Hip replacement surgery is a common procedure that is necessary when the hip joint is worn or damaged. But what if the joint replacement could be avoided? Mayo Clinic's Center for Regenerative Medicine is pioneering alternatives for some patients, including younger adults.

On the Mayo Clinic Q&A podcast, Dr. Rafael Sierra, an orthopedic surgeon at Mayo Clinic, discusses who may be a candidate for a regenerative medicine approach to treating joint damage.

Watch: Dr. Sierra discusses regenerative medicine alternative to hip replacement

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The thought of hip replacement surgery made Blake Robinson extremely anxious, and for years, he put off the procedure. But when the pain became too much to bear, his medical team helped Blake overcome his fear. Now with the surgery behind him, and his hip pain gone, he's grateful for the high-quality care he received.

Preparing for a surgery can be nerve-wracking. Nearly everyone is at least a little unsettled in the days leading up to a procedure, not knowing exactly what to expect, but Blake Robinson was highly anxious. The 58-year-old Eau Claire, Wisconsin, man — whose only surgery had been a tonsillectomy in childhood — put off the hip replacement surgery he sorely needed for years, largely held back by his fear of the unknown.

But the pain finally got the best of him, and he could put off surgery no more. That's when, Blake says, he'll forever be thankful for the understanding and supportive orthopedic team who took him through the process of his total hip replacement.

"Every person knew their job," Blake says. "They did it well. They were courteous. They were kind. It just amazed me."

At a turning point

Blake, a seasonal parks staff member with the Eau Claire County Parks and Forestry Division, says the root of his joint problems started in the mid-1980s when he slipped on ice and broke his ankle.

"I didn't receive proper medical attention and, for years, I was walking just a little bit off with a limp," he says. "I'm pretty sure that's what slowly wore down my hip."

Blake, who has degenerative arthritis, was able to manage the discomfort in the beginning. But the pain steadily progressed, making his left hip stiffer and limiting his mobility as the years went by. In 2013, while on a hiking trip with his son, there was no question something was awry.

"We hiked about 8 miles to a lake and camped overnight," he says. "We really had a wonderful time. But I just noticed then I was really starting to struggle with the pain, and the movement was getting almost unbearable."

Initially suspecting a back injury, Blake first sought chiropractic care. After reviewing X-rays, his chiropractor recommended he see an orthopedic surgeon. Blake met with Edgar Hicks, M.D., at Mayo Clinic Health System in Eau Claire for an initial orthopedics consult in January 2018.

"Dr. Brand makes you feel at ease. When he says he's going to do something, he follows through with it."

Blake Robinson

"That consultation with Dr. Hicks helped me decide whether or not I wanted to do this at all," Blake says. "I was really scared. I was very nervous of the unknown and just had no idea what things were going to be like. But the consultation convinced me that this was the route I needed to take."

A few days after meeting with Dr. Hicks, Blake consulted with orthopedic surgeon Rusty Brand, M.D. That appointment also went well, and Blake decided to move forward with surgery. He had a left hip replacement in February 2018.

"Dr. Brand makes you feel at ease," Blake says. "When he says he's going to do something, he follows through with it. The surgery turned out exactly like he had told me it would."

Everything went as expected with the surgery, which involved replacing Blake's worn out ball-and-socket hip joint with an artificial hip ball-and-socket. Blake recovered nicely afterward.

"He did very well," Dr. Brand says. "It ended up being one of those things like: 'Oh, my gosh. Why did I put it off as long as I did?' Overall, he had a significant improvement in his quality of life, which is why we do the surgery."

In good hands

Dr. Brand recognizes that Blake is far from alone in his reservations about having surgery. He says many patients feel apprehensive prior to surgery, but the Orthopedic Surgery team reassures them that they're in good hands and will be well taken care of.

"This is something we do every day here," Dr. Brand says. "I don't dabble in hip replacement. Our department here is pretty subspecialized, and hips and knees are pretty much all I do."

Blake marvels now at how much better he feels since the surgery — to the point that he's almost ready to consider having a procedure on his right hip.

"The difference is amazing," he says. "My new left hip is so much stronger than the old one on the right. If anything, I'm starting to have issues with my right hip now, which used to be the good hip."

"Mayo Clinic Health System, to me, just runs like a well-oiled machine. I'm so grateful to have such quality health care available in my community."

Blake Robinson

Looking back now, Blake says he doesn't know what he waited for. He feels leaps and bounds better and would recommend to anyone in a similar situation that they pursue surgery, too

"I'm the perfect example of how you're scared, and you don't know what's going to go on, and they just walk you through everything — from start to finish," Blake says. "Mayo Clinic Health System, to me, just runs like a well-oiled machine. I'm so grateful to have such quality health care available in my community."

Dr. Brand, in turn, thanks Blake for trusting him to do his first major surgery. "I want to express our gratitude to him for putting his confidence in us when he was anxious about having a procedure," Dr. Brand says. "Our goal is to improve quality of life and get patients back to doing things they maybe would not be able to do because of their hip or knee. We're very happy for Blake."

Note: A version of this story previously was published in Hometown Health.

HELPFUL LINKS

• Learn more about hip replacement.
• Talk with others about joint replacement on Mayo Clinic Connect.
• Explore Mayo Clinic Health System.
• Request an appointment.

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“Neuropathy after surgery can significantly affect postsurgical outcomes,” says Nathan Staff, M.D., Ph.D., Mayo Clinic neurologist. “The good news is that if we’re able to identify patients experiencing postsurgical inflammatory neuropathy, rather than damage caused by a mechanical process, we may be able to provide treatment immediately to mitigate pain and improve overall outcomes.”

The study was a retrospective case series, including patients who developed pain and weakness in a limb after undergoing hip surgery where there was no documented direct or traction injury during surgery. Nerve biopsy demonstrated an inflammatory neuropathy in all patients.

Neuropathy refers to damage to the peripheral nerves in the limbs. Patients with neuropathy often experience numbness, tingling, pain and weakness that starts in their feet and moves upward. Neuropathy described in this study is isolated to the limb where the hip surgery occurred — often affecting the sciatic nerve that runs down the leg and controls strength and sensation.

Dr. Staff says it is important that physicians understand that nerve damage may be related to an inflammatory issue, and there are some telltale signs for physicians to look for:

• Patient’s neuropathy isn’t immediate, but rather it develops over time
• Severe pain
• Neuropathy progresses
• Different anatomical distribution than expected

“We know new or worsened weakness after hip surgery can be attributed to surgical factors, such as stretching, compression, contusion, hematoma or even transection of the nerve. But now we know that this weakness may be attributed to an inflammatory issue, and it’s important that physicians look for this cause, too,” says Dr. Staff.

Study authors also include Ruple Laughlin, M.D., P.B. Dyck, M.D., James Watson, M.D., Robert Spinner, M.D., Kimberly Amrami, M.D., Rafael Sierra, M.D., and Robert Trousdale, M.D., all of Mayo Clinic.

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MEDIA CONTACT:
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[Video and animation are available in the downloads. Reporter pkgs. can be edited into vo/sots and incorporated into your local reporting.]

Read script: 3D Printer Helps Hips

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Video, animation and script are available in the downloads above. Reporter pkgs can be edited into vo/sots and incorporated into your local reporting.

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To listen, click the link below.

Recovery From Hip Surgery

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...On my second visit to Mayo Clinic, I met Dr. Miguel Cabanela. I could tell when he walked in the room that he was the doctor for me. He listened to my parent’s concerns and questions, but most importantly he talked to me. I have Cerebral Palsy, and because my speech is hard to understand, many people don’t talk to me or think I don’t understand. When Dr. Cabanela asked me if I had any more questions, I asked if hip resurfacing would work. He looked at me with a smile and said, “You’ve been researching on the internet.” We both laughed. It was at the point that he recognized how much I did understand what was going on. He explained to me why he thought a PAO (Periacetabular Osteotomy) was the best option for me. I decided he was the best doctor for me and we scheduled my surgery for March 17th – a lucky day for me....

See Lindsay's entire story here. You can share your story about Mayo Clinic here.

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