A Hip Approach | by Debra Melani

new hip

Posted on Fri, Jan 18, 2013

Innovative replacement technique vaults many patients back to their active lifestyles

Jeffrey Leib

Jeffrey Leib pauses during a walk with his friend Baxter

As a retired newspaper reporter, Jeffrey Leib has a habit of checking things out. So when doctors told him a deteriorated hip was causing his debilitating pain and needed to be replaced, he started searching the Internet, talking to patients, asking for facts. By the time he landed on the operating table, the former Denver Post writer was confident he had gotten the scoop.

Instead of going blindly into a traditional hip replacement, which can take months of recuperation before getting back to the lifestyle he had been missing for more than a year, Leib, 64, researched the pros and cons of different techniques, opting for a highly minimally invasive procedure still offered by only a few doctors in the state. Pioneered in Colorado by Sky Ridge Medical Center surgeons Drs. Robert Greenhow and Craig Loucks, the technique, called the anterior hip approach, has baby boomers like Leib back to their active lifestyles in as little has six weeks.

“I was walking with difficulty, basically dragging my leg around,” says Leib, describing his pain as an ache that sometimes radiated up and down his leg. “I was very, very unhappy with the lack of ability to maintain physical exercise,” says Leib, who mostly missed his bicycling. “It was difficult to sit for long periods. It was very difficult to sleep. It was affecting my lifestyle in almost every way, and I was ready for a solution.”

Leib exemplifies many of the patients crowding orthopedic offices today in search of hip- or knee-pain relief. His typical patient, says Leib’s surgeon, Rose Medical Center’s Dr. Dennis Chang, has osteoarthritis, is very active and falls in the 40- to 60-year age range. Dr. Chang attributes an uptick in joint replacements to 75 million aging baby boomers – the oldest of whom are hitting retirement age – and their refusal to sacrifice their lifestyles. “They want to continue playing golf. They want to continue being active.”

Osteoarthritis, which affects more than 27 million Americans today, results from the erosion of cartilage in the joints, which leaves bone rubbing on bone. Age, obesity and wear-and-tear all contribute to incidence of the disease, which has the medical profession bracing for a major spike in patients. Many of their patients are tech-savvy athletes, such as skiers from Vail, who find them and the anterior approach on the Internet, say Drs. Greenhow and Loucks, who were the first surgeons to offer the procedure in Colorado in 2004 and have, between them, performed nearly 3,000 of the surgeries.

The chief difference between the anterior approach (when surgeons access the hip area from the patient’s front) and traditional lateral or posterior approaches (when doctors access the area from the side or back) is that no muscles are cut with the newer technique. “With the posterior approach, you cut usually five or six muscles and tendons to get into the hip,” Dr. Greenhow says. Although most patients do fine with either approach, the newer procedure leads to quicker recovery and fewer post-surgery restrictions, and is gaining momentum in the orthopedic field.

“I remember Dr. Chang writing on the chalkboard when I got out of surgery: There are no hip precautions for this patient,” Leib says. “I think he was writing that to the nurses,” he says, but that’s when it sunk in that the surgery he chose was really different. For traditional hip-replacement patients, who generally take three to six months to return to full activity, the risk of dislocation of the new hip is much higher, as supporting muscles and tissues are compromised. Patients are strictly forbidden from flexing and bending during the first few weeks of recovery.

“With the anterior approach, those problems have been reduced to almost zero, and it’s because no muscle is cut,” says Dr. Loucks, referring to dislocation and leg lengthening, another hip-replacement risk. Patients researching techniques should be aware that some surgeons using and advertising “minimally invasive” surgeries are still using a posterior, non-muscle-sparing approach.

After joining Sky Ridge Medical Center more than two years ago and watching Drs. Greenhow and Loucks perform the surgery, anesthesiologist Dr. Garrett Sullivan had to do no research before choosing the technique for his own hip replacement. “I was very impressed with the technique: with the speed in which it could be performed, with the lack of blood loss, and with the recovery of patients when I would see them after surgery in the hospital.”

So after the shock of learning that the increasing groin pain that had been slowly robbing him of his activities, such as hiking, golfing and skiing, was due to a severely deteriorated hip at age 58, Dr. Sullivan had his hip replaced last year. “It really came on as a surprise,” he says. “But we had a patient yesterday who was 38, so it happens.”

Dr. Sullivan’s recovery went smoothly; he was walking without a cane and discharged within 48 hours. His wife took a video of him strolling around the block 72 hours after surgery, looking as if nothing had happened. “It’s pretty amazing,” Dr. Sullivan says. “My sister had hers done the traditional way in June, and she had to be on crutches for six weeks.” He was driving in one week, back to work in three weeks – “which requires a lot of bending over and lifting of patients” – and golfing and telemark skiing when the seasons rolled around three months later, Dr. Sullivan says.

Both Leib and Dr. Sullivan were impressed by the lack of pain following surgery, which is generally less than with traditional surgery but varies with patients, Dr. Chang says. “When I came out of surgery, I remember my thought at the time was that all the discomfort and pain was immediately, instantly gone,” Leib says of his first hip surgery three years ago. Last year, he had his other hip replaced. “I think it’s pretty unusual, but I think between the two operations, I took a grand total of one pain pill.”

Although both Leib and Dr. Sullivan waited for treatment until surgery was called for, patients with joint pain should see an orthopedic surgeon before their activities are affected, so that other treatments, such as physical therapy, modifications of high-impact activities and anti-inflammatories, can be tried. Because artificial joints do wear out and need surgical replacement (generally in about 20 years), patients shouldn’t opt for surgery before it is needed, surgeons say. “We want to exhaust every other option first,” Dr. Greenhow says.

But all three surgeons say they disagree with something they often see: putting surgery off too long. “If they can’t walk up and down a flight of stairs, if they can’t walk their dog, is it realistic to have them waiting until they are 60?” Dr. Chang asks. And, in addition to maintaining quality of life, staying active is a health issue that shouldn’t be ignored, especially with today’s obesity epidemic, he says. “It’s a lot easier to remain fit and maintain your body weight when you are not in pain.”

Leib’s best advice for patients facing joint replacement is to make their own decision after doing their own research, which he says is critical and easy to do today with the Internet. For instance, his research underscored the importance of finding a surgeon well-trained and experienced in the emerging procedure. “Even though I had a great experience,” Leib says, “you don’t want to jump into something like this without doing your own research.”

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