A hip replacement has the potential to change your life. The procedure can restore your ability to walk without pain and get back to activities you may avoid because of severe hip osteoarthritis.
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As little as 10 years ago, the procedure was rather rigorous, with a long, 10-inch incision, a hospital stay and time at a rehab facility. Now, however, newer, more advanced techniques are changing the patient’s experience of joint replacement surgery.
Now, for example, the incision usually is half as long, using a local anesthetic. Many patients go home the next day after having already taken some steps.
Advances in joint replacement techniques in recent years mirror the evolution of other types of surgery toward more minimally invasive approaches, fewer complications and shorter stays in the hospital. In some cases, joint replacement can even be done as an outpatient procedure.
“This is possible because of advances in surgical techniques, improved pain management and better patient selection,” says orthopaedic surgeon Wael Barsoum, MD, President of Cleveland Clinic Florida.
“When I first started doing joint replacements, we made incisions that were 8 to 12 inches long,” Dr. Barsoum says. “We would open everything up so we could see the entire area and be confident the implant was placed correctly.” This meant cutting healthy tissue and removing and then reattaching muscles, he says.
Because the instruments used for joint replacement surgery have gotten smaller, surgeons now have the option to use shorter incisions of three to four inches for hip replacement and 4 to 5 inches for knee replacement.
“We also respect the importance of preserving muscles and avoiding cutting healthy tissue as much as possible,” Dr. Barsoum says. The result is less pain and quicker recovery.
Better pain management
At Cleveland Clinic, about 90 percent of joint replacements are performed under a short-acting spinal anesthetic, Dr. Barsoum says. The anesthetic, which numbs the patient from the waist down, lasts about two hours.
Patients also receive a long-acting local anesthetic around the surgical site, which controls pain for up to two days after surgery. Use of narcotics, such as morphine and fentanyl, is limited because the drugs can cause nausea, dizziness and other complications.
“By minimizing complications from anesthesia, we can get patients moving more quickly,” Dr. Barsoum says.
Who’s a candidate?
Not everyone is a candidate for minimally invasive surgery with a short hospital stay. In general, people who are more fit and have few other health problems do the best, Dr. Barsoum says.
“We know the possible complications, when they are likely to happen and to whom,” Dr. Barsoum says. “Using that information, we can select patients for whom it is safe to do joint replacements with a 23-hour hospital stay, or even as an outpatient procedure.”
If you are considering joint replacement, Dr .Barsoum recommends choosing a highly experienced surgeon who performs a large volume of the procedure you will have. If you’ll be going home the day after (or the day of) surgery, it’s important to be comfortable with the decision and to have support at home from family and friends.