August 2001
Hip Replacement: A Lifestyle-Saving Procedure

Having a hip replaced is rarely an urgent, life-saving procedure. Fairfielder Joan Ireland's orthopedic surgeon, Murray Morrison, MD, explained that to her. "He told me, 'Hip replacement is elective. When you no longer can bear the discomfort in your joint, and the pain is interfering with your lifestyle, then it's time to do something,'" she says.

For Joan, that time came when she realized that her arthritic right hip was so painful she couldn't put her weight on it, and she couldn't play golf, go biking, or even walk on the beach—her favorite activity at her winter home in Florida.

For her, hip replacement was a lifestyle-saving procedure.

Dr. Morrison sent Joan for hip x-rays, which showed that her degenerative arthritis had progressed. It was indeed time for hip reconstruction.

The next step, to make sure Joan's body could tolerate major surgery, was a physical exam by her primary care physician, which Joan passed with no problem.

After that, everything moved ahead quickly. As a part of the Joint Reconstruction Center's regular procedure, case manager and certified orthopedic nurse Karen Essig, RN, got in touch with Joan before the surgery to ask about her medical history, tell her what the surgery would involve, and determine what kind of care Joan would need in the weeks after the surgery. Hip replacement patients need to think ahead of time about making the home safe during their recovery (for instance, eliminating the need to use stairs, rolling up scatter rugs for the duration, making sure there's a grab bar in the tub or shower, making sure they can pass through doorways while using a walker.) Visiting nurses are available from United Visiting Nurse Association to do pre-surgery home safety inspections.

Much of this pre-surgery education was accomplished by telephone, because Joan was still in Florida. In fact, Joan could have chosen to have her surgery in Florida, but she preferred to come back to Bridgeport. She and her husband, Dr. Elwood Ireland, have such confidence in Dr. Morrison and Bridgeport Hospital that she knew exactly who she wanted to do her procedure, and where.

On June 7, 2000, Joan was wheeled into the operating room at Bridgeport Hospital.

Replacement hip joints consist of two parts, a ball and a socket, just like nature's version of the hip. The replacement parts come in several sizes, and it's important to make sure the replacement fits the patient. To do this, Dr. Morrison held a template up to Joan's hip x-ray, which showed him the proper size of socket for her hip joint.

After choosing the proper replacement, Dr. Morrison cleaned the worn cartilage out of Joan's socket, or acetabulum (Latin, meaning "vinegar bowl"!), using a device that shaped the socket to fit that replacement. The new socket, made of smooth plastic on the inside of the curve, was porous metal on the outside, a bit like a Brillo pad. Over time, Joan's natural bone would grow into the pores in the metal, holding the socket securely in place without any form of adhesive.

Next Dr. Morrison cleaned out the canal in the center of the femur—the thigh bone—to accept the replacement ball joint. He cemented it in place with special adhesive, measuring to make sure that the length of Joan's right leg matched her left leg.

And when Joan woke up in her hospital room, she had a new, pain-free joint.

"I know hip replacement is a major procedure," Joan says, "but it wasn't as major as I thought it might be . I went into the operating room in the morning, and woke up in my hospital room before lunchtime. I had a device by my bed that gave me some control over the dosage of my intravenous pain-relief medicine (a patient-controlled analgesia pump). But I never used it—I never needed the extra painkiller," Joan says.

Joan spent three days in the hospital, where therapists from Ahlbin Rehabilitation Centers got her up and walking, and started her on the therapy routine that would help her get her strength back. "You really have to rebuild all those muscles," Joan says, admitting that the therapy was the hardest part of the whole procedure for her.

Rehab continues after patients go home, of course. Depending on the patient, rehab might be provided in an Inpatient Rehabilitation Unit such as the one at Bridgeport Hospital, in a skilled nursing facility, or in the patient's home, with therapy and home health care services such as United Visiting Nurse Association can provide. For Joan, short-term rehabilitation in a skilled nursing facility was appropriate. Her next step was physical therapy in her home. Outpatient rehabilitation, which can be provided at any of Ahlbin Rehabilitation Center's convenient satellite locations, was the final step. Within ten days Joan was at home, getting her therapy as an outpatient. Within six weeks Joan was chipping balls on the golf course, and soon afterwards she could go about her normal routine, including driving, walking the beach, and biking with her husband.

The Irelands have always been cyclists. Once, just after Dr. Ireland graduated from Harvard Medical School, the couple biked all the way from Boston to Niagara Falls, NY, to attend a friend's wedding. "It took us two weeks, and of course we were the hit of the wedding!" Joan recalls.

To this day, the Irelands still enjoy bike rides around Connecticut, and doing all the things they weren't able to do together before Joan's hip replacement procedure saved her lifestyle.

If you have hip or knee pain, call 888-357-2396 and ask for referral to a physician at The Joint Reconstruction Center.

To reach United Visiting Nurse Association, call 203-330-9198. For Ahlbin Rehabilitation Centers, call 203-366-7551. For information about The Joint Reconstruction Center at Bridgeport Hospital, call 203-384-4441.