Beginners guide

ImageThe information supplied by the Orthopaedic Department of the Auckland DHB is simply fantastic. All any individual can do is to add a few personal thoughts. These lay comments have no medical authority whatsoever.



ImageChoose the best anaesthetic for you.

The Anaesthetists at Auckland Hospital take people into their confidence and allow the patient to make choices. This is a sign of respect on the one hand, but also a recognition on the other that we do not know a lot about the long term effects of general anaesthetics. The patient needs to take responsibility for themselves.

My recommendation would be a “spinal”. This is an injection straight into the base of the spinal chord. That sounds tricky but my anaethitist assured me that because the spinal chord is then beginning to spread out it is easier than a lay person might imagine. With a spinal you stay awake during the operation. However they throw a blue sheet over you so that you cannot actually watch what is going on. Looking at a blue sheet is rather boring so I ended up dozing off thinking of other things. The spinal is administered while you are sitting up on the operating table, and by the time you have stretched out it is already taking effect. The only disadvantage is that it is a one-shot affair, so if something really did go wrong you would need to revert back to a general. The doctors have now done so many hip-replacements that they seem to know exactly how long the operation will take and nothing does go wrong.

The second choice would be an “epidural”. This is an injection into the outer layer of the spinal chord. With this a “device” is left in place. The advantages are twofold. If you need another shot to give the doctors more time for the operation this is easily administered, and after the operation morphein for pain control can be fed straight into your spine. The disadvantages are that the “device” then has to be taken out, and you end up wanting to lie on your back in bed which leaves everything in the wrong place.

The third choice is a general. This gets your brain involved in the anaesthetic, but uninvolved in the operation. Denial is one of the great problems in our society. Denial does not deal with issues, so that eventually you have to front up to them. My feeling is that dealing with the trauma of the operation during the operation is the way to go. After the operation you can focus on healing. In the same way I never have injection at the dentist. The pain and getting your tooth dealt to is all over in one shot. Having the pain later as you thaw out only delays healing.

Post operatively the two big issues are the ongoing risk of infection, and dislocation.

It had never occurred to me that rejection is something your body needs to deal with, although that should have been obvious. Your immune system wants to reject your artificial hip, just as it would want to reject a new heart or a new liver. This means that avoiding infection is an ongoing issue rather than just a matter of keeping the bugs away during the operation. In practical terms this means that any infection will be attracted to your hip. Tell your dentist. If he is going to clean your teeth you will need to take antibiotics. I do not trust antibiotics so I took the approach of cleaning my own teeth to avoid the issue. My advice would be to get a complete dental check up, including the dentist cleaning your teeth, before your hip operation.

Dislocation sounded like one of those risks, but it is all more serious than that. If your hip dislocates once it increases your chance of it happening again, and again. There are horror stories but it is best if you find out about them after your operation. There are things you can do and things you must not do. I still have not got it sorted. My advice would be to listen very carefully. The time will come when you can forget about how to walk up stairs. Never however take the risk of a dislocation.