November 20, 2017

Advancements In Hip Surgery

The very first hip replacement surgeries were attempted over 120 years ago (1891) by Themistocles Gluck in Berlin, Germany.

 

It consisted of a femoral head made of ivory fastened to the top of the thigh bone with nickel plated screws, plaster of Paris, and glue. Needless to say, there were some problems. Nearly 50 years later, Dr. Austin T. Moore at Columbia Hospital in South Carolina used the first metallic implant to treat a broken hip. His design, the so-called Austin Moore Prosthesis was introduced in 1952 for certain types of hip fractures and to this day is available for use in operating rooms throughout the world.

The modern world of “hip replacement” surgery was launched forward owing to the work of Englishman Sir John Charnley in 1962.

His artificial hip consisted of two parts, the cup made of Teflon that fit in the pelvis as the socket, and the femoral stem, which was pounded in to the upper end of the thigh bone. Both of these components were cemented, attached to the bone, with the use of poly methyl methacrylate (PMMA). This material, the bone cement, was mixed in the operating room resembling the consistency of bread dough that within a few minutes hardened like bone acting as a glue which would attach the prosthesis to the bone. As most of the hip replacements failed within two years, Dr. Charnley realized that Teflon was not a good material to use, and he replaced it with a type of plastic called ultra high molecular weight polyethylene (UHMWPE).

Since that time, there have been numerous advances and innovations in both materials and techniques of hip replacement. One such innovation that I highly recommend to patients for their consideration is the anterior approach for hip replacement. This is novel in number of ways. For one, the incision is very short, usually no more than four or five inches. Secondly, rather than the traditional cutting of muscles to get to the hip, the anterior approach goes between muscles, spreading rather than cutting them. Since no muscles are actually cut, it leads to a faster recovery, with the patient walking (full weight-bearing) within hours after the surgery, with usually less pain, often allowing them to go home after just one day in the hospital.

How is the anterior hip approach different?

  • Because the hospital stay is so short (often less than 24 hours) extra time in patient education before surgery is spent to help the patient fully understand what to expect before, during, and after the surgery.
  • The surgery is done on a special high-tech operating room table (Dixie Regional Medical Center has two of these tables) that controls the position of the hip during surgery.
  • Intra-operative x-ray for precise placement of the artificial hip components is used during surgery.
  • The surgical path to get to the hip via the anterior approach goes between muscles causing less damage to the hip.
  • Seldom is a blood transfusion needed. My rate of transfusion in the last year was a little less than 4% (national average is 16%)

Potential Benefits of the anterior approach:

  • Because the anterior approach is tissue-sparing, key muscles on the side or back of the hip are not cut during the surgery, likely resulting in less scaring and decreased post-operative pain.
  • Using real-time x-ray control during surgery we are able to have more precise placement and sizing of the artificial hip components.
  • With the muscles and tendons largely intact, the hip, immediately after surgery, is inherently more stable—hence fewer restrictions for the patient.
  • Full weight-bearing is usually allowed immediately after surgery.
  • With less surgical trauma during the anterior approach there is likely a quicker overall recovery.
  • Very little physical therapy, usually none, is required after an anterior total hip replacement
  • Most patients when discharged from the hospital go directly home and not to a rehabilitation facility. In my experience, I’ve found that patients recover much better in the setting of their own home.

As with any major surgery, all risks must be considered. Not every patient is a candidate for the anterior approach. I encourage you to discuss with your surgeon which type of surgery is best for you.

For more information, visit: drandersonortho.com or call the office of Michael Anderson, M.D. at Coral Desert Orthopedics in St. George at 435-628-9393.

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