Please help me anticipate the logistics for my surgery

In My Humble Opinion
1

As discussed in last month’s mini-rant thread, in February I began the process of getting my carcass brought up to speed, health-wise.

Yesterday, I brought my hip/pelvis xrays to an orthopedic surgeon for a consult. His conclusion, after examining the xray, reading the radiologist’s report, and manipulating my hip, was that the ball of my right femur is fused into the socket (also, he thinks I may have ankylosing spondylitis, and maybe some rheumatism, and he’s ordering some blood tests on that). His basic recommendation is that we begin the authorization process for a full hip replacement right away.

So last night at work, I got my supervisor to arrange for an FMLA paperwork packet to be sent to me, and we discussed the possibility of a limited duty position so as to minimize the amount of time I have to be out of work.

For the record, my job is not particularly arduous. I only get called into action when the machinery goes into a breakdown condition that the operators can’t recover from, and most of the fixes to those turn out to involve rebooting a computer or two. In between mail runs, retrieving mailpieces that have fallen off their conveyors is likely to involve crawling around in some relatively cramped spaces. Actual mechanical repairs, when they’re needed, don’t involve heavy lifting.

From the above description, is there anyone who can give me an estimate on how many weeks I should plan on recovering, before trying to go back to that level of work?

Another issue: my daughter is returning from New York in a couple of weeks, with no intention of going back any time soon. She’s gotten it into her head that if she’s going to be living in California, it would behoove her to have a driver’s license. I have no argument with that stance, but I’ve always taken the position that the obtaining of a license (and particularly the paying of auto insurance premiums) is going to be on her nickel.

While she’s open to (and planning on) getting a job ASAP upon her return, she seems to be getting it into her head that maybe her old man’s imminent need for a chauffeur is an angle she can work to make it so I pick up those costs. She did not react with equanimity to my suggestion that I could get by on the bus for a few weeks. Still, it does raise the question:

Keeping in mind that this is my right hip we’re talking about, and the car is an American one with accelerator and brake pedals intended to be operated with the right foot, can anyone give me an estimate on how long I should expect to be unable to drive myself around? If it makes any difference, the car is a Ford Edge, a mid-size crossover, and getting behind the wheel should not require dangerous contortions.

Thanks in advance for any informed responses.

2

Also (for those with experience in the American healthcare system), assuming no complications,* how long should I expect to stay in the hospital, post-surgery?

*(for all that I disdain thoughts of exercise and diets involving self-denial, I am in pretty robust condition)

3

I had a knee replacement, not a hip, but I was only in the hospital overnight. I have a friend who had a hip and she spent two days in the hospital. Both she and I had in-home PT for three weeks. I was back to walking at the gym by week 3. She was too. My doctor did not want me to drive for six weeks, though. (Ford Escape, automatic.)

Good luck to you. I think you will find it is easier than you expect. I know several people who have had both knees and hips and all of us found it easier than we expected; I know these people from my gym and all of us were older (late 60s through 80s) but in pretty good shape.

However, you might find having a chauffeur a bigger help than you think.

4

I’ve been under FMLA before. Your questions seem a little weird in regard to the situation. I think the paperwork is pretty standard; you have 12 weeks, during this time your position must be kept for you(there’ are nitpicks to this probably, but I’m keeping things simple), also you get to retain your health benefits.

You must be cleared by a doctor before you can return to work (I think this would apply in your case anyway).

If you are unable to work at full capacity usually the employer is expected to act in good faith as far as making slight accommodations goes.

One thing I am really curious about though is why are you asking a bunch of people on the internet when you can return to work after major surgery:confused: I highly doubt any of the doctors on the board would even venture a guess; so anyone who does venture a guess would clearly not be qualified to give an accurate opinion.

Good luck with the surgery, Mostly I’m responding because I had a similar situation and it was helpful to have the right information about what was involved.

5

Well, the getting-back-to work ASAP thing is because on my current schedule, night shift and Sunday shift premiums add about 11% to my basic pay. If I’m on sick leave alone, those premiums aren’t there, and it takes a discernible toll on my take-home pay. I really want to minimize the length of time I’m on “short rations,” so to speak.

As to why I’m asking here, it’s because my sense is that experience-based responses from a large enough number of Dopers could give me a baseline against which to set my expectations between now and the time I have my next consult.

6

Makes sense. How open is your employer to making accommodations? If you approach it the right way, sometimes you can come up with all sorts of solutions; every situation is different though.

7

Correction 16%

My supervisor tells me that’s a bit up in the air. In his experience, the maintenance manager never allowed limited duty assignments to maintenance employees. The maintenance manager position has changed hands since the last long-term FMLA-related absence, and I’ll have to inquire with the new manager.

My ideal outcome would be to get detailed to a desk job at a different facility for the duration. If I can manipulate them into doing that without officially asking for it, I get time-and-a-half while I’m out of my standard billet. :smiley:

*actual likelihood of this outcome: maybe .001%

8

My brother had a torn labrum in his hip repaired a few years ago, and my friend is currently recovering from the same thing as we speak. Not the same as what you’ve got going on (I assume their’s is less of an ordeal?) but I must say recovery has been pretty hellish.

She’s pretty much helpless and for a while needed help getting in and out of bed (moving her leg). It will have been 3 weeks this past Monday and she is able to move herself now but other than shuffling to the bathroom and dragging herself downstairs once a day to visit with the kids (her husband and parents are watching them, don’t worry!) she’s still pretty much bed-bound. It’s near impossible to sit in a chair and she has trouble with the crutches (my brother didn’t seem to have much trouble with crutches). I think she has to go to therapy almost every day.

My friend is a pretty tough woman and not the sort to want to be waited on, so she’s not over-exaggerating her condition.

I remember with my brother it took quite a while for him to be back to normal. He wasn’t working at the time, though. But I also remember that he did not have the same help and support that my friend has, and he has 2 little kids, so he was sort of forced to speed up his recovery. FWIW he still is in pain, 2 or 3 years later.

My friend is trying really hard to make sure she stays with the doctor’s & therapist’s orders so that she heals right and all this mess won’t be for naught.

I bet you’ll be in the hospital for a bit, seeing as how your thing is much more complicated than a torn labrum. And in my experience, the hip takes forever to heal. It’s quite a rough spot.

Being that it’s week 3 for my friend’s torn hip labrum and just this week they have her upright on crutches in therapy, I am going to guess 6 weeks minimum for you to be out of work. Sitting in an office chair takes more of your hip than you think! But very much a WAG.

The good thing is, though, is that everyone who is involved has done all this before and will have plenty of instruction for you and ways to make everything go smoothly. Seems the hard part is following the instructions, and having the patience to let yourself heal.

Oh, and make sure you have Netflix.

9

My father recently had his right hip replaced. I’m not giving medical advice (and the docs and PT people will drill you on it anyway), but I can tell you a bit about his experience. Here’s the most relevant part, with the tl;dr explanation below:

You will not be allowed to bend over or raise your knee above hip height for probably about 6 weeks. Doing so could unsocket your hip, requiring another surgery. So don’t even think about it. I’m pretty sure this means crawling is out of the question for 6 weeks. Likewise kneeling, crouching, or otherwise positioning yourself around awkwardly placed machines is going to be verboten. Driving is going to be another sticking point. You’ll be able to ride home a few days after the surgery, but the doc is probably going to want you to avoid actually driving for the full 6 weeks. (And to not ride any more than necessary.) Painkillers are another reason you won’t be driving, but you should be off those much sooner.

  1. Pre-surgery: Arrange furniture so you have a clear path everywhere you need to go that’s wide enough for a walker. Pick a chair where you’re going to be spending most of your time and arrange things so you can have everything you need in reach of it. A relatively tall chair is best, because it will be easier to get out of without bending too much. Make sure to have some way to elevate your feet.

  2. Day of surgery: No food or drink. Bathe with special soap. Show up when they tell you to, answer a bunch of questions (probably several times each), get knocked out.

  3. The surgery takes several hours, followed by more time in recovery. Dad went in at ~8:00 AM and was in his room by about 1:00 PM.

  4. His surgery went well, and after he’d been settled in his room for a couple of hours, a physical therapist came in with a walker, got him out of bed, and made him walk around the room. This set the theme: they wanted him to walk as much as he could without hurting himself.

  5. He was thoroughly catechized on three points:
    a) Do NOT cross your legs.
    b) Do NOT turn your foot inward (or outward much).
    c) Do NOT do anything that causes your hip to exceed a 90-degree angle. (This includes raising your knee above your hip, bending forward while sitting down, and bending over to pick things up/put on shoes/whatever.)

The reason for this drill is that the only thing holding the hip joint in place is muscle tissue, and that tissue had to be cut apart to replace the joint. If you break the rules, your hip could come out of the socket, and the doc will have to open you back up to fix it, and you get to start all over again.

  1. They sent him home with various gear–walker, bedside/raised toilet, grabber, sock puller, long shoehorn. Most, you will notice, is aimed at keeping him from bending over.

  2. He had a home health nurse coming by daily for at least the first week, checking on him, changing dressings, and so forth. He also had a daily PT visit with list of exercises. Mostly, he walked laps in the house with his walker for the first week, then started walking outside a little.

  3. No showers. Don’t get the incision/dressing wet, which mostly means sponge baths, sitting on a bath stool. He got his staples out after a couple of weeks, then had to wait 48 hours after that to have a shower.

  4. 4 weeks after the surgery, he was able to walk without a cane.

  5. If all goes well, about 6 weeks after the surgery, he’ll have full mobility back. 6 weeks is probably when you can expect to be cleared for normal work.

10

Thanks for the detailed description of your dad’s experience, Balance. Seems like I could be in for a harrowing time, not least due to financial implications.

What is “special soap,” though?

11

They gave him an antiseptic soap to bathe with the night and morning before the surgery to help minimize the chance of infection. I think the stuff was called Hibiclens.

On the bright side, he is now walking without a cane for the first time in years, and in much less ongoing pain. It’s a major surgery, but it has a really high rate of success and effectiveness.

(Sorry I didn’t reply sooner–I didn’t notice you had responded.)

12

No worries.

First time without a cane in years? Man, I hope that my insurance company doesn’t require me to walk with a cane for a few years before they approve this.

13

I think the most important thing is what kind of shape are you in? Are you overweight? Are you active? Work out? Play sports? Jog? Smoke? Etc.

I should think these things would have real impact on your recovery, and account for the wide variety of recovery experiences you hear about.

When you say financial impact are you meaning the drop in your wage or the actual hospital costs? As I come from the land of universal healthcare I’m curious what it costs to get a hip replacement. I have a friend about to get his second. (After golf season, this time. The first one cost him a season of golf due to poor planning!)

Wishing you good luck with it all!

14

Thanks very much.

We found ourselves with a couple of thousand dollars of out of pocket costs after kaylasmom had her hip replaced in 2011. Hers was done on an emergency basis, though. I’m hopeful that the planned nature of this one will allow me to do at least SOME comparison shopping and bring that down a bit.

My before-tax income will be dropping by a little more than $200/week for the duration of my sick leave. So I’d like to minimize THAT as well.

As for my physical condition, I’ve been a non-smoker since 2001, I could stand to lose some fifty pounds, and I really don’t like to exercise. Jogging has been out of the question for several years, of course.

15

IANAD

That’s the old way! I had mine done (full replacement, left hip) almost exactly 6 months ago. What I had, and what you want, kaylasdad is an “anterior hip replacement”. If your current orthopedist doesn’t offer it, look until you find one that does. Many Orthos don’t offer it because it takes more of their time and requires specalized equipment.

Anterior means that, instead of going in through the side or back of your hip through all the big muscles, the replacement is done through a smaller incision in the front. This method speeds recovery greatly AND eliminates all of the restrictions of posterior hip replacement. You can move any way you can as soon after surgery as you can. From the link above:

I asked my doctor what that really meant and he said “If you can stand the pain, you can do it, period. No restrictions”.

My surgery was late in the day on Tuesday, I was home by Wednesday evening. I took vacation time the rest of that week, worked from home the following week and drove myself to work thereafter (caveats - left hip, desk job). I was on a walker for 2-3 days, on a cane for another 10 days or so, and limped for a week or so more. Within 10 weeks I was playing golf again.

If you work hard at the after surgery therapy, both in the PT office and at home, you can easily match my recovery.

I’ll be glad to answer any other questions you may have.

16

I agree completely with Dr Jackson, above; I had my right hip done in late 2011 with the old way, simply because I could not afford to wait (damn the deductibles!). I was back at work, desk job, in 10 days; hospital was 3 days. I felt like I’d been hit by a truck, but it improved quickly. No driving for me for 6 weeks, but I walk to work and had friends close for errands. It’s a significant thing, but should be over with well within 6 weeks; but go anterior if you can.

17

I checked with my father. He says his surgeon used to do the anterior procedure, but found that while the recovery progressed faster during the first three weeks, it converged with the recovery from the other procedure at that point. The downside to the anterior procedure that he didn’t like was that it required working close to the femoral artery and a major nerve (sciatic, I think). So, he regards it as somewhat riskier, with little long-term benefit. It does avoid most of the movement restrictions (but remember that doesn’t mean you’ll automatically be up to crawling around shortly after the surgery).

The best thing to do is discuss both procedures with your doc and decide which is best for you.

Oh, and Dad says, “Don’t put it off.” If he’d known how much good it would do him, he’d have had it done several years ago.

18

Many thanks for the new information. I will certainly be discussing this with my surgeon. Does anyone who has had the anterior replacement procedure know how insurance companies are about authorizing that technique?

19

Ass matters stand, I understand that I should be waiting another week or two before contacting the surgeon’s office during this preliminary phase of obtaining authorizations. Also, I note that one of my surgeon’s partners performed a posterior replacement on my wife in 2011.

I guess I better get in touch with them on Monday to see if this guy does anterior procedures at all, and start shopping around if he doesn’t. It would be silly to get the authorization, and then have to start all over.

20

Dangit. Neither he nor any of his partners use the anterior approach. So it looks like I can do it anterior (maybe) OR I can do it with minimal delay, but not both.