Hip-hip hooray! Replacement surgery a smooth ride for columnist
After July’s spine surgery, getting a new, titanium hip is a stroll in the park. And it should last longer than I do.
By Neil Steinberg Jan 31, 2020, 1:00pm CST
Neil Steinberg’s new hip: It’s made mostly of titanium, with a ceramic head and plastic liner. It should last longer than he does. Neil Steinberg / Sun-Times
“Another one of those chopped-up weeks,” said Sam, a friendly Metra conductor on the 6:26, when asked how it’s going.
”Exactly!” I enthused, delighted at his unintentional double entendre.
He meant New Year’s Day coming midweek, like Christmas, breaking up his December schedule. I was thinking of why I was on an early train: to head to Northwestern Memorial Hospital to be cut open, the second time in six months.
”Chopped up” is not a polite description of the surgical process, ignoring the years of laborious training doctors go through, the great skill and care they exhibit. I apologize for that. But humor is essential for getting through even a fairly simple operation, like having my arthritic hip replaced with an artificial one. In the weeks up to the event, I developed a patter to explain to friends and, more
importantly, try to convince myself just how easy hip surgery is.
”The thing is very quick,” I’d say. “You stroll in to the hospital, stop at a mark on the corridor floor. A medical team rushes out, like a pit crew at the Indy 500 changing a tire. One yanks your pants down, another swabs the affected area with Bactine. Meanwhile, the surgeon ambles by, whips out a knife, makes a few Hibachi chef-slicing motions — shwick, shwick, shwick — your old hip is glistening on a metal tray, and the new one is slapped in. Up go the pants, the surgeon puffs on his fingertips and strolls off in one direction while you stride happily away in the other.”
The reality was a bit more complicated. At Northwestern, we were given a number on a card, which my wife tucked away.
”944091!” a compact young woman in green scrubs announced. My wife fumbled in her purse, but the card eluded her fingers for a moment, prompting the woman to call out “Steinberg!”
We sprang up, babbling apologies. She marched us int o a room, ordered me to undress, followed by more instructions, with the air of a drama student in an acting class challenged to express contempt through a set of ordinary commands: “Take your clothes off.” “Put them in this bag.” “Put this under your tongue” and such. My wife and I exchanged glances. Maybe we’d picked the wrong day to do this.
”Not yet!” the woman said. Neither my wife nor I could recall later what I had started to do. But we remembered that phrase, resounding like a gunshot.
End of a long shift, I thought, trying to be generous.
”Do you have the power of attorney, or are you making your own decisions?” she snapped at me. I looked at my wife, beseechingly.
”He’s making his own decisions,” she said.
Deciding to have the operation took me years. My hip started hurting at least five years ago. I’d bring along a rubber ball on airplane trips to tuck under my right hip to relieve the pressure and then while driving. In autumn 2018, I started seeing orthopedic surgeons. They said the same thing: Wait because an artificial hip lasts only so long, and you don’t want to have to do this again when you’re 75.
Dr. Kevin Hardt, who did the hip-replacement surgery. Northwestern Medicine
Turns out that isn’t true, not according to the surgeon I finally picked, Dr. Kevin Hardt. I found him because I had complex spine surgery in July. First, I figured, in for a dime, in for a dollar. The hip would be easy by comparison. Second, I had a spine surgeon, Dr. Alpesh Patel, I knew and trusted, so I asked him to recommend someone. He served up Hardt.
During our initial consultation, Hardt said hips introduced in 2000 were significantly better than what came before. So the replacement should last until my body fails around it. I had limped around for years for nothing. Still, I worried about jumping the gun and whether I should keep ignoring the hip, which didn’t hurt so much now that I was using a cane..
He reassured me I wasn’t being premature.
”Yours is the worst hip I’m going to see today,” Hardt said.
The day of the surgery, after the brusque woman in scrubs left, things immediately got better. An anesthesiologist gently explained I had two options: local or general anesthesia. The first — basically a spinal, like what’s given to women before childbirth — has the better outcome. But some people are so terrified they opt for general anesthesia, which works less well and is more perilous.
”Well, I’m terrified as anybody,” I said, exaggerating. “But I also trust your judgment. And, if spinal works better, then let’s go for that.”
I try to flatter the professionalism of doctors. They like that. And try to never betray any kind of medical knowledge myself. They don’t like that.
Someone swabbed a very cold liquid on my lower back. I woke up in recovery, feeling extraordinarily happy.
The part I missed was where I was rolled into a surgical theater, and Hardt performed a right total-hip arthroplasty — a hip replacement, one of more than 300,000 done in the United States last year. While 1980s hair-metal music blared — Def Leppard, Motley Crue — he made a three-inch incision in my right hip, on which he previously had signed his initials in pen to reduce chances of taking out the wrong one. He pushed the thick muscles of my thigh aside. The doctors popped the joint ball from its hip socket then, taking an oscillating Stryker saw, Hardt cut off the ball-shaped head off the top of my femur.
Then, Hardt used a spinning reamer — which he described as a “power cheese-grater” — to clean out the cartilage from the socket and create a 55mm hole in which to stick a 56mm artificial socket. Wedging is a key technique in hip replacements. Some surgeons rely solely on a tight fit, but Hardt inserted two screws to be safe.
After you chisel a hole into the top of the leg bone, you just jam in one of these Echo Bi-Metric Microplasty Hip Stem tools. After you chisel a hole into the top of the leg bone, you just jam in one of these Echo Bi-Metric Microplasty Hip Stem tools. Then, on to the top of my leg bone. He reamed a hole and jammed in an Echo Bi-Metric Microplasty Hip Stem, size 13 — midrange. Its porous surface allows the bone to quickly grow into it. Sometimes, with older patients suffering from osteoporosis, the doctor must create a bigger hole and slide the titanium stem in rather than wedging it tight, counting on cement to hold it in place. Not necessary in my case; my bones “are like stone,” Hardt said later — thank you, Bialystok — and drove it in with an impacter, medical-speak for a hammer.
The surgery was easy (for me; I can’t speak for Hardt). The week after was hard. Two hours after I woke up, a physical therapist was walking me around with a walker. The next day, a friendly young man, Chris, made sure I could put my clothes on and use the bathroom, then the hospital discharged me — after one night in the hospital. In 2000, the average stay was five days.
There was a lot of information, some of it conflicting. Before I was released, a nurse sat me down and went over the eight medications I had to take. Included in my stash, she said, would be three narcotic hydromorphone tablets as a “rescue” drug in case the pain became overwhelming.
When I got home and looked in the bottle, I saw they had given me 42 hydromorphone tablets. There was also something unexpected — Lovenox, a blood-thinner (clots are a concern, as is infection). This I had to inject into my stomach every day for a week. The needle didn’t hurt; it was very thin. But sticking it in was a psychological hurdle. The trick is, not to think about it. Just empty your mind and do it.
The first week, the leg was swollen and often hurt. Four days after I got home, I passed the time by finally reading the eight-page “After Visit Summary.” The first page contained the sentence, “For the first 7 days after you leave the hospital, it is critical that you elevate your leg above the level of your heart 4 times per day for 1 hour each time.” The bold part was actually underlined. Now, they tell me. I thought, not having done that at all.
I considered reaching out to the doctor — that word “critical” was worrisome. What would happen? Might the hip just fall out? But Hardt hadn’t given me a human being to contact. I had no direct way to ask and wasn’t confident that the electronic portal Northwestern is so proud of would actually produce an answer before I was doing the samba again. So I just ignored the instruction and can now say that if by “critical” they meant “completely optional,” then they were on the mark. Or maybe I just got lucky.
A week after getting home, I pitched the narcotics. Ten days, and I went downtown with my son to dinner, using a cane. After two weeks, I could feel the column-writing circuit in my brain start humming and told my bosses I was ready to come back.
At four weeks, last Monday, I went swimming at the YMCA for the first time since surgery. For 40 minutes. It used to be I would feel the deteriorating hip bark with every flutter kick.
Now, it feels just fine.
I am very glad this worked out for you.
No comments:
Post a Comment