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dp
05-30-2012, 01:39 PM
Not so OT - metal parts included!

Monday a week ago I went in for the hip replacement. The surgery is rather brutal, unavoidably, as it involves the largest joints in the body. The process is well documented on YouTube and the technology is clever and intended to provide the least amount of collateral damage.

Several tools familiar to all of us are used: A universal saw removes the femural head (the ball), a broach is used to fit the now opened femur to the replacement spike which holds the new ball, and a circular rasp creates a pocket for the new socket. A number of purpose built levers are employed, and an assistant is on hand to perform the dislocation once the femur capsule is opened up. To the degree possible all access is done between muscle and ligament groups. One ligament is severed to reveal the ball and is later stitched together. This alone probably accounts for most of the recovery time and pain.

The ball on my new hip is chromed steel and the socket is plastic - don't have the specifics, but it has been found that metal on metal was not working and metal was migrating away from the joint and causing distress for a lot of patients. The ball sits on what looks like a jt-33 taper :) and nothing holds it all together except pressure from the connective tissue and your own weight.

The opening was stitched with 29 SS staples and a drain was attached to a spring-loaded evacuator cup. Before the end of day zero I was walking around, and by day 1 I had been up and down stairs. I was walking with a diagonal stride with a walker on day 2. Now starting day 8 I'm able to walk without any aids, and pain is managed by taking one oxycodone every 4 hours. I'm also taking Coumadin with an INR of 2.1 as a target. I'm pushing myself hard with the exercises.

I'm having the most discomfort from sciatica at this point and not anything from the hip surgery other than is expected from twisting the connective tissue, essentially hyper-extending it, to allow access to the work area. The sciatica is from stenosis resulting from a ruptured disk in 1993 and which has since fused.

Gone is the awful pain in the hip joint caused by bone on bone wear and motion. I'm not looking forward to the last pain pill as they have been hiding other pain issues I have had from the stenosis, but will deal with that when the time comes. As an experiment I skipped two 4-hour periods of the Oxycodone, taking only Tylenol, and when that stuff wears off all hell breaks loose. The body seems to be more sensitive than before taking it, and you feel everything, suddenly. And some of it seems to be on fire. I can see how these pain relievers become addictive and thus why I'm taking only half-doses. The sutures come out next Tuesday, and with that will come additional comfort.

The care givers in the recovery rooms are amazing people and helpful and anticipatory in the extreme. I can't imagine a better experience for the circumstances.

I've even logged onto and worked on systems at work to help out with the short staff problem there.

DFMiller
05-30-2012, 02:24 PM
Dennis,
Glad to hear you are making great progress.
Any chance it was Turcite on the bearing surface. If that's the case I hope they garnet blasted before they glued it in. Or that's what Forrest tells me.
Best of luck getting fully operational soon.
Dave

flylo
05-30-2012, 02:41 PM
Godspeed on the recovery! That's the machining we should be doing. We have Styker in Kalamazoo & I bet they do well. When you get the bill see if it lists the parts it would be interesting to know the cost. When they did my back 5 hrs in surgery, 2 in recovery & 5 day's in the hospital with no complications. Just the hospital bill was $232,000. When I was born Moms water broke at 6 months, she was in the hospital 1 month, I was born at 7 months weighed 3#, went down to 2# & was in an incubator for 1 month. Total bill $2500. Wonder what it would be now? :confused:
Sorry I keep forgetting they're non profit!

Alistair Hosie
05-30-2012, 03:34 PM
You will soon be totally out of pain and (mr stevenson I don't meanhe's going to die so eyes off his tool collection:D ) anyway my old pal had it done he was constantly in pain then a miraculous recovery post op. I wish you well brother keep the faith and you'll soon be making chips with the rest and best of us keep well I am glad it's all over painwise for you Alistair

lazlo
05-30-2012, 04:31 PM
Glad to hear you're on the mend Dennis!

My dad just had both hips replaced, 6 months in between. The post-surgery physical therapy isn't fun, as you're probably finding :(

dockrat
05-30-2012, 06:46 PM
Glad everything went well Dennis. It wont be long and you will be out in the sun on the Harley!!!!

sasquatch
05-30-2012, 06:58 PM
Good to hear a great operative success story!!

Man,, you folks in the USA have some "Bankrupting " hospital bills!!!

BRUTAL!!

Black_Moons
05-30-2012, 07:37 PM
The opening was stitched with 29 SS staples and a drain was attached to a spring-loaded evacuator cup.

Nono, thats your new oiling point! make sure to oil daily or the joint will wear and rust :rolleyes:
For a good laugh, Ask your doctor while he is around another doctor for the best oil to use, They will be arguing about it for hours! :eek:

sasquatch
05-30-2012, 07:53 PM
In canada all hip replacement joints now come with a Brass grease fitting.
Recommended lube times depend on the useage, but rough service like running marathons and high jumping require high pressure lube (Sold at hospitals,) and lube times vary , but usually every thirty days under rough service.

Alignment is usually a matter of visual, (if one appears to be toeing out or in , ) 1/16th toe in is standard, with 2 degrees of + camber.

Toolguy
05-30-2012, 08:10 PM
Glad to hear you're doing well. I bet even the doctors couldn't have explained it in machine shop terms like you did!:p

Black_Moons
05-30-2012, 08:34 PM
In canada all hip replacement joints now come with a Brass grease fitting.
Recommended lube times depend on the useage, but rough service like running marathons and high jumping require high pressure lube (Sold at hospitals,) and lube times vary , but usually every thirty days under rough service.

Alignment is usually a matter of visual, (if one appears to be toeing out or in , ) 1/16th toe in is standard, with 2 degrees of + camber.

Im told a little ethonal will help to greatly increase your camber. Won't help with alignment much however...

sasquatch
05-30-2012, 08:39 PM
I forgot to mention Caster, which really doesn't apply to most cases, unless the patient does a lot of "Backing up" hmmm,

Iv'e seen a couple here actually that do that at times.:D :D


Then there's "Speed wobble" which applies mostly to husbands under the influence, comming home late with the lady of the house waiting up for him.:eek:

Dr Stan
05-30-2012, 08:49 PM
Glad to hear you are doing well. I'll be headed down that road eventually at least for knee replacements. I'm actually past the time when my orthopedic surgeon in NE said I'd probably need a new left knee. BTW, several years ago he developed a procedure to preform a hip replacement with only a 2 1/2" incision. Sure reduced the recovery time.

Pay attention to your physical therapist. I had PT after every knee surgery, except for the first one. Made all the difference in the world. The one here in KY let slip her kick name, Sadistic Sarah. Boy does she live up to it and I'd tease her about wearing leather outfits. :D Doesn't hurt that she's easy on the eyes. :D

sasquatch
05-30-2012, 08:53 PM
Dr. Stan, Re; She's easy on the eyes:

At our age -(some of us anyway), that's about our limit these days anyway.:D

gnm109
05-30-2012, 09:03 PM
You will do well. Nowadays, hip replacement surgery is rather routine. I had miy left hip joint replaced in 1985 with the, at that time new, "grow-in" procedure. No glue was used, but rather the porous outside of a straight-sided femoral prosthesis was be pressed tightly into the inside of the bored out femur and growth of bone callus tissue would lock it in tightly after a few weeks. I don't think that they use glue very much these days.

You are correct that the metal on metal units are not good as they lead to wear products from the joint which cause havoc in the surrounding tissues.

My first hip lasted from 1985 until about 2004 when I somehow developed an infection which eventually caused it to loosen and fail. It took all of a year to eliminate the infection so that I could get a new hip. That was done in 2005 and all is well now.

The main thing is to get some physical therapy so that you can regain the full use of the muscles surrounding the jiont. That can take time but it will return eventually.

Oh, and don't jump off of any loading docks. :D

J. Randall
05-30-2012, 09:33 PM
Glad you are doing well, I went home on the morning of the 5th day with the promise that I would do all the therapy exercises, and I did religiously, worked up to more than the required reps, and continued to do them for several months. That was in 97 and I have never had a twinge out of it. Everyone is different on the pain meds, I hate them and quit hitting the button on the morphine pump about 12 hrs. after the surgery, other than an occasional darvocet that I took for my AS I never used any other pain meds. My spine is totally fused and like you I had more back pain than anything else after the surgery.
James

BudB
05-30-2012, 09:35 PM
I spent 21 of the past 30 years in the orthopedics business, mostly on the facilities side but some R&D, It is amazing what can be replaced. As was said the surgery is rather brutal but the results can be life altering. In the 80's surgeons wanted to wait as late in your life span as possible to avoid revisions but now with porous products, titanium, and improved poly bearing surfaces.....why wait. Enjoy life and deal with a revision if and when it becomes required. Keep with the PT!

BudB
05-30-2012, 09:46 PM
The hip material is a chrome-cobalt alloy and the plastic liner in the Cr-Co cup is UHMW polyethylene.

Bob Ford
05-30-2012, 09:55 PM
Dennis,

Do not give up the pain reduction in the long run is worth the trials you are going through.

Bob

gwilson
05-30-2012, 10:05 PM
I'm going to have to have a left knee one of these days,and sooner,a right thumb joint. Wore it out playing finger style guitar since 1954.

I've had spinal stenosis and a titanium implant,but it looks like the joints above and below it have given out. I heard they have a way of injecting the discs with fluid to make them "inflate"again,rather than more metal implants. I won't be able to get my socks on if I get even less mobile in my back.

Good luck on your recovery.

R W
06-09-2012, 09:06 PM
Had both hips done on 25th May , home from hospital yesterday

Evan
06-09-2012, 09:42 PM
Good luck on the recovery Dennis. Nice description. I started reading to my wife and got told to shut up part way through. :D

I cannot figure out why anybody ever thought that similar metal on metal would ever work in a hip joint. It doesn't work anywhere else.

dp
06-09-2012, 10:16 PM
Had both hips done on 25th May , home from hospital yesterday

OMG - I can't imagine the challenges to rehab for you! Best wishes for a speedy recovery, RW.

Mine was May 21 and I'm finally free of all the tape, staples, and stitches, and down to just Tylenol for pain killers. I can walk about 100 yards or so at a stretch without a cane/crutches, just cooked dinner, and am getting around well. Still a lot of pain, though, but it seems to decrease each day. Doing that without at least one good leg would seem impossible, so I'm rooting for you!

And I've turned in my resignation and am on the way to retirement, again :)

dp
06-09-2012, 10:22 PM
Good luck on the recovery Dennis. Nice description. I started reading to my wife and got told to shut up part way through. :D

I cannot figure out why anybody ever thought that similar metal on metal would ever work in a hip joint. It doesn't work anywhere else.

I described it to my BIL as deboning a chicken. The hip joint comes apart with the same "pop!". I guess there were some nasty lawsuits with metal shearing off the ball/socket interface

gnm109
06-09-2012, 10:29 PM
Good luck on the recovery Dennis. Nice description. I started reading to my wife and got told to shut up part way through. :D

I cannot figure out why anybody ever thought that similar metal on metal would ever work in a hip joint. It doesn't work anywhere else.


I certainly agree. I discussed the types of joints before my two installations (1985 and 2004) and the clear choice was the metal into plastic.

flylo
06-09-2012, 10:54 PM
My dad had 1 hip & was awake talking o them the whole time. Heard the saw drill, screwgunm felt them hammer it in,etc. Do yoy have to wear a bone growth stimulator? After my back surgery I had to wear one 8 hours a day for 6 month while sitting in a recliner. Sucked!

gnm109
06-09-2012, 11:56 PM
My dad had 1 hip & was awake talking o them the whole time. Heard the saw drill, screwgunm felt them hammer it in,etc. Do yoy have to wear a bone growth stimulator? After my back surgery I had to wear one 8 hours a day for 6 month while sitting in a recliner. Sucked!


No, I didn't have a bone growth stimulator. Perhaps your doctor felt that there was a need.

I cant imagine being awake while all of that is going on.

oil mac
06-10-2012, 07:38 AM
Dennis glad all has gone well, & you are mobile, such procedures are a miracle of engineering surgery Get well & back making chips , as soon as. A guy i know had to have one replaced for some weird reason, The so &so would not give me the old unit , wonder how machinable that stuff would be?:D

Maybe the surgeon took it down to the scrappy, In this country everything else gets stolen:eek:

dp
06-10-2012, 11:30 AM
Dennis glad all has gone well, & you are mobile, such procedures are a miracle of engineering surgery Get well & back making chips , as soon as. A guy i know had to have one replaced for some weird reason, The so &so would not give me the old unit , wonder how machinable that stuff would be?:D

Maybe the surgeon took it down to the scrappy, In this country everything else gets stolen:eek:

Hehe - I did ask for the pull-offs, but the surgeon said that everything goes to a lab (scrapper). I wonder how much it was worth :D

dp
06-10-2012, 11:32 AM
I didn't get any bone growth info, but I did buy a TENS device over the weekend to try out. Anyone have or use one of these?

http://en.wikipedia.org/wiki/TENS_device

Guido
06-10-2012, 11:34 AM
Oilfields developed turbine type flow meters for measuring sand laden fluids for use in oil/gas well fracture stimulation processes. Meters installed in 24/365 service, measuring silt laden salt water have life expectancies of 25 years, plus.

Anyone for trying a carbide ball joint?

--G

gnm109
06-10-2012, 12:47 PM
Cobalt/chromium or cobalt vitallium alloys are commonly used to fabricate parts for total hip joint replacement.

dp
06-10-2012, 02:29 PM
I got the bill on Friday, and just the new joint assy was $19,500. Damn proud of that, they are!

darryl
06-10-2012, 08:51 PM
Sheesh- for that price you could have got cast-forged billet unobtainium :)

dp
06-10-2012, 09:59 PM
Sheesh- for that price you could have got cast-forged billet unobtainium :)


All I know is when they bury my ashes they'd better have a loud clunk when shaken!

In case you din't know:

http://www.youtube.com/watch?feature=player_embedded&v=gwx-ZSwnBmo

BudB
06-10-2012, 10:16 PM
The main issue with the metal-on-metal hip was debris from wear of Cr-Co. There is still some dispute about the effects but once the lawyers/juries got involved it was easier to walk away from good technology than to fight. Some of the ball and sockets were actually much larger in diameter lessening the loading on the ball by 30-50% This cannot be done with the metal-plastic hips as the plastic needs to be supported and there just isn't enough room to back up the plastic.

BudB
06-10-2012, 10:18 PM
It is not unusual to receive a hip or knee back at the factory after cremation . Yippee!

sasquatch
06-10-2012, 10:21 PM
So, would that be a "rebuilt" aftermarket one then?:rolleyes:

oldtiffie
06-11-2012, 12:12 AM
I got the bill on Friday, and just the new joint assy was $19,500. Damn proud of that, they are!

Of course you had the option of not gettihng it fitted but most I know who have had hip, knee and other joints replaced reckon that irrespective of the cost, it was worth every dollar (lots).

Medicare and Private Hospital insurance eases the money pain here quite a bit.

Its all part of the aging process.

lakeside53
06-11-2012, 02:07 AM
I got the bill on Friday, and just the new joint assy was $19,500. Damn proud of that, they are!


A friend of mine was having surgery last week at Harborview, and they found a brain aneurysm. The two hour procedure became 7.5 hours. The bill - $220,000... of which $120,000 was the stent:eek:

OK... The patient survived... but how can they justify $120,000 for what "looks" like a spring from a ball point pen?:confused:

Oh.. her insurance pays 80%...

Evan
06-11-2012, 02:49 PM
I got the bill on Friday, and just the new joint assy was $19,500. Damn proud of that, they are!

And that is a very good example of what is wrong with the medical system, here and in the US. That is just plain highway robbery. If you have coverage you are still paying for it, one way or another. Of course, a lot of what is wrong with the medical system is a direct result of what is wrong with the tort legal system.

Even so, there is no possible way to justify that price that doesn't include an enormous amount of profit.

Dr Stan
06-11-2012, 02:53 PM
A friend of mine was having surgery last week at Harborview, and they found a brain aneurysm. The two hour procedure became 7.5 hours. The bill - $220,000... of which $120,000 was the stent:eek:

OK... The patient survived... but how can they justify $120,000 for what "looks" like a spring from a ball point pen?:confused:

Oh.. her insurance pays 80%...

Because the #1 reason people go to med school is "to make lots and lots of money". :(

Evan
06-11-2012, 03:16 PM
Prescription drugs are cheaper in Canada because the government imposes price controls on drugs. The most the manufacturers are permitted to make is 100% profit. :rolleyes:

lazlo
06-11-2012, 06:26 PM
Because the #1 reason people go to med school is "to make lots and lots of money". :(

Apparently you're a Ph.D, and not an MD :) The doctors aren't the one's making money -- the health "insurance" companies are.

gnm109
06-11-2012, 06:32 PM
If you people don't want medical treatment and don't wish anyone to "make a profit" you should learn to live with the pain and just let it go. That's what I would do if I felt that someone was profiteering on me.

I guess the doctors could work in a garage somewhere and not even worrry about things like infection and misdiagnoses. If they were to do that, things would be much less expensive.

Evan
06-11-2012, 06:40 PM
If you people don't want medical treatment and don't wish anyone to "make a profit" you should learn to live with the pain and just let it go.

Nobody said anything about not making a profit. The problem is the amount of profit. A few years ago we had a similar discussion about bone screws and the gist of it was that stainless steel bone screws the same as you can buy at the hardware store for a couple of bucks for 10 sell for a hundred dollars per piece when called a "bone screw".

That isn't "making a profit". It's Profiteering.



profiteer
noun /ˌprɒf.ɪˈtɪər//ˌprɑː.fɪˈtɪr/ [C] disapproving

Definition
a person who takes advantage of a situation in which other people are suffering to make a profit, often by selling at a high price goods which are difficult to get
a war profiteer

profiteering noun /ˌprɒf.ɪˈtɪə.rɪŋ//ˌprɑː.fɪˈtɪr.ɪŋ/ [U]
The pharmaceutical company has been charged with profiteering from the AIDS crisis.

(Definition of profiteer noun from the Cambridge Advanced Learner's Dictionary & Thesaurus Cambridge University Press)

The entire medical industry is guilty of profiteering.

gnm109
06-11-2012, 06:52 PM
Nobody said anything about not making a profit. The problem is the amount of profit. A few years ago we had a similar discussion about bone screws and the gist of it was that stainless steel bone screws the same as you can buy at the hardware store for a couple of bucks for 10 sell for a hundred dollars per piece when called a "bone screw".

That isn't "making a profit". It's Profiteering.



The entire medical industry is guilty of profiteering.


Well, if you think that, then you should just stay away because nothing's going to change any time soon.

Are the screws that you buy in the hardware store certified to be sterile? Are they made of the same alloys that are used in the medical arena? Are they under the same mountain of regulations under the US, Canadian or other country's rules? Probably not.

Next time you need a medical screw or implement, tell them that you want to use something from the hardware store. LOL.

You have no facts yet you say there's "too much profit". This is an interesting position.

lazlo
06-11-2012, 07:12 PM
You have no facts yet you say there's "too much profit". This is an interesting position.

Healthcare costs have spiraled over the last 10 years, despite historic low malpractice lawsuits and payouts.
Your doctor isn't making any more now than he/she was 10 years ago, but 4 of the top 10 highest paid CEO's on Earth are the chairs of American healthcare companies.

John Hammergren, CEO of McKesson, is paid $145 million/year. Joel Gemunder, CEO of Omincare, is paid $100 million/year. Takes a lot of $120,000 stents to cover their salaries. :rolleyes:

This is from Speaker Boehner's web page:

http://www.speaker.gov/UploadedFiles/09-02-10_KFH.jpg

oldtiffie
06-11-2012, 07:23 PM
Irrespective of medical costs and the subsidy/insurance or what ever there will be a substantial "out of pocket" expense which should be planned for as a contingent item at any time in your life - the more so in terms of cost and frequency as you get older.

Moaning and groaning about it here or to anyone else is not going to change it at all - so why do it - or are you just griping for the sake of it?

Of course, there is always the option that gnm109 advises:


If you people don't want medical treatment and don't wish anyone to "make a profit" you should learn to live with the pain and just let it go. That's what I would do if I felt that someone was profiteering on me.

I guess the doctors could work in a garage somewhere and not even worrry about things like infection and misdiagnoses. If they were to do that, things would be much less expensive.

dp
06-11-2012, 08:39 PM
In my case, since I was still employed at the time of the surgery, my workplace insurance is the first one tapped to pay the bills. What is left goes to Medicare, and what they don't pay, I do. So far the bill is at about $60,000.

lakeside53
06-11-2012, 08:59 PM
The insurance co is likey to "adjust" the total from $220,000 to about $145,000. A steal if you have insurance:rolleyes:

oldtiffie
06-11-2012, 09:06 PM
In my case, since I was still employed at the time of the surgery, my workplace insurance is the first one tapped to pay the bills. What is left goes to Medicare, and what they don't pay, I do. So far the bill is at about $60,000.

Perhaps you've had "Gypsie's warning" of what might be in the offing - who knows?

Its going to be hard to cover the loss of employer/employee medical insurance when you retire.

Have you had thoughts of withdrawing your notice to your employer - or can you?

lazlo
06-11-2012, 10:04 PM
In my case, since I was still employed at the time of the surgery, my workplace insurance is the first one tapped to pay the bills. What is left goes to Medicare, and what they don't pay, I do. So far the bill is at about $60,000.

Oh wow, that sucks Dennis!

My dad had both his hips replaced at the Mayo clinic, all covered by Medicare.
Did you use a surgeon that was out of network with your employer??

dp
06-11-2012, 10:30 PM
Oh wow, that sucks Dennis!

My dad had both his hips replaced at the Mayo clinic, all covered by Medicare.
Did you use a surgeon that was out of network with your employer??

Nope - the problem was we couldn't find anyone to replace me at work so I stayed on until the surgery, already scheduled, was due. I might have to explain the cost better - so far, total is $60,000 and climbing. Dunno yet what my part is going to be, but both the insurance and Medicare have deductibles. As a hedge I cashed out some stock options in case the market tanks further :)

TGTool
06-11-2012, 10:43 PM
I had some bad luck with insurance I didn't recognize coming up. We had recently gone to high deductible, putting the difference in cost into an HSA. It looked like a good strategy based on past history.

One surgery was late in the year (skin cancer) followed by plastic surgery and followup radiation. The second plastic surgery procedure and radiation fell into the following year so I had both deductibles to meet. Kinda sucked but there were bigger things going on and I'm not sure with cancer I would have said "Let's wait a couple more months" anyway. Dermatologist had already missed the diagnosis by several months even though I'd pointed out to him what I was suspicious of and concerned about. C'est la vie.