| FAQs |
What do I do if I want to have my case reviewed by Dr. Byrd?Every effort is made to thoughtfully review your case. This is done as a courtesy without charge, so please be patient. Most patients are referred by another orthopaedic surgeon. This is important for you because many conditions causing pain in the hip area may not be coming from the joint at all. It would be frustrating to go through the correspondence and anticipation just to find that this is not the direction to go. Your orthopaedic surgeon can do an appropriate evaluation and determine whether your hip is the likely source of your troubles. Also, it is important to have an orthopaedist close to home as you may have other orthopaedic issues that arise in the future and you should have someone who is familiar and interested in your care. Your orthopaedist can contact our office and send along the appropriate records. If it looks like there might be cause for a visit, then it is especially important to have x-rays and any other imaging studies that have been done, such as MRIs. If you choose to gather this information yourself, it is best to have all records that might pertain to your hip problem. This helps to avoid gaps that will inordinately delay your evaluation. Our office receives many records and this obligates us to be efficient in this process so that each person can be thoughtfully evaluated. We really cannot begin the review until the records and studies are complete. You are welcome to check on the status. Once the information is complete, it still takes a couple of weeks to have these appropriately reviewed. An introductory letter from your orthopaedist summarizing your case is always especially helpful. On reviewing the records, often Dr. Byrd dictates a summary including various tests that may need to be done. Remember that this summary is still considered informal, since it is impossible to accurately form conclusions without actually evaluating and examining a patient in person. If indeed you wish to request a review, please complete the attached Hip Review Request Form and send to us along with all doctor's notes, x-rays, MRI's and any other information that relates to your hip problem. The review process is not started until all information is received. What if I want to come for an evaluation?We certainly try to accommodate peoples’ interest in coming for an evaluation. It is very much in your interest if we have a chance to review your records prior to your appointment. This gives you the best chance of having a productive visit and the most likelihood that Dr. Byrd can provide constructive input to your care. Also, if special tests might be needed, these can be scheduled in coordination with your appointment. What if I wanted to plan on staying to have surgery?We frequently have patients who come for an evaluation and plan on staying to have surgery. However, all the planning prior to your visit becomes even more important. We try to make certain, prior to your arrival, that this is the right direction to take, but there is always a chance that the plans could change based on your evaluation here. You should be prepared that surgery could be cancelled, if it does not seem to be the proper direction to take. With preparation, we try to minimize this likelihood. We understand that there is much planning and spiritual preparation on your part to embark on this undertaking, just to have your plans changed. We also need to be considerate of other patients who could have potentially used that spot. Prior to your trip to Nashville, our office will be in communication with your referring physician and you should have had direct contact from us as well. Typically, you will be evaluated by Dr. Byrd on the day prior to your surgery. He will have already reviewed your records and previous studies. If any additional testing is planned, it would be scheduled for that day. Following your evaluation, if all remains as planned, surgery will proceed the following day. Most patients will remain in town until the day after their surgery. They will have a chance to visit with Dr. Byrd and also be seen by the physical therapist. You should be comfortable with the arrangements that have been made prior to your trip to Nashville. You should feel well informed about what will occur during the course of your visit. If in doubt, or unclear, then ask questions. What happens on the day of my surgery?If you are scheduled for surgery you should receive information about what to expect the night before and the morning prior to your surgery. If general medical tests are needed, such as blood work, chest x-ray, or EKG, these should all be scheduled. You will be evaluated by the anesthesia team that works closely with Dr. Byrd. You will usually arrive one to two hours prior to your scheduled surgery. The surgery is performed under general anesthesia and typically takes one to two hours. Dr. Byrd will speak with your family members following the procedure, and then usually about 45 minutes later, a family member may sit with you in the recovery area. Most patients are able to leave the outpatient surgery facility about two hours following their surgery. You will need crutches. If you have a pair you may bring them with you, otherwise, a pair will be provided. What happens the day after my surgery?Depending on your schedule, Dr. Byrd will try to visit with you in the office. He will review the findings from surgery and what implications this may have for the future. He will also outline a strategy for your recovery and resumption of activities. A large absorbent dressing placed at the time of surgery will be removed by the clinical staff. Physical therapy is usually scheduled to initiate a rehab program specific for your surgical diagnosis. The therapist can then coordinate your ongoing rehabilitation with a therapist closer to home and also serves as a contact resource for rehabilitation questions that come up during the course of your recovery. Most patients are able to travel the day following their surgery. Patients traveling outside of the continental United States will sometimes plan on staying an extra day just as a precautionary measure for their discomfort and length of travel. What happens during surgery?The procedure is performed under general anesthesia, which is important for thorough muscle relaxation. This relaxation makes it easier to separate the joint surfaces for the operation. The legs are positioned in a device that allows distraction of the affected hip. The amount of distraction force necessary is variable, but typically starts with upwards of fifty pounds or more. As the ligaments around the hip joint relax, this force diminishes during the course of the procedure. The hip is then injected with fluid. This distends the joint and allows further separation of the surfaces while reducing the amount of traction. With the joint surfaces separated, the arthroscopic instruments are then placed in the hip. Typically, three entry sites are used for the interior of the hip joint, one toward the front and two on the side of the hip area. The incisions for these entry sites are about ¼ inch long. Through these incisions the arthroscope and specially designed arthroscopic instruments are placed for inspecting the joint and performing surgery. The joint is infused with fluid during the procedure, so it is actually performed in an underwater environment inside the hip. Once the work in the interior of the hip is completed, the instruments are removed and the traction is released. The hip is then flexed, which relaxes the ligamentous capsule around the joint. The instruments can then be repositioned within the capsule, viewing the periphery of the hip where other problems may be present. Sometimes an extra incision is needed in this area. What should I expect immediately after surgery?The amount of discomfort associated with this procedure can be variable, but is controlled with oral prescription pain medication. At the completion of the operation, some anesthetic is usually injected into the joint that may reduce your discomfort for 3 or 4 hours after the operation. Even still, pain medication is necessary and it is best to take it before the pain becomes severe. You may actually experience a little aching in your knee or ankle just as a consequence of the distraction force pulling on your leg during the first part of the operation. Since the procedure is performed in a fluid environment, some of this leaks into the surrounding soft tissues. A bulky absorbent dressing is placed to absorb some of this fluid that may gradually seep out through the small skin incisions. This is changed the first day following surgery and can simply be replaced with small band-aides over each of the incisions. These incisions will have one or two stitches in place that are removed one week following surgery. Crutches are encouraged for the first 5 or 6 days following surgery. This helps to avoid limping too badly while getting over the initial soreness of the surgery and the muscles start working again. Unless instructed otherwise, crutches can be discontinued as long as you are comfortable. For patients with more advanced deterioration, such as arthritis, crutches are sometimes helpful for the first couple of weeks. Only for a few specific circumstances are crutches required for a more prolonged period of time. You are able to shower the second day following surgery. Water can run over the incisions, but try to avoid spray directly on this area. Do not immerse your hip in a tub or pool until the sutures have been removed and the small incisions are completely dry. Typically, you will need prescription pain medication off and on for the first week or so following your surgery. Often, during the day, non-prescription products such as Motrin or Tylenol may be sufficient, but night time seems to be when something stronger may be needed intermittently even beyond the first week. Do I have to return to Nashville for a check up?Your follow up is important to us. If your recovery is going smoothly, it may not be necessary to make a return visit to Nashville. The parameters on healing and success of the procedure are mostly reflected by how you are feeling and what you are able to do. Much of this can be coordinated by phone. Our office will be checking with you periodically, as we routinely keep track of all of our surgical patients. Knowing how you recover helps in counseling future patients. Communication is important. You should always feel that there is someone to answer your questions and assist in addressing issues that arise. However, this is also why it is important to have an orthopaedic surgeon familiar with your care in your home area. We can try to provide assistance, but are physically a long distance away for any urgent needs. Your follow up appointment will be scheduled based on the nature of your hip joint problem and your goals for resuming activities. However, as your follow up date approaches often this can simply be handled by phone if your recuperation is going satisfactorily. What should I expect during the normal recuperation following this surgery?The recovery following arthroscopic surgery is variable. This is partly dictated by the nature of the damage encountered and what was done to address it. Also, some people simply recover quicker than others. In general, you will be on crutches for 5 or 6 days. It is safe to place weight on your leg, but the crutches simply help to lessen the limp while the muscles around the joint regain their normal function. You can discontinue the crutches as your symptoms allow. Some patients, especially with arthritic conditions, may be more comfortable using crutches for the first couple of weeks. Crutches are necessary for a more prolonged period of time, only for specific conditions, such as when the bone has been stimulated to generate cartilage healing. It takes about one month to get over the initial soreness of the surgery. Some symptoms may continue to improve for up to one year following arthroscopy, but usually by about 3 months most patients have a pretty clear idea of how successful the procedure has been. Thus, you can anticipate needing to be a little careful with your hip for the first 2 to 3 months before just letting your symptoms be your guide. You may not be completely recovered in 3 months, but this is far enough along to start to test the joint. One observation that we have made is that patients often may feel better within only one month following their procedure. We have termed this the “Honeymoon” period. This early response is not a reliable indicator of the operation’s eventual success. This is the point where patients are most susceptible to “overdoing it”. It is unlikely that you will incur more damage, but if the symptoms are exacerbated it may take longer to get this quieted back down and delay your recovery. Thus, regardless of how well things may be going within the first month or so, this is not a point to intensify your activity based just on the symptoms. What complications are associated with this procedure?In general, we estimate that there is about a 1 in 100 chance of experiencing some type of complication. This can include simply feeling worse off following the procedure. General considerations associated with any surgery of the lower extremities include the risk of anesthesia, developing blood clots, various types of pain syndromes, or even death. Major nerves and vessels reside around the hip joint. These are a safe distance from the surgical sites for arthroscopy, but there is always some small potential concern for injury that could permanently damage the leg. There are small sensory nerve branches near the hip that provide sensation along the outside of the thigh. Occasionally, one of these branches can be stretched during the course of surgery in the joint, resulting in an area of numbness. Much of this resolves, but the resolution is sometimes incomplete. Also, during surgery, the hip joint space must be separated by applying traction on the leg against a counter force post that stabilizes the pelvis. We have seen at least one case where pressure from this post resulted in some temporary numbness of the genitalia for about 3 weeks following surgery. In our experience, this has been exceedingly rare, but emphasizes that with surgery there is always a chance of something expected or something unexpected occurring. The most important perspective that we offer is that any surgery is a violation of the joint. Arthroscopic surgery is much less invasive than the traditional open procedures, but anytime the joint is violated there is always a chance of causing harm or damage. The best that the surgeon can do is be as careful as humanly possible and be sure that the operation is being performed for appropriate reasons. |
