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New Route To A New Hip

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DALLAS, Texas (Ivanhoe Newswire) - One hundred and twenty thousand people will have a hip replaced this year. That's 10,000 people a month who are suffering with a pain so bad it hurts when they walk, or even move their joints. Now, there is a new technique for replacing the hip that is getting people up and moving faster than ever before.

"My right hip started aching and it wouldn't go away," Osteoarthritis Patient, Karen McKinzie, told Ivanhoe.

The pain became so intense for 61-year-old Karen McKinzie, even her 85-year-old mother could walk faster than she could.

"It made me feel old and tired," McKinzie said.

Karen lived with the pain for years. Finally, diagnosed with osteoarthritis, her doctor suggested a new type of hip replacement. It's called Anterior Hip Replacement.

Traditionally, surgeons removed the arthritic hip by cutting into the side or back of the hip.

"The disadvantage in that is that tendons and muscles have to be cut in order to access the hip joint; that leads to more pain and also it leads to a risk of the hip dislocating after surgery," Doctor Steven Sanders, MD, an Orthopedic Surgeon at Baylor Health Care System, told Ivanhoe.

Now, surgeons approach the hip from the front side without cutting any muscles or tendons, reducing recovery time from six weeks to ten days. A day after her surgery Karen was up walking, even planning her training schedule for her first 5K.

"I feel younger now than I did several years ago," said McKinzie.

Another benefit for this approach, with conventional hip replacement surgery, there are strict precautions after surgery for hip movement which slows down recovery. 

With the anterior approach, patients are allowed to bend their hip freely and can bear full weight almost immediately.  This also helps speed up recovery time and helps patients return to normal function faster.

RESEARCH SUMMARY

BACKGROUND: Hip replacement, also called total hip arthroplasty, is a surgical procedure to replace a worn out or damaged hip with prosthesis (an artificial joint). This surgery may be considered following a hip fracture (breaking of the bone) or for someone who has severe pain due to arthritis. (SOURCE:http://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/hip_replacement_surgery_procedure)

WHY IT'S DONE: The goal of hip replacement surgery is to relieve pain and increase the mobility and function of a damaged hip joint. Conditions that can damage the hip joint, sometimes necessitating hip replacement surgery, include:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Broken hip
  • Bone tumor
  • Osteonecrosis

(SOURCE: www.mayoclinic.com/health/hip-replacement)

LATEST TECHNOLOGY: Every year more than a quarter of a million Americans have total hip replacement surgery. It's almost always a successful operation that frees patients from what's often described as disabling pain. But in recent years, there's been lots of discussion about "anterior approach" hip replacement, a surgical technique that's different than the standard procedure. It's one that proponents say can lead to quicker recovery, three to four weeks compared to six to eight weeks for typical surgery. The Anterior Approach to hip replacement surgery allows the surgeon to reach the hip joint from the front of the hip as opposed to the lateral (side) or the posterior (back) approach. This way, the hip can be replaced without detachment of muscle from the pelvis or femur during surgery. (SOURCE: www.npr.org; www.newhipnews.com

INTERVIEW

Steven Sanders, MD, who specializes in Orthopedic Surgery at the Baylor Health Care System, talks about an innovative hip replacement, which can save doctors from cutting muscle or tendon.

How long have you been replacing hips? 

Dr. Sanders: I have been replacing hips for the past 16 years.

How many hip replacement surgeries do you do in a day? 

Dr. Sanders: It is variable, but it may be three to four a day. 

That seems unreal that many people are getting hips replaced.

Dr. Sanders: Well, arthritis is very prevalent now and as our population is aging we are seeing much more of that.

Why do you think that is? Is it just that we are more active and wearing them out more? 

Dr. Sanders: I think patients are more active now and have busier lifestyles, and people are living longer too; they are healthier in many regards.

How have you seen hip replacements change from 16 years ago to today?

Dr. Sanders: The way most surgeons still perform hip replacement surgery is entering the hip joint either from the side of the hip or from the back of the hip, and that is the way I was trained several years ago as well. The disadvantage in that is that tendons and muscles have to be cut in order to access the hip joint. That leads to more pain, it leads to more potential swelling, a potential risk of transfusion, and it also leads to a risk of the hip dislocating after surgery. So, all of those patients are always taught how to sit properly, how to turn, how to not turn, in order to protect the hip until everything heals. That leads to a much lengthier recovery.

This new hip replacement; what is different about it?

Dr. Sanders: The way I perform hip replacement is a very innovative technique, a few surgeons around do it, and we actually approach the hip from the front side of the hip. The advantage in that is we do not have to cut any muscles or tendons. We can just work around the muscles and tendons and so therefore, we are able to preserve the anatomy there. Patients do not have that risk of dislocation and they recover much quicker. It is very amazing that with traditional replacement, most patients would be using a walker around six weeks after surgery. Now with anterior hip replacement, most patients use it maybe a week, ten days.

When are they back to normal? 

Dr. Sanders: Normal is a whole different definition. It depends on what your goals are with lifestyle, but I would say patients are doing more than they could do before the surgery at around six weeks.

Is the incision smaller too?

Dr. Sanders: The incision is actually about the same, and the incision is not what is important. What is important is what is done underneath the skin.

So explain that just a little bit more in detail.

Dr. Sanders: The difference is not necessarily the size of the incision, but it is the ability to not cut those muscles and tendons that lead to increased functional compromise after surgery, pain, swelling, bleeding, etc.

When you are cutting those muscles and tendons, how many would you be cutting? 

Dr. Sanders: Typically, there are around three to four that are cut in order to access the hip.

You have to think those are probably pretty strong, well-developed ones too? 

Dr. Sanders: They are. I mean, they are not major muscle groups but they are important in the stability of the hip joint.

How long have you been doing this type of surgery?

Dr. Sanders: I have been doing this surgery now going on four years, regarding anterior hip replacement.

Are there any risks that are different than the traditional ones? 

Dr. Sanders: No. There are no different risks.

Is there anybody that you would not do this type of hip replacement?

Dr. Sanders: I have expanded my indications to virtually almost all patients. There are a few exceptions. If a person has a certain disease or certain problems with the hip that just have to be approached from the backside of the hip, then we'll do it the more traditional way, but most people with routine hip arthritis, we do the hip from the front side.

We are talking to a patient, Mrs. McKenzie. Do you remember her?

Dr. Sanders: Yes.

What was she like when you first saw her?

Dr. Sanders: She was really having severe problems. She had lost most of her function regarding her ability to do the things that she enjoyed. She was having daily pain, she was having pain that woke her at night, and she was having very restricted movement.

Have you seen her after the surgery?

Dr. Sanders: Yes.

What is she like now? 

Dr. Sanders: She is very happy. She says this has changed my life forever. Within two weeks after surgery, she was dancing at a wedding. 

What about that? We take it for granted that we are going to be in pain, but you see people every day that it is like their whole life has changed. 

Dr. Sanders: One of the things that I love about hip replacement surgery is the dramatic change it does make in a patient's life. They go from being severely restricted and almost immobile to some degree to a whole new quality of life, and it is very satisfying to me as a physician and surgeon. 

Why did they start the hip replacements going in through the back or side?

Dr. Sanders: With the history of hip replacement, it all began in Europe mainly dealing with pelvic fractures, and so the hips actually were approached from the front side. That became abandoned in the United States. The first hip replacements were done around 1960 in the United States and it evolved into different techniques in performing the hip surgery. The preference in the United States was approaching the hip either from the side or from the back side.

Why is that though?  

Dr. Sanders: There was thinking that it was an easier way to do it.

So when people come in and you start talking hip replacement, is there one question everybody has that you can put to rest right now?

Dr. Sanders: Most patients ask how painful it is, and I can tell you without exception every patient is pleasantly surprised that it is not near the expectation that they had and that they are much more comfortable after surgery. They are surprised at how quickly they are up and walking and they are surprised how immediately that pain they had before surgery is gone. 

After doing all these hip replacements and being with patients all day long, is there anything you have changed in your life that you do not do now that you used to do when it comes to hips and knees?

Dr. Sanders: It's a hard question to answer. What I personally do? At my age now I do not run for exercise. I used to several years ago, but I think that most patients or most people in general after about 40 years old are really not designed to be able to do that and so our joints begin braking down. For us older folks, I think low impact exercise is very effective and very efficient too. 

How can you be more accurate with this surgery?

Dr. Sanders: With traditional surgery, typically the patient is laying on their side on the operating table. The surgeon's technique and making sure that the implants are properly positioned so that the legs are exactly the same length after surgery is all really based on experience and feel, and sometimes that accuracy can be difficult to achieve. When we do the hip replacement from the front side, the patient is lying on their back on the operating table and that gives us the ability to use an x-ray machine as we do the procedure to actually visualize the implants, make sure the position is perfect, and that the leg lengths are perfect as well. So, that has greatly been an improvement in the patient's overall longevity of the implants and of their function afterwards as well. 

A problem area that doctors have is not getting the socket in correctly, and then that kind of changes everything when you do not do that, right? 

Dr. Sanders: Correct. The socket or the cup position is very critical to the longevity of the implants. If the cup position is not properly positioned, then that can lead to accelerated wear and tear of the implants which can result in implant failure. Also, it could increase the risk of dislocation as well.

What percentage experience dislocation?

Dr. Sanders: Overall in the literature, the risk of dislocation after a traditional posterior approach surgery or lateral surgery is around 3% to 4%. With anterior hip replacement it is less than 0.1%. 

Is this easier if the person is heavy?

Dr. Sanders: Anterior hip replacement can be easier actually to perform on larger patients because there is less tissue on the front of the hip than there is on the back or the side of the hip. The way the patient is positioned on the operating table actually lets any excessive adipose tissue fall back out of the way and it does become an easier operation to perform on larger patients.

FOR MORE INFORMATION, PLEASE CONTACT:

Susan Hall
Baylor Health Care System
214.820.1817
susanh@baylorhealth.edu

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