Hip pain can often discourage people from pursuing their daily activities, as well as stop them from enjoying favorite pastimes.
Fear of surgery and the unknown can also be significant deterrents to getting a needed joint replacement procedure. Surgery to treat hip pain has often been assumed to be a long, painful route for relief. Today, however, many new and innovative treatment options are available that can improve the quality of life of those suffering from hip pain while returning the patient to their desired activities much quicker than in past years.
Surgeons practicing at Hoag Orthopedic Institute have extensive experience in several less invasive approaches to hip replacement surgery that allow for a more rapid surgical recovery. Two of the more popular ways to perform hip replacement surgery are the less invasive “posterior” approach and the less invasive “direct anterior” approach. The type of hip replacement that is suitable for each individual may only be determined through discussion with his or her orthopedic surgeon.
The good news is that regardless of the type of approach ultimately selected, thanks to available techniques and approaches, the patient will experience a more rapid recovery and faster return to normal activities.
The “direct anterior” approach to hip replacement is one of several less invasive techniques. By utilizing a state-of-the-art operating table to manipulate the leg, it is often possible to implant a hip replacement without cutting any muscles or tendons, which leads to less post-operative pain, quicker return to function, and does not require postoperative range of motion restrictions. It also allows for real time X-ray analysis of implant position during surgery and allows the surgeon to more accurately reproduce normal hip anatomy and leg length equality.
Hoag Orthopedic Institute-affiliated orthopedic surgeons Steven Barnett, M.D. and Robert Gorab, M.D. have been early adopters and advocates of this approach and educate other surgeons nationwide on the technique. Both surgeons have extensive experience with this procedure, completing it successfully on over 1,300 patients during the past three years. They have recently presented peer-reviewed data at a national orthopedic meeting that supports excellent outcomes, low complication rates, and rapid recovery on their first 704 patients using this approach. When compared to patients that underwent total hip replacement surgery utilizing traditional approaches, this patient group required significantly less pain medication while in the hospital, progressed with physical therapy at a faster pace, and were discharged from the hospital in half the number of days on average, with some being discharged the next day.
James Caillouette, M.D., one of the founding partners of Hoag Orthopedic Institute, has helped advance new total hip replacement techniques for more than a decade and has presented on the topic of minimally invasive hip replacement to both national and international medical forums. In addition, Dr. Caillouette believes there is more to a successful joint replacement than the surgical technique alone. Physical and emotional preparation, management of fear, education and advances in management of discomfort all lead to most patients being able to walk (with assistance) within less than 24 hours and progress quickly to normal weight bearing.
This holistic approach to the complete joint replacement experience is at the core of success for his patients. In fact, Dr. Caillouette has performed many total hip replacements in the outpatient surgery center, where patients go home the next morning.
Steven Gausewitz, M.D., also a Hoag Orthopedic Institute surgeon and partner at Newport Orthopedic Institute, states, “Total hip replacement is a proven, safe and effective treatment for painful hip conditions. The procedure has evolved in ways that make the recovery more rapid, resulting in a more closely aligned structure than that of a normal joint, and improved durability in such that it can be offered to younger and more active individuals.” Dr. Gausewitz also believes that the soft tissues can be better preserved while accurately placing and securing the implants, with shorter incisions and less overall trauma.
“Anesthesia and pain control also continue to improve dramatically allowing patients to return home in less than 24 hours.”
Stephen Mikulak, M.D., who has been practicing minimally invasive hip surgeries for 11 years in
Newport Beach, has an opinion similar to Dr. Gausewitz in his description of the advancements in total hip replacement. “The successful combination of using a small incision, specially-designed instruments and eliminating the need to cut muscle, in combination with novel pain management protocols, allows patients to be up and walking within hours of surgery, often without assistance,” states Dr. Mikulak.
Patient perspectives
Successful hip replacement puts trainer back on the field
Bill Cunerty, previously the head football coach at Saddleback College and now a trainer and evaluator for potential NFL football players participating in the Combine, decided his hip was causing him enough pain that he needed to see a doctor or else he may have to quit his career and favorite hobby—golf.
After researching different types of hip replacements, Bill met with a Hoag Orthopedic Institute surgeon and after discussing his options, decided on the direct anterior approach surgery for hip replacement. The result was an outstanding experience and successful surgery. “I felt no pain following surgery, and did not have to take any pain medication so I was able to return quickly to my daily activities,” shares Bill. “This surgery has drastically improved my life because my hip pain is gone.”
Hoag anesthesiologist for outpatient total hip replacement
Lionel Powell, M.D., an anesthesiologist who works with Hoag Orthopedic Institute and Hoag Hospital, sees quite a few hip surgeries in his work. After realizing that he personally needed a hip replacement, he met with his orthopedic surgeon to discuss the options. Given his otherwise good health, he and his surgeon determined that his total hip replacement could take place at the Orthopedic Surgery Center of Orange County. Within hours after surgery, Dr. Powell was walking with a walker and was discharged in less than 24 hours. “I was pleasantly surprised that I could bend to tie my shoes, walk up and down stairs and comfortably return to work within just a couple of weeks,” states Dr. Powell.
He attributes the success of his experience not only to the talent of his surgeon but also to the team approach–from his surgeon to the surgery staff and rehabilitation professionals—who all provided him streamlined, superior care. “It is important for the surgeon and patient to collaboratively determine which venue is most appropriate for surgery,” adds Dr. Powell. “In my case, my health status and post-surgical needs all came into play in the decision for a total hip replacement.”
Successful outcome for football referee and runner
NFL referee Laird Hayes had been a long distance runner for many years, but the deterioration of cartilage and resulting bone on bone pain in his hip was preventing him from moving comfortably around the football field. After completing his own research and having in-depth conversations with the orthopedic surgeon he has trusted for previous surgeries, Laird decided to move ahead with a minimally invasive total hip replacement. His procedure utilized a small, posterior incision complimented by an approach to the joint, which spared trauma to the surrounding muscles. Laird happily recounts that he was walking with a walker less than 24 hours after surgery, and went home in less than 48 hours and felt no appreciable pain. “The strong relationship and trust I have with my surgeon is a large part of my successful outcome,” shares Laird. He also points out that diligent compliance with his physical therapy program got him back to work on the football field sooner than he expected.
For more information on total hip replacement, including podcasts on joint replacement, visit the Hoag Orthopedic Institute website Patient Resource Center, or call 888-635-1685.