Having Hip Replacement Surgery: What to Expect

I, I, I need a hip replacement. For 32 years of playing squash, my right hip is killing me. I want to get back in the game. I've been avoiding it for two years. I could go anywhere. I could go to Abu Dhabi. I could go to Dubai. I can do anywhere in the United States. And I also can come to Canada.

So nobody knows this, but in Canada, we have some of the most advanced doctors in the world in hip and knee. There's a guy here, Sebastian Rodriguez is his name. He's the guy. He's the goat for hip replacement. Where is he? Humber River Hospital. So I went up there. I met the administration. I met him. I met the whole team. I saw the lab. They've got this incredible AI digital training lab for knee and hip where you actually put on 3D goggles, and you have a scalpel, and you are taught the procedure in 3D. It's unbelievable. We're leading the world in that, and everybody's crapping on the Canadian medical system.

So I chose that hospital for my hip replacement. I'm going to blow those guys up. I'm going to say, "Look, let's videotape the procedure, and if I live through it, that'll be very good." And so, you know, it's sort of, let's celebrate what we do so well here, and give these guys the shout out they deserve because I combed the world. I went everywhere. If you're getting hip replacement and you're in India, you're in Abu Dhabi, you're in Riyadh, you want that hospital. I could have done my surgery anywhere, and I was planning on doing it elsewhere.

But just as luck would have it, and this is completely just random, I met Joe Gorman at my restaurant in Toronto here the night before my wife was coming in for a routine MRI. He came up to me and said, "I think your wife's coming to our hospital tomorrow. Do you know about our hospital?" I said, "No, I never heard of it. Why don't you come up and have a look at it?" Right after that MRI, I met, you know, Sebastian Rodriguez.

He said, "This is not a torn hip. This is a hip replacement you're going to need." "You're giving me bad news? Well, it looks like, Kevin, you have some arthritis in your hip, and it looks like we might have to do a hip replacement to get you back to being Mr. Wonderful."

"Full point out where this disaster is, so you can see here. There's a little... the cartilage is gone, and your bones are touching, which is causing that pinching and pain in the front of your hip."

Okay, so you know, I can keep waiting and live in pain because I thought it was a pulled groin muscle, but it's bad news. I think that the most definitive solution for permanently, especially for the stuff that you want to do, is probably replacing your hip. "Go, I'm going to do it."

So, I'm going to take you on a little journey. I'm going to replace my hip, and I'll report in because some of you are going to have to go through this. You might as well hear it from me first. Let's do it together, so to speak. I'll keep you posted, and you know, I'll probably video the surgery, and if I don't die, it'll be just great content.

That's how this happened. And then, of course, I was in the facility. I said, "Look, well, if that's going to occur, show me what you got." And I learned all about the program. I did my research. I mean, I was going to take the advice they gave me and go get it done somewhere else, to be honest with you. I can go anywhere I want. I'm very fortunate. But after seeing the team and the process in the hospital and just all the tech... I love technology.

And the whole idea that there was a chance this would be a day surgery, I just signed up. That's what happened, and I'm very happy I did. This is a hidden gem, this place. Frankly, nobody knows about it, but I'm going to try and change that. This is the best place on Earth to do a hip surgery. There's no question about it. Of course, I'm biased, but I wouldn't go anywhere else.

This place is like an airport terminal. "What's the idea behind the designers?" "Sure, great. So when we built the hospital, we actually did recognize that people have trouble finding their way through hospitals. And when you've got a blank slate, you want to plan not only for now but the future.

And so we recognized airports are good at moving people. If we used an airport model and we set up our clinics and our ambulatory work on the south side of the building, which is a large part of what we do, patients would be able to be instructed to go to door A, door B, door C. That would bring them into the building to their clinic appointment and up to the second, fourth, and fifth floor where we also have clinics."

So this was all pre-planned. That's the ambulatory part. We're very busy there. On the north side of the building is our emergency department: 400 patients a day, and our dialysis, 500 patients a day. So we also separated that activity from the ambulatory patients coming in.

So we actually created it on purpose as a good way of wayfinding and a good way to move large volumes of people through an organization while it still feels peaceful. I found the whole area was very tightly controlled. I received the anesthetic. I was admitted. I actually had the surgery, brought back for recovery. I don't think I moved 15 yards intentionally.

Okay, so let's talk about that—tell that's very unique. I remember being hauled up an elevator, then down a hall, and you know, the whole deal. Again, we had the luxury of a new slate, right? A new freestanding center to build. We built this hospital with three vision elements: green, because sustainability is very important, and we are the second most energy-efficient hospital in the world.

"That's interesting." "Yeah, we'll talk about that. As the second most energy-efficient health—there's a greening council for healthcare, and they did a study of as many hospitals as they could look at—well over 400 or 500 hospitals. And we were the most energy efficient."

"Well, I didn't know that, so you're not advertising?" "No, we're not." "I know."

Then the next thing is we understood that if we were going to use our healthcare dollars effectively, we needed to design with lean and digital in mind. We actually studied the walking movements of our staff in our old buildings. We built models and we said, "How can we fix that problem?" And we consulted with our staff, "What digital technology can we give you? What design can we give you?"

And when we went out and designed our building, we did time studies on that model with the new design. The whole goal is the less I move you, the less I have to spend on staff moving you. The less distance staff have to move, the quicker they can get back to the next procedure, set that OR room up. And it's all about saving steps.

Okay, this is big for the hip surgery. I'm in the room where I'm changing just before I go in. I guess just pre-waiting for surgery, but I'll just give you a little view of this. This hospital's amazingly advanced. It's almost like an airport terminal.

"FEA modern feels brand new."

Got to get a nerve block—gives you an idea what that looks like because doing hip surgery here, it's kind of an interesting protocol on what happens because you actually freeze your lower extremities, and then it's like getting a colonoscopy. You're not quite under, although you don't remember it later, but I'm a little freaked out. Got to get the nerve block.

"Okay, here's the pre-op chic. Look. You've got the multiple gowns, little headgear, and I'm very close to going in that operating room. We're going for the right hip today, and I'm hoping, being optimistic, that I'll be walking later today. We'll see what happens."

I'm with the doctor that actually provided the anesthetic for me, and it was an extraordinary experience because it wasn't just one.

"Let's talk about that morning, that day. I recall three different protocols. First, you froze my lower region."

"Right. How? Let's talk about that. What is that procedure?"

"Yeah, so it's one of the options that we have, particularly for lower limb surgery. So it's called spinal anesthetic—very common. It's used extensively. It's essentially the same thing that women get for a C-section, where it freezes your body below, so you don't feel any pain and you can have the surgery just under that.

I mean, I didn't have to be knocked out. I could have been awake and watched, or at least listened."

"Correct, which I did not choose to do." "Correct. Yeah, I just didn't want to do that. But also, after that, you inserted two needles where I watched that occur."

"That's right, right around the hip joint."

"What was that?"

"So that was regional anesthesia, or ultrasound-guided nerve blocks, and the goal—the spinal anesthetic provides more complete, essentially pain relief, but it's very short-lived. So it only lasts, you know, 45 minutes for your case, versus the nerve blocks that give you pain relief in a very local area, so it doesn't affect your strength. You can still move, you know, right after the surgery."

"It's not quite internal, but you know, just around the capsule of the hip. One is called P-A-Y, the other one is Q, if anybody's interested. But the idea is that it provides much longer pain relief. You know, really within, let's say, the maximum benefit is like 10 hours, and it starts to kind of slowly go down."

"Because I had virtually no pain on set, I did it Friday morning, Saturday I was walking around, Sunday I was walking around, Monday I started to feel a little pain, Tuesday the highest, yes. And then after that, it’s been getting better, so it’s really sort of an 8-day cycle."

"But that was the second."

"That's right."

"The third was you telling me, 'Do I want to be awake for this, or would I like to check out a Dodge?' I said, 'I'd like to check out a Dodge.'"

"Yeah, and so what was that?"

"That kind of anesthetic was that? It not a general, was it?"

"Correct, so it's not a general; it was just mild sedation, right? So just want you to be asleep, unconscious, but still breathe in by yourself, and then when the sedation is turned off, so in this case, it was just propofol. When that sedation is turned off, you're wide awake.

You know, you're not drowsy, you're not nauseous, and because of the nerve blocks, you're not in much pain, so you wouldn't need narcotics which have all sorts of side effects which could limit your recovery."

"So that third element was sedation with propofol."

"Getting prepared here. This is the IV that's going to be with me for the whole thing. You know, drugs will be going in through there and also hydration. Got a warm blanket on. This is my block."

"That's great. So the whole blocking thing is to numb the lower extremities."

"Okay, not as bad as I thought it was going to be. And now my legs are—no, I can't really move my toes, so that must be working. A warm Christmas feeling."

"Yeah, and that is the majority of the hard work because now all the work's done. You just get a good nap."

"Great. So the medication that keeps you asleep, as we talked about, is different than in general anesthetic."

"Yeah, it's sort of the medication we do when people come in for colos, you know, some things like that. It gives you a very, very good sleep and usually gives you very good dreams. So if you think of something to go to sleep to, usually that dream can come true."

"How do you feel?"

"I feel good. I feel frozen. And I definitely want to be dialed to zero, that's for sure."

"Looks like the time is coming, and here's a surgeon coming in."

"Once you were seen in the block area, so Dr. Pel and Dr. Dilva, who your anesthetist that day, they did those blocks in your hip. So that helps freeze you from the waist down—so the spinal anesthetic and then the local blocks."

"Once that's done, we bring you into the operating room, and your feet are strapped into the boots for the handn table. Those ski boots that look for, so that's really to control your feet on the bed so that we can move your leg in extension and hyperextend it, and then I'll help to rotate your feet to help position you for the surgery so you get it precisely."

"I'm strapped in."

"The feet are moved with the ski boots."

"Exactly, so we get you strapped into the bed. At that time, you probably remember just before you drifted off to sleep, a lot of monitors are placed, so we place monitors to make sure we can monitor your heart rate, your oxygenation level, how you're feeling. We put a body warmer on top of you to keep you warm because the rest of you is exposed, and you can lose body heat, so we want to keep you nice and toasty. We then prep the area for your hip, so that involves using a chlorexidine sponge the night before to clean—you know those wipes on your hip the day of surgery. We scrub down your skin, we then paint it with an antiseptic solution, we let that dry, and then we prep and drape you. So what that means is we put all those sterile drapes over your body to cover you up, so then anything inside that field is a sterile operation. So inside the pans, once everything's nice and clean, there's basically no bacteria. We block off all the other parts of your body so that your skin's not going to be in contact with the surgical wound.

We do a timeout procedure, so that's like a checklist like before an airplane takes off. The pilots do a checklist to make sure, you know, do the rudder work, plane work, we have fuel checklist and everything takes off. Same thing happens at surgery, so we do that. We say, 'Who are we operating on? Mr. Lii. What side are we doing?' We’re doing the right hip. What materials are we using? We check that the nurses have all the implants, have all the necessary trays.

'Is he going home today?' Yeah, he's going home today. 'Are there any special things? Like, you know, do you have a pacemaker, or do you have extra blood thinners? Are there any concerns from the anesthetics point of view that I need to be aware of as a surgeon, and likewise do I want to make the anesthetist aware of anything technically that maybe he should know about, like, 'Hey, this is going to take a little longer because he's a bigger guy,' or 'This is a more complicated surgery?' So we do that timeout. That's really important in surgery so that people don't do the wrong side or the wrong procedure."

"Right, okay. And then we operate. Walk us through that."

"So we do a bikini incision, which we'll take a look at in a few minutes when we take a look at your incision. So it's a five or six centimeter incision in line with the skin. We cut through the skin and then the fascia and the tissues underneath it. Once we get to the fascial layer, that's that sort of thickened, sort of leathery-type tissue over your muscles. We go through that layer. We don't cut the muscles with the anterior hip replacement; we just sort of move them over."

"Does that bruise them, stress them out a bit?"

"It does stress them because we have to push and pull them a little bit, so that's why you will feel like a Charlie horse or achy after."

"It did, yeah. But it's very different than muscular pain, which if you cut and retie—that pain with people who've had a posterior or a lateral approach, hip people have significant pain after those procedures."

"Got it. Okay, so once we get inside, we get to the hip joint which is enveloped in a capsule. I'll open up that capsule, and then we cut your femoral head and neck off."

"So what that is, is that when you're cutting my leg off?"

"Basically not cutting your leg off. We're just removing the bone."

"I think it's more eloquent to put that."

"Just, yeah, um, it's deboning the filet."

"It's deboning, yes, but bon filet a little better for flavor in my opinion."

"But, um, so then we take out the head and neck, we measure that—how big that FAL head is, and then we ream. What that is is there's a little metal circular reamer that we put into the acetabulum because your hip was perfectly spherical at one point when God gave it to you, but when you start to have arthritis, you know, it becomes eccentric and warm, and we want to remove whatever little bits of cartilage are left. We take out that remaining cartilage in the bone, and within that makes a perfect sphere or hemisphere within which we're going to put the cup."

"So that cup that I just showed you."

"Exactly, so we got to craft that."

"Exactly. So we got to— I want it to be bleeding, so the bleeding is what helps get into the bone to help it heal, and I want to position it correctly so you don’t want to be too far into the pelvis or too far out, right? So then we impact the cup and that's a manual fit. So the cup is actually a millimeter bigger than what we ream, and so it's a tight press fit basically, so your bone is actually holding that in place."

"And then we use, at our institution, we use IntelliJoint, which is a navigational tool—a Canadian company out of Waterloo."

"So that's why I have a scar on the left side."

"Exactly. So on that side, we had put two pins in and we mounted a camera that allows us to measure your hip."

"So where's the camera?"

"The camera's outside your body, but it's anchored to your pelvis, so even if you rock a little bit or move, it's always going to register at the same point."

"Got it. And with that, we can place your cup correctly, so there's a lot using that Intelli—what's it called?"

"IntelliJoint."

"IntelliJoint to basically place it with perfect precision."

"Yeah, so the angle—so it's like how when you put the cup in, it's not only about how deep it is or where it is; it's the positioning. What's the angles? So this will give me the angles of exactly where I want to position your cup."

"We aim for, you know, 40° of inclination and 20 degrees of anterversion. But if you do this blindly or by side, you're just relying on a surgeon's experience and some bony landmarks. But we know historically if we go back and critically look at ourselves, only half the time are we really getting it perfect or right."

"O, so you really want the intelligence."

"You want something to navigate your hip to make sure that it's placed in the correct spot."

"Does everybody use this technology?"

"I think we're the first in Canada to make it widespread where all our anterior hips were done with IntelliJoint, and the benefit of that navigation is that we got rid of X-ray. So classically, we used to use an X-ray in the operation to see, 'Hey, what does this hip look like? Are we close?' But even with IntelliJoint, we did a study—we looked at our best 200 X-rays and our best 200 cases with IntelliJoint, and IntelliJoint outperforms X-rays in terms of accuracy."

"You want the IntelliJoint."

"I mean, you definitely want that. It's an intelligent decision."

"Yes, well, I mean, it's like shameless promotion, but you definitely want it."

"Yeah, yeah, yeah."

"And so once we put in your cup, we put in a plastic liner. So that's sort of the bearing surface that goes into your pelvis. Again, we then calibrate IntelliJoint to establish a new center of rotation or where your hip's going to articulate, and then we move on to the femur, which is your thigh bone."

"So half your operation done at this point?"

"Yeah, so then we have to do some releases of the capsule that hold your hip in. We bring your thigh up and out of the wound—the bone out of the wound, so it's sticking out."

"It's not sticking out completely, but enough that we can safely access that through that incision."

"So then we get into the femur, which is your thigh bone. We use a series of broaches to go inside to enlarge a canal. Once we have a good fit, we then put in the real stem and bang that with a hammer. It's big hammers."

"Yeah, I mean, that's the whole fun of the op."

"That's the shot everybody's going to remember."

"Yeah, everyone remembers the mallet."

"Yeah, yeah."

"And then we put on some trial heads, and then we reduce your hip, and take it through a trial. What that is, is we're going to do—it's like a practice for him. We're going to see, like, 'Hey, how long did we make him? How does he feel?' And so, there are different sizes of balls that we can use to do that.

So again, we measure with IntelliJoint, and IntelliJoint will tell us, 'Like, hey, he's 5 millimeters longer.' I'm like, 'Oh, that's where he needs to be because he lost 5 millimeters of cartilage.'

And so then once we put in your real ball and reduce your hip, and I'm happy, then we put in the real components and then knock it back in and reduce it and close you up, and that takes how long?"

"The surgeon part of this can take, you know, on average depending on the surgeon, anywhere from 30 to 45 minutes, and you know, I think yours is about 45 minutes."

"It's incredible. I feel pretty good. I can't feel anything in my leg yet, but I don't feel sick. I don't feel that anesthetic thing. I'm awake. This is pretty good. First of all, I'm glad it's over."

"But, um, well, this is better than the alternative."

"Are you there?"

"So listen, if you have to face this, you want to get it over with. That's what I think. I think I waited too long because nobody likes surgery, but now that I'm out of it, I'm pretty happy. A, I'm alive. B, I don't feel so bad. And what a great team here. It was just amazing."

"Twenty years ago, hip surgery was not a day in, day out. It was a big deal."

"It was a big deal."

"I think I was only here 3 hours and 40 minutes."

"You were, and that's intentional, right?"

"It is intentional. Let me tell you why. We're able to do it more than others, first of all, big commitment by the team to work together. And you have to have a team that works together. And because we've been able to save operational money, we can convert that into equipment and technology for the hospital."

"Okay, now that was a few years ago. Then along came the robotic systems, and the robotic systems, and we were one of the first hospitals to have them. It allows really accurate placement of the joint, and that's important, right? You have to get that."

"For me, that's very important."

"It's very important for everybody."

"Then our teams came together—physician, staff, environmental services, everybody—and said, 'How do we streamline this that we can do them faster and quicker? How can we manage pain so the patient’s up walking, as you said, 45 minutes later and be pain-free?' And our anesthetists worked with our surgeons and our teams and created a very unique block."

"Are you training others in this?"

"Yes, we are! I mean, if I were wanting to build a clinic for hip anywhere in the world, I want to do it like this."

"So do they come here?"

"Absolutely! Some of the other tools that we've used are like VR training for our nursing staff and things like that, and also for our team dynamics building."

"That's right."

"And then what we've had is we've had multiple sites come in and visit, and we've had many, many, many provinces and different hospitals and facilities come here and learn what we're doing so that we can actually impart that. And we're very transparent—there's no secret because what we want to do is collectively as a whole improve healthcare, not just in Canada but for whoever wants to work on this."

"I want to thank you so much. I'm still in my recovery period. It's just I walked out of here 43 minutes after I woke up. I was walking around the day after, I drove the day after that, then the block wore off on Tuesday. Then it started to hurt, but then that ice machine—Game Ready—I wear that 4 hours a day—incredible—never took any opioids. Never did want to, and I'm—it's been amazing.

So I want to thank you very much. Keep up the good work, and we're going to try and get this message out there because it deserves—it's a story that deserves to be told. We're the best-kept secret in the world is what we—you definitely are."

"Well, maybe that's a good thing; you're my secret."

"It's fantastic. It was really great."

"It was great. Thank you so much. Appreciate it."