New and Improved: Innovative Hip Replacement
Technique Dramatically Reduces Pain and Speeds
Recovery
by Craig Israelite, MD, and Charles Nelson,
MD
Hip joints don’t last forever.
Just ask the 250,000 Americans who had hip replacement
surgery last year. Many of them suffered from
severe arthritis, a condition in which the cartilage
on the surface of the hip bone wears away, causing
significant pain. Total hip replacement surgery
is a godsend because it enables these patients
to regain mobility. In fact, the operation has
proven so successful in recent years that it is
considered one of the most effective procedures
in modern medicine.
At Penn Presbyterian Medical Center, although
we routinely perform hip joint replacement surgeries
using a variety of state-of-the-art procedures,
equipment and materials, we are always on the
lookout for new discoveries.
Several years ago, we investigated an interesting
new technique called the 2-Incision MIS Total
Hip Replacement that showed great promise in a
handful of orthopaedic centers around the country.
Here is what makes it different from other hip
replacement surgeries: Instead of making one incision
to remove the hip joint and imbed new components,
the procedure involves two small incisions each
at the front and back of the hip. Then, in lieu
of cutting muscles to insert new joint components,
the muscles are separated, like parting a curtain.
After deciding that our patients could greatly
benefit from the procedure, we received specialized
training in the technique and began using it his
past fall. We are currently the only facility
in the Philadelphia area offering this particular
hip replacement surgery.
What is so special about this particular hip
replacement technique?
Here’s a brief overview:
- Reduced Pain – Because the muscles
near the hip are pushed apart, but not cut,
patients experience less post-operative pain
than with traditional hip replacement surgery
methods.
- Quicker Recovery - Hip replacement
surgery patients usually take four to six weeks
to begin walking; using this new minimally invasive
surgery, patients typically begin to ambulate
the day after surgery and, after three days,
are discharged from the hospital to home rehabilitation
therapy.
- Strength Preservation - Cutting muscles
or tendons increases the chances of post-operative
weakness and the formation of scar tissue. By
eliminating the cutting process, muscle strength
is maintained and patients return to activities
of daily living more rapidly.
- Reduced Risk of Blood Clots –
During this surgery, where we have access to
the hip from the front and the back incisions,
the leg and hip are not manipulated as much
as they are during a traditional, single-incision
hip replacement procedure. This has the potential
to minimize trauma to blood vessels and muscles,
thus reducing the incidence of blood clots.
- Improved Component Positioning –
During the procedure, we use fluoroscopy, a
moving picture X-ray, to evaluate the positioning
of the new hip joint components as we install
them (as opposed to reviewing the component
with post-operative X-rays after a traditional
hip replacement surgery). This enhances our
ability to position the component precisely
into the joint socket so that leg length remains
as consistent as possible.
We have used the technique on patients of all
ages, including some who are in their late 70s,
but this hip replacement procedure is not appropriate
for every patient. People with significant obesity,
major deformities of the hip, severe osteoporosis
or poor bone stock and those who have had previous
hip replacement surgery are not candidates for
the procedure.
However, for many patients, this new technique
offers the potential for a quicker recovery, reduced
pain and strength maintenance.
That’s why the surgery fascinated us when
we first learned about it.
We consider it one small step in our ongoing
search for new and improved orthopaedic surgical
methods and one giant step for patients who seek
21st century treatment for painful hip joints.
  Craig
Israelite, MD and Charles
L. Nelson, MD are board-certified orthopaedic
surgeons at the Penn Orthopaedic Institute at
Penn Presbyterian Medical Center. Both are assistant
professors at the University of Pennsylvania School
of Medicine and have been recognized in Philadelphia
Magazine’s 2002 “Tops Docs”
issue.
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