Announcer: Production of Being Well is made possible in part by Sarah Bush Lincoln Health Systems, supporting healthy lifestyles.

Eating a heart healthy diet, staying active, managing stress and regular check-ups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at SarahBush.org.

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Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

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We promise to make a healthy difference each and every day.

St. Anthony's, together we are better.

Ke'an: Thank you for tuning in for this episode of Being Well.

I'm your host, Ke'an Armstrong and today we're talking about hip replacement.

I'm joined with my guest, Dr. Coleman, from Sarah Bush Lincoln Health Center.

He's an orthopedic surgeon.

Thank you so much for joining us today.

James: Thank you for having me.

Ke'an: Hip replacement affects a lot of people.

I want to know a little bit about, before we get to talking about hip replacement, what is the hip anatomy?

Can you explain it a little bit?

James: Yes.

The hip anatomy is unlike a lot of joints.

It's a ball and socket joint, where you actually have a socket that contains the femoral head, or the ball, and it's a very stable joint.

It doesn't come out of place very often.

Like other joints in your body, it can become arthritic.

And when it becomes arthritic, it hurts.

Ke'an: And it can hurt pretty bad.

James: Yes, definitely.

Ke'an: Does age affect it?

You say arthritic.

Can that happen earlier in life, too?

James: Oh, it certainly can.

People develop arthritis of the hip either because their hip anatomy was abnormal from birth.

It's congenital.

Their hip is not shaped normally.

They may have had a dislocated hip as a child that had some initial treatment, but then later on, but at a very early age they become arthritic because their hip is distinctly abnormal to start with.

There are certain other conditions of childhood that can give rise to an arthritic hip, but they're not that common.

Probably one of the most common causes is genetics.

People, you know if you talk to anybody who's got an arthritic hip, they may have had a parent or a brother or some other close relative who has arthritis.

A lot of that's very genetic.

It can be due to trauma, but it has to be pretty significant trauma.

Prior hip fractures can result in an arthritic hip.

A lot of it's genetic, though.

Ke'an: All right.

I'm thinking sometimes when you say it could be trauma, do we need to be careful what we're doing earlier in life, as far as physical activities, to keep away from having hip problems?

James: I don't think so.

I think that is one joint that is pretty safe.

You can, most people can do most any activity they would like and not put themselves at much risk for post traumatic arthritis from whatever they're doing.

Ke'an: Okay.

When you talk about arthritis, I think sometimes it's hard to figure out, when do I need to go see a surgeon, or what do I need to do.

Is it a back problem?

Is it a knee problem?

And thinking, oh it is my hip.

How do you answer that for folks watching?

James: Okay.

First of all, that was a very good question because a back problem can give you hip pain only.

Obviously a hip problem, like hip arthritis, can give you hip pain only.

Believe it or not, sometimes knee pain is the only symptom a person will have if they have an arthritic hip, so it can be kind of hard to tell.

Usually, pain in the front of the hip, like in the groin, that is where people will feel their arthritis pain.

They'll feel it there and they will feel it into their thigh bone, into the, you know down the front of their leg.

Usually it is not associated with numbness.

Now if a person has posterior hip pain in their rear end that goes down their leg, and especially if it's associated with numbness anywhere in their leg, it's probably not an arthritic hip.

It's probably a back problem.

Back problems typically present with pain in the back of the hip that will go down the thigh, or maybe it doesn't go down the thigh.

The knee pain that's associated with an arthritic hip, moving the hip hurts the knee.

That's the clue.

It's complicated enough that sometimes if you're really unsure, go see your doctor.

They can tell you a lot of times what it is.

They'll know.

Ke'an: All right.

Speaking of all the different parts from the waist down, what about if a person has feet problems?

Can that lead up to the hip hurting, as well?

James: I think it can, but it's probably a more simple explanation.

If you limp, you might start having pain in the adjacent joint.

I see people all the time who had, for instance, they broke their leg.

Then they were in a cast.

Then they were on crutches.

Then their back starts hurting.

Or their hip can start hurting.

So, yes.

Ke'an: When it's hurting so bad that they're saying, "You know what.

I really think I have a hip problem here."

Do they go see their physician first?

Do you need a referral to get to someone to get a hip replacement?

James: Well, for somebody to have Dr. Coleman look at their hip, they don't need a referral.

They just have to call and make an appointment.

I think that's the way it is with the other orthopedic surgeons at the hospital.

But people do commonly, and correctly, contact their own doctor who they see for other things and say, "I'm having this problem."

Their doctors are probably pretty good at figuring out what it is.

But they can come to see the orthopedic surgeon without having a referral, definitely.

Ke'an: If a person's saying, "You know what.

I just don't want to go to the doctor.

I don't want to go through that hassle."

If they wait, or if they delay coming to see you, does that make the problem worse?

James: No, not really.

In the cases or the instances where, there's only one instance I can think of where it would not be a good idea, and that is if the socket is being eroded away.

Sometimes in arthritis, the bone just starts getting ground away or eroded away.

If a lot of the socket gets destroyed by the process, hip replacements are harder to do and get a good result from, and not be at risk for having to have it redone.

But in the absence of that, there's no time limit on how long you can go really.

Ke'an: Okay.

Now thinking about hip replacement, it seems like a big surgery for somebody to go through.

I mean, that's sort of the thinking that people have is like, "Oh my goodness.

That's a major surgery."

But you're here to talk about something that's a little bit different than that.

James: That's right.

It doesn't take away from that it's a big surgery.

I think it is.

It's a big deal.

Having your joint replaced is a big deal.

Ke'an: Absolutely.

That may be a little less invasive?

James: Right.

Ke'an: Okay.

James: The latest and becoming one of the more popular ways of doing a hip replacement is to go from the front.

Because when the procedure is done by making an incision in the front of the hip, no muscles or tendons need to be cut.

Everything is left intact.

It makes recovering from the surgery just a totally different experience.

Ke'an: Yeah, absolutely.

Is there less pain involved then?

James: Yes.

Definitely.

There's less pain and there are less restrictions placed on the person in the post operative period because for instance, one of the things is that the hip can dislocate after surgery.

It dislocates easier.

The dislocation rate after surgery is higher for different approaches, certainly, than when done from the front.

The dislocation rate is minimal.

I think it still exists, but that's less.

I think that it hurts less, so people feel like doing more quickly.

And modern implant technology is fabulous.

And so people can and do return to the active life that they want to have quickly.

Ke'an: Okay, so given this approach versus what people would normally think would be invasive, what's the timeline difference and the pain associated with what people have known more in the past, I guess with hip replacement?

James: Well, I didn't hear of hip replacements being done as an out patient prior to this.

Ke'an: Right.

James: And I've done them as an outpatient since the start of it.

Ke'an: That's amazing.

James: It is totally amazing.

It is almost like, just a minute, I'll be right back.

I'm gonna go have my hip replaced.

Ke'an: That's crazy.

James: I mean, it's almost that good.

It is.

It is though.

I do these procedures, and then I'll go check on the patients in the afternoon.

I'll do them in the morning and go up in the afternoon and they get up and they walk and they feel good.

Then some go home.

That next day, for sure, a lot of people go home.

Most people stay overnight because, you know, insurance companies, that's not part of their program is outpatient hip surgery, so they're inclined not to pay for it.

But it's amazing really.

Ke'an: Describe the process a little bit.

If someone was going to come in and get this approach done, how do they prepare for it?

What's the ...

Walk somebody through it.

James: Okay.

The way it works is you come into the hospital the day of the surgery.

You can't eat or drink anything after midnight, like every other surgery.

You get an IV started.

Then you go back.

Spinal anesthesia is the way to go.

That's where you are numb from the waist down.

That anesthesia's the best for total joints because you can't have lung problems because a tube wasn't put down your throat.

They have less pain after the surgery and the rate of blood clot formation after surgery is less.

And their blood loss during the surgery is less.

This has all been well documented.

So a spinal anesthesia's the way to go, but if you can't have it, it's still okay.

Have a general.

You go back, have the surgery.

Now one of the other really revolutionary things that's been developed is the way we control pain after the surgery, because having it done from the front still hurts, but not as much as other ways, I think.

But we inject some medicine.

It's a long acting numbing medicine, I guess is the way to think of it, but it's more than that, around the hip.

When people wake up, especially if they had a spinal, they don't hurt much.

They have just very little pain.

Most people just take a pain pill if they have pain.

There are others that need more than that, but most do not.

That lasts and they never have that really bad pain ever.

I would say 98% of people come back a week later saying that they feel tremendously better than they did before they had the hip replacement.

Ke'an: Wow.

James: They were having really bad pain prior to the surgery, and after the surgery, they just have a small amount of pain.

Ke'an: A small amount.

James: Yes.

Ke'an: So the recovery time is less.

The pain is less.

Are there complications associated with it at all?

James: There are.

The complications are basically the same complications that can occur within a hip replacement.

You can lose enough blood to need a transfusion.

You can have a femur fracture.

That usually occurs at the time of the surgery.

You can still have hip dislocations, but they're much less common.

Infection can occur, after any surgery, including a hip replacement done through an anterior approach.

But those complications are all very uncommon.

Ke'an: Okay.

With this anterior approach, you don't cut through the muscle.

You don't cut through tendons.

So with other approaches, they do?

James: You definitely do in the other approaches, but I will say, I did posterior approach, which is probably one of the most widely used approaches in the country, for 25 years and people did really well.

The long term results are just as good.

A good total hip is a good total hip.

But it's just hard to compare the recovery time and the amount of pain you have in the recovery time to procedures done from the front.

Ke'an: Okay.

James: And that's why I started doing them that way.

Ke'an: All right.

Can you explain to folks watching, what is it that you actually do when you're doing the surgery for a total hip replacement?

Are you putting a device in there that does what it's normally supposed to do?

What does it look like?

James: Okay.

What it involves is there is a femoral neck and the femoral head.

The head is the ball.

The neck connects the head to the shaft of the femur, the long bone, the thigh bone.

To do the procedure, the femoral neck is cut and the head with that small part of the neck is removed because it's arthritic and diseased, and then a stem is put in the shaft of the femur that has attached to it a neck that replaces the neck that was cut.

And then there are balls of various sizes that you can use.

It's kind of like tinker toys, in a way.

Then we put in an artificial socket that matches the head size, so that when you pop the hip back in place, you have a smooth head articulating with a perfectly polished, smooth socket and the components are well fixed to the bone.

This brings up a subject.

Modern implant technology is great and the bone grows into the implant.

The implant has a rough, porous coating and the bone grows into it.

Then once the bone grows into it, the implant is fixed very well for good.

Ke'an: Wow.

So it just becomes part of your body.

James: Yeah.

It's stuck in there and they're very hard to get out.

The other way of fixing them is to cement them in.

That definitely has indications, but it's just done less frequently.

But it's a good way to go if it's indicated.

Ke'an: Okay.

Who would be a good candidate for this type of hip replacement?

James: Well, anybody who has, you know, significant arthritis and bad pain and has tried simple things to take care of it.

Sometimes an arthritis medication that you take when or if you're hurting is enough to get people by and they should not be doing a hip replacement.

Because that first method, taking the medication, has virtually no complications.

I mean, people can get a GI bleed from taking too much arthritis medication, but mostly the treatment is well tolerated.

It doesn't introduce the whole host of problems that people can have if they have a problem after hip replacement.

Most people who have bad pain and a good case of arthritis is a candidate.

The younger they are, the less excited people are about doing hip replacements, for obvious reasons, but I've seen patients, I didn't do the case myself, but who were as young as 17, believe it or not, and have a hip replacement.

I mean, trauma can do that.

Bad disease.

They'll do it these days.

Implant technology is actually good enough that it will last a very long time, even in these younger, more active people.

It's very cool.

Ke'an: Yeah.

That seems, yeah.

17 seems awful young to have to have a hip replacement.

You normally hear it happening in senior citizens and older adults.

James: A person would have to be pretty bad.

Right.

Ke'an: What are the restrictions after having this approach done and this hip replacement done?

James: Well, the main restrictions would be on how, what extremes of motion you place on your hip because probably, you know, a hip which is artificial, could be dislocated by somebody who knew how to do it.

I could not walk up to dislocate anybody's hip if they never had a hip replacement.

Good luck.

You almost have to get, have some severe trauma.

Restrictions on how much or what extremes of range of motion you have in your hip because it could dislocate.

High impact activities, like jumping rope or jogging, could be frowned upon really, but it's hard to jump rope for longer than 10 minutes anyway.

You know, I think those kind of activities, and beyond that, there's not a lot you cannot do.

Ke'an: Okay.

Are the restrictions less with this approach as they are for what we've seen in the past?

James: Yes, and I think it goes back to dislocation because hips done by a posterior approach definitely dislocate easier, almost universally than hips done from an anterior approach.

Some are very stable, but most do not have the stability that the other ones do.

Ke'an: Okay.

Are long term outcomes better after a total hip done this way?

James: Probably not because the outcome is measured by do I have pain and can I do everything I'd like to do, and how many years is it going to last.

A successful total hip done by any approach works really well.

Ke'an: All right.

Do you use a robotic mechanism or a scope?

How do you ... What does it look like?

James: It's very open surgeon.

It's done by, there are robotics.

I do not use that technique.

A lot of it's done by, and this is actually a good question, because by posterior approach, it's all by feel.

You can feel where the shaft of the bone is.

You get very good at doing it because you know how to do it and you've got ... With an anterior approach, we use X-ray.

Not to do the whole procedure, but at any moment in time I have the person laying flat on an OR table.

I can have an X-ray immediately.

A live X-ray, which is in the room and right there on standby.

If I want to check the position of my implants, I can look and say, right now, what is it.

How do we keep hips from dislocating?

It's implant position.

When done from a posterior approach, you put them in there and you think the position's good, but you don't really know how it is until they're off the table and you took an X-ray.

When you do it from the front, part of the procedure is you have X-ray right there.

And I know with perfect accuracy exactly what the implant position is.

If it's good or if it's bad.

I can determine the leg lengths.

Because when you do a hip replacement, I can lengthen the leg, shorten the leg, change the hip substantially.

And I can see an X-ray and know that the leg has to be exactly as long as it's supposed to be.

The implant position is perfect.

That's another reason I love doing it because I know that when I'm done, it's correct.

Ke'an: Yeah.

That's fascinating.

James: It is.

Ke'an: Is there therapy or rehabilitation that follows this approach, as well?

James: I do think there is.

For the first several weeks, what a person needs to be doing is getting up, walking, moving around.

That alone, that in and of itself, it helps to prevent blood clots.

Then after they've healed sufficiently, their muscles, no matter if they had it done anterior or posterior, they've taken a hit because prior to having a hip replacement, the people become less and less active and they're weak.

Then they have a surgical procedure, which the reflex is muscle weakening, whether or not a muscle was cut.

So strengthening is definitely, should be part of the program and for some people that means therapy.

Other people take the bull by the horns and do it themselves.

Ke'an: Okay.

What if somebody has had hip surgery in the past?

Can they get this type of surgery, as well?

James: They can.

That's common where somebody may have had a hip fracture that was treated surgically and now they have an arthritic hip, and that's converted to a total.

Or numerous other surgeries, including prior total hips that wore out or the implant loosened from the bone, or something like that.

Then those people have what's called a revision hip replacement.

The surgeries can be redone, if you want to use that term.

Ke'an: Okay.

Now what about, can they get hip replacements on both sides?

James: Yes.

Ke'an: Okay.

James: And with anterior hips, now I have not been doing them that way, but there are a lot of surgeons who would do both of them at the same sitting.

So you can not only have them, but you can have them both done at once in certain instances, if the surgeon thinks it's safe.

Ke'an: All right.

Well this has been really educational.

We have just a couple of minutes left.

Have we covered everything?

Is there anything that's new and upcoming that's interesting and fascinating that you'd like to share, as well?

James: I think that we've covered the important things.

What's interesting and fascinating is technology changes everything.

Ke'an: Yes.

James: There are so many very cool things, you know, in line, coming down the pike.

You don't know, you know tomorrow is going to bring something new.

What's here, the state of the art is very, very good.

For people who have bad hips, it's one of the best pain relief procedures on the planet.

It really is.

Don't be afraid of it.

Ke'an: Don't be afraid of it.

It's come a long way.

Thank you.

So very educational.

Adults have been working on the problem of teen pregnancy for years.

Now a new study shows that another group is also starting to think about it, teenagers.

Kim Hutcherson reports.

Kim Hutcherson: Contraception use among sexually active teenagers is higher now than it was in the late 80's.

That's one of the findings from the National Survey of Family Growth, which is administered by the Centers for Disease Control and Prevention.

Since 1988, the CDC has been tracking the sexual behaviors and activities of American teenagers between the ages of 15 and 19.

Researchers interviewed teens in their homes and responses are collected in complete privacy.

The most recent report gathered data from more than 4,000 teenagers between 2011 and 2015.

It found that while rates of sexual activity among teenagers are essentially unchanged since the late 1980's, the use of contraceptives has gone up significantly.

90% of female teenagers said they use some form of contraception, compared to 80% in 1988.

95% of male teenagers reported contraceptive use, up from 84% 30 years ago.

Condoms, the pill, and withdrawal were the most commonly used forms of birth control reported.

For today's health minute, I'm Kim Hutcherson.

Announcer: Production of Being Well is made possible in part by HSHS St. Anthony's Memorial Hospital.

Delivering compassionate care close to home.

From advanced surgical techniques and testing to convenient care for your family.

We promise to make a healthy difference each and every day.

St. Anthony's, together we are better.

Sarah Bush Lincoln Health Systems, supporting health lifestyles.

Eating a heart healthy diet, staying active, managing stress and regular check-ups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at SarahBush.org.

Rediscover Paris.

Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.