RE: Re: - small incision

[Guest guest]

Hi Ed,

I read your note with interest. I am not an expert on incisions – it wasn’t

something that bothered me at all. But here are some facts about my op done 4

weeks ago yesterday:

* Incision – anterolateral (I believe); crescent shape (the curve is towards

the front of the body and the start/end points of the incision towards the back)

of approx 9†(circa 20cm)

* Closed with self-dissolving (subcutaneous sutures)

* I showered on day 2 after the op

* The incision healed such that by day 8 I no longer wore a dressing/plaster

over it

* Rested on op side by day 10

* Slept on op side by day 15

* Operation lasted 1hour and 45 minutes (it was hard for the OS to dislocate the

hip due to sclerotic bone growth on the acetabulum side round and over the femur

head which had to be chipped away first; in the OS’s op notes this comment is

followed by the following one “Patient has very hard bones.â€)

* I had no blood transfusion.

* The op started with a spinal (I wanted to be aware of what was going on and

the OS was happy to provide a “running commentaryâ€). However, the spinal

apparently wasn’t fully effective as the anaesthesiologist and the surgeon

later told that I said I could feel the incision when it reached the top of my

hip – the OS then instructed the anaesthesiologist to “knock me out†which

he did with a “mild anaesthetic†(his words). Mild or not, this had the

effect of wiping my memory back some 30’ which I have been unable to retrieve

(so, my last memory is of my conversation with the anaesthesiologist outside the

operating theatre, but the next 30’ leading up to my comment that I can feel

the incision have disappeared).

* The device used for resurfacing was Cormet

* The recovery to-date has been exceptionally smooth and pain-free (bear in mind

I have an extremely high pain threshold)

So, you seem to be even more right in your conclusion than you thought – even

the size of incision or the length of the op do not seem to impact the blood

transfusion requirement, or the speed with which ones incision heals, or how

soon one will be able to turn on the op side.

Regards

Dan

* +44 (0)7974 981-407

* +44 (0)20 8501-2573

@ dan.milosevic@...

_____

From: ehlderksen

Sent: 17 March 2004 05:39

To: surfacehippy

Subject: Re: - small incision

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.

>

>

>