Smaller can mean faster
In Heuck's first meeting with Miller, the physician was very direct. "You've exhausted your non-operative options," Miller said, "and your best option is to have the hip replaced." Heuck's left hip had never formed properly—that had caused the difference in his leg lengths—and it failed quickly, relative to his age, Miller said. "That's often the case."
Miller explained what he wanted to do: Instead of a 10- to 12-inch incision, a three-to four-inch incision; instead of a general anesthesia, which often causes postoperative nausea and mental confusion, a spinal anesthesia, which would avoid that side effect and dampen nerve fibers that respond to surgical pain. He would also use a long-acting local infusion of a numbing, Novocain-like medication, in combination with a drug that causes blood vessels to constrict and keep the numbing medication from dispersing.
After the surgery, Heuck would be given pain medications, but fewer narcotics, which can interfere with a patient's ability to participate in therapy. Within hours of the surgery, Miller would be asking Heuck to get up right away, and expecting physical therapists to help Heuck walk and get himself in and out of bed. That kind of immediate activity, Miller said, can cut rehabilitation time to weeks instead of months.
It's a hugely different scenario from the early days of hip and knee replacements, in the 1960's, when patients might spend three to four months in the hospital and then many more months recovering full function.
With newly-designed instrumentation that allows less damage to muscles, through that smaller incision, the kind of fast recovery Heuck experienced is now possible. "Healthy, younger patients can go home the morning after," Miller said. "The goal is to get people healed quicker so they can get back to work and get back to life."
The smaller incision surgery is more technically demanding, Miller said. "You have to know how to look at things, to know what you're looking for. You have to have lots of experience and specific training with hips and knees before you do small incision replacements."
Less fuss, less pain
Before his surgery, Heuck and his wife, Janie, had to attend a pre-surgery class, of sorts, to learn what to expect. Heuck said he was surprised at first because he was 20 years younger than everyone else. Then, as the class continued and the instructor was explaining about drains and bandages, Heuck said, she kept turning to him and saying, "Oh, you won't have that with Dr. Miller," Heuck began to appreciate how his hip replacement might be different from most.
"I don't think I had a full appreciation of how wonderful it was going to be," said Janie Heuck. "It was all new to us." She visited her husband in the recovery room immediately after surgery and expected to say hello and leave. "I thought he would be loopy, and he was completely coherent!"