Total hip replacement: In and out in a day
Reno resident Dave Fish is pretty rough on his body. As the owner of Eclipse Pizza, he's on his feet all day.
"It's a busy environment," he says. "I'm standing up. I'm chatting. I'm running pizza. Making pizza... Taking care of business." Fish says it's a fun environment, "but it's just, you know, it takes a little hustle."
And in his downtime, Fish coaches masters swimming and competes in some of the most elite endurance races.
"Twenty-one Ironman triathlons, a lot of running, a lot of biking, a lot of skiing, a lot of hiking. So," he says,"it's taken its toll over the years."
So Fish will become one of the 700,000+ people who will get a total hip replacement in the US this year. That CDC statistic, though, indicates surgeries done in a hospital, where the patient will stay days after the procedure. Fish is getting his done as an outpatient at the Reno Orthopaedic Clinic. His is the first total hip replacement done outpatient in northern Nevada.
The day before his hip replacement, Fish ran five miles and then worked until closing.
"At the end of the night, in bed, it just hurts," he says. "You know, after a long day working or standing up or doing whatever it's just a constant, constant pain."
"You can see in his case that he's completely worn out this space, the bone is actually digging into bone... And so it's almost like a rectangle in a circle trying to move."
Harvard-trained orthopaedic surgeon Jackson Jones performs these surgeries differently than the current norm: from the front of the hip joint, instead of alongside the hip.
"The other approaches require that you cut through muscle to get down to the hip," Jones says. "With the anterior approach we don't have to cut any muscle, we can go in between a couple different muscle planes and when people don't have muscle to heal you're not worried about attachments of muscle to bone they get up moving faster."
So fast, Jones says Fish will be walking out the door the day of his procedure. An example that a hospital stay is becoming unneccessary for the healthiest of patients.
"You get them up faster. You get them home. Which everyone wants to be home. But more importantly infection rates are lower when you're not in hospitals," Jones says. "Infection rates can be lower, it's a little more comfortable setting. And if you're home, you're actually safer than if you're in the hospital."
The surgery itself took Jones and his team about an hour and a half. The bad ball and socket, replaced with titanium and polyethylene parts. Because of Jones's anterior approach, patients with a lot of muscle actually feel more pain after this surgery than those without a lot of muscle. He compares it to an extremely hard workout.
"You've got plenty of muscle in there," Jones said to Fish post-operation, "So I expect some stiffness."
Two hours after being wheeled into recovery, Fish stands up in a walker. And 45 minutes after that, he goes up and back down a flight of stairs with the Reno Orthopaedic Clinic's physical therapist.
"It doesn't hurt at all," Fish says after his feat on the staircase. "Just that IT band is tight."
Just five hours after his total hip replacement, Fish is wheeled out of the ROC Surgery Center, and is headed home.
Two weeks after the surgery, Fish is riding a recumbent bike for a half-hour. And he tells his surgeon that every day, it gets better and better.
"In terms of activity level," Jones says to him "just let pain be your guide. The sky's the limit. You can go as big as you want, but go in small increments."
Four weeks after his total hip replacement, Fish is back working at the pizza parlor. He does have a bench in case he gets tired.
"The actual pain from the hip it's virtually gone," he says.
Fish is cycling and swiming again. And he looks forward to doing a whole lot more on his bionic hip.
Dr. Jones says patients go through screening before he will consider doing the total hip replacement at the ROC Surgery Center. Higher risk patients do not qualify. But getting the procedure in the surgery center is much cheaper for insurance. We purposely didn't include video of the surgery itself in this story for broadcast. To view portions of the surgery, click the extended version video in this story.