Former Intern Hospitals of Paris
Former clinical associate professor-assistant of the Hospitals of Paris
Former Head of Department of Orthopaedic Surgery of hospitals Bichat/Beaujon
Member of the National French Academy of Surgery
A primary hip replacement corresponds to the first implantation of a total hip prosthesis (in a hip that has never been implanted before).
The operation is usually scheduled within one month after the first surgery visit. The period of one month is required in case of comorbidity (sweet, diabetes heart history...), allowing sufficient time for additional explorations if necessary. If this is not the case, the period may be shorter. The visit with the anesthesiologist (the one that will make you the anesthesia), is an obligation and should ideally take place 2 to 3 weeks before the operation.
For foreign patients, it is important that the indication of total knee replacement has already been decided and carefully designed by the patient. It is also important to organize your stay in France after the operation. When everything works well, the discharge from the clinic may be pronounced on the second postoperative day. Shorter stays are possible. However, it is important to stay nearby and consult your surgeon the following week before returning home. Good markets and comfortable hotels are available nearby for patients and families. It is
recommended that patients be accompanied by a parent staying with him the first days at the hotel.
For patients coming from another country, it is preferable to ensure that the costs are covered by health insurance. The costs can be contained on the basis of a short-lived stay at the clinic. For example, the clinic will ask 8000 euros for 3 nights in a private room. The cost can be reduced to less than 7000 euros for a stay of 2 nights in a double room. Anesthesiologist (1000) and the surgeon's fees (2000) are not included. Including their fees, the total cost of the operation (replacement of hip, knee or ankle primary) are of about 10000 euros.
You must of course learn functional benefits provided by this operation which are very important, restoring a normal hip so-called "forgotten" in the vast majority of cases. But it is a serious procedure that has a number of risks that must be taken only when you can no longer live normally because of your arthritic pain and/or your stiffness. You must know the complications of this operation before you have surgery for several reasons: it is not to scare you, nor for your surgeon to discard a liability (I warned you etc...). No. Knowledge of complications instead allows you to prepare yourself by reducing risk factors, to better face them if they do occur, to better organize your life later if you take the necessary steps to take the time to treat these complications (professional, family).
Reduce risk factors prior to surgery is important: If you have overweight, you should consider reduce it by taking the advice of a specialist doctor or a dietician. Most of the time, can';t get there alone. Dental infectious homes must be eradicated and you must appear with good oral hygiene. This may seem surprising, but it is statistically the first source of prosthetic infection. A visit to the dentist is therefore necessary. If you go regularly, this visit will be most of the time a simple scaling. These precautions should be continued after the operation on a final
basis, with an annual visit to the dentist. Skin lesions (Erysipelas, eczema, varicose ulcers) on the same member must be treated and healed before the operation. Diabetes insulin-dependent or not must be balanced with standardized numbers of blood sugar. See if necessary your diabetologist.
In men, prostate-related urinary disorders must be treated medically or surgically by a urologist. If you have a prostatic adenoma neglected, urination may crash in the aftermath of the operation, leading to prolonged implementation of a urinary catheter. If the risk is considered too important, it may be necessary to undergo a prostate transuretral resection prior to orthopedic surgery. Smoking or alcohol consumption must be absolutely stopped 2 months prior to the intervention. Otherwise, you'll be brutally weaned by necessity in the postoperative, which can lead to serious complications challenging the result of the operation. The risks associated with other diseases that you would have incurred before the operation, including cardiovascular conditions, and the balancing of your previous treatments will be discussed with your anesthesiologist. A visit with him is systematic and also mandatory and will be scheduled by the surgeon when the operative indication have been approved and a date of intervention set with you.
You can also ask him about the type of anesthesia that he will incur: epidural or general anesthesia. Your surgeon will explain what are these complications and their treatment. They are of course dominated by the infection, but this isn't the only possible and the risk of these complications can be increased by your preoperative health status and other associated diseases. Most of these complications can be treated and healed but it takes time. Reoperation or even a change of prosthesis may be required. You must therefore anticipate this eventuality and avoid having essential imperatives in immediate surgery suites.
The operation lasts about an hour. You should know that the duration of the operation is not an important parameter and that it may take an hour or an hour and a half instead of an hour. This has no influence on the recovery time.
An operation of this magnitude is normally followed by pain. Everything is done to minimize the pain and make it bearable. With current technology, at wake up you will feel sort of soreness and pulling, rather related to the skin incision than to the work done in depth.
Theanesthesiologist adapts analgesic treatment in the immediate aftermath of the intervention. In general, the level of pain is moderate and very tolerable. A shot of Morphine may be necessary the first night. In all cases, the level of the pain decreases rapidly after the operation and becomes very tolerable in the next day, allowing the mobilization and walk in full support. Subsequently, an occasional treatment (if necessary) by Paracetamol is enough during the first month.
The sooner the better to avoid Embolic complications (shutter of a vein called thrombophlebitis with its dreaded complication which is pulmonary embolism, where a piece of the clot breaks off and migrates to the lungs). The fixation of the prosthesis is strong enough to allow the immediate resumption of support and regain autonomy. Most patients get up and start walking the day of the operation. You must be helped by the physiotherapist or surgeon to perform this first stand up gradually.
When the first raise, you must sit a few minutes at the edge of the bed to compose herself before standing up. The use of 2 crutches or Walker is necessary during the first stand up. The key is to control your movements so as to not to fall. The operated leg may feel overly heavy and it's normal. Initially you will need assistance to mobilize it and put you in a sitting position.
When things are going normally, you can go the 3 rd or 4 th postoperative day. Some patients with a business wish to go home the day of the surgery. It is possible if there is a home help. Generally speaking, you can't stay alone at home the first week. You will need help to do your shopping and help you in your travels, especially in the case of stairs to cross. You also need assistance to put on the contention stockings, because they are tight enough. To get out of the clinic, you need the permission of the anesthesiologist and surgeon, who will check the absence of temperature, the nature clean and dry of the wound, and the resumption of autonomy (to be able to stand and walk alone).
In the majority of cases, a transfusion is not necessary. In some cases, it may be required especially if you had a preoperative anemia. In fact, the anesthesiologist that you will see before the operation will seek to correct the anemia (iron injections or EPO). But this may not be enough. In addition, if you have other diseases of cardiovascular order, no postoperative anemia cannot be tolerated and transfusion indications are wide. Transfusion is painless and has the solely disadvantage to delay your release.
Please contact a liberal nurse who will come to your home once a day to give subcutaneous injection of anticoagulants during 1 month, at fixed hours, weekends and holidays included. She can help you on this occasion to put on your contention stockings, which it is desirable to keep 1-2 months depending on your venous condition. Under certain conditions, injections can be replaced by oral tablets.
For the rest, you're a little vacation. There is little rehabilitation. A physiotherapist can come 2-3 times at home to make you walk, go up and down the steps of a staircase. Subsequently, must stick to walk at least half an hour in the morning and half an hour in the afternoon by going outside with good well adherent sneakers. Of course, you can walk more if your heart tells you. You'll quickly find that the rods are no more essential for you around your home. You will keep them by security outside some time, but should leave them on average at the
end of the first month.
It is recommended not to drive in the first 6 weeks and do not take car or public transport (metro, bus). You may have trouble to put you out of the car, especially if it is low. In General, avoid the lower seats during the first 6 weeks. Make sure that your bed is normally raised (no mattress on the floor). You might need a WC elevator that will be prescribed in all ways. You should not sit in the tub and stand in the shower to wash (with a non-slip mat). Finally prefer chairs to soft and low sits.
Once you are back home, the wound should be controlled once a week by a nurse, who will also change the dressing. Stiches will resorb spontaneously. At every moment, you can join your surgeon by phone. Do not hesitate to call him if you notice some persistent seepage from the wound. Do not take antibiotics. Take a photo and send it to your surgeon. He might ask you to come back for a visit. If everything works well, you won’t see your surgeon before the 6 th postoperative week for a clinical and radiographic control. He will then let you resume all your usual activities including driving. It is preferable that you stay and rest at home during theses 6 first postoperative weeks. You will be then able to move and travel by air or train.
Except professional necessity, the duration of the work stoppage is 2 months. Some independent self-employed workers wish to resume their activities as soon as possible. It is better in this case provide for sedentary work at home. Conversely some manual or force workers will request additional time before the resumption of their activities. Anyway, everything should be planned before the operation. Important appointments, contract signatures, long-distance travel must not be programmed in surgery suites. It will be time to program them and move forward them if all goes well.
It must be reasonably wait at least 3 weeks avoiding positions with strong inflections of hip.
This depends of course on the sport. It takes 6 weeks which is the time of healing of the peri joint capsule. Subsequently, it must be very incremental and do not expect to recover a normal level before 6 months to 1 year. You must be especially careful to sports at risk (in altitude) and recover all of its articular amplitudes and muscle strength before exposed position. But some patients may ultimately achieve excellent sports levels with a hip prosthesis and there are countless marathoners hip prostheses.
It is possible to operate both sides at the same time. An abundant literature on the subject has not demonstrated a higher rate of complications (compared to successive unilateral procedures). All patients, I later interviewed after a bilateral operation, confirmed that the pain was bearable, and don'have consumed more analgesics than patients having undergone unilateral procedures. No one regretted this choice, because they were happy not to return later for a second operation. In particular, the rehabilitation period has not doubled and was not longer than that of a unilateral procedure, because both sides are moving together. It is therefore a serious time savings. In addition, the rehabilitation of a unilateral operation, while the side contralateral pathological remains painful, is not easier.
So, I suggest bilateral procedures to all those patients who complain of pain equivalent in the 2 sides. In fact, if I propose a unilateral procedure, these patients are unable to choose the first side to operate, because both sides are equally symptomatic. Bilateral procedures are also indicated in patients with a bilateral contracture in flexum. The only downside of bilateral procedures is greater blood loss, increasing the likelihood of transfusion. Therefore, it is particularly important to follow a procedure of blood savings, increasing hemoglobin before surgery, if necessary. Against persistent anemia contra indicates the bilateral procedure.
Personally, I don't recommend simultaneous bilateral procedures, but prefer to operate the two sides successively in the same anesthesia. After the first side, blood loss is estimated with the anesthesiologist, and surgery is continued only if loss of blood from the first side were moderate. Patients should be aware of this interim evaluation and know that the second side will perhaps not be executed.