2 weeks Ago
Once upon a time, undergoing a total hip or knee replacement meant days in the hospital post-operatively and months of grueling physical therapy afterward, toward a recovery. These procedures are still considered major surgeries, but today, for the most part, they are same-day surgeries, with new techniques and technologies that are redefining outcomes. For patient Eric Madsen, a resident of Charleston in his early 60s, it was hip pain that propelled him to see an orthopedic surgeon for a consultation.
"Initially, I thought it was my lower back, since I’d had spinal surgery in 1983, and figured it was probably associated with that," said Madsen. "I went to see Novant Health’s orthopedic surgeon, Dr. Del Schutte, because I’d been limping around, and trying not to put too much weight on my hips.
Once the doctor had the X-rays done, it turned out that both hips were bad and needed surgery." Madsen would need total hip replacements, as his worn-out cartilage, along with other tissues in his joints, were no longer buffering the movement of his bones, causing intense pain as his bones rubbed up against one another. In the surgery, the damaged bone and cartilage is removed and replaced with prosthetic components.
The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur - the large bone that runs from your hip to your thigh. More than 550,000 total hip replacements are performed in the United States every year, and advances in techniques and materials have greatly improved the process today since the early years in the 1960s when the technology for replacing hips was first introduced. “The lifespan of a total hip used to be 10-15 years,” said Dr.
Schutte. “Now we like to say that the procedure takes 40 minutes and will last for 40 years. The days of metal implants are long gone, replaced by titanium, which is the material closest to the bone.
The artificial hip joint is not cemented in place, but because of the porous surface of the implant, and the way in which they are wedged into place, it allows bone to grow into the artificial joint in about four to six weeks into the implant and hold the joint in place.” Ordinarily, the recovery time is about six weeks to participate in daily activities. By three months, patients have regained their maximal strength and endurance following the surgery.
For patient Madsen, there was a glitch in his recovery due to a previously unknown congenital problem. But quick thinking on the part of his medical care team prevented what could have been a major calamity. Although some surgeons do not see patients post-operatively for six weeks, Madsen saw Dr.
Schutte within a few days of his surgery, and it was determined the swelling in his leg wasn’t normal. Dr. Schutte sent his patient to Novant Health vascular surgeon Dr.
Edward Morrison immediately to make sure there wasn’t any clotting. "When Eric got to our office, his left leg and hip were twice the size of his right, and we knew there was a big problem," said Dr. Morrison.
"An ultrasound revealed he had clots from his navel to his knee." "Morrison told me I was in bad shape," said Madsen. "He told me if I was his brother, he’d put me in a wheelchair, wheel me across the street to the hospital, put me in the ICU, and do surgery in the morning.
So, that’s exactly what we did." Until recently, clots were handled by giving the patient blood thinners, hospitalizing them for days while waiting for the clots to dissolve. But clots can be dangerous because they can break off and travel to your lungs, causing a pulmonary embolism that can be fatal.
The immediate removal of the clots with a new technique resolves the problem. "We did what’s called a thrombectomy, where we literally sucked out the clots," said Dr. Morrison.
"We used to use a substance called TPA to dissolve the clots. Now we have mechanical devices to remove them immediately. As it turns out, Eric had a condition he was probably born with called May-Thurner syndrome, but which he never knew about.
It involves the narrowing of a particular vein, and this is what was responsible for the clotting. If Eric had known, he would have been a candidate for a filter, pre-op, to prevent a pulmonary embolism. And, when he has the other hip done, he would take a dose of a strong blood thinner, right after the surgery.
Eric had a fabulous result and prevented a problem. After his next surgery, we would see him two days later and do an ultrasound." The key to any knee or hip surgery is follow-up, and Madsen credits both doctors with saving his life, for their timely response to his condition.
"Eric’s situation was one in a million, and there’s no way to pick it up pre-operatively," said Dr. Schutte. "This is a concierge practice.
When Eric called, we answered. The bigger risk is people who delay seeing the patient, not some rare syndrome." Dr.
Schutte also performs total knee replacements, but refers to them as knee resurfacing procedures, as the last 3/8” of the knee bone is literally resurfaced. There have been advances in this surgery as surgeons now cut around the muscle, rather than through it, sparing the quadricep. It’s a quicker surgery with a faster recovery time.
There were 790,000 of these procedures done last year in the U.S. While there have been reports recently in the media about replacing cartilage rather than replacing the knee joint, Dr.
Schutte is hesitant about the hype. "Stem cells don’t regrow cartilage," explained Dr. Schutte.
"And, the injections of hyaluronic acid to cushion and lubricate the joint really don’t work and were only expected to give relief for six months, at most. Of course, there is also the placebo effect, so 50% of the time patients will say they saw some improvement. Creating cartilage in a lab is still experimental.
And, as for cartilage transplants? They are very rarely indicated, and except for a small subset of the population, this really doesn’t apply. If you have torn cartilage in your knee, it may be possible to use a nickel sized piece of cartilage from the back of your own knee, but this is really rare." The average age of the knee and hip replacement patient is getting younger all the time.
As the average life expectancy ticks up, many Americans are no longer willing to sacrifice decades of their favorite activities - whether it’s skiing, tennis, or running around with the grandkids - especially when the procedure is easier, recovery time is quicker, and the joints are lasting so much longer. Meanwhile, Madsen is back to long walks on the beach, swimming, and enjoying life in the Lowcountry. [SIDEBAR] DOING THIS NOW MAY HELP TO AVOID A KNEE OR HIP REPLACEMENT LATER IN LIFE.
