When it comes to replacing parts, we boomers want the Jiffy Lube treatment: You're in, you're out, you're fine.
And so it was with my friend Sandra Hughes, 52, whose osteoarthritis was making it increasingly difficult for her to walk without pain. She needed to replace her right hip but didn't want to be stuck in the body shop for months, hobbling along with loaner canes and walkers.
Sandra's an active mother of two, a lawyer looking to change careers and a swimmer. She had things to do, no time for long recoveries, no interest in a long hospital stay or, worse, a week or two in a rehab facility.
"I want to have a perfect hip after this," she told me before her surgery. So, like any respectable boomer, Sandra did some research on her options.
Here are the vehicles she found on the lot.
The Cadillac Kick the tires all you want, the most traditional hip replacement surgery is a big, time-tested and generally predictable operation. Using a 10- to 12-inch incision, the surgeon has room to work and can see what he's doing. And what he's doing, when you stop to think about it, is pretty amazing. (I can understand this best while daydreaming about eating a chicken thigh, but, please, feel free to use your own mental image.)
Put simply, in all hip replacement operations, the surgeon: 1) separates the thighbone, or femur, from the socket; 2) removes the damaged top of the thighbone with a saw; 3) removes the damaged bone and cartilage from the socket using a tool called a "reamer"; 4) puts in an artificial socket; 5) hollows out the top end of the thighbone; then 6) drives an artificial "top" -- a ball on a stick -- deep into the thighbone. Most patients spend about four days in the hospital, followed by days or weeks in a rehab facility, then weeks or months on crutches.
This surgery may be easiest for surgeons who don't do a lot of hip replacements, since it allows them to eyeball everything. It may work best for patients who are particularly large -- fat or tall. And this operation has decades of data indicating high success rates. On the downside, the big incision means big-time muscle and tissue damage, which can take months to heal.
The Camry In the past half-dozen years, many orthopedic surgeons have begun to question the need for the Caddy when a downsized vehicle might provide the same reliable ride. They've opted for a midsize surgery.
"We're doing the same operation, just through a smaller window," explained Thomas Sculco, surgeon-in-chief at the Hospital for Special Surgery in New York. Instead of a foot-long incision, Sculco makes a three- to four-inch cut, then uses tools that have been customized to work in the smaller space.
With the smaller cut, patients "bleed less, spend less time in the hospital and recover faster," said Sculco, who has done this surgery thousands of times. Several studies show that complication and morbidity rates are no higher than they are with the bigger incision.
Sculco said recovery time is dramatically shorter than with the Cadillac surgery. Patients typically go home after one or two days, skip rehab and can be back to work with a cane within a few weeks. But muscles and tendons are still being pushed around.
The Miata Here's where things get controversial. The Camry, as Sculco said, "is a modification of the approach we've been doing for 30 to 40 years," but the Miata represents a whole new, sporty method.
Instead of one cut, surgeons make two one- to two-inch cuts, one in the groin and one in the "back pants pocket," as Paul Manner, an assistant professor of orthopedic surgery at George Washington University Medical Center, explained. The surgeon inserts the tools there and operates while watching an X-ray monitor. Manner said not being able to see the joint directly makes the operation "a little bit harder to do. . . . [Also,] there are some issues with getting the head of the femur out and putting the prosthesis in such a small incision."
Manner said he's performed this type of surgery, which was first done in 2001, about 80 times. "Nobody out there has done all that many of these," he said, and many surgeons wonder, "Why on earth would we want to take something that works very well and fiddle with it?"
His answer: "What it really comes down to is how the patients feel postoperatively. That's the reason we do this operation. Our goal is to get rid of the pain." To that end, Manner said the Miata approach cuts pain, bleeding, hospital and recovery time.
Sculco scoffs at that. His view: "It's literally impossible not to damage the muscle in some way." And, he says, the recovery time for the Camry and Miata-style surgeries is virtually the same.
Still, like a boomer facing a midlife crisis, my friend Sandra opted for the Miata. In late March, Manner did the operation. Sandra stayed in the hospital for two nights, proved she could walk up and down stairs, then went home. She walked without a cane or walker at four days. She drove at two weeks (remember, it was her right hip, too!). At our book group three weeks after the operation, she looked great. No limp.
At six weeks, she says "walking is no problem, and I'm ready to try swimming again." She still has some discomfort and less than optimal flexibility ("picking something up off the floor is still very awkward"), but she expected worse. She's also decided on her new career: working on behalf of nursing home residents.
For Sandra, hip replacement surgery was nearly routine maintenance. A boomer's dream come true.
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