January 23, 2011
Suzanne Lonngren, 56, has had both of her hips replaced, in separate surgeries 1½ years apart. Same surgeon. Same hospital. But the two recoveries were like “night and day,” she said.
The first time, the Lombard resident had a traditional hip replacement. For her second surgery, she was the beneficiary of a new less-invasive technique that doesn’t require detaching muscles from the hip or thigh bones.
“There was much, much, much less pain,” said Lonngren, a surgical nurse and former ballet dancer. “No matter how you do it, (hip replacement is) a pretty violent surgery; it’s pretty rough, but this is far nicer and gentler.”
The operation was done by Dr. Steven Louis of Hinsdale Orthopaedics, one of a handful of Chicago-area surgeons using the direct anterior approach. The surgeon reaches the hip joint from the front, pushing aside key muscles and tendons instead of cutting them.
Traditionally, hip replacement is done using a posterior (rear) or lateral (side) approach.
“The actual replacement is the same,” Louis said. “It’s just how you get there; it’s what’s not damaged or cut,”
Louis has completed more than 100 hip replacements using this approach. He does the operation at Advocate Good Samaritan Hospital in Downers Grove, one of a few hospitals with the high-tech operating table used in this surgery. Loyola University Medical Center in Maywood also has the specialized table, and surgeons there have performed more than 250 direct anterior hip replacements.
With the patient’s foot in what resembles a ski boot, the leg is extended and rotated backward, then held in position for the surgery.
Because the muscles aren’t cut, patients have less pain and recover more quickly, surgeons say.
The risk of hip dislocation after surgery is much lower. After a traditional hip replacement, patients are warned not to bend the hip more than 90 degrees, not to cross their legs or tie their shoes and to sleep with a pillow between their knees. There are no restrictions following hip surgery with the direct anterior approach.
“It’s just your body’s pain tolerance; if it hurts, don’t do it,” said Lonngren, who was back to making dinner, going shopping and using the stairs about a week after her second hip replacement.
The new technique also makes it easier to operate on both hips at once, Louis said.
Hugh Crebs, 61, of Naperville needed both hips replaced due to severe arthritis, but didn’t want to go through recovery and physical therapy twice. His wife found Dr. Louis through an online search.
“My life has completely changed since the surgery,” said Crebs, who is looking forward to getting back to yard work in the spring.
There are a few downsides to the direct anterior approach: The patient sustains slightly more blood loss; the procedure is physically harder on the surgeon; and the procedure takes longer than a traditional hip replacement.
For those reasons, the extra training needed and the specialized table costing up to $100,000, most hip replacements will continue to be done using the traditional approach, Louis said.
But 10 to 15 years from now, he predicts, about half of the surgeries will use the new approach
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