Total Hip Replacement: A Personal Perspective

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Chapter VI. The Day of Surgery

The day finally arrived. Everything thus far had gone like clockwork and I was ready to dive right into the main event. Interestingly enough, the total hip replacement surgery is considered “ambulatory surgery”—I would be walking in, but definitely not walking out! I dressed in some minimal clothing, well aware that I would be spending most of my next four or five days wearing very fashionable, open-backed hospital gowns. We were at the Sheraton, only five minutes away from the hospital, so we dawdled a bit, checked out, and then headed over.

Waiting to be called

As instructed, I proceeded to an area called “Ambulatory Surgery,” signed in, sat down, and began to wait. And wait. And wait. After waiting an hour and a half, both Margie and I were getting antsy. She decided to ask about what was going on. The receptionist informed her that I had been scheduled for the second surgery in Theatre #4, in which my surgeon had just finished his first operation of the day. He was in the surgeon’s lounge and I would be called shortly. “Shortly” turned out to be almost immediately!

Bingo! Time to rock and roll! Things started moving fast. I was given a packet of information and told to report to general surgery prep on the second floor. It was finally happening and there was no turning back.

With Margie in tow, I entered the elevator and pressed the “2” button. Was I apprehensive at all? No. But why? I know that many brave people have a very deep fear of surgery. There is nothing shameful or weak about that fear. In fact, I think it is probably more consistent with normal adult behavior to be fearful of surgery than not. One is losing control, leaving one’s body in the hands of strangers. I kept thinking, “Am I nuts? I’m not scared at all.” Well, in thinking about it afterward, I decided that my lack of fear was attributable to three distinct notions. First, this would be a great adventure. I had had surgery some 17 years beforehand and I had been intrigued by all the equipment and operating room activity. I was anxious to see the differences between that earlier surgery and this one. Second, I had developed a great amount of faith and trust in the surgeon and the hospital. Feeling that I was in good, experienced hands, there was no reason to worry. Lastly, to quench what is usually the greatest fear associated with major surgery, I rationalized that if I were to die I would slip quietly and obliviously into the night, never knowing that I left this earth.

OK, so I would probably concur with the assessment that I am totally nuts.

General preparation

After that brief bit of soul searching in the elevator, it was back to the preparation. The general preparation area was small, with four beds, a tiny bathroom/dressing room, a waiting room with four or five chairs, and a reception desk. I handed my information to the receptionist, who gave me a gown and a plastic bag, directed me toward the dressing room, and told me to change into the gown and put my clothing and other effects into the plastic bag.

I can never figure out how to tie those ridiculous gowns in the back. As incompetent as I am, it usually takes me five minutes just to snap the sleeves together. Who came up with that design? I guess it was an attempt at fulfilling the two contradictory goals of simultaneously maximizing modesty and access. Cursing softly at first, and then not so softly, I finally called for Margie to help me tie the thing. (Mind you, I knew it would be coming off, so I had to rhetorically question the need to be so diligent about tying the back.)

Once securely gowned, I was given a bed of my own—a gurney, really. A nice, non-patronizing nurse named Susan very quickly and professionally hooked up my I.V. tube, fitted my designer shower cap, and then did something quite important. With a black ballpoint pen, she wrote “NO!” on my right hip, the one that was not supposed to be replaced. I was at once amused and impressed—reassured that the proper hip would be the one replaced.

Next, my anesthesiologist arrived with the epidural catheter and the associated equipment. Its insertion was painless. I was prepped and ready to roll.

Margie asked Susan if she thought it would be possible for her to obtain permission from the surgeon to observe the surgery. Even though Margie is a doctor, it is the hospital’s policy to prohibit friends and family of the surgical patient from the operating room. This made sense to me. I imagine that people can become emotional and irrational when things are appearing to go wrong—or even if everything was proceeding normally, given the hectic atmosphere of the O.R.

My gurney was rolling. I felt bad that Margie would have nothing to do but wait instead of watching my operation, but I could not do anything about that. Therefore, as I passed under a big red sign stating “NO VISITORS PAST THIS POINT,” I said, “Thanks, Margeroo. See you on the flip side!”

The operating room

I quickly determined that I was in the operating room when I saw the gigantic lighting equipment overhead. From this point, events happened too quickly for me to get a good look around at all the equipment and people. I was moved from the gurney to the table. The presence of human hands on my body at this point was comforting—unexpectedly so, because these were the hands of strangers. I interpreted the touches as kind, caring, and gentle, which related back, I suppose, to my trust and confidence in the surgical team. The anesthesiologist placed a clear mask over my face, instructing me to take a couple of deep breaths. That was the last thing I remembered from the operating room. Zzzzzzzzzzzzzzzz.

While I lay sleeping

Based on my reading the surgeon’s reports in the aftermath and piecing together other information, I can tell you what happened before and during the surgery even though I was not mentally aware of a single thing that went on. (Obviously, the Versed or whatever other drug they gave me worked very well.)

I suppose that because I am bearded, it was necessary to slop Betadine disinfectant all over my face. My beard must have been suspected of harboring every form of microbe, virus, cootie, and fungus known to medical science. In the aftermath of surgery, I discovered direct evidence that the Betadine bath occurred. I have a digital photo, courtesy of Dr. Margie the Photographer, showing my Betadined face, and I was still picking Betadine out of my moustache days later.

Also worthy of note are the intubations that happened while I was too oblivious to object. Obviously, the anesthesiologist wanted to be able to closely monitor and assist with breathing, so there were tubes in the nose and throat. Further down, it would have been a major disruption to the surgical procedure if I were to have asked at some point during the operation whether I could go to the bathroom to relieve myself. A Foley catheter was inserted to eliminate the need to get up and go to the bathroom. I found evidence of the anesthesiologist’s other tools of the trade in the aftermath of surgery. For example, a couple of days later I discovered a single, stray EKG contact that had obviously eluded the removal team’s capture.

In a properly researched book, I would give you specifics of the surgery. I merely provide a general outline of the procedure here, as those details are quite readily available elsewhere, particularly in the three books I have recommended in an earlier chapter.

After the patient is anesthetized and properly positioned on the operating table, an incision is made along the side of the thigh, from mid-thigh to well atop the hip. The surgeon works through layers of muscle and fat to expose the hip joint, which is then dislocated. The femoral head is sawn off and the socket area (acetabulum) is smoothed out in preparation for receiving the new socket. The femur is drilled out to enable the insertion of the prosthesis with the ball part of the new joint. The new joint parts are hammered into place and fitted together. (Cement, similar to Super Glue, is applied to secure the various components to bone if the joint is of the cemented variety, which mine was not. Traditionally, cemented joints are used in older patients.) Drains are inserted, if necessary. Then the wound is closed with either standard sutures or surgical staples. The whole procedure generally requires an hour and a half to two hours*.

* Mine required closer to four hours. In Dr. G’s words to Margie, “Not only was his muscle tissue very dense, but also his fat was very dense!” Everything on me is dense.

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