|
  
Hip and Happening
Last December, Lee Sardella, a 76 year-old retired maintenance supervisor from Phoenix, had reached the end of his very long rope with hip problems. A victim of the bone disorder Paget's Disease, he first began to experience excruciating pain in his left hip seventeen years ago leaving him with back pain, a rather stooped attitude and a shorter leg. Hot-packs and massages did not help so he went to an orthopedic surgeon who recommended a total hip replacement. He had a fair amount of discomfort with ambulation thereafter. After ten years the pain returned with a vengeance because his artificial hip had loosened. He had a revision of this hip replacement, which relieved his discomfort; but seven years later the pain came back. Mr. Sardella decided to see Anthony K. Hedley, M.D., an orthopedic surgeon he had seen on TV at St. Luke's Medical Center, in Phoenix, discussing new hip implants, which were specifically designed for revision surgery. These implants, by Stryker-Howmedica-Osteonics, were designed for use without cement and are modular to facilitate restoration of leg length.
"I am as tall as I should be," says Mr. Sardella. "Dr. Hedley restored my natural height and naturally it straightened out by back. I am still in the healing process, but the pain and stiffness are gone and everything looks pretty good."
Dr. Hedley, who along with Theodore P. Firestone, M.D., at the Institute for Bone and Joint Disorders, perform about 150 such hip revision surgeries each year at St. Luke’s Medical Center from a total of 800 surgeries annually. He says that outcomes of this type of surgery in this day and age should not be as miraculous as it seems. Unfortunately he says sometimes the original hip replacement surgery is not done correctly or the fixation of the prosthesis does not hold up well to the rigors that it is subjected to.
Often these initial implants will loosen or wear with time and need to be revised.
In hip revision surgery, two of the biggest challenges are restoring bone loss and leg length. Because revisions traditionally have required cement for fixation and monoblock prostheses, the restoration of leg length has not always been as accurate as desired. By using newer modular prostheses, which are anchored further down the thigh bone thus avoiding the upper end of the femur which may have been somewhat destroyed by the previously loose prostheses, the leg length is then restored. Thus, the new prosthesis gains distal fixation in the femoral bone and the modularity allows the surgeon the flexibility to restore leg length more accurately. There is a large range of stem sizes and lengths as well as modular portions that allow for this reconstruction.
“There is always a little bit of art in this; it is not a pure science, but the modular prosthesis give us a great deal more flexibility,” says Dr. Hedley. Once you have established a solid foundation with the stem fixed further down the thigh, you can then add the appropriate modular bodies to the stem thus allowing the surgeon to fine-tune the creation of ideal leg length. This design also allows us to bypass significantly destroyed bone in the proximal femur, which avoids the necessity for complex bone grafting procedures (transplanting bone from one part of the body to another or using bone from bone banks). By taking this step out of the hip revision procedure, the length of the surgery and hospital recovery with their associated costs—all of which are usually higher in the revision surgery—are reduced.
But the real results Dr. Hedley notes are measured in the amount of pain reduction and restoration of leg length as well as return to reasonable function. While most revision surgeries do not live up to the patient’s original hip replacement operations, Dr. Hedley stated that many of his revisions are giving patients the range of motion and function that they had after their first operation and, in some cases, even more. “You can often bring patients back to where they should have been and even beyond in the first place,” says Dr. Hedley.
Dr. Anthony Hedley specializes in hip and knee replacements. |
Restoring the knee by using this modular technology, Dr. Hedley is finding similar results in total knee replacements and total knee revision surgeries. As in hip replacement surgery, the goal is to eliminate pain and restore function by rebuilding areas of the knee with bone loss. That appears to be the result for Diane Waterfield, a 59-year-old administrative assistant at Rio Salado College in Tempe who had suffered from painful osteoarthritis in her left knee, which had also resulted in some bone loss on the distal portion of the femur (lower end of the thigh bone). In her recent surgery, Dr. Hedley was able to use a modular implant to compensate for this bone loss while restoring the normal joint line and function of the knee.
“We have modular add-ons which allow us to compensate for bone loss both on the femur and the tibial side; and in some cases, by using more stabilized components, we can compensate for ligamentous insufficiency,” says Dr. Hedley. “These components allow us to get the patients up and going pretty quickly.”
The results? “I couldn’t bend over, go upstairs or walk more than one-quarter mile,” says Ms. Waterfield who describes herself as an outdoors person. “When I get through the exercise program, I should be able to resume hiking, even low impact aerobics.” Likewise Fritz Klaus, a 69 year-old retired auto repair shop owner from Surprise, had a total knee replacement operation on his left knee eight weeks ago because of chronic arthritis. So successful was the surgery that he is back playing golf and doubles tennis. |
Based on the positive results that he had achieved with his left knee replacement, Mr. Klaus decided to go ahead and have his right knee replaced too. Mr. Klaus says he knows that technology played a role in his repair, but he gives most of the credit to Dr. Hedley. “If I did not have him as a surgeon, I would not be on my feet today.”
That outcome and an active lifestyle, notes Dr. Hedley, are what he is really after in both hip and knee replacement surgery, especially for the elderly patient. Without daily activity, he explains, the patient’s physical and psychological health tends to decline resulting in increasing dependence on family, even early admission to a nursing home or assisted living environments and sometimes an early demise.
“A lot of these patients need cardiovascular exercise, so getting back to walking, swimming and cycling is all part of the plan,” says Dr. Hedley. “Also, your twilight years should be as independent as possible and joint replacement surgery is money well invested in that direction.”
What to Expect
Now that your doctor has recommended hip replacement surgery, here’s what will happen. Before your surgery at St. Luke’s Medical Center, you’ll undergo tests such as X-rays, blood tests and possibly an electrocardiogram of the heart. During the 90 minute operation, the surgeon will replace the worn head of the thigh bone with a metal or ceramic ball mounted on a stem, and resurface the socket with a polyethylene plastic cup. The prosthesis may be cemented in place with a grout similar to dental cement, or securely pressed into place using no cement. After the surgery, you’ll remain in the hospital up to a week to recover.
Initially after discharge you’ll likely need the help of a walker or crutches to get around. Daily exercises and physical therapy will be prescribed, as your end result is greatly affected by your compliance with a post-operative exercise routine. You’ll also be taught techniques to help you walk, negotiate stairs, get in and out of chairs and cars, as well as to get on and off toilet seats.
A full recovery can take six months, sometimes longer, depending upon how well the patient responds to physical therapy. Lee Sardella, 76, who had hip revision surgery last December, says he had to use a cane at first, but after physical therapy at the Institute he’s now walking unaided, working out at his local swim club. Says Mr. Sardella, “Everything is looking good.”
For information or referrals: (602) 553-3113  |
|
