This article is a transcribed edited summary of a video Bob and Brad recorded in February of 2021 . For the original video go to https://www.youtube.com/watch?v=fee0p8zh4o4
Bob: Today our title that we’re going to discuss is the seven most important questions to ask your hip surgeon. So, obviously you’re going in for hip surgery for some reason. It might be a hip replacement, might be a pinning, but this is pretty comprehensive, and Brad and I were talking about this. They don’t all necessarily have to be of your surgeon. It might be his assistant, your nurse, it might even be your physical therapist for some of these later on.
Brad: Right. This is an important video because, you ever go to the doctor and you walk out and you say, “Oh, I wanted to ask him that,” and you completely forgot about it, and things are rushed, the doctor doesn’t have a lot of time to spend with you or whatever.
Bob: You can also find a print out of these questions on our hip program page. Number one, can you try physical therapy first? Imagine that two physical therapists saying that you should try physical therapy first. We’ve seen many times that people think they’re going to need surgery and they have therapy, and it goes well, and they end up not even needing the surgery or delaying it.
Brad: I’ve got a patient right now, extremely tight hips, who’s limping around for quite a while.
Bob: A friend of yours, right?
Brad: Yeah. He just had a stroke too. But it’s coming along so we’re working at this as well and we’re stretching it out, things are getting better. He’s probably going to need a hip replacement but at least he’s got some relief and it’s going to delay it, make things more comfortable until it’s absolutely needed.
Bob: Right. At the very least, you’re preparing the hip for surgery. If you still have the surgery, it’s in better shape. Number two, what is the risk to performing surgery now? So, you want to ask, “Can I avoid surgery? Can I wait six months or a year? Is it going to compromise your outcome? Is it going to affect your outcome?” Now, I don’t think that’s as important on hips as it is on shoulders. Rotator cuff injuries can get worse. But it’s still a good question to have and to me, I always ask the patient, “Is your health going to be okay in a year or a year and a half?” Because sometimes you’re not able to tolerate a surgery as you get older.
Brad: Sure. If you have a heart problem and the doctor will go over that with those precautions about what limits you from having the surgery.
Bob: Okay, number three. Again, this is kind of all tied together. What are the alternatives to surgery? Physical therapy, there’s anti-inflammatories, there’s injections, and just education on how to run your life and keep from hurting your hip.
Bob: Number four, what is the expected length of recovery? How many days will you be in the hospital? And then we have lots of sub-questions for that, too. Let’s go ahead and start and it looks like I’m number one. How long will you need to follow the hip precautions? If you don’t know what hip precautions are, they’re guidelines given to the patient after surgery, and they include such things as, “Don’t cross your legs, don’t bend you hip greater than 90 degrees” and all that.
Brad: And again, make sure that’s clear because there’s more than one type of hip procedure and precautions are different.
Bob: Yes. For each doctor, they’re different.
Brad: Next one, will you need full-time or part-time care? If so, how long? So, let’s talk about when you return home, are you going to be able to be independent or you need to have a spouse or family member or maybe home care come in to help you out.
Bob: And that requires pre-planning obviously. Will you need a hospital bed at home? Good question.
Brad: How soon will you be able to walk after surgery? Weight-bearing status. Typically, as 100% weight-bearing, or as tolerated, but not always. Sometimes you may have complications and there are some restrictions for that.
Bob: Well, especially if you fractured your hip, and in that case, you might be non-weightbearing. So, that’s going to greatly affect your ability to get around. If you are not full weight-bearing. Will you need crutches or a walker? And if so, how long? So, you want to prepare ahead because you aren’t going to go out to the store and get crutches, or I guess you can order online too, when you’re at home
Brad: Sometimes they’re given to you there, or they issue it to you at the hospital, but make sure that you don’t want to be stuck to be waiting for a walker at home for two days. That’s very uncomfortable. It’s not safe.
Brad: When can you lie on the operative side? So, sleeping in bed or you’re on the couch can you roll over on the side that’s been operated on? Very important to know.
Bob: It’s funny. It’s usually sooner than I think. They allow it quick usually. A lot of time on the recheck they’ll say it’s okay.
Brad: Yeah, and that’s on the hip. I think with a fracture or something like that, that’s when you really need to pay attention more.
Bob: How soon will you be able to climb stairs after surgery? So, if you have a lot of stairs, in therapy, a lot of times we work on that before you go home, if you’re staying the hospital.
Brad: There’s a specific pattern on how to go up and downstairs to take the pressure off you’re operated hip.
Bob: There’s a right way and a wrong way.
Brad: When can you shower after surgery? That’s a good one. You don’t want to have an infection in the incision because that will really raise havoc in your life, so get that very clear.
Bob: When can you drive? It’s an important one, because when are you going to be able to start getting around?
Brad: Independence, you know? How soon will I be able to resume normal lifestyle activities besides walking?
Bob: Well, going back to work. The people at work are going to be asking you, “When can you come back?” So, that’s a good question to ask. Again, does it always have to be the surgeon. I don’t know if I’d load up the surgeon with all these questions. But I would ask someone that is in the know.
Brad: If it’s a typical hip replacement surgery, they can oftentimes say it’s probably going to be this, but if it’s a fracture or something like that, there’s too many other variables that may intervene with that.
Bob: What are your lifting limits? That’s a good one.
Brad: You must pay attention and listen to them.
Bob: I left this next one for Brad.
Brad: Oh, yes. When is sexual intercourse feasible after surgery? It’s a good one to know because you don’t want to have a dislocation or mishap there. That could be a problem.
Bob: Again, this is probably a later question, which sports can you participate in?
Brad: Yeah. Plan on none for a little while.
Bob: Yeah. There’s some that you may never be able to do again.
Brad: I know someone, I haven’t seen him for a while, but he had a total hip replacement in his early 50’s and he plays, they call it masters hockey. He wants to get back into it and I’m saying, “Forget it, buddy.”
Bob: Well, at least it’s not pounding.
Brad: Yeah, well, when you fall, and you’re going to fall. You’re in your fifties and playing hockey and even though they don’t go after people aggressively, but they’re guys. Things are going to happen.
Bob: Yeah, you get caught up in the emotion. All right, let’s go to number five. This is the main questions now. And this one, I hope you can maybe find out without asking the surgeon, but how many hip surgeries do you do a year, and how many surgeries of this type? This is an important question because they have found through studies that the surgeons that do more hip surgeries obviously have better results. It just makes sense. If you’re doing one a year, I don’t think I’d go along with that guy. I don’t even know if I’d go along with the guy that does shoulders, hips, you know, he’s doing everything. I would like the guy that’s doing a lot of hip surgeries.
Brad: Yeah, you must do the homework on that.
Bob: Number six, what are the risks of complication, and what is your complication rate? You can find that out, how often does this doctor have people that have problems, and how often do they have people die?
Brad: A big one is infection rate. If you can look at the percentage of infection rate, their history, that’s probably one of the biggest things.
Bob: Yeah. Number seven, final question, but then there’s some sub-questions on that too. If you’re going to undergo hip replacement surgery, you may want to ask these specific questions then. These are just for hip replacement. So, number one, what is the implant made of? You want to know if you’re going to set off metal detectors in the airport.
Brad: And if so, then you do have to carry a piece of paper or something in your wallet that helps you get through, because that happens. This has been going on for years. How long will your joint replacement last? That’s a good one. Is it going to be 10 years? 20 years? If you’re going to be playing hockey.
Bob: Yeah, it’s going to be less than that. And this is going to be a good one for physical therapists. What can you do to keep your joint replacement working as long as possible? Again, your therapist can guide you on that.
Brad: What activities or factors could make you joint replacement wear out more quickly?
Bob: Falling in hockey would do that.
Brad: Yeah, yeah. Obviously, any falls is not going to be good, but can you go back to running? I’m quite certain that’s a negative.
Bob: Probably no, sorry.
Brad: But biking, that may be a different situation. You’ll have to make sure your bike’s seat is adjusted properly. Things like that.
Bob: Good one for your therapist again. And this one’s going to have to be the surgeon or maybe his assistant. Will you need antibiotics for dental care?
Brad: Oh, right. Yeah, I know I’ve had knee and hip patients when they go to the doctor, they must let them know. Sometimes they must take a round of antibiotics before they go in. It’s something like you can get an infection in your mouth.
Bob: And then it travels to your hip.
Brad: Right. For some reason, these replaced joints attract these, and you can get infection without even opening the skin, and it’s amazing how that happens, but that’s a concern and they should make you very aware of that.
Bob: Yeah, it happened to my mother-in-law. It was her knee, but she didn’t have any cuts down there, but she had some nosebleeds and stuff, and I don’t know if she got it through her nose or picked up a bug.
Brad: Yeah, it gets into your system.
Bob: It seem to go right towards that joint.
Brad: Right. The metal in there, it’s not a normal thing, to have that in your body, so it reacts different. It’s a good question to ask the surgeons.
Bob: I’d like to hear a surgeon espouse his few thoughts on that. All right, thanks!
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