Caring Medical - Where the world comes for ProlotherapySame Day Hip Replacement Surgery | Minimally invasive hip replacement

Ross Hauser, MD  | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
David N. Woznica, MD | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
Katherine L. Worsnick, MPAS, PA-C  | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
Danielle R. Steilen-Matias, MMS, PA-C | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois

Same Day Hip Replacement Surgery | Minimally invasive hip replacement

Many people that we see with hip pain are in our offices because they are exploring options to an already recommended traditional hip replacement surgery. One option they may be exploring is the “same day hip replacement” or “Minimally invasive hip replacement” surgery. Another option is non-surgical treatment. In our clinics, this non-surgical treatment would be Prolotherapy, Platelet Rich Plasma Therapy and/or stem cell therapy. These are much more aggressive conservative care approaches that rebuild damaged tissue in the hip through regenerative injections into and around the joint. Let’s get to the research…

“I had a really good hip replacement surgery on my right side. I just don’t want to go through all that again on the left side.”

Many people do not want hip replacements. In our clinics, we see many patients who already had a very successful hip replacement but do not want a hip replacement on this other side. Why?

The most common answers are:

  • “I don’t want to go through all that again.”
  • “I am older now and I do not know what my ability will be to recover from such a big surgery.”
  • “I do not want to take the drugs.”

Over the years we have spoken to many hip replacement patients, as mentioned some of them were completely satisfied with their first hip replacement. They were very concerned about the second surgery.

“I have to work, I cannot take the time off to rehab a hip replacement, same day hip replacement sounds right for me.” Maybe not. IT IS STILL A HIP REPLACEMENT SURGERY

The main reason that someone is in our clinic exploring non-surgical treatments for their degenerative hip condition is mostly the same reason they are looking at minimally invasive hip replacement: they cannot take the time off from work to rehab.

  • While the idea of same-day hip replacement certainly has its appeal. It also has some misconceptions.
  • Many people believe the same day hip replacement is a walk into the hospital in the morning and they walk out at night with a new hip without further ado. Of course, this is not how the procedure works. There is preparation for the surgery and there is rehabilitation from the hip surgery.
  • For many, it simply means a smaller surgical incision and getting out of the hospital faster. 

IT IS STILL A HIP REPLACEMENT SURGERY. As we do in many of our articles, when we want an opinion on surgery, we go to the surgeons. They are the best qualified to offer concerns about a specific medical procedure.

The realistic expectation of same day hip replacement: Same day hip replacement is not right for everyone


Minimally invasive hip replacement – same risks as a standard hip replacement – increased risk in an iatrogenic (surgery causing) nerve palsy (nerve damage/paralysis) during the minimally invasive approach.

Minimally invasive hip replacement can provide benefits over traditional open hip replacement. When the surgery works, it can work very well. But that can be said for open hip replacement surgery as well. The problem is, when it does not work that well. Let’s listen to the surgeons.

In the August 2018 edition of International Orthopaedics (1), university medical hospital surgeons in Germany and Italy combined research to publish a study that compared the clinical outcomes of patients who either had a total hip replacement performed via the minimally invasive technique or a standard-invasive total hip replacement.

  • There were 4761 patients, included in the study, 4842 total hip replacements (81 patients had both sides done).
  • The patients were followed up at about 22 months after the procedure.
    • Findings in favor of the minimally invasive group:
      • less total estimated blood loss
      • shorter surgical duration
      • and a shorter length of stay in the hospital.
    • Findings in favor the standard-invasive group
      • less hip pain after surgery
      • better hip function, range of motion.
      • less leg length discrepancy, which may account for less pain.

Both surgeries still presented similar risks:

  • femoral fractures
  • hip dislocation, and
  • the need for revision surgery.

The surgeons did note that there was an increased risk in an iatrogenic (surgery causing) nerve palsy (nerve damage/paralysis) during the minimally invasive approach.

Study conclusion: “Based on currently available evidences concerning the outcomes following total hip replacement and the analysis of our results, we stated no remarkable benefits of the minimally invasive compared to the standard-invasive surgery.”

“no remarkable benefits of the minimally invasive compared to the standard-invasive surgery.”

In the medical journal Clinical Orthopaedics and Related Research, (2doctors at the Anderson Orthopaedic Research Institute & Inova Center for Joint Replacement at Mount Vernon Hospital, Virginia, and The Rothman Institute & Thomas Jefferson University Hospital, in Philadelphia provided these insights into the same day hip replacement procedure:

  • “Patients should understand that published studies that have examined same-day and early discharge protocols after total hip replacement have been done in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects.”
    • In other words: published studies are issued on only the patients that have the best chance of success. Same day hip replacement is not right for everyone.

The supportive research findings:

  • The purpose of this study was to evaluate and compare patients undergoing total hip replacement who are discharged on the same day as the surgery. Those called “outpatients” who were in the hospital less than 12 hours with those who are discharged after an overnight hospital stay (“inpatient”) with regard to the following outcomes:
    • (1) postoperative pain;
    • (2) perioperative complications and healthcare provider visits (readmission, emergency department or physician office); and
    • (3) relative work effort for the surgeon’s office staff.

Who is a good candidate for same day hip replacement?

The researchers then identified who would be a good candidate for the procedure.

  • Patients who were younger than 75 years of age at surgery,
  • who could ambulate (walk) without a walker,
  • who were not on chronic opioids, and
  • whose body mass index was less than 40 kg/m2 (less than morbidly obese or grade III obesity)

What were the results of this study: The researchers then identified the success ratio of the same day hip replacement procedure.

The researchers found 24% (27 of 112) of patients planning to have same day release surgery were not able to be discharged the same day. Some had to stay overnight in the hospital.

Is a same day hip replacement discharge something patients even want?

Here is an interesting survey from doctors who perform same day hip replacements published in the The Journal of Arthroplasty.(3)

Survey results of patients offered same day release joint replacement:

  • Very few patients expected sameday discharge or a one night stay in the hospital.
  • Only  55.3% of men and 31.7% of women reported that they were comfortable with outpatient same day joint replacement
    • The same group believed that the best benefit of same-day release joint replacement was faster recovery and decreased the likelihood of infection.

Recovery and rehabilitation from Same Day Hip Replacement Surgery

  • Very limited mobility 4 to 5 days. You will need a caregiver or family member.
  • If after the surgery you can walk on crutches or with the use of a walker, you will likely have in-home physical therapy. If you cannot walk with aids, then it will be strongly suggested that you go to a nursing home to recover.
  • You must be careful and not fall! During recovery some patients may “overdo it,” and their activities make them a fall risk. A fall can damage the hip replacement hardware and require further surgery.
  • No driving at least 3 to 6 weeks, maybe longer
  • After 6 weeks, as long as there is full hip movement, your doctor may recommend that you can return to work if it is not a physically demanding job.
  • Sexual activity can be resumed at this time as well, after 6 weeks, as long as there is full hip movement.

All the while there is also physical therapy, visiting nurses, and other home help people.

Options that keep your own hip

The purpose of our writing this article is because many people who contact our office are looking for an alternative to traditional total hip replacement. They see possibilities in Prolotherapy and stem cell therapy as a completely non-surgical option.

In the video below, a patient examination is performed and discussed to show who would be a good candidate for Prolotherapy, a non-surgical, in-office procedure.

The benefits of Prolotherapy:

  • Same-day, in-office simple procedure
  • Can often go back to work the same day

We invite you to continue on with your research at these articles on our site:

  • The evidence for Prolotherapy as a hip-preserving alternative to arthroscopy and hip replacement
    • For someone in chronic pain, in this case, from degenerative hip disease, we know you will spend hours in front of a computer searching for information that will help you. The times you are searching the most are most likely when you are in a more acute painful situation. If you are like others we have helped, you have reached a point of “hip preservation treatments.” This means that your hip has not degenerated enough for hip replacement and that there is a chance that you can save your hip from replacement surgery at least for a while. But in what condition? We hope this article will offer you some insights and answers in helping you understand, manage and make decisions in regard to your chronic hip pain.
  • Platelet Rich Plasma for treating Hip Osteoarthritis
    • Our offices have been offering regenerative medicine injections since 1993 as a service to people who wish to avoid hip replacement surgery. As part of our comprehensive program, we offer Platelet Rich Plasma Therapy, or as we describe it Platelet Rich Plasma Prolotherapy.
      • Platelet Rich Plasma treatment may have been explained to you as a one-time injection treatment. You may have been told this one injection will help with your problems of hip joint erosion and address the concern of irreversible hip damage.

      This is not how we offer this treatment.

      In our experience when somebody has degenerated hip disease and the cartilage is wearing away and being lost, you simply cannot repair the cartilage without addressing what is causing the cartilage damage. This is the joint erosion or irreversible joint damage you are hearing so much about. It manifests itself as instability in your hip, the feeling that your hip is giving way or is loose and wobbly.

  • Hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis
    • We get many emails asking about hip pain treatments. In people with osteoarthritis of the hip, the questions usually surround a treatment that will delay or prolong the need for hip replacement surgery. One such treatment is viscosupplementation, commonly referred to as hyaluronic acid injections or “gel shots.”
    • Gel shots are usually not the first, second, or even third line treatment for hip osteoarthritis. They are usually given when other treatments have failed to alleviate someone’s hip pain. These treatments include the typical conservative care of corticosteroid injections, pain medications and anti-inflammatory medications. In some instances, physical therapy and yoga are recommended for hip pain patients.
    • In theory, the idea of replacing or supplementing the protective and lubricating fluids of the hip sound like a good idea. So why is it not the first line of treatment for hip osteoarthritis and why do leading research centers suggest that the treatments do not work as well as hoped?

In our clinical experience and empirical observation has led us NOT to recommend viscosupplementation for hip osteoarthritis

In the video examples of patients being treated with stem cell or bone marrow Prolotherapy. This is our alternative to hip replacement surgery.

Do you have a question about hip replacement surgery or need help?
Get help and Information from our Caring Medical staff

Prolotherapy Specialists Minimally invasive hip replacement

Danielle Steilen-Matias, PA-C | Katherine Worsnick, PA-C | Ross Hauser, MD | David Woznica, MD

References

1 Migliorini F, Biagini M, Rath B, Meisen N, Tingart M, Eschweiler J. Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials. International orthopaedics. 2018 Aug 31:1-0. [Google Scholar]
2 Goyal N, Chen AF, Padgett SE, Tan TL, Kheir MM, Hopper RH, Hamilton WG, Hozack WJ. Otto Aufranc Award: A multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clinical Orthopaedics and Related Research®. 2017 Feb 1;475(2):364-72. [Google Scholar]
3 Meneghini RM, Ziemba-Davis M. Patient Perceptions Regarding Outpatient Hip and Knee Arthroplasties. The Journal of arthroplasty. 2017 Sep 1;32(9):2701-5. [Google Scholar]

 

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