Derek L. Hill, D.O.

Fellowship-Trained Orthopedic Surgeon and Specialist

Getting Ready For Joint Replacement Surgery

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Whether it be knee replacement surgery or hip replacement surgery, there are a few key facts to know and important tasks to do to get ready for joint replacement surgery. Knowing what to expect in recovery is also very important.

Ask your doctor about preparing for the surgery prior to your scheduled operation day. Then before your surgery, prepare for your recovery at home:

  • Make arrangements for rides from the hospital and to doctor appointments, and for picking up prescriptions and groceries.
  • Rearrange objects you’ll need frequently, such as clothes, toiletries, and cooking items where they can be reached without bending or stretching.
  • Www.SutterHealth.org suggests getting a Disabled Handicapped Parking Sticker for your car ahead of time. Get the forms from the Department of Motor Vehicles and have your doctor sign them before your surgery.
  • Reduce the chance of potential trips or falls by removing extension cords, plants, throw rugs, etc. from hallways and entryways. Make sure you have a wide, uncluttered path through your home.
  • Www.mayoclinic.org advises to centralize your sleeping quarters on the ground floor, near your kitchen and bath, since climbing stairs may not be possible the first few weeks.
  • Prepare yourself for a life-changing medical procedure by strengthening yourself physically. Get proper nutrition and stop smoking. Rest as much as possible. Prepare yourself mentally by realizing that pain will be part of your recovery.

What to expect after joint replacement surgery:

  • Be sure to follow all the doctor’s orders. Infections and blood clots are real risks. Exercise your ankles and feet, and use support stockings if they are prescribed.
  • Accept that you will be disabled for a few weeks and you will need help for minor tasks. You will need someone to stay with you if you live alone, to help you shower, eat, and get in and out of bed and around the home.
  • You will need a lot of rest after joint replacement surgery. You will have medications for the pain, but you may still be uncomfortable for the first few days.
  • You’ll need someone to drive you to appointments. You will not be able to drive for several weeks.
  • Use pillows to allow sitting comfortably, and be sure your chair is sturdy. Have a raised toilet seat with handles ready in your bathroom.

Joint replacement surgery is a major event and life changing. You will be able to do more things after the recovery. But being ready, and knowing what to expect, will help you through the surgery and help you recover totally.

Written by: Ruby Holder Moseley, FizzNiche Staff Writer

13 Things You Should Know About Hip Replacement

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Pixmac000084403770Hip replacement is an operation in which degenerating parts of the hip joint are replaced with prosthetic ones made from metal and plastic. The following are several important things you need to know about this operation:

  1. Around 300,000 hip replacement operations are done in the US each year. The main function of this major operation is to eradicate pain and improve the patient’s quality of life.
  2. Osteoarthritis is the most common reason that patients have hip replacements. This condition is caused by wear and tear of the hip joint and it causes pain when walking. This pain is usually not relieved by medications, physical therapy, joint lubricants or cortisone injections.
  3. Other conditions that affect the hip and necessitate hip replacements include trauma, inflammatory arthritis like rheumatoid arthritis and osteonecrosis, which develops when the bone cells die due to inadequate blood supply. Children with developmental dysplasia of the hip also tend to have this operation when they become adults.
  4. Most hip replacements are done on seniors because they are prone to developing degenerative conditions like osteoarthritis and fragility fractures from osteoporosis. Person in their 20s and 30s can also require hip replacements if they have conditions like osteonecrosis, hip dysplasia and severe rheumatoid arthritis.
  5. When planning to have a hip replacement, the two most important things to take into consideration are the hospital and the surgeon. An experienced orthopedic surgeon who has done many hip replacement procedures is a good choice.
  6. Many surgeons currently prefer the anterior (frontal) hip approach when doing the hip replacement operation because it is said to have faster recovery as less muscle is damaged. However, there are no studies to support that it is better than other approaches like the posterior-lateral approach.
  7. Most orthopedic surgeons advise against replacing both hips at the same time because of the high medical risks involved. These risks include blood clots, infections and other cardiovascular and pulmonary risks. If a patient needs to have both knees replaced, it is generally recommended that they have one operation and recover before going for the next one. Blood clots which develop after the operation can be prevented by ensuring the patient is mobile as soon as possible and giving them blood thinning medications. Infections can be prevented by taking antibiotics after the operation and before having dental work.
  8. Hip replacement surgery operations can take from 1 to 3 hours. During the procedure the surgeon uses a surgical-grade power saw and drill to cut through the original hip bone. They then ream out the cartilage from the hip socket and reshape the socket before inserting the prosthesis. The prosthesis is attached with epoxy cement or with a mesh that the bone can grow into.
  9. Hip replacement is done under general anesthesia and most patients spend around an hour in the recovery room after the operation. Once they wake up, they are helped to move around with a walker. Pain medications are initially administered in a medicine pump before being changed to tablets taken by mouth. Most patients are discharged within a few days after the operation. Once at home they need special equipment like a walker and a special toilet to keep them from bending their hips past 90 degrees.
  10. Around 6 to 8 weeks after the hip replacement operation, most patients are still going through physical therapy and generally feeling pretty good. Some may resume work around this time though it may take up to 3 months before they resume all their normal activities.
  11. With time the prosthetic hips feel natural that most people forget they were not born with them. Doctors recommend low impact exercises like swimming, water aerobics and cycling to help them remain active. However they should avoid high impact exercises since they can wear down the new joints.
  12. Despite these few limitations, many patients are happy after hip replacement operations since they get a new lease of life as they are once again able to move without pain. They also regain flexibility and the ability to do activities like bending to pick a flower and sitting on the floor to play with grandchildren.
  13. Hip replacements currently last for about 15 to 20 years. This means that patients in their 40s who undergo this operation may need another one later on in their life. However, with ongoing research and innovations like the biologic hip replacements, it is suspected that future joint replacements will last for more than 60 years.

Written by: Marian Kim, FizzNiche Staff Writer

Article credit: http://health.usnews.com/health-news/patient-advice/slideshows/13-things-to-know-before-your-hip-replacement?int=98e708

15 Questions To Ask Your Doctor Before Knee Or Hip Replacement Surgery

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mature female doctor with group colleaguesKnee and hip pain can really put a dent in day to day activities and quality of life. As a result, especially in cases of severe arthritis, knee and hip replacements have become a fairly common solution. But before going under the knife, there are some questions that should be asked.

The first should be if there are any non-surgical solutions. Before surgery is considered, there are things such as weight loss and exercise that may help. Medications, injections, and braces may also help. When those have all been tried and surgery has been decided on, there are other questions you should ask your doctor. Questions such as…

  1. How much will the surgery improve my pain and/or quality of life?
  2. What are the possible problems I may face as a result of the surgery?
  3. What are the different types of replacements?
  4. Will I be under general or regional anesthesia?
  5. How many of these surgeries has my doctor performed and what were the results?
  6. Should I make any changes around the house and how much assistance will I need when I get home?
  7. How long will I be in the hospital?
  8. How much pain will I feel?
  9. What will my pain management consist of?
  10. How long before I’m up and around again?
  11. Will I need physical therapy?
  12. Can I do the therapy at home or will I need to go someplace for it?
  13. Is there anything I won’t be able to do after the surgery?
  14. When can I drive, and return to work?
  15. How long can I expect the joint to last?

Knee and hip replacement can make huge improvements in quality of life and can lessen pain drastically. But it’s important to know all your options before undergoing it, and it’s also important to know what’s going to happen before, during, and after the surgery. So don’t hesitate to ask your doctor any and all questions you may have.

Written by: Tricia Doane, FizzNiche Staff Writer

Safe Exercises for Knee & Hip Rehabilitation

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Exercising womanHip replacement surgery is an operation that is done to replace damaged bones and cartilage in the hip with prosthetic ones. The American Academy of Orthopedic Surgeons recommends that patients who have had this operation begin exercising soon after, in order to improve circulation in their legs and prevent blood clots.

Ankle Pumps

Exercises that can be done at home to boost blood flow include ankle pumps. To do this exercise lie on your back with your feet spread slightly apart and slowly push them up and down several times. Take a break and then repeat the pumping motions several times during the day.

Ankle Rotations

Ankle rotations are other exercises which can be done immediately after the operation. This exercise involves moving the ankle inward toward the other foot and outward away from it.

Hip Abduction Exercises

Hip abduction exercises can also be done right after the operation. To do this exercise, slide one leg to the side as far as you can and then slide it back inwards toward the other leg. Ten repetitions can be done on each side three times a day.

Hip Extensions

According to the US National Library of Medicine, exercises that can be done to strengthen the leg muscles and make the hip joint more flexible include hip extensions. To do this exercise, lie down on your back and tighten your butt muscles for ten seconds. Relax the muscles and repeat ten times thrice a day.

Quad Sets

Massachusetts General Hospital recommends quad sets since they strengthen the quadriceps muscles without straining the replaced hip joint. To do this exercise, lie on your back with your legs straight. Tighten the quads on the front of the thigh as you push the knee down. Hold for 5 seconds and relax the muscles. Do 10 repetitions three times a day on each side.

Long Arc Knee Extensions

Long arc knee extensions are other safe exercises that can be done at home after hip replacement surgery to help a patient rehabilitate. To do this exercise sit on a chair and raise one foot forward until the knee is straight. Hold for five seconds and slowly lower it while bending the knee as far as you can. Preform one set of ten repetitions three times a day on each side.

Written by: Marian Kim, FizzNiche Staff Writer

When You’re Considering Knee or Hip Replacement

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Pixmac000076209833Weighing the positives and negatives of hip or knee replacement surgery means finding out if you’re the “right patient.” Enjoying a more active lifestyle and dealing with less pain are the obvious benefits. But, the inherent risks of surgery–infections and complications–must always be considered.

Dr. Tariz Nayfeh, MD, PhD, and assistant professor of orthopedic surgery at Johns Hopkins Bayview Medical Center, Baltimore MD says that…
“Joint replacement surgery can be … life-changing … but it won’t help everyone with hip or knee pain.”

Nayfeh explains the cautions of this surgery for certain people. Joint replacement may not help you if you have these problems:

  • recent infections (which could spread to the surgical site)
  • history of heart attack, stroke or diabetes
  • obesity
  • scans showing no damage in joint
  • pain when resting

WebMD experts describe the basic criteria for the appropriate candidate for hip or knee replacement. You will likely benefit from the procedure if you’ve had:

  • severe, chronic pain, lasting at least six months
  • difficulty walking, getting up from a chair, climbing stairs or other normal activities
  • pain that affects quality of daily life and mood
  • joint and bone damage in x-rays and other imaging
  • failure of non-surgical treatments such as walkers, injections and medications
  • a knee that is swollen or deformed

Joint replacements are now considered common, and are successful in pain relief and increased mobility for about 90% of patients. However, the benefits must be considered along with the risks, when you’re deciding whether or not to have a surgical knee or hip replacement.

Original article: www.webmd.com/osteoarthritis/knee-hip-replacement-14/candidate-surgery

Written by: Ruby Moseley, FizzNiche Staff Writer

Tips For a Successful Hip Replacement Surgery

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375x321_the_hipAccording to the National Hospital Discharge Survey, approximately 332,000 people in America have a total hip replacement each year. If your chronic hip pain has gotten you and your doctor talking about hip replacement surgery, there are a few things to consider before taking this critical step.

Lose Weight (Heavy Patients)

A hip prosthesis can only comfortably support a person of normal weight. If you are heavy, it is advisable to lose weight before your surgery. Most surgeons will not perform hip replacement surgery on any patient whose BMI is in the high 30s.

Research Your Surgeon Carefully

Once you and your doctor have decided the best course of action for you is hip replacement surgery, ask which surgeon he recommends. Then, do some of your own research. If you know someone who has had the surgery, talk with them and get an idea of their experience.

An experienced surgeon will have performed at least 100 hip replacement surgeries and does at least 30 replacements per year. Don’t be too timid to ask the hard questions. After all, this is your body that the surgeon will be working on.

See a Physical Therapist Before Your Surgery

It is a good idea to visit with a physical therapist before your surgery. She will get an idea of your current function so she is better equipped to help you afterward. Also, this “prehab” will help to strengthen the muscles in your hips and legs, which will lessen your recovery time. Furthermore, it will improve your circulation, which may help to prevent potentially-dangerous blood clots.

Stick with Your Physical Therapy

While it may seem like a common sense piece of advice, you would be surprised how many patients skimp on their physical therapy and refuse to do their at-home exercises. You may be worn out and in pain but this is the time to stick with your physical therapy and continue to exercise at home so you will experience your fullest recovery possible.

Avoid Drug Dependency

Some patients have an understandable concern about possible prescription drug dependency and even addiction. To avoid this potential risk, take your medications only as prescribed and pay close attention to how your body feels as you recover. You may not need as much of the medication as you begin to heal. If, at any point, you believe you are developing a habit, discuss this with your doctor immediately.

Hip replacement surgery can be intimidating but if you follow these tips, the process will go more smoothly. Within a few months, you should feel significant pain relief and an increase in mobility as you get back to your regular enjoyed activities.

Written by: Jaime Heidel, FizzNiche Staff Writer

Home Health Recovery After Total Hip Replacement Surgery

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375x321_the_hipAccording to WebMD, “Total Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint, often made from metal and plastic components. It is usually done when all other treatment options have failed to provide adequate pain relief. The procedure should relieve a painful hip joint, making walking easier.”

Recovery after total hip replacement surgery requires strict adherence to your doctor and physical therapist to avoid a setback. Within 24 hours following hip replacement surgery, as long as there are no complications, you will begin physical therapy to help you start walking again with the use of a walker, crutches, or a cane. Physical therapy will last anywhere from weeks to months after surgery depending on age, pain perception, motivation, and the healing rate we each have.

Much of your healing will take place at home, in conjunction with regular doctor visits and rehab appointments. Have your caregiver set up your home before you return home from surgery to aid you in a successful recovery.

Listed below are a few common things to do in preparation to help make life easier at home after total hip replacement surgery:

• Limit your use of stair climbing to a minimum. If you must use the stairs, plan in advance so that you only go up and down once or twice a day.
• Sit in a firm, straight-back chair. Avoid using a recliner.
• To help prevent falls, remove all throw rugs, keep floors clean and rooms clutter free.
• Use an elevated toilet seat. This will help keep you from bending too far at the hips.
• Keep all enthusiastic pets away until you have healed completely.
• Use walking aids (i.e. a walker, crutches, or cane). Discuss in advance with the doctor to see what he or she recommends.
• Purchase a bench to put in the shower or have one installed.
• Attend regular physical therapy sessions to aid your recovery.
Consult with your doctor before returning to such activities such as driving, sexual activity, and exercise.

Reference: http://www.webmd.com/osteoarthritis/guide/hip-replacement-surgery

Written by: Jamacia Taylor, FizzNiche Staff Writer

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4 Tips For Managing Pain After Total Hip Replacement

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Pixmac000084403770If you’ve had total hip replacement surgery, you already realize that you can’t make it to the Chubby Checker Twist contest next weekend! It may take up to eight weeks to be able to do light impact exercises and get back to most of your normal activities. Until then, managing your pain after hip surgery is your first priority.
Here are four tips to simplify dealing with the pain:

 

  1. Managing pain with ICE: For the first two weeks ice will be very effective in reducing swelling and therefore pain, after hip replacement. Be sure to cover the icepack with a cloth to avoid freezer burning your skin.
  2. Managing pain with ELEVATION: Slant a stack of three pillows, so that there is little bend in the knee. Pressure under the knee can cause clots. Keeping your feet above the level of your hip will aid the flow of blood.
  3. Managing pain with stretching: Even when you’re in bed, you can rotate your feet at the ankle. Point and flex your toes to loosen up tight calf muscles. Muscle tightness, muscle spasms, stiffness and pain when you first get up are normal. Managing this pain with stretching will maximize your recovery after hip replacement surgery.
  4. Managing pain with exercise: Simple exercise routines and walking will be the only activities you’ll want to do during the first 3-4 weeks. NOTE: don’t overdo it! It’s going to be a gradual process to heal. Overworking your muscles and joints can and will set you back. Don’t exercise to the point of feeling pain. Remember you are managing your pain.

Your doctor can advise you of the best exercises to speed your recovery and manage your pain after total hip replacement surgery. He or she will also explain to you the exercises to avoid, such as running, jogging and lifting heavy items.  By about 8 weeks you should be able to walk, cycle, swim, golf, hike and do gentle aerobics workouts.

Disclaimer: following this advice does not mean that you can make the next Chubby Checker Twist contest…consult your doctor about that one!

Ruby Moseley, FizzNiche Staff Writer

From a Total Hip Replacement to Full Recovery:Exercises That Can Help

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physical-therapyTotal hip replacement surgery may sound scary, but it has become a routine operation with very low complication rates. The second most common joint replacement procedure following knee replacements, in 2012, there was almost 300,000 hip replacement operations performed in the United States. Of course, before you undergo any major surgery, do your research so that you know what your options are and the recovery time. Choose a reputable hospital to help you feel assured that you will receive the best aftercare.

After total hip replacement surgery, your orthopedic surgeon and physical therapist may recommend that you exercise at least 20-30 minutes a day. It will be painful and uncomfortable, but it will also help:

  • Increase blood circulation to your legs and feet
  • Prevent the risk of blood clots
  • Strengthen your muscles and improve movement of the replaced hip

Total Hip Replacement Postoperative exercises your physical therapist may have you perform include:

  1. Ankle Pumps: Lie on your back and slowly push your foot up and down as much as you can. Repeat every 5-10 minutes.
  2. Ankle Rotations: Turn your ankle toward your other foot and then away. Repeat 5 times in each direction, 3-4 times a day.
  3. Bed-Supported Knee Bends: Bend your knee, place your foot down flat and slide it towards your buttocks. Keep your heel on the bed. Repeat 10 times, 3-4 times a day.
  4. Buttocks Contractions: Squeeze you buttock muscles, hold for a 5 count then relax the muscle. Repeat 10 times, 3-4 times a day.
  5. Abduction Exercise: Extend your leg straight out to your side, as far as you can, and then bring it back in. Repeat this 10 times, 3-4 times a day.
  6. Quadriceps Set: Tighten your thigh muscle while you straighten out your knee. Hold for a 5-10 count. Repeat 10 times over a period of 10 minutes, and continue until your thigh is fatigued.
  7. Straight Leg-Raises: Straighten your knee and tighten your thigh muscle at the same time. With your thigh muscle tightened lift your leg up off the bed and hold the position for a 5-10 count. At the end of your count slowly lower your leg to the bed. Repeat this exercise until your thigh is fatigued.

Standing Exercises (for support use a chair or firm surface):

  1. Standing Knee-Raises: Slightly bend your knee and lift it toward your chest. Do not lift your knee higher than your waist. Hold the position for a 2-3 count then slowly put your leg down. Repeat this exercise 10 times, 3-4 times a day.
  2. Standing Hip Abduction: Stand up and point your hip, knee and foot straight forward. Keep your knee straight and extend your leg away from your body. Slowly bring your leg in toward your body and place your foot back on the floor. Repeat this exercise 10 times, 3-4 times a day.
  3. Standing Hip Extensions: Stand up, keep your back straight, and slowly lift your operated leg backward. Hold the position for a 2-3 count then return your foot to the floor. Repeat 10 times, 3-4 times a day.
  4. Walking: After surgery your doctor will want you to start walking short distances and performing light exercise to help rebuild strength and movement in your hip muscles.

In order to prevent a set back or worse do not overexert yourself during recovery. Listen to your physical therapist because he/she is trained to help you.

—Jamacia Magee, Staff Writer at FizzNiche

Medical Disclaimer: Be sure to check with your physician before starting a new exercise routine or if you have any health care-related questions.

What Happens After Total Hip Replacement Surgery?

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375x321_the_hipTotal hip replacement surgery is undergone to help relieve a painful hip joint. It is usually one of the last options taken, when all other treatments have not provided an adequate amount of pain relief. When undergoing total hip replacement surgery, a surgeon will remove the arthritic and painful hip joint and replace it with an artificial joint. This procedure should make walking easier for the patient and improve his/her overall quality of life.

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