Re: - small incision

[Guest guest]

Hi Sherry,

From what I can tell, the size of the incision does not seem to be

terribly important one way or the other. Here is why:

First, my current understanding from bits and pieces on web sites and

other postings (if I am wrong I am sure I will be corrected):

Small incision is associated with the anterior-lateral approach.

Incision is right on top of the joint, but the gluteus medius &

minimus are in the way and have to be partially lifted from the

greater trochanter.

Posterior approach: large incision, have to go through the gluteus

maximus which is parted lengthwise to inflict minimal damage to the

muscle.

From my own experience I know that skin and muscle tissue heals much

faster than tendons and bone. So is the " controversy " of anterior

versus posterior primarily a perceived one, based on " looking good " ?

My incision is only 4 inch. Supposed advantages: less blood loss;

faster healing/less damage; esthetic(?). As to the blood loss: I

needed two transfusions and was just barely allowed to leave the

hospital on Day 3 ( " crit " = 30.1). I had stopped taken medicine pre-op

as instructed. From other msgs I see that not everybody needs a

transfusion (is that exceptional or fairly common?), not even people

with the larger incisions. On my hospital bill I saw a $900 charge

for the blood salvaging machine during surgery, so they did not

forget that .Is my case unusual then?

Healing of the incision was very good; however I still can not sleep

on my incision side (I am 4 months post-op).Incision area is not the

problem. The side of my whole upper thigh and knee starts getting

sore after 30 min or so. Tight IT Band was suspected but it turned

out not be tight at all. It doesn't concern me much and I expect that

to improve over time; but it is curious, no? I remember a post from

a patient from Dr De Smet (a bilateral I believe) who slept on his

large scar on Day2 or so!

Less damage to tendons/muscles?

Hard to say. My first week post-op was certainly not a " top ten

story " . Overal I am doing very well, but I do have the usual problems

with the " knee-to-chest " ROM, which was the subject of Sundog's post

and I intend to reply to his msg in more detail.

On his website Dr De Smet writes that a disadvantage of the small

incision is that it affects the gluteus medius and he prefers the

larger posterior incision because of easier access (improved speed

and more room to manoever).The only disadvantage is " potentially a

slightly higher risk of dislocation if not done properly " during the

healing period. Of course, he is " The Master " so he does it " properly " .

Anesthesia:

As Des mentioned, the larger incision may be a little better because

of the shorter time, unless of course you opt for a spinal/epidural.

As far as " general " ones go, I have had 7 in the last 18 years and I

definitely have more memory problems than my age warrants(no nasty

comments please)

So, from all the stories I have read on this board there seems to be

no direct correlation (yet?)between incision size (or prosthesis for

that matter) and the individual recovery stories. They are all over

the place. If you have a good surgeon you cannot lose and individual

circumstances seem to play the most important role.

Ed

Mont RC+ Nov 03

> Hi Sherry:

>

> When opting for a smaller incision, bear in mind that the surgery

may take

> longer and therefore you're under the general anesthetic for

longer. I'm not

> 100% sure about the actual substantive difference but my belief it

is

> considerable.

>

> When I say that, I have in mind the 35 min. surgery for my BHR

versus several

> hours. If your surgeon is experienced, the recovery time shouldn't

be

> appreciably different with a bigger cut. You still have to take it

easy for 6 weeks,

> one way or the other.

>

> When you get to " our age " , we need all the brain cells we can hang

onto,

> especially when you still have teenagers in the house. Long general

anesthetics

> tend to be a problem in many ways.

>

> Des Tuck

>

>

> In a message dated 3/16/2004 9:35:30 AM Pacific Standard Time,

> one4sherry@y... writes:

> After Lee Webb responded to one of my E-mails, I learned that Dr.

Gross does

> a mini-incision resurf with the incision being about 5-6 " vs. the

traditional

> 8-10 " . I was specifically wanting a mini-incision procedure

because it is

> less traumatic - less tendon and muscle cut - which all boils down

to a shorter

> hospital stay and a total recovery of 1/2 the time of a traditional

THR.

>

>

>