Sometimes You Opt for Tried and True
Many of you e-mailed your condolences and advice regarding my upcoming total hip replacement. Thank you so much. Interestingly, a sizable group wondered why I have chosen a traditional total hip replacement. You urged me to pursue the newer, increasingly popular, “minimally invasive” surgery.
Because selecting a surgeon and his/her techniques is perhaps the most important step, I want to share my decision-making.
I also cite, and highly recommend, an article, sent to me by a friend, from the Oct. 7, 2003, issue of the New York Times. “Weighing Pain, Gain and Risk in Replacing a Hip” by Laurie Tarkan offers graphics, medical opinions and comparative studies. This article informs us that standard hip replacement surgery usually requires an 8-to-10-inch incision and cuts leg muscles to access the deteriorated hip joint. Less invasive procedures, which include “mini-hip” and “two-incision” surgery, emphasize 1.5-to-4 inch incisions. Muscles generally are moved aside rather than cut. The latter process promises speedier rehabilitation and less pain. However, this surgery can be more challenging for the doctor. The smallness of the incision can make it difficult to see the entire hip joint.
Some doctors believe that the progress in post-surgery rehabilitation has less to do with the size of surgical incisions and more to do with medical advances. These include improvements in anesthesia, pain management, physical therapy, patient education and post-surgery activity advice. In addition, surgeons who use traditional methods now tend to make smaller incisions than in the past. My surgeon anticipates a 6-inch incision.
In my opinion, minimally invasive surgery, while certainly appealing, is the new kid on the block. Traditional hip surgery, some 30 years in the making, is tried, true, and complication rates are low. And while there are respected surgeons doing a good job with minimally invasive surgery, I have also heard of very poor outcomes.
I briefly contemplated searching for an unknown doctor, who may not be covered by my health plan, and who has recently learned the new techniques. And I decided in favor of techniques that have, over time, sorted out the kinks.
I chose a surgeon who has been trained by the best, does only hips and knees, and has honed his craft, day after day, for 20 years. And although I would love a fast rehabilitation, I believe it is the long haul that counts. How the new joint fits into my body and works for the next 15–20 years is ultimately what is most important.
Perhaps my decision-making is conservative. I have always valued the wisdom earned through work and experience, solid training and steadfastness over what is new and shiny. I also place a high premium on trusting that my surgeon will make the best decisions for the long-term health of my hip joint as well as myself. And he did say he expects to get me back into the swimming pool two weeks after surgery, or as soon as the stitches heal.