New Operating Table Improves Hip Replacement Surgery
March 17, 2004, 8:51PM
By DEBORAH MANN LAKE
Special to the Chronicle
Using a device that looks more like a torture rack than a surgical table, surgeons are now able to replace a hip through the front of the pelvis, limiting tissue and muscle damage and leading to faster recovery.
"You don't have to cut any muscle; you can just move it aside," said Dr. Stefan Kreuzer, an orthopedic surgeon with Memorial Hermann Memorial City Hospital, who has used the procedure on 20 patients since December. "In two or three days patients are leaving the hospital with no assisted devices. The muscles aren't traumatized, so they can work immediately."
The hip includes a femoral bone head (the ball) and an acetabulum, the cavity or depression on the hip bone (the socket).
As people age, the cartilage that provides cushioning for the ball and socket wears away and arthritic inflammation can occur. Eventually bone will wear on bone, causing pain affecting everyday movement.
"I was in so much pain I couldn't concentrate on anything," said Deborah Woehler, 49, whose hip was replaced by Kreuzer on February 20th. "You know, you don't feel happy because you can't do anything. I couldn't walk up a hill to play golf."
Anti-inflammatory medications and steroid injections are generally the first line of defense, but eventually the hip joint may have to be replaced.
Because the leg must be positioned awkwardly to expose the joint, hip replacement surgery is usually done through the back. Major gluteal muscles and tendons must be cut away from the femur and pelvis, which means the patient will experience more pain after surgery and a longer recovery.
"With the posterior procedure, you have to completely detach the short external rotator muscles from the femur," Kreuzer said.
The table, used for many years in Europe, allows the surgeon to enter from the front of the body, where there is a natural dividing point for the muscles where the leg meets the torso.
The patient's legs are strapped into boots on the table, which rotates the leg externally and extends the hip, dropping the foot toward the floor.
While the incision may be 3 or 4 inches long, there is less cutting into tissue and muscle below the skin surface.
Kreuzer said hospital stays have been shortened to two or three days instead of the usual five days with the traditional posterior surgery. Rehabilitation also has shortened from a week or two of inpatient treatment at a facility to just a few sessions of outpatient treatment with a physical therapist.
The procedure will not work for severely deformed hips, he said, or when repairing an existing replacement.
"I had my surgery on Friday morning and by that night, I was walking nearly half a mile with a walker," Woehler said. "By Sunday, I had quit using a walker and went home that night and started walking two miles a day."
Barbara Hohensee, 63, who had the surgery Jan. 13 on her right hip, said she was able to walk with minimum assistance the next day.
"Dr. Kreuzer said I could put all my weight on my right foot, and I stepped and held onto his arm," Hohensee said. "I thought I would feel pain shooting down my leg, but I felt nothing. I could even go up and down stairs. It was amazing."
When the physical therapist arrived at her home to begin rehabilitation, Hohensee met her at the door without using even a cane.
"The physical therapist almost fainted. She said she had patients two and three weeks after their (traditional) surgery and they were barely walking with a walker," Hohensee said.