FAQ
If you are a resident of Ontario, you must be referred to Dr. Rodriguez-Elizalde by another physician in order to be seen in consultation. Usually your family physician, or sometimes another orthopedic surgeon will refer you using the form found here.
Yes. Non-OHIP, or out of country patients that want surgery are candidates based on the same criteria Dr. Rodriguez-Elizalde uses to screen regular elective patients. Most international patients require a consultation, x-rays, and a review of their clinical condition in person prior to surgery.
The length of stay for each patient varies, depending on the procedure, family availability, insurance coverage, and travel plans. The hospital has set rates depending on the procedure, and often these accounts have to be settled prior to surgery happening. If you have foreign insurance, the Hospital often can deal directly with them.
If you would like more information, or to schedule a consultation, please fill our the referral form and contact our office. Referral by another physician is not necessary in the case of international patients.
First, if you have upcoming surgery scheduled with another orthopedic surgeon, do not cancel it. Toronto is fortunate to have so many reputable orthopedic surgeons serving the community and catchment area. Given the current wait-times, a consultation and surgical date will take several months, and you should not forgo an assured surgical spot if you already have one.
If you have had previous surgery or want to discuss your case, like any other referral, you will need your family doctor to forward a request to our office.
Referrals are processed in the order they are received. Most hip and knee arthritis referrals being assessed for surgery are considered “urgent” if they are causing daily pain to the patient. Unfortunately, this is the majority of the referrals our office receives.
Referrals are reviewed once a week, and booked for consultation with Dr. Rodriguez-Elizalde. Our office will notify both you and your family doctor of the upcoming appointment once scheduled. Once reviewed, it takes approximately 3-4 months to be seen in consultation.
This is the most common question our office receives. Currently, Dr. Rodriguez-Elizalde has approximately a 10-12 month wait list for surgery once seen in consultation.
This is the second most common question. Despite perceived efforts, our provincial government limits the amount of surgery physicians can do. The province has allocated a set number of “funded” procedures that each LHIN (Local Health Integrated Network) or region can perform. Hip and Knee replacements fall into this category. These are then distributed to each Hospital within the LHIN catchment, and further distributed to each surgeon.
This means, that we are able to only do so many procedures per week, despite the need, as evidenced by the long wait lists. The province limits the total number of procedures done – because it ultimately is a means to save money. Health care dollars are limited and unfortunately that translates to the rationing of resources by the government.
When you are seen in consultation, Dr. Rodriguez-Elizalde may make some recommendations in terms of your pain medications. Dr. Rodriguez-Elizalde favours multi-modal pain management (the combination of various types of medications) instead of heavy narcotic (opioid) use.
Narcotics or opioids, should be used as a last resort to treat pain. Physiotherapy, exercise and non-opioid medications should be the initial treatment of choice, because of the side effects and monitoring required when on narcotic medications.
Dr. Rodriguez-Elizalde can help guide your pain medication regime, but if you require long-term narcotic use, you will need to liaise with your family doctor.
Dr. Rodriguez-Elizalde does not prescribe medical marijuana.
Yes. Please allow 1-2 weeks for forms to be filled. They can be directly faxed to the necessary parties, or returned to yourself.
Because of this, if you need them for an elective procedure, please submit them in advance of your surgical date. There is a small cost associated with this serivce.
All hip replacement procedures, no matter the surgical approach (Anterior, Lateral or Posterior) have the same indications. Usually, surgery is done because of degenerative arthritis in the hip, causing pain that cannot be controlled by non-surgical means (physiotherapy, exercise or pain medications).
Pain typically presents in the groin, thigh and buttock. It can feel like a dull constant ache, or sharp stabbing pain depending on the activity. Stiffness is also common, and progressive. Pain in the low back, or outside part of the pelvis may not necessarily be the hip, so a physical exam and x-rays are necessary to definitely make a diagnosis.
When a decision has been made to proceed with surgery, know that whomever your surgeon, and regardless of the surgical approach, most people have an excellent long-term outcome.
Dr. Rodriguez-Elizalde is currently performing all his elective total hip replacements through the Direct Anterior Approach, and even some of his revision cases. Despite conflicting information from lots of sources of the internet, most people needing a hip replacement are actually candidates for the Anterior Approach.
There are no age restrictions, males and females are both candidates, and with some exceptions, size is not an issue. Some hip replacement candidates are more complicated than others, and offer more risk, but that is typical of any surgical procedure.
The bottom line is if you have been told you need a hip replacement, you are likely a candidate for DA hip surgery.
There are lots of reports of the increased risk of “nerve” damage during DA Hip Surgery. This primarily refers to the Lateral Femoral Cutaneous Nerve, which supplies the skin on the outside of the thigh.
The nerve crosses the surgical path, and despite careful technique it is not uncommon for there to be some temporary numbness on the outside of the thigh after surgery. This happens in about 30% of people, and is more typical in men. The numbness is not usually associated with pain, and usually resolves within 2-3 months after surgery.
In certain cases, patients may be left with some permanent skin numbness.
There have been reports that DA hip surgery loses more blood and requires transfusions often. These primarily are from case series involving surgeons during their initial learning curve (first 20-50 cases). Once a surgeon has established a routine, and understands where potential bleeding is coming from, this isn’t a problem. Coupled with the use of Transexamic Acid, which is now routine for all joint replacement surgery, the transfusion rate in total hip replacement surgery is below 2%. If undergoing a bilateral (both hopes done at the same time) procedure, it is under 5%.
The practice of pre-donating ones own blood in case of its necessity is largely historic. Firstly, given the extremely low rates of transfusion, the safe collection, storage and re-administration of ones own blood is not economically feasible for most institutions for joint replacement surgery.
Secondly, the viability of blood cells is approximately only 1 month, which doesn’t give your own body time to adequately replenish what’s been donated. So, you end up coming into surgery with a lower starting hemoglobin (the marker we use to measure your blood, before and after) than if your blood was never pre-donated.
Yes – or as close as possible. The use of an intraoperative x-ray allows for millimeter length corrections, and as close a replication of the normal side as possible.
However, there are things to keep in mind. Most hip patients are shorter on the affected side – and need to be lengthened during surgery. In doing so, patients often initially perceive their leg is longer, even though it isn’t. It takes time to accommodate to this new normal, as the pelvis readjusts itself (since there is no pain, you limp less, but have to relearn how to walk). It takes years of progressive pain, limping and wear before your hip replacement, but only an hour to change it.
The key is to give yourself time to settle into your new hip.
Immediately after surgery, your goals will be pain control and safely ambulating about on your new hip. Once this happens, your progress will vary.
The deep achy feeling, and occasional sharp pains from your hip arthritis should be gone once you wake up from anesthesia. However, you will have some pain and burning from the incision, mostly in front of your thigh. This pain and the “tightness” some patients describe, are common, but usually more bearable than the severe arthritic pain patients had before surgery.
Bruising and swelling are common after surgery, and due to gravity will travel down your leg with time. This is normal.
The first few steps after sitting are usually the worst. You will feel stiffer the longer you sit and are immobile. The key is frequent (but not strenuous or prolonged) movement.
When you leave the hospital, you will have a prescription for a blood thinner, anti-inflammatory, nerve pain medication and 2 types of pain medication: one for lighter pain and one heavier medication in case of severe pain. Often people come back, not having used either for more than a few days.
But pain, like patients, is highly variable, and unfortunately for me, less predictable. Remember to do your prescribed therapy with a good physio. A link to the protocol can be found here.
The implants used in today’s hip and knee surgery is largely governed by existing hospital contracts. The company we routinely use at Humber is ZimmerBiomet. The actual stem is called the Taperloc Complete Microplasty Stem. The cup is called the Allofit IT Alloclassic shell. Both have established track records spanning decades, with good long term clinical success.
In most artificial hips, the components used are:
- The cup: usually made of a titanium alloy, potentially augmented by a screw
- The liner: which sits inside the cup is usually made of plastic (polyethylene). Slight variations exist on the final processing of the plastic selected exist, depending on the patient receiving it
- The stem: made of a titanium alloy
- The head: typically a metal (cobalt-chrome alloy) is used, but certain patients may also receive a ceramic head
Not really. “The best implant system for you is the one your surgeon is the most comfortable with.”
Special requests for other companies, designs, and materials compromise the above mantra and don’t allow the surgeon to do what is most reproducible in his hands.
No. The government currently does not allow this type of up-selling, which is common in other areas of medicine (ophthalmology and dentistry are examples). However, rest assured that Dr. Rodriguez-Elizalde will use what’s best for you from a quality and longevity perspective.
No. True allergies to nickel and the other metals used in total joint surgery is exceedingly rare. There are only a handful of such cases worldwide, after the implantation of hundreds of millions of such devices
Sebastian is an Orthopedic Trauma and Adult Hip and Knee surgeon at Humber Hospital, in Toronto, with a special interest in revision and complex cases.
He completed his orthopedic surgery residency at the University of Ottawa, after which he was accepted for Fellowship training at the Hospital for Special Surgery in New York, in Hip and Knee Arthroplasty.