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Saturday, Mar 28, 2015

A different approach to hip replacements

Hernando Today Correspondents


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Gary Jonathon was active his entire life, working as a sign painter and installer since he was a young boy. And as he aged and began feeling typical aches and pains, Jonathon refused to give in to his ailments. But when the pain in his hip started affecting his ability to move like he once had, he became concerned.

A visit to his doctor revealed that Jonathon was suffering from an acute fracture in his hip joint that had given way to the onset of arthritis. The cartilage that was meant to buffer the impact of the bone on bone was creating unmanageable pain. At the suggestion of his doctor, Jonathon decided to undergo a full hip replacement procedure.

That hip replacement surgery 16 years ago made a significant difference in Jonathon's pain and mobility. After recovering in the hospital and at home and undergoing rehabilitation to strengthen the muscles damaged during surgery, Jonathon was back to almost 100 percent of his condition pre-surgery.

But recently, Jonathon once again started feeling a familiar gnawing pain in the other hip. He was advised he would need a second hip surgery, something he tried to put off as long as possible because of the long recovery time.

"I didn't want to be laid up that long," he said.

Hip replacement surgery, also referred to as total hip arthroplasty, involves the removal of the diseased hip joint and replacing it with a prosthesis, or artificial joint. The prosthesis consists of a ball component and a socket, which might be made of metal, ceramic or plastic. The implants are biocompatible and designed for acceptance by the body.

According to the American Academy of Orthopedic Surgeons, the most common causes of chronic hip pain and disability are forms of arthritis.

Osteoarthritis is the "wear and tear," age-related type. Osteoarthritis usually occurs in those age 50 and older. Cartilage that cushions the bones of the hip wears away and the bones rub together, causing pain and stiffness.

Rheumatoid arthritis is an autoimmune disease where the synovial membrane becomes inflamed and thickened. It is the most common type of disorders termed "inflammatory arthritis."

Post-traumatic arthritis often follows a serious hip injury or fracture.

Avascular necrosis occurs after an injury to the hip, like a dislocation or fracture. It can also be caused by some diseases.

Childhood hip disease, while treated in childhood, may still lead to arthritis later in life.

Arthoplasty is typically recommended when arthritis or injury has caused damage to the hip joint. Symptoms include pain and limited mobility. Surgery is considered when medication, changes in everyday activities and walking supports are no longer adequately relieving symptoms.

Arthoplasty is considered one of the most successful procedures in medicine with as many as 300,000 performed each year in the United States.

Traditional posterior hip replacement surgery, what Jonathon received 15 years ago, gets to the hip joint through an incision made in the buttocks.

The surgeon then cuts through layers of muscle and saws through the bone to replace the diseased joint with the prosthesis.

A less-invasive approach, called "Anterior Approach to Hip Replacement," was introduced in France in the 1940s, said Dr. Fady Zeidan, a Spring Hill orthopedic surgeon. Until recently Zeidan was the only surgeon in Hernando County doing hip replacements using the anterior approach.

The actual replacement of the damaged hip with a prosthesis is the same, Zeidan said. But the techniques used by the surgeon to get into the hip are where the two differ.

Using a Hana table, the patient is positioned so the surgeon can make a single small incision, move the muscle aside rather than cutting through it and replace the diseased hip with the prosthesis.

With no damage to the muscles, the recovery time is significantly reduced. There is also less risk of infection.

The learning curve is steep, he said, which is one reason most surgeons continue to perform the posterior approach. But the benefits to the patient are massive. Many of his patients are on their feet the same day and back to their normal routines within a week.

"My only problem with this procedure is that they feel too good," Zeidan said with chuckle. "They want to do too much."

Since his first introduction to the technique, Zeidan has performed 700 hip replacements using the Anterior Approach.

It is a patient-driven procedure, he said, prompted by the positive feedback of post-surgery patients who sing the praises of the technique.

After suffering with chronic pain in both hips for three years, Spring Hill resident Linda Bradley was told by her physician that she needed hip replacement surgery. In her early 50s, Bradley had suffered multiple traumatic events, which accounted for her diseased hip joints. "It evidently was brought on by stress," she said.

In October of last year, Bradley underwent a double hip replacement on the same day, performed by Zeidan using the Anterior Approach.

"I wanted to get up and move that same day," Bradley remembered. Within a week she was resuming her normal routine. "Things I now take for granted, touching my toes, kneeling, crossing my legs, I can now do. You know, those things normal women do."

"I can't say enough about Dr. Zeidan," she said. "He's a lifesaver."

Zeidan will host a presentation about the Anterior Approach to Hip Replacement Surgery at 5 p.m. Tuesday at the Silverthorn Country Club.

A video presentation with discussion will be presented. For more information, contact Zeidan at (352) 686-6114. His office is located at 10441 Quality Drive, Suite 202; Spring Hill.

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