With incision at different angle, quicker recovery for joint surgery
BY CELESTE BUSK, Sun-Times Media | May, 12 2010
There's a relatively new alternative to conventional hip replacement, a local orthopedic surgeon says.
What this means to seniors and aging Baby Boomers is a surgery that is less invasive, with reduced pain, faster recovery, improved mobility and fewer restrictions afterward, said Dr. David Smith, an orthopedic surgeon at Bone and Joint Physicians in Oak Lawn. The facility is using the anterior approach for a majority of its hip replacements.
"We're still replacing the hip, but we're doing it from a different angle - the front instead of the back or side," said Smith, who has performed the procedure on more than 300 patients. "This allows us to work between the muscles, rather than having to cut or detach them from the hip or thighbones."
Experts say the most common reason for hip replacement surgery is osteoarthritis, a type of arthritis characterized by the loss in joint cartilage and changes in bone.
Linda Place-Watson, a 59-year-old Steger resident, suffered with osteoarthritis for two years because she feared a lengthy and painful recovery from hip replacement surgery. Because of the pain, simple household chores were difficult and her mobility was limited.
"My mother had traditional hip replacement surgery about six years ago and I saw how much she suffered. I wanted to see if I could find an alternative that could lead to less pain and a quicker recovery," Place-Watson said.
So she searched on the Internet and learned about the anterior approach and that it offers faster recovery with less pain. So two years ago Place-Watson had her left hip replaced by Smith.
"Had I known about the anterior approach a few years earlier, I would not have waited and endured the pain for so long," she said. She was out of the hospital after three days, and with the help of physical therapy and rehabilitation, she was able to get around by herself with little or no pain within three weeks.
With traditional hip replacement surgery, patient hospital stays are typically four to five days and recovery can range from three to six months, Smith said.
"After the operation I had no restrictions. They got me up and I was walking down the hall with a walker the next day. The pain I endured for two years was gone," Place-Watson said.
So when her doctor said her right hip also needed to be replaced, she didn't hesitate and didn't waste any time. Without reluctance or delay, she had her second hip replacement surgery nearly five months after her first.
With incision at different angle, quicker recovery for joint surgery
BY CELESTE BUSK, Sun-Times Media | May, 12 2010
After Linda Place-Watson helped her mother through hip replacement surgery in 2005 and the long, painful recovery that followed, she knew she never wanted to go through that herself.
"She was in pain for a long time," said Place-Watson of Steger. "She had difficulties for a good six months (and then) she wasn't even really back to normal."
But less than three years later, at the relatively young age of 57, Place-Watson got the news that she too would need both hips replaced. "I was just loaded with arthritis," Place-Watson said. Commuting on the train each day was all she could accomplish, leaving her husband to do all the work in their home.
She worried about how she'd handle work and home responsibilities if she had to go through the same surgeries her mother had needed. "After I found out I had to have surgery, I'm thinking, 'Oh my God, six months out of my life.'"
Frustrated with a lack of options, and experiencing more pain as time went on, Place-Watson said she turned to the Internet. "It had been three years since my mom had done it, so I thought, what's changed since then?"
What Place-Watson found was a lesser-known, less-invasive alternative surgery called anterior approach hip replacement. She started calling local hospitals and found that Ingalls Memorial Hospital in Harvey had the specialized operating table necessary for the surgery.
The hospital put Place-Watson in touch with Dr. David J. Smith, an orthopedic surgeon with Bone & Joint Physicians in Oak Lawn. Smith, who has been doing anterior hip replacement for three years, said more patients are finding him through the Internet. "I've had people come from out of state," he said.
Smith explained that the anterior approach –– going in from the front of the patient's body –– goes back as far as 1947, but that hip replacement has been done through a posterior approach –– from the back or side –– more than 90 percent of the time.
"That was what most of us were taught," he said. "The downside of it is that you split the fibers (of the gluteus maximus muscle), which is really where the powerful muscles are. To push off to go up stairs, you use (those muscles)." Smith added that a posterior approach also requires the surgeon to detach some other muscles from the bone.
But with the anterior approach, muscles only need to be moved and separated to gain access, Smith said. There's less cutting and less disruption of nerve fibers around the hip.
Smith said another advantage to the anterior approach is that the patient is lying on his back for the procedure, making alignment easier. This position also allows the use of fluoroscopy, a type of X-ray, during surgery, which takes more accurate pictures of how everything is lining up, he said.
On the downside, Smith said, the anterior procedure can be difficult for surgeons to learn. For the patient, Smith said, there is "a slight increased risk of a fracture of the femur (though) it can happen with either (type of surgery)."
Smith stressed that most hip replacement surgeries, no matter what approach is used, have a good outcome. But he'd like more people to hear about anterior surgery.
After hearing all the facts, Place-Watson arranged for Smith to do her first hip using the anterior approach. The day after surgery, therapists got Place-Watson up and walking. She was feeling so good, they had to ask her to hold back, she said.
"He said, 'Slow down, slow down, we're not doing a race,'" she said. Four days after surgery, Place-Watson was home, able to climb stairs, bend over and put on her own shoes. She had at-home physical therapy for three weeks and was home for a total of two months. Four months later, she had her other hip replaced.
Now a year later, Place-Watson has resumed activities that pain had prevented before the surgery. She plans to walk in a Weight Watchers 5K Walk-It Challenge in June.
"I can actually function," she said. "I can walk again, I can go shopping, I can walk with [my] dogs, I can exercise."
