Hip bone’s connected to the knee bone . . .
A new approach to total hip-replacement surgery comes at the right time, as surgeons expect an increased demand for both hip- and knee-replacement procedures
LA GRANDE — The Grande Ronde Hospital Orthopedic Clinic welcomes Dr. Ben Olson this September, who will introduce the most current surgical technique to total hip-replacement surgery — the anterior approach.
At a recent DocTalk meeting at the Grande Ronde Hospital (GRH), orthopedic surgeon Dr. Chad Burgoyne introduced his new clinic associate, Olson, as they both spoke about knee and hip replacements and serving an aging population of baby boomers throughout Northeastern Oregon.
“As baby boomers start emerging into their senior years, we’ll see more need for knee and hip replacements,” said Burgoyne. “One-third of my practice is joint replacements, and I also practice at the Wallowa Memorial Hospital.”
Burgoyne said he currently performs about six knee replacements per month, but he anticipates an increase, especially among the 65- to 70-year-old patient population.
The main cause of joint pain is osteoarthritis, which destroys the bone’s natural elastic cushion (cartilage). Osteoarthritis is a degenerative disease and an estimated 70 million people in the U.S. have a form of arthritis. This often leads to bone-on-bone contact, soreness and swelling.
Knowing when it’s time to consider knee or hip arthroplasty is an individual issue that a patient needs to discuss with an orthopedic specialist.
“When considering knee or hip replacement, ask yourself if your pain limits what you can do,” said Burgoyne. “We all live with a certain amount of pain, but if your pain is at 4 or 5, then it may be time to do something about it.”
In addition to pain, Olson said there are other tell-tale symptoms, including a continuum of arthritis, a leg-length discrepancy, one hip higher than the other, pain that makes you grumpy and having a hard time bending down or tying your shoe.
“The pain may radiate to the knee and hip or you may have muscle spasms at the hip and nothing is working,” said Olson. “Then it’s time to try different modalities of treatment.”
Some of the conservative approaches that Olson and Burgoyne would recommend for joint pain include water therapy, exercise and physical therapy, medications (NSAIDS) and steroid injections.
“We’re cautious with anti-inflammatories,” Olson said, “because the hip is not approved for lubricant injections.”
When the conservative approaches to treatment fail to work, then surgery will be discussed with the patient.
“It’s difficult to tell when that time is right. We try everything, and this is the next step,” said Olson, “but hip- and knee-replacement surgeries are the most successful treatment in all medicine. Ninety percent of patients were able to return to their favorite activities.”
Olson and Burgoyne both have sports medicine backgrounds and have frequently treated a variety of knee and hip-related injuries.
“In 2011 over 325,000 total hip replacements were performed in the U.S. I’ve participated in 500 joint replacement surgeries on patients of all ages,” said Olson, who had a sports medicine fellowship with the University of New Mexico in Albuquerque.
With the addition of Olson to the GRH Orthopedic Clinic, he will introduce the anterior (front) approach to hip replacement, a less invasive surgery with several benefits over the traditional posterior (back) and lateral (side) approaches.
The anterior approach means that the incision is performed in front of the hip joint on the thigh instead of on the side of the hip or on the buttock. With the anterior approach, the patient lies on his back while a small incision (6 to 8 centimeters) is made — unlike the posterior or lateral approaches where the patient lies on his stomach or side during surgery.
With the anterior approach, the surgeon works between the muscles and tissues without detaching them from the hip or thigh bones. This lends to a faster recovery for many patients and fewer restrictions during recovery.
With a posterior or lateral approach, the muscles are detached and more tissues are disrupted during surgery. Also patients who had the posterior approach sometimes dislocated the new hip through the rear muscles while bending over during recovery.
In an anterior approach, the surgeon can check the component placement and leg length using X-rays during the procedure, but with the posterior or lateral approach, post-operative X-rays are taken to check the component placement and leg length.
As with all surgeries, Olson said there are risks. In the case of hip- replacement surgery, 1.63 percent of patients experience some post-operative problems, but overall, studies show that more than 96 percent of patients who had a hip replacement move freely without pain.
Burgoyne added that with knee surgery, the volume of blood loss averages about 750 cubic centimeters (cc) and for hip surgery even less at 250 cc. At these low volumes, blood transfusions are not deemed necessary, and the patient benefits.
“We find patients seem to recover faster and have less post-operative complications without blood,” said Olson.
The introduction of the anterior approach to hip-replacement surgery at the GRH, will allow rural patients throughout Northeastern Oregon equal access to the most current technology available in arthroplasty.
For an appointment with any of the GRH orthopedic clinic specialists, call the clinic at 541-663-3100. The clinic is at 710 Sunset Drive, Suite F, in La Grande.