Praying Without Pain
“Houston Methodist has the tools and the know-how to improve the lives of patients who have had a previously unsuccessful outcome.”
By George Kovacik
Published in Leading Medicine, Vol. 5, Number 2
"It's nice to be free after living all these years with so much pain." - Sister Angelica Menta
Daily mass is Sister Angelica Menta’s sanctuary. Every day for more than 65 years, she’s attended church to give thanks, ask for forgiveness and find peace through prayer. But when it comes to living a healthy, pain-free life, that peace has eluded her.
As a farm girl growing up in upstate New York, Menta was tough and very athletic. She could hit, throw and catch a baseball as well as any boy in the neighborhood. But unlike those boys, she had a serious health problem. She was born with a dislocated hip that left one leg shorter than the other, and when it slipped out of place, it caused excruciating pain. At times, even a slight movement caused pain. As she got older, kneeling in church became a big problem.
“On a scale of one to 10, the pain was around an eight. My hip always felt hot ... like someone was jabbing me with a sharp object,” Menta said. “I’ve had at least 10 surgeries to repair my hip, including a total hip replacement, but nothing seemed to completely get rid of the pain.” Then she met Dr. Stephen Incavo, an orthopedic surgeon with Houston Methodist Hospital.
When Incavo examined her, he discovered an infection was causing the constant pain in her right hip. He recommended she undergo revision surgery, a long and sometimes arduous process for both patient and surgeon.
“We tackle these cases because we have the expertise, and we are willing to give the time necessary to help these patients,” Incavo said. “Houston Methodist has the tools and the know-how to improve the lives of patients who have had a previously unsuccessful outcome.”
A patient may need a hip replacement revised if they fracture around the prosthesis, or the bearing surface wears out and becomes unstable. Revision surgeries are more complicated than initial hip replacements because of poor bone quality and the difficulty in properly securing the revision hip replacements in position. Removing the old prosthesis can require more extensive surgery and can take a toll on patients, who in most cases are older. When a hip replacement is infected, the revision process usually involves at least two surgeries and a recovery period of up to a year.
“Once bacteria invade the metal or plastic prosthesis, all of the foreign material needs to be removed, including the replaced parts. The area has to be thoroughly cleaned so the body can heal itself,” Incavo said. “Until a few years ago, the patient was left with nothing in the place of the removed prosthesis, and they were confined to bed rest for an extended period of time.”
Incavo says the development of antibiotic spacers in recent years has allowed patients to get up and around, using a walker or wheelchair during the revision process. The spacers, made out of traditional bone cement (the same material used to attach knee and hip replacements), are filled with a high dose of powdered antibiotics. The antibiotics seep out of the spacer over a six week period, delivering them to the infected area. The cement fills the gap and helps heal the infection and gives surgeons more space and soft tissue to work with later on. Additional antibiotics also are given intravenously to maximally treat the infection.
“Once the infection has been eradicated, we can go back in with new implants and once again replace the hip,” Incavo said. “In more than 80 percent of the cases I’ve performed, the infection has not returned.”
Incavo says patients will have some pain with the spacers in place, but it is required to fix the problem. The spacers are not as comfortable as a true hip replacement, but he said it is better than strict bed rest or even being in traction.
Over the past two years, life for Menta has been “100 percent better.” Her routine includes counseling people on how to stay positive in trying times and spending 45 minutes a day on a stationary bike. Most importantly, she is now able to go to her safe place — daily mass, where she can kneel down and pray pain-free.
“The process of going through the surgeries was difficult but well worth it,” Menta said. “After living all these years with so much pain it’s nice to be free.”
Is Hip Replacement Surgery for You?
Whether to have hip replacement surgery should be a cooperative decision made by you, your family, your primary care doctor and your orthopedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopedic surgeon for an initial evaluation.
Although many patients who undergo hip replacement surgery are 60 to 80 years of age, orthopedic surgeons evaluate patients individually. Recommendations for surgery are based on the extent of your pain, disability and general health status — not solely on age.
You may benefit from hip replacement surgery if:
- Hip pain limits your everyday activities such as walking or bending
- Hip pain continues while resting, either day or night
- Stiffness in a hip limits your ability to move or lift your leg
- You have little pain relief from anti-infl ammatory drugs or glucosamine sulfate
- You have harmful or unpleasant side effects from your hip medications
- Other treatments such as physical therapy or the use of a cane do not relieve hip pain
Source: American Academy of Orthopaedic Surgeons