outpatient total hip replacement on a 41-year-old owner of a kickboxing gym. “She recovered easily and is back kickboxing and running her gym.”
It seems these are exciting times as far as joint replacements are concerned. “The parts have become so advanced that, when doing total hip on a 40- or 50-year-old, there's a very real possibility it'll be the last operation they'll ever need,” Carter said.
Wesley Lackey, Theide's surgeon, said she was a perfect candidate for outpatient total hip-replacement surgery because, though her joints were worn out, her muscles were strong.
"There are a number of things that we look at before going the outpatient route to make sure it's safe,” Carter explained. Patients cleared for outpatient total hip replacement have no serious medical conditions, and no history of failing systems.
Carter said that outpatient total hip replacement is made possible today by the profession's developed understanding of pain management, by identifying the healthy people who are eligible, and by employing the “anterior approach.” “This is a surgical approach in which the incision goes in the front of the hip,” he said. “You go right between muscle groups, retract them to access the hip joint.”
The anterior approach is less invasive and, thus, less damaging to muscle tissue. The literature clearly shows that this method speeds up recovery time, said Carter, who exclusively performs the anterior approach.
Theide's experience illustrates this truth. Four months after surgery, she was scuba diving in Bonair. Six months after surgery, she completed the Hilly Hundred cycling event. “My outcome was so wonderful — to get my life back so quickly to doing the things I love!"
The key to her speedy recovery — besides good health and strong muscle tone— was in faithfully doing her rehabilitation exercises, Theide said. Though she was more than able to manage her personal rehab, MCJR teaches patients to do therapy on their own. “The majority of my patients don't use formalized therapy,” Carter said. Studies, he said, show that recovery is the same whether a patient attends outside therapy or performs their exercises at home.
Theide also attributes her success to planning ahead so that she'd arrive home comfortably after surgery. “This is an important thing to have in place — what you need, the set-up of your house, who will be there to help you.”
Since Theide wasn't a fan of being overnight at the hospital, “Being able to go home was a blessing. I was really excited to be able to go home and recover in my own environment."
Carter wholeheartedly agrees that as long as a patient is cleared for outpatient surgery, it is preferable because of the patient experience. He'd rather get patients into the comfort of their home while the numbing is still in effect, rather than later when meds are wearing off and things are feeling sore. “Outpatient satisfaction has been awesome,” he said. “Not one has reported a negative experience.”
Theide said she can't imagine what things would have been like if she'd continued waiting to address her hip pain. For most people, Carter explains, “The natural course is for hip pain to get worse.” To cope, people begin avoiding activities they love and overall grow less active. Since becoming withdrawn and sedentary is holistically at odds with good health, he said, “There's a cost to waiting. It's not worth it on a lot of levels.”
To select an orthopedic center, Carter suggests identifying one that performs a high volume of joint replacements per year. Sheer volume guarantees varied experiences and readies surgeons for whatever they encounter during surgery. MCJR's small team of three surgeons performed 1,700 just last year. On the day we talked, Carter had performed seven total hip-replacement surgeries. “It was awesome,” he said. “I think we helped some people today."