What is hip replacement surgery?
The amount of pain you experience after surgery may depend on several factors, including type of surgery, the implants used and your overall health.

“Joint replacement procedures have a certain amount of discomfort no matter what,” Dr. Himschoot said.

There are different types of hip replacement or partial replacement surgeries. There are also hip resurfacing procedures that cap the bones with metal or ceramic implants, instead of replacing them with a synthetic joint. The goal of a hip replacement, either total or partial, is to restore or maintain movement and flexibility in the joint.

The causes of hip pain and damage can include:

• Osteoarthritis, which commonly occurs with normal everyday activity over time: Osteoarthritis damages the cartilage at the ends of the bones and helps joints move smoothly.
• Rheumatoid arthritis is caused by an overactive immune system, which creates inflammation that can erode cartilage and occasionally underlying bone, resulting in joint damage.
• Osteonecrosis is a less common condition, when there isn’t enough blood supplied to the ball portion of the hip joint, which can cause the bone to collapse and deform.

You also may need a partial or total hip replacement if you injure the joint. Hip fractures are more common as we age, especially in women. 

Hip replacement may be an option if your chronic pain:

• Persists, despite pain medication
• Worsens with walking, even with a cane or walker
• Interferes with sleep
• Affects the ability to walk up or down stairs
• Makes it difficult to rise from sitting down

Your doctor can help you decide whether you’re ready for joint replacement surgery.

Pain during and after hip surgery

You will be given anesthesia (pain management) for the surgery. Depending on your specific situation, you may be given a regional anesthetic, which blocks nerves to a certain part of your body. You are still awake during the procedure, but you may have a light sedative to help you relax. You may be given a general anesthetic, which acts on the brain and nervous system and puts your body to sleep. 

Immediately after surgery, you will spend time in recovery. There will be some pain and soreness at the incision site. There may be some bruising, and you may feel very tired. Your pain will be monitored and managed by hospital staff. You will get up to walk as soon as possible after the operation, using a cane or walker. Many people report feeling more pain on the second day after surgery.

“The goal is to stay a step ahead of your pain with ice or pain medication,” Dr. Himschoot said. “You will go home with prescriptions for your pain management and directions on how to use those medications, as well as other pain relief techniques.”

Your experience will be unique to you, but many people report:

• Discomfort in the hip for one to three months after surgery
• Discontinuing pain medication one to four weeks after surgery
• Resuming normal activity, with possible mild discomfort, in about six months
• Being pain free in about a year

Recovering from a hip replacement

Hip replacement recovery also may include:

•  Physical therapy (PT): You will start PT in the hospital after surgery and continue for several months. This includes stretches for mobility and strengthening exercises for the muscles around the new hip. 
• Assistive devices such as a walker or cane
• Nondrug approaches like ice, heat or massage.
• Medications including opioids, nonsteroidal anti-inflammatory drugs (also called NSAIDs) or other medicine.

Hip replacement recovery experiences vary from person to person. Factors that affect your pain levels include:

• Your individual tolerance for pain and discomfort
• Age, health and overall fitness level
• How well you follow your doctor’s instructions for your recovery after surgery, including for physical therapy and medications

Your surgeon and the rest of your medical team will be there to guide you through your hip replacement recovery and beyond. 

If you or a loved one has questions about minimally invasive hip replacement surgery and other replacement procedures, ask your doctor. They can help dispel myths about joint replacement, assess whether you may be a good candidate for hip surgery and help you choose an orthopedic surgeon.

The post Many factors affect how much pain you may have after joint replacement: Age, overall health and more appeared first on Norton Healthcare.

Kevin J. Himschoot, M.D., orthopedic surgeon with Norton Orthopedic Institute, suggests thinking about the following:

Pain

Does your pain in your hip come and go? Does it occur only during strenuous activity? Or is it constant hip pain that interferes with daily life?

If your pain comes and goes, you’re likely not ready for surgery. The good news: There are some nonsurgical ways to get pain relief. These may include taking nonsteroidal anti-inflammatory drugs (NSAIDs) or steroid injections for pain relief. Physical therapy exercises and stretches can improve strength and mobility by loosening muscles, ligaments or the hip joint capsule — ligaments and fibers that surround the joint. 

Read more: Don’t ignore these 5 symptoms of joint pain

Age and activity

Next, think about your age and activity level. If you are active and would like to stay active for many years to come, a hip replacement may make that possible. Surgeons are performing joint replacement surgery on younger patients than they have in the past. However, surgery typically will not be considered until you are in your 50s. Also, unless X-rays show moderate to advanced hip arthritis, nonsurgical treatment will be recommended.

Weight and overall health

Finally, how is the rest of your health, including your weight? Carrying extra weight is a big factor in hip pain. Surgeons typically will not perform hip replacement surgery on patients with a body mass index over 40, as it increases complications during and after surgery.

However, there are physical therapy programs tailored to help with weight loss while supporting and aiming to improve chronic hip pain. Your health care provider can help you find a physical therapy or weight loss program to suit your needs.

Do you have heart disease or diabetes? Is your diabetes under control with an appropriate hemoglobin A1C level? Optimizing chronic medical conditions will be necessary prior to surgery.

You’ll also want to make sure you’re mentally prepared for a tough couple of weeks after surgery.

Can you push through pain during physical therapy as you work on strengthening and moving your new joint?

Total hip replacement surgery versus partial hip replacement

If you have extensive hip joint damage due to conditions such as osteoarthritis or rheumatoid arthritis, you may be a candidate for a total hip replacement. In this procedure, known formally as total hip arthroplasty, both the ball (femoral head) and socket (acetabulum) are replaced with an artificial joint.

A partial hip replacement replaces only the femoral head. This is considered in cases where the acetabulum is healthy. An example of such an instance is a hip injury such as a fractured femoral head.

The post How can you tell if you need a hip replacement? appeared first on Norton Healthcare.

But how painful is the hip replacement surgery itself, and what’s the recovery like from getting an artificial joint? 

“There are options to alleviate pain that don’t involve surgery, but there often comes a point for many of my patients when they know it’s time for a hip replacement,” said Jeffrey D. Stimac, M.D., a joint replacement surgeon with Norton Orthopedic Institute. 

Hip replacement surgery is most commonly performed on people between ages 50 and 80, but they can be performed on patients of any age, from teenagers with juvenile arthritis to older patients with degenerative arthritis. Surgery is recommended based on pain and disability. 

Much of the decision depends on whether pain relief isn’t sufficient from anti-inflammatory pain medication, physical therapy, modifications to daily activities and use of walking supports.

According to the American Academy of Orthopaedic Surgeons, you might benefit from hip replacement surgery if your hip pain limits everyday activities such as walking or bending, if the pain persists day and night, or if the stiffness limits your ability to move or lift your leg.

Here’s a rundown of the pain you will experience throughout the process: 

During the approximately hourlong hip replacement surgery itself, you are under anesthesia and feel no pain. 

The surgeon will make an incision, remove diseased and damaged bone and cartilage and leave healthy bone intact. The surgeon then will install the hip implant: a replacement hip socket with a metal stem inserted into the top of the thigh bone, which is then topped with a replacement ball.

When you awake from anesthesia, you are monitored in the recovery area. Soon after, you will be encouraged to sit up and walk using a cane or a walker, under the supervision of a physical therapist. This is to help prevent complications such as blood clots in the legs.

Hip replacement surgery is typically an outpatient procedure, meaning you are often sent home the same day. 

Your orthopedic surgeon at Norton Orthopedic Institute will perform an anterior hip replacement if you are a good candidate. This anterior approach, from the front rather than the back, involves cutting less muscle.

Hip replacement recovery 

Immediately following hip surgery, you will feel some discomfort at the site of the incision and around the hip. There also may be some pain in the thigh and knee. This is associated with the change in length of your leg.

Pain from surgery typically will diminish within days. After surgery, you start on a walker or a cane for balance, but usually don’t need the walker for more than a couple of days and don’t need either a cane or a walker at your two-week follow-up appointment. 

Norton Orthopedic Institute will give you exercises to keep you moving and strengthen your hip joint and the muscles around it, which will be weak after surgery. Physical therapists will come to your house to make sure you do the exercises as prescribed, which helps speed recovery. 

Daily activities and exercises will help you regain use of the muscles and the joint.  

Full recovery typically can take six to eight months, but it’s not uncommon to be exercising normally on your new hip joint two months after surgery. 

In the long run, hip replacement surgery should reduce pain, restore strength and mobility to your hip, and help you return to normal activities. It’s important to talk to your doctor if you are still experiencing pain that affects day-to-day activities months after surgery. 

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Liz went to see her doctor, and images of her hip showed the joint was worn out, according to Liz. She was told she’d need hip replacement surgery.

“I had no idea. It was a complete shock,” Liz said.

Less than a week later, Liz’s husband wheeled her into Norton Brownsboro Hospital for hip replacement surgery.

“When he was pushing me in the wheelchair, he didn’t know if that was going to be the new normal,” Liz said.

Surgery at 2 p.m. and home the same day

Kevin J. Himschoot, M.D., orthopedic surgeon with Norton Orthopedic Institute, performed the surgery. The incision was made on the front of Liz’s pelvis rather than the back. That way, less muscle is spared while accessing the joint, making for a faster recovery.

“He was very kind. He really listened to what was happening with me. He was sympathetic to my problem. He knew I was struggling, and he was very reassuring,” Liz said.

The surgery was at 2 p.m., and Liz went home from the hospital later that day. Before she left, a physical therapist worked with her at the hospital to make sure she’d be able to make it up the steps into her home. She used a walker to get around the house, but didn’t need it anymore after a few days.

After the surgery, a physical therapist came to Liz’s house to work with her. Her hip joint and the muscles around it were weak after surgery. The day after surgery, for example, Liz struggled to lie on her back, lift her left leg and move it to the side.

Working with the physical therapist, she was able to strengthen the muscles around her hip bit by bit.

“For the surgery to be successful, you have to be truly committed to physical therapy,” Liz said.

Back to hiking and checking the national parks off her bucket list

Before the surgery, Dr. Himschoot asked Liz about her goals for the hip replacement surgery. She said she wanted to keep up with her grandchildren, and she has been doing just that. On a recent fall day, Liz was jumping in the leaves with her 5-year-old grandson. She is also back to attending Jazzercise classes every day.

“I can do pretty much anything I want. I have no restrictions,” Liz said.

She tells everyone she knows not to put off hip replacement surgery due to fears.

“It’s life-changing. You’re up and walking around that day,” she said.

She’s gotten back out into nature, which she loves — fly fishing in Alaska and hiking at a state park in Texas.

Now that she is active again, Liz plans to resume her quest to hike in every national park. She’s been to half of them, and she and her husband are looking at national parks in North and South Dakota for next summer.

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Your partner likely has taken on many of the duties of caregiver as your arthritic knee or hip became gradually more debilitating. The study, presented as part of an American Academy of Orthopaedic Surgeons seminar, found that a spouse’s quality of life improves after hip or knee replacement surgery.

“It’s not uncommon to see two or more people benefit from one person’s hip or knee replacement surgery,” said Jeffrey Stimac, M.D., Norton Orthopedic Institute orthopedic surgeon specially trained in reconstructive surgery. “As the patient’s osteoarthritis gradually worsens over the years, their spouse’s life is affected as their lives become consumed with the patient’s pain and limitations.”

The study interviewed 33 couples with an average age in their late 60s who had been married on average about 36 years. They had been living with an osteoarthritis diagnosis for about seven years. Each partner was interviewed separately, and the patients had recovered completely at the time of the interview.

Spouses reported that their lives had improved as they had become able to participate in more activities with their partner.

Specifically, the benefits spouses cited after hip or knee replacement surgery most often were:

• Ability to carry on with social and leisure activities with their partner
• No longer witnessed the patient experiencing pain
• Diminished caregiver burden
• A sense of independence to resume their normal life
• Improved marital relationship
• Improved social and family life
• Freedom to travel

Patients most often reported getting around easier, resuming leisure and sporting activities, less pain and improved social and family lives after hip or knee replacement surgery.

The post Spouses and partners are beneficiaries of knee and hip replacements too, study finds appeared first on Norton Healthcare.

“Whether it’s getting back to skiing or kneeling and playing with their grandkids, I have the tools and the training to help,” said Dr. Himschoot, the newest member of the team at Norton Orthopedic Institute.

Dr. Himschoot specializes in hip and knee replacements. He also treats previous replacements and performs partial knee replacements.

Robotic-assisted precision for joint replacements

Dr. Himschoot joined Norton Orthopedic Institute after completing a fellowship at Norton Brownsboro Hospital. He learned the latest techniques for hip and knee replacements, including a robotic-assisted knee replacement procedure pioneered at Norton Orthopedic Institute.

“The robots we’re using are much better than the human eye at being able to make adjustments by a millimeter or half a degree at a time,” he said.

Norton Orthopedic Institute was first in the Louisville area to use the ROSA Knee System. In addition to its superior precision, the system uses X-rays to create a 3D model of the existing anatomy so surgeons can plan specifics of the replacement ahead of time. Other robotic-assisted systems rely on higher-radiation imaging methods.

Dr. Himschoot also performs the latest total hip replacement technique, which similarly uses X-rays to model the anatomy and allows him to place the artificial hip with down-to-the-millimeter precision.

“It’s more precise than it’s ever been done before,” Dr. Himschoot said. “Compared with 20 years ago, it’s a night and day difference. It certainly leads to better patient outcomes.”

Giving quality of life back to patients

Originally from Sanford, Florida, a suburb of Orlando, Dr. Himschoot said he wanted to be surgeon since he was in high school.

“Surgery was my first dream, my first and only passion of what I wanted to be when I grew up,” he said.

Surgery was a natural fit since he spent a lot of time growing up working with tools with his father, and with his uncle, who fixed houses for living.

“When I did my orthopedics rotation in medical school, it felt like it was back home,” he said. “It just clicked.”

Dr. Himschoot attended Florida State University College of Medicine, in Tallahassee, and did his medical residency at the University of Louisville School of Medicine before his fellowship in hip and knee replacement at Norton Brownsboro Hospital.

“I think the biggest the reason I went into the reconstruction work is giving people back what they had in terms of a functionality and quality of life,” Dr. Himschoot said. “That’s how I try to approach patients. I’m lucky to be in a field where I can do that.”

When he’s not working, Dr. Himschoot enjoys spending time outside. As a native Floridian, he loves fishing and spending time on the water. He also enjoys time with his family and 6-month-old son.

New to Louisville, Dr. Himschoot said he is impressed by his new neighbors’ warmth and hospitality.

“There’s a culture and a pulse to the city I’ve enjoyed getting to know,” he said. “I want to stay here and make it home.”

The post Performing joint replacements with precision that restores quality of life drives Kevin Himschoot, M.D. appeared first on Norton Healthcare.

“I’d get steroid injections, and it would feel better for a while; and then the pain would come back.” Lee said. “People would say, ‘You’re limping,’ and I’d say, ‘I know. It hurts.’”

Worst of all yoga, kayaking with her 11-year-old twins and other activities were becoming more and more difficult. One day, she was walking from a two-hour meeting when her hip simply stopped working. Only after massaging the joint was she able to make it to her car.

A week later, her orthopedic surgeon with Norton Orthopedic Institute, confirmed what Lee suspected. She needed hip replacement surgery. She was 54 at the time.

Surgery at 7 a.m., home about 1 p.m.

What Lee didn’t expect when she went to Norton Orthopedic Institute was that she’d be home hours after her surgery and that she’d be active again in two months.

Lee had her hip replacement surgery at 7 a.m. on a December day. Instead of general anesthesia, she received an epidural for pain and a sedative to make her sleep. After surgery, she received a visit from a physical therapist and instructions on how to use a walker.

“They want you to get up and walk in the hospital. They make you do stairs,” Lee said. She was home around 1 p.m. Lee started physical therapy the next day.

“This was the big thing. They send a physical therapist to your house to make sure you do the physical therapy as prescribed,” Lee said. “They gave me exercises, and I did them religiously. They want you to keep moving.”

Eight weeks after surgery, Lee was back to exercising, walking every day and becoming more and more active.

Norton Orthopedic Institute surgeons pioneered a less disruptive technique for hip replacements. Rather than access the hip from the back, making incisions in front makes for a faster recovery and less pain for most because key muscles are not affected during the surgery.

Back to yoga, kayaking and learning to surf

When she does yoga now, Lee is able to do poses she couldn’t do before.

She’s also back to kayaking on the Blue River in Indiana. She’d been worried she was going to have to give it up for good. Getting in and out of the kayak is no longer difficult.

After the hip replacement, Lee also said she isn’t sore — and isn’t limited in what she can do. This summer, Lee and her twins went surfing for the first time, on Nantucket Island in Massachusetts.

“I was telling the surfing instructor I got a new hip in December. The instructor said, ‘No way dude,’” Lee said. “I won’t say I got up for more than a few seconds at a time, but the hip worked fine.”

Lee no longer endures the daily soreness and bone-on-bone pain in her right hip.

“It would be worse at the end of the day and stiff in the morning. I was very conscious I didn’t have the full function on that right side. I’d be afraid I’d fall going down steps. I had to be careful,” Lee said.

Lee’s only regret is waiting as long as she did to get her hip replacement.

“If you can’t do any of the things you like to do, don’t wait. Get it done. Now you can go home the same day. It’s amazing,” she said. “There’s no reason not to have it done.”

The post From a December hip replacement to learning to surf by summer appeared first on Norton Healthcare.

It’s “one of the things that made us fall in love with this city,” Dr. Kure said, referring to himself and his fiancée. “I hope to help more of them enjoy that lifestyle for as long as possible.”

Dr. Kure is an orthopedic surgeon with Norton Orthopedic Institute, providing trauma care, joint replacements and other treatments that help keep his patients moving.

Dr. Kure uses an advancement in joint replacement that has become a growing trend in total hip arthroplasty. This less invasive approach allows patients to start recovering faster.

Traditionally, hip replacement surgery involved a large incision on the rear or side to access the diseased bone. Recovery was long and involved at least a couple nights in the hospital. A less invasive approach through the front uses a smaller incision, and even some patients can potentially go home the same day.

“People can walk out of the hospital the same day with limited pain and restrictions; we’re getting them back on their feet much faster,” Dr. Kure said.

Less invasive procedures with shorter recoveries make joint replacements a more attractive solution for patients, including those who enjoy sports and the outdoors.

According to Dr. Kure, the key is not only using the most cutting-edge technique, but ensuring that the surgeon and patient work together as a team.

“Setting patient expectations plays a significant role in what I do,” he said. “You have the best surgical outcome when the team inside and outside the hospital is all working together, and the patient is motivated to get back and do whatever it takes to get there.”

A childhood dream to be a surgeon

Growing up in Grand Blanc, Michigan, Dr. Kure envisioned a career as a surgeon.

“Growing up in medical family, I was exposed to medicine from a very young age, and I honestly always knew that I wanted to do surgery.”

The decision to specialize in orthopedic surgery came early too. A lifelong sports enthusiast, Dr. Kure understands the desire to keep moving.

“I bike, golf and participate in water sports,” he said. “I try to be active in all seasons, so I know I would be frustrated if an injury held me back.”

Inspired by the notion of helping others live life fully, he graduated from Michigan State University in East Lansing and entered the College of Osteopathic Medicine at Des Moines University in Iowa, focused on becoming an orthopedic surgeon. He came to Louisville for an orthopedic surgery fellowship at the University of Louisville after completing his residency in his home state of Michigan.

“The fellowship was a great opportunity to see a lot of Level I trauma,” Dr. Kure said. “It allowed me to gain great experience with traumatic injuries.”

Strong patient-doctor relationships are at the heart of Dr. Kure’s approach to medicine.

“One thing that is fascinating about orthopedic surgery is that you get to work with such different groups of people,” Dr. Kure said. “You work with the healthy and the unhealthy; young and old; active and inactive patients.”

Dr. Kure divides his time between general orthopedic patients and those with traumatic injuries.  No matter who the patient is, Dr. Kure’s goal is always the same.

“It’s about getting people back to a better quality of life, increasing their mobility and giving them the opportunity to do things they previously enjoyed,” he said.

The post More hip replacement patients can recover at home quicker with the arrival of Carl Kure, D.O. appeared first on Norton Healthcare.

With Norton Healthcare teaming with the Louisville Cardinals as their official health care provider, Dr. Smith is also the head team physician for University of Louisville football.

“It’s an honor to have this wonderful opportunity and responsibility of taking care of the athletes from my hometown and alma mater,” Dr. Smith said.

Dr. Smith’s role with the team includes  preventive care and treating injuries. Other patients can benefit from his expertise at Norton Sports Health and Norton Orthopedic Institute.

“We take care of patients of all ages and activity levels,” Dr. Smith said.  “We take care of sports injuries, arthritis, trauma, providing non- operative and operative options including arthroscopic surgery and joint replacements.”

Norton Orthopedic Institute has more than 80 providers, including orthopedic surgeons at 30 locations in Louisville and Southern Indiana.

“When treating athletes, not only is our goal to get them back to the field as quickly and safely as possible, but also back to the same level of competition and performance.” Dr. Smith said.

With patients who are not athletes, Dr. Smith said the goal is still getting people back to their previous lifestyle and fitness level. In the case of arthritis, the aim is reducing pain.

With his surgical training, Dr. Smith can determine which conditions don’t require an operation. As a result, most of his patients receive more conservative treatments than surgery.

“We’re happy to get you better and get you doing what you want to do,” he said. “If you have a knee replacement or hip fracture surgery, we want to get you up and going right away. Over time, the pain subsides, and you can comfortably walk to church or the grocery store. That’s a success, too.”

Dr. Smith said he enjoys developing a relationship with patients and their families. With all his patients, Dr. Smith said he takes the time to listen.

Smith grew up in Oldham County, outside Louisville, playing football, baseball, and tennis. When he was 11, he realized there were specialized doctors who cared for athletes when he read about injured stars like the legendary professional football and baseball player Bo Jackson.

“Initially, I thought orthopedics was only sports medicine,” Dr. Smith said.  “Over time, I came to learn about the entire spectrum of the conditions we treat.”

Dr. Smith attended the University of Louisville both as an undergraduate and for medical school. He did his medical residency at the University of Toledo Medical Center and a fellowship in Sports Medicine at Wake Forest University.

Dr. Smith then began practice in a small town in Southern Indiana taking care of the athletes from several local high schools. Working for Norton Healthcare and returning to Louisville was a homecoming. Dr. Smith’s wife is from Henry County. The couple have threeschool-aged children.

Caring for Division I athletes is a dream come true for Dr. Smith.

“Taking care of patients of all ages and activity levels has been very rewarding. My new role allows me to treat these collegiate athletes on and off the field,” he said.

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Norton Healthcare and LHC Group Inc. announced recently the formation of a joint venture partnership – creating Norton Home Health – to enhance in-home health care services for patients in Louisville and across the region. The two organizations will collaborate to help patients manage their chronic conditions, seamlessly transition from hospital care, and rest and recover in an environment where they are most comfortable.

“We are pleased to partner with LHC Group to enhance the home health services we provide for our patients,” said Russell F. Cox, president and CEO, Norton Healthcare. “Through Norton Home Health, patients will receive care to regain strength and independence following an injury or illness, or when dealing with a chronic condition or disabling disease. They will also benefit from a multidisciplinary approach to treatment that is monitored through their integrated electronic medical record, stay connected to their health record and communicate with their provider through MyNortonChart.”

In-home care supports faster recovery and patient independence.

“It’s a benefit for our patients to receive healthcare in their own environment as they work to regain strength and independence,” said Kathleen Exline, system vice president, Performance Excellence and Care Continuum, Norton Healthcare. “Our providers, including home health nurses, therapists and social workers, will offer valuable guidance and support, and provide the educational tools and resources patients and families need to make informed decisions on care for themselves or a loved one.”

Home health care is an effective and affordable solution for many patients’ post-acute care needs and situations. This partnership will help patients manage health care costs and hospital admission rates. It will provide a full range of home care, and patients can trust that the treatment plans their doctors prescribe will be followed thoroughly.

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