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Cedar Rapids, Iowa 52401
Hip hip hooray! New hips now come with faster recovery
COVID hospital restrictions help accelerate move to more outpatient surgeries
When Steve Overbeck, 66, of Cedar Rapids, had hip replacement surgery a decade ago due to arthritis, his procedure required a hospital stay with time on the rehabilitation floor, using a walker and cane for six weeks, and physical therapy afterwards.
When his friend had one three years ago, “He ditched the walker after two weeks, used the cane about one more week, and then you would have never known he had had any hip replacement at all,” Overbeck said. “He was walking two miles a day in three weeks.”
For decades, recovery after hip replacement surgeries went like Overbeck’s, with many movement limitations and precautions put on patients for weeks.
During the COVID lockdowns across the country, when restrictions were put on in-patient and elective surgeries, what was already a trend of accelerating the pace of recovery hit the fast-forward button.
Dr. Taylor Dennison. Submitted photo.
Dr. Brent Whited. Submitted photo.
While surgical techniques have also improved — including making smaller incisions and being more mindful of the handling of tissue during surgery — the more crucial change has been earlier mobilization of patients and less “babying” them.
“We used to have more restrictions on patients, and I think a lot of the hospital stays were a carryover because we’d always done it this way,” said Dr. Taylor Dennison, an orthopedic surgeon at Steindler Orthopedic Clinic in Iowa City. “We didn’t realize that actually mobilizing patients earlier has facilitated that recovery quicker.”
Dr. Brent Whited, in his 14th year of practice doing joint replacement surgeries at Steindler, has seen these changes occur firsthand. He also credits better anesthesia techniques — such as regional nerve blocks and medication around the site of the surgery for more effective pain control — and medicines that produce less bleeding, bruising and swelling with leading to faster recoveries.
“Some people will almost walk back into your office two weeks after the surgery looking like a normal person,” Whited said. “The trend certainly is a more rapid recovery than I can remember starting in 2010.”
What to expect
The surgery itself usually takes about an hour. For a surgery that starts at 7:30 a.m., the patient is in recovery by 8:30 or 9 a.m. Staff get the patient up and walking within a couple of hours of the surgery once the anesthetic wears off. Those who are outpatients will usually be able to walk out by noon.
The average patient will use a walker for one to two weeks after surgery and maybe a cane for a week or two after that. People who are in good shape may only need a walker or cane for a few days.
Hip replacements are different from knee replacements in that physical therapy is not usually necessary. Usually, self-directed physical therapy at home is enough for most. However, if there’s associated muscle weakness or a limp, more formal physical therapy can help.
While doctors generally advise against a lot of impact activities (running, jumping, heavy lifting), patients are physically capable of being active — it just makes the joint wear out faster.
Dr. Taylor Dennison examines a patient. Submitted photo.
“I tend to lean more toward letting patients do what they feel capable of, in general that’s what they tend to do anyway,” Dennison said.
Post-op visits will dwindle to regular surveillance every five to 10 years, with X-rays monitoring the condition of the joint. If patients have a change in their pain or mobility, they should be seen sooner.
While the majority of hip replacement patients can do an outpatient or same-day surgery, more medically complex patients — the elderly or those who were low mobility to begin with — could still need to stay in the hospital for a few days, but still less time than was prescribed in the past.
Who needs surgery
A majority of the patients seen at Steindler for hip replacements have osteoarthritis, a degenerative condition where the cartilage in the hip joint wears away slowly over time. Other conditions include rheumatoid arthritis, avascular necrosis, hip fractures or other hip joint disorders.
For non-acute conditions, non-operative therapies such as lifestyle modifications, injections and physical therapy are usually tried first until the pain starts affecting the patient’s mobility or quality of life.
Most osteoarthritis patients will actually feel the pain in their groin or front of the hip and associate it with a muscle strain instead of a hip problem.
“If that’s the place where you’re having a lot of pain, and it’s starting to limit your activity, it might make sense to go see someone and have it looked at,” Dennison said. This could be an orthopedic surgeon or your family physician.
Whited said that in the past, the thought was to not do hip replacements for younger patients because they are more active, and the joint will wear out faster.
Now he tells his patients to expect their hip replacement to be durable for 20 to 30 years. His youngest patient was in their early 20s.
“To me, if it wears out at age 50, that’s a pretty fair trade if you’ve been active and a productive person for all those years,” Whited said.
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