Hip Replacement/Revision Surgery
A Change for the Better
The second time her hip dislocated, it took Shelly Leclaire two hours to navigate from the living room to the kitchen where she could call for help. The sixth time, her young grandchildren were sleeping over during Christmas vacation. Shelly, 60, who lives in Hopedale, had a hip replacement for painful osteoarthritis at a Boston hospital in February 2020.
Most people who undergo hip replacement have a dramatic reduction in pain and a significant improvement in their quality of life. However, there is a small risk of dislocation – when the ball of the new implant comes out of the socket. “You know there’s a possibility it can happen, but you’re never prepared for that level of pain when it dislocates,” Shelly recalls. “There’s no warning. It just happens and there’s nothing you can do to stop it. You’re basically stuck, so you can’t move, and the pain is absolutely excruciating.”
Over 10 months, Shelly suffered six dislocations. The doctors she consulted wanted to take a conservative approach and wait for the area to heal before doing another surgery. Geoffrey Stoker, MD, an orthopedic surgeon at Milford Regional Orthopedics, had another strategy for her to consider. Dr. Stoker’s practice focuses on partial and total knee and hip replacement, including revision procedures – surgeries performed to replace or reconstruct a failed joint replacement.
On February 26, about a year after her total hip replacement, Shelly underwent revision hip surgery at Milford Regional. Dr. Stoker relates that when he met Shelly and reviewed her X-rays, he suspected that the cup position from the initial hip replacement was contributing to her problem.
“Your natural hip is a ball-and-socket-type joint,” he explains. “A primary (first-time) hip replacement recreates that. The surgeon puts a metal cup into the pelvis, a metal stem in the femur, a liner that snaps into the cup, and a head that attaches to the stem and rolls around within the liner. For the vast majority of people with Shelly’s cup position, it would have been fine, but for whatever reason, with her biomechanics, it just didn’t work for her.” In a dislocation, the ball slides out of the socket and the joint no longer articulates properly. When a total hip dislocates, the head typically slides up the pelvis and the leg becomes shorter than the other, says Dr. Stoker. Dislocations can occur soon after surgery or years down the line. “Depending on the research you read, upwards of 80 percent of people still have their hip replacement after 20 years,” states Dr. Stoker. “For most people getting them in their 50s and 60s, you hope it lasts the rest of their lives. About one to four percent of patients have a dislocation following a hip replacement, and after it comes out once in the early postoperative period, there is a 25-35 percent chance of it dislocating again.”
After a dislocation happens, patients typically go to an emergency department for treatment. Most
times, they’re given anesthesia and undergo a closed reduction, a procedure for treating a hip dislocation without surgery, says Dr. Stoker. It involves manipulation of the thigh bone (femur) to put the hip back in place. After the first or second dislocation, a brace is sometimes prescribed in hopes of preventing at-risk hip movement and promoting healing, but this option didn’t help Shelly. For situations in which the hip continues to dislocate, revision surgery may be an option. Other reasons for revision include loosening of the implant, infection, fracture or liner wear, adds Dr. Stoker.
“I looked at Shelly’s X-ray and thought there was an opportunity to change her cup’s position and head size,” he recalls. “Considering how much her life was affected and how debilitated she was, I was willing to do a revision sooner rather than later.”
Although Dr. Stoker was optimistic, he couldn’t guarantee it would be successful. “I left the stem in the femur and changed the other parts,” explains Dr. Stoker. “I put in a new cup that was bigger and faces more forward and increased the head size from 32 to 49 millimeters.”
Shelly remembers that before meeting Dr. Stoker, she grappled with anxiety about another dislocation. The first incident was seven weeks after her hip replacement, and although she was fitted for a brace, she suffered a second dislocation a week later. In total, she called the paramedics six times in 2020, she recalls. Each time, they needed to start an IV, monitor her vitals, and give her pain medicine before attempting to move her out of her home and into the ambulance.
After the two-hour ordeal when she couldn’t call for help, Shelly made sure her phone was with her at all times in case of an emergency. Between episodes, she felt fine physically, but the threat of dislocation kept lurking in her mind. “As soon as they pop it back in, I’m pain-free, and I hold my breath,” she says. “It’s like you’re waiting and waiting, and then it happens, validating your fear. The quality of my life was zero. I wouldn’t walk anywhere. I wouldn’t sit on a beach chair because it was so low. A friend made me an 8-inch cushion to sit on so I was higher.”
Several months passed between her fifth and sixth episode, and Shelly hoped she might be out of the woods – until it happened again. After her emergency room visit, the Milford Regional staff connected her with Dr. Stoker, a recent addition to the orthopedic team, for a follow-up appointment. “On my discharge papers, they put down his phone number,” Shelly says. “I called his office the next day and they already knew about me. I went in for an appointment at 4:30 that afternoon. Dr. Stoker felt he could help me, and he did. I put my trust in him."
Shelly stayed overnight for her revision surgery and was sent home with standard range of motion restrictions or “precautions.” Dr. Stoker explains that Shelly had a posterior hip replacement and revision because her original surgery was posterior, which has an incision at the back of the hip. It has a slightly higher risk of dislocation than an anterior approach, which goes through the front of the hip. Due to this risk, posterior patients generally have more, albeit temporary, range of motion restrictions postoperatively, such as not crossing the legs. According to Dr. Stoker, he performs anterior replacements on about 90 percent of his primary hip replacement patients.
This approach for hip replacement has become more prevalent in the last 10 years. Dr. Stoker follows up with patients at two weeks, six weeks, three months, six months and yearly. Three weeks after her surgery, Shelly was going up and down the stairs, walking her dog and driving. Gradually, her anxiety about another dislocation grew less and less. Now she can look back on those memories with relief that the ordeal is over.
“The surgical care was phenomenal, and the nurses and doctor in the operating room were wonderful,” says Shelly. “I can’t say enough about the experience I had from beginning to end. Dr. Stoker called me the night before my surgery and asked me if I had any questions. He was there pre-op, post-op and the next day. He took the time to make me feel comfortable enough that I could trust him. Dr. Stoker does a fabulous job and really takes time with his patients. He changed my life.”
Appointments can be made with Dr. Stoker by calling 774-462-3345.
Read more about Dr. Stoker here.
