4 ms·

Well, this is far afield from the normal discussions here, but: 8 years ago, I had a pretty bad cycling crash and broke my hip -- which, if you're not aware, m

Well, this is far afield from the normal discussions here, but: 8 years ago, I had a pretty bad cycling crash and broke my hip -- which, if you're not aware, means I broke the "femoral neck", or the narrow bit of bone between the long part of the femur and the "ball" that goes into your pelvis. Post-repair, my x-ray looked like this: http://i.imgur.com/gRqg50J.png http://i.imgur.com/gRqg50J.png Anyway, with that much hardware in a repair, you're probably starting the clock on needing a full replacement. I think they were hoping for 10-15 years, but I got only 8 before joint pain and bone loss forced the issue. Last Monday -- so, 15 days ago -- I went in at 5AM for a total hip replacement. Which was done on an OUTPATIENT basis. I walked out of the hospital (with a walker, granted) on the new joint, and was at home in a lounge chair by 5PM. By the end of the week, I was off the walker entirely and using a cane. By day 9, I was routinely moving around the house without even the CANE, though I need it for any meaningful walk. The main thing I'm supposed to be doing is walking. I could manage a half mile within a week. Last night I walked 1.2 miles at a 30% faster pace than my first half-mile walk. I should be shut of even the cane in another week or two. To me, this kind of objectively major SKELETON EDIT being effectively banal from a medical POV is pretty surreal. I mean, it's not "put Luke in the bacta tank" surreal, but it's a whole lot closer to that I realized was realistic. (Now: I'm completely willing to note that the ease I've had with this is tied to a number of factors, including probably first the fact that I live in a top-tier city for this kind of medical attention, and I have excellent health insurance. But still.)

skrbjc 4y ago
My brother had a shoulder surgery that he put off for many years. The doctor actually told him that he did the right thing because the type of surgery he needed has some such a long way in the last 10 years. It's great that we're still making so much progress in these areas.
- flemhans 4y ago
  How far behind is e.g. Europe compared to the U.S.? Do these innovations generally spread, or are they hindered by local regulations in each country?
  - feeela 4y ago
    The main difference between Europe and the US on this point is health insurance (or the lack of in the US). Those technologies are available worldwide - it heavily depends on whether you can afford it or not.
  - capableweb 4y ago
    Many of the worlds best hospitals are in Europe, in countries like Denmark, Germany, Sweden, France and Sweden. Just as one example, Charité in Berlin is world famous and have had "more than half of all German Nobel Prize winners in Physiology or Medicine" (https://www.charite.de/en/ https://www.charite.de/en/), just as one example. Granted, many of the best hospitals are indeed in the US, but I guess less people have access to the many great hospitals in the US (or can afford access rather) compared to hospitals in Europe.
    - deleted 4y ago
      [deleted]
  - iancmceachern 4y ago
    Generally the US, Europe, and a few other countries like Japan, South Korea, etc. are all pretty comparable.
mensetmanusman 4y ago
That’s amazing. Decades ago you would be crippled for life after an event like that. Now you might be essentially back to functioning :)
- ubermonkey 4y ago
  The really amazing thing is that even 20 years ago, a return to full activity with no limitations was nearly a given after a THR. The improvements here are mostly in terms of how quickly that recovery happens. My mother, in her working life, was a physical therapist, but she's been retired for 25 years. In her career, the hip replacement was miraculous but required a serious hospital stay, and had a higher complication rate. Improved techniques and understandings about the recover process have made ENORMOUS differences since then.
kirubakaran 4y ago
Congratulations! > I live in a top-tier city for this kind of medical attention What city is that, if you don't mind?
- ubermonkey 4y ago
  Houston. We have shitty weather in the summer, and the landscape is so flat as to make pancakes look topographically interesting, but if you have cancer or need orthopedic surgery it's hard to find a better place to go.
  - fuzzfactor 4y ago
    >Houston. A place that has hospitals the size of skyscrapers.
    - ubermonkey 4y ago
      Well, I mean, some of the hospitals ARE skyscrapers. Houston is weird because of its lack of zoning (well, it's weird for lots of reasons, but that's one of them). This contributed to the fact that there is no single "skyline" here. Certainly downtown has prominent towers, but there are also towers in the "Galleria Area", in the Greenway area, and of course in the Medical Center. However, my actual procedure was done in a fairly short (4 or 5 story) dedicated orthopedic facility not in any of those areas, but associated with Memorial Herman.
- kragen 4y ago
  maybe beijing, shanghai, zurich, minneapolis, or moscow
  - ubermonkey 4y ago
    Assuming there is only one Kragen, I am amused but not surprised to see you here.
    - 4y ago
raydiatian 4y ago
SKELETON EDIT could be a sci fi novel name.
ryanisnan 4y ago
This is incredible. I have heard that surgeons are effectively carpenters of the human body, which minimizes their skills I think a bit unfairly. This is technology at its finest. Congratulations on the speedy recovery!
- WheelsAtLarge 4y ago
  "carpenters of the human body" I've seen a video of a knee replacement. And yes, it's very much like a carpenter working on a piece of wood. The hammering, the nailing, the sawing, it's all there. If someone was doing it to me, I would definitely be freaked out.
- capableweb 4y ago
  Sounds to me that you are minimizing the skills of carpenters rather :) I meant that mostly in gist, but they are really essential, just like surgeons, only that the objects the manipulate happens to be different, and mistakes by surgeons tend to be more "costly" in terms of human life.
drewbeck 4y ago
I've got a new hip in my future and I've been hearing more of these stories. Incredible, and incredibly relieving. Congrats on your new skelly!
- ubermonkey 4y ago
  The good news for you is that, assuming yours is an initial intervention and not a "revision" (ie, like mine, where they removed a repair and replaced it with an implant), you'll have an even EASIER time. My initial break was complex enough that they needed to incisions. One of them is kind of the front of my groin/pelvis, and that site got infected and required some intervention to heal. It healed ugly, with lots of scarring. NORMALLY, though, for a replacement that's exactly where they'd go in ("anterior approach"). My surgeon wisely demurred and opted for the older posterior entry, around the back of my left thigh and buttock, but that means a slightly more complex recovery with more restrictions for longer. Basically, if I bend too much a given way, or twist, or put too much load on it, I risk dislocating the implant, which would be VERY VERY BAD. Even so, the scar tissue & such presented too much of a risk of healing issues, infection, etc, so it's a trade we were okay with. You, though, will probably GET the anterior approach, which doesn't have this risk.
rolenthedeep 4y ago
I love telling people all about how I tore my biceps clean off the bone and a surgeon went in there and just screwed it back on. There's now a screw in my humerus that's holding my muscles together. Also got a sick scar and a story to gross out people at parties. Definitely wasn't worth $15k though.
jdmcnugent 4y ago
Orthopedic surgeon here. Outpatient total joint replacements have taken off like a rocket in the last few years, in part due to advances in due to pain control (pre operative peripheral nerve blocks, etc), accelerated physical therapy, and all around better management and prevention of all the common postop complaints (nausea, opioid induced constipation, etc), but I would say the number one driver has been that insurance companies (including Medicare) will finally pay for it to be done outpatient. 3 years ago you had to keep people in the hospital at least overnight to even get reimbursed. The same phenomenon has happened with many of the spine procedures that can now be done outpatient. The actual surgical techniques have not really changed much over the last few decades other than popularizing a few approaches (anterior vs posterior) or bearing surfaces (metal on polyethylene vs ceramic on polyethylene, etc).
- ubermonkey 4y ago
  That's really interesting. I would have assumed that it was the insurers providing at least some of the push for an outpatient process here in order to keep costs down, but that would've been pure speculation. I was under by 7am, and aware of enough to look at the clock on the wall in the recovery area by 1030 or so. Time is weird for a bit, but by 1230 I was in a room still a little dazed, but eating. At that point it was a checklist party. I had to see several specialty providers -- PT, OT, respiratory person for the incentive spirometer lesson -- plus eat, drink, walk and pee. As I had been a very compliant patient the night before, and had peed BEFORE the procedure, it was the last one that took the longest despite drinking a ton of water. It seemed clear there were several "offramps" that I could've needed that would have resulted in an overnight stay, like the postoperative nausea you mention, but I was fine.
ornornor 4y ago
My father, although much older than you probably, has had that procedure done in a much smaller European city with pretty much the same experience. It was incredible that he could get out the hospital the sam me day and be walking pretty much right after.
- ubermonkey 4y ago
  What kills me is that it's recently become ENTIRELY PLAUSIBLE that I might not be much older than your dad. Hey, if you're lucky, it'll happen to you, too. :) (I'm 52.)

skrbjc 4y ago

My brother had a shoulder surgery that he put off for many years. The doctor actually told him that he did the right thing because the type of surgery he needed has some such a long way in the last 10 years. It's great that we're still making so much progress in these areas.

flemhans 4y ago
How far behind is e.g. Europe compared to the U.S.? Do these innovations generally spread, or are they hindered by local regulations in each country?
- feeela 4y ago
  The main difference between Europe and the US on this point is health insurance (or the lack of in the US). Those technologies are available worldwide - it heavily depends on whether you can afford it or not.
- capableweb 4y ago
  Many of the worlds best hospitals are in Europe, in countries like Denmark, Germany, Sweden, France and Sweden. Just as one example, Charité in Berlin is world famous and have had "more than half of all German Nobel Prize winners in Physiology or Medicine" (https://www.charite.de/en/ https://www.charite.de/en/), just as one example. Granted, many of the best hospitals are indeed in the US, but I guess less people have access to the many great hospitals in the US (or can afford access rather) compared to hospitals in Europe.
  - deleted 4y ago
    [deleted]
- iancmceachern 4y ago
  Generally the US, Europe, and a few other countries like Japan, South Korea, etc. are all pretty comparable.

mensetmanusman 4y ago

That’s amazing. Decades ago you would be crippled for life after an event like that. Now you might be essentially back to functioning :)

ubermonkey 4y ago
The really amazing thing is that even 20 years ago, a return to full activity with no limitations was nearly a given after a THR. The improvements here are mostly in terms of how quickly that recovery happens. My mother, in her working life, was a physical therapist, but she's been retired for 25 years. In her career, the hip replacement was miraculous but required a serious hospital stay, and had a higher complication rate. Improved techniques and understandings about the recover process have made ENORMOUS differences since then.

kirubakaran 4y ago

Congratulations! > I live in a top-tier city for this kind of medical attention What city is that, if you don't mind?

ubermonkey 4y ago
Houston. We have shitty weather in the summer, and the landscape is so flat as to make pancakes look topographically interesting, but if you have cancer or need orthopedic surgery it's hard to find a better place to go.
- fuzzfactor 4y ago
  >Houston. A place that has hospitals the size of skyscrapers.
  - ubermonkey 4y ago
    Well, I mean, some of the hospitals ARE skyscrapers. Houston is weird because of its lack of zoning (well, it's weird for lots of reasons, but that's one of them). This contributed to the fact that there is no single "skyline" here. Certainly downtown has prominent towers, but there are also towers in the "Galleria Area", in the Greenway area, and of course in the Medical Center. However, my actual procedure was done in a fairly short (4 or 5 story) dedicated orthopedic facility not in any of those areas, but associated with Memorial Herman.
kragen 4y ago
maybe beijing, shanghai, zurich, minneapolis, or moscow
- ubermonkey 4y ago
  Assuming there is only one Kragen, I am amused but not surprised to see you here.
  - 4y ago

raydiatian 4y ago

SKELETON EDIT could be a sci fi novel name.

ryanisnan 4y ago

This is incredible. I have heard that surgeons are effectively carpenters of the human body, which minimizes their skills I think a bit unfairly. This is technology at its finest. Congratulations on the speedy recovery!

WheelsAtLarge 4y ago
"carpenters of the human body" I've seen a video of a knee replacement. And yes, it's very much like a carpenter working on a piece of wood. The hammering, the nailing, the sawing, it's all there. If someone was doing it to me, I would definitely be freaked out.
capableweb 4y ago
Sounds to me that you are minimizing the skills of carpenters rather :) I meant that mostly in gist, but they are really essential, just like surgeons, only that the objects the manipulate happens to be different, and mistakes by surgeons tend to be more "costly" in terms of human life.

drewbeck 4y ago

I've got a new hip in my future and I've been hearing more of these stories. Incredible, and incredibly relieving. Congrats on your new skelly!

ubermonkey 4y ago
The good news for you is that, assuming yours is an initial intervention and not a "revision" (ie, like mine, where they removed a repair and replaced it with an implant), you'll have an even EASIER time. My initial break was complex enough that they needed to incisions. One of them is kind of the front of my groin/pelvis, and that site got infected and required some intervention to heal. It healed ugly, with lots of scarring. NORMALLY, though, for a replacement that's exactly where they'd go in ("anterior approach"). My surgeon wisely demurred and opted for the older posterior entry, around the back of my left thigh and buttock, but that means a slightly more complex recovery with more restrictions for longer. Basically, if I bend too much a given way, or twist, or put too much load on it, I risk dislocating the implant, which would be VERY VERY BAD. Even so, the scar tissue & such presented too much of a risk of healing issues, infection, etc, so it's a trade we were okay with. You, though, will probably GET the anterior approach, which doesn't have this risk.

rolenthedeep 4y ago

I love telling people all about how I tore my biceps clean off the bone and a surgeon went in there and just screwed it back on. There's now a screw in my humerus that's holding my muscles together. Also got a sick scar and a story to gross out people at parties. Definitely wasn't worth $15k though.

jdmcnugent 4y ago

Orthopedic surgeon here. Outpatient total joint replacements have taken off like a rocket in the last few years, in part due to advances in due to pain control (pre operative peripheral nerve blocks, etc), accelerated physical therapy, and all around better management and prevention of all the common postop complaints (nausea, opioid induced constipation, etc), but I would say the number one driver has been that insurance companies (including Medicare) will finally pay for it to be done outpatient. 3 years ago you had to keep people in the hospital at least overnight to even get reimbursed. The same phenomenon has happened with many of the spine procedures that can now be done outpatient. The actual surgical techniques have not really changed much over the last few decades other than popularizing a few approaches (anterior vs posterior) or bearing surfaces (metal on polyethylene vs ceramic on polyethylene, etc).

ubermonkey 4y ago
That's really interesting. I would have assumed that it was the insurers providing at least some of the push for an outpatient process here in order to keep costs down, but that would've been pure speculation. I was under by 7am, and aware of enough to look at the clock on the wall in the recovery area by 1030 or so. Time is weird for a bit, but by 1230 I was in a room still a little dazed, but eating. At that point it was a checklist party. I had to see several specialty providers -- PT, OT, respiratory person for the incentive spirometer lesson -- plus eat, drink, walk and pee. As I had been a very compliant patient the night before, and had peed BEFORE the procedure, it was the last one that took the longest despite drinking a ton of water. It seemed clear there were several "offramps" that I could've needed that would have resulted in an overnight stay, like the postoperative nausea you mention, but I was fine.

ornornor 4y ago

My father, although much older than you probably, has had that procedure done in a much smaller European city with pretty much the same experience. It was incredible that he could get out the hospital the sam me day and be walking pretty much right after.

ubermonkey 4y ago
What kills me is that it's recently become ENTIRELY PLAUSIBLE that I might not be much older than your dad. Hey, if you're lucky, it'll happen to you, too. :) (I'm 52.)