Orthopedic Care – Patient Success!
Oh My Aching Hip! When to consider hip replacement
For years, Leslie Warren of Bethlehem had been an avid gardener and motorcyclist. That is, until sharp pain in his hip started interfering with his activities.
“Getting on and off the bike started to bother me,” he recalls. “Then it became painful just going up and down stairs. I consider myself to be a tough old bird, so I just sucked it up and kept going.”
As the pain persisted, Leslie tried various simple remedies. Yoga and stretching exercises helped a bit. Chiropractic care gave him some relief – but all only for a short time. The last straw came when he added a slip-sheet to his truck’s front seat, so he could slide his way in and out. His daughters laughed and said, “Dad, you really have to get that hip fixed!”
Although surgery is sometimes necessary, his philosophy is to “cut last”
His choice of physician was easy. “My wife, Maureen, had had her knees replaced by Dr. William De Long of St. Luke’s Orthopedic Care,” Leslie said. Her outcome was so good that he was confident that he’d have similar results.
Dr. De Long is the chairman of orthopedic surgery at St. Luke’s, and he’s well known in the medical field for his passion, expertise, and reputation.
Although surgery is sometimes necessary, his philosophy is to “cut last”. As he puts it, “You shouldn’t be aggressive with surgical intervention. The joints you’re born with are the best you’ll ever have, so we do our best to make those joints serviceable again. You can buy time with injectables, oral medications, physical therapy – these are all ways to make joints that are starting to wear last longer.”
In a sense, Leslie had already been taking that approach, but it went further under Dr. De Long’s care. “Leslie came to me in 2016,” De Long says. “His family doctor had been treating Leslie’s pain with medication often used to treat arthritis, but he wasn’t getting enough relief. After a physical exam and X-ray, we knew that his hip problem was far advanced.” Even cortisone injections failed.
Finally, as a last resort, Dr. De Long proposed surgery. “When other treatments aren’t working, and the pain and disability really affect the patient’s quality of life, we have the option of surgery,” Dr. De Long says.
He and Leslie had a long discussion about the proposed procedure – its risks and benefits, the possibility of complications, and a post-op recovery plan. Thanks to the highest level of confidence that Leslie had in Dr. De Long, he decided to move forward with the procedure.
“I didn’t look at the surgery lightly,” he says. “A hip replacement is a major operation. But we had already tried everything else, and the pain was still there. It kept me awake at night.”
Although many surgeons use a traditional “posterior” entry, Dr. De Long favors an “anterior” approach. He explained that it’s a less complicated procedure. It requires a smaller incision, and the surgeon simply separates two muscles to gain access to the joint capsule. The posterior approach requires actually cutting muscles and tendons during the operation.
“I’ve found that such patients recover much more quickly,” he says. “In fact, 95% of them have only an overnight stay in the hospital, and are ambulatory right away, just using a cane to get around.”
“I had an incredible experience with my surgery”
“When I woke up post-op, the world seemed different to me,” Leslie recalls. “And then I realized why – I’d been in severe pain for years, and now it was gone! It was a real breakthrough.”
Leslie was out of bed and walking around a bit that same day, and the next day, “I raced a nurse down the hall! Of course, I was using a walker,” he laughs.
“You really can’t understand how disabling chronic pain can be until you experience it yourself,” Dr. De Long adds. “Getting around becomes a real challenge, and Leslie wanted to overcome it.”
But major orthopedic surgery doesn’t end with stitches and staples. Physical therapy is necessary to rebuild strength and mobility. Dr. De Long says a course of physical therapy for posterior patients usually lasts 6-8 weeks, but just 3-5 for anterior. “But Leslie finished his in just 2 weeks. He did extremely well, in part because he was in good physical shape before the surgery.”
Less-fit patients sometimes undergo a period of “prehab” work, which can help make the rehab phase proceed better. Leslie explains, “I kept working out prior to the operation, and tried to accept the pain as the price I was paying to stay fit.” His physical therapy program included stretching, muscle building, and movement coordination. “It was very helpful,” he says. “The staff there really got me going again.”
Leslie has since returned to his personal exercise regimen, which includes three weekly sessions at the Bethlehem YMCA of weightlifting, and “running” on an elliptical trainer.
“I had an incredible experience with my surgery and with the follow-up care,” Leslie concludes. “I know that St. Luke’s is concerned about the ‘big picture’ of people’s health, not just individual procedures.”
“And I have a much better attitude toward life – physically and psychologically – since becoming pain-free.”
For more information, visit ortho.slhn.org
Posterior Approach
Hospital Stay: 3-10 days
Incision Location: along the outer buttock
Incision Length: 10-12”
Incision Complexity: muscles around the hip joint need to be cut and repaired
Recovery Time: 2-4 months; minimal bending, no internal rotation or turning the leg inward for 6-12 weeks
Anterior Approach
Hospital Stay: 2-4 days
Incision Location: along the front or slightly to the side of the hip
Incision Length: 4-5”
Incision Complexity: muscles around the hip joint are not cut
Recovery: 2-8 weeks; no specific precautions, more rapid return to normal activities, less pain
