Five Questions with

The main focus of the Anterior Approach is to replace the hip without disturbing any of the muscle attachments to the bone.  Additionally, because we don’t disturb the muscle attachment, patients get quicker recovery with less pain. This also leads to less chance for hip dislocation.  And with Anterior Approach, we have been able to also improve accuracy of hip biomechanics, the result of getting the artificial hip socket positioned correctly and also the leg length and the other hip biomechanics correct. The combined effects of less tissue trauma, preservation of musculature, and maintaining hip biomechanics specific to the individual account for the benefits of anterior approach.

The average age of people we treat for hip replacement is the early 60s. I have some hip replacement patients that are as young as in their 20s and patients that are in their 90s. That is really a wide age range.  I would also say that there is probably a fairly equal distribution between men and women for hip replacement.

 

Arthritis is the main indication for hip replacement.  Others are trauma, or common older patient trauma which could be results of fractures of other bones.

 

Some people live throughout their life with their cartilage being fine.  Others see cartilage start degenerating when they are in the 40s.  There is a lot we still have to learn about the hip and about human joints that we don’t yet know. As orthopaedic surgeons, we tend to think in mechanical terms like injury causing arthritis. Or people that are obese which puts too much load on the joint. Additionally, there are always some abnormalities that occur due to human genetics.  One of the most common is a shallow hip socket and we have treatment for that.

 

There are certain events that happened where there is a paradigm change.  It’s my view Anterior Approach has been a paradigm change in how hip replacement has been done.  We are going away from having the patient on their side during surgery, either getting a posterior or lateral approach.  Now the patient is on their back getting an anterior approach. At this point we are working hard at improving Anterior Approach with methodologies and associated technologies. Those improvements have included a special operating table that manipulates the body on the outside but also operates inside the body with a robotic arm.  There are also different power instruments that help with more accurate instrumentation in the bone, as well as computer software that we are using.  As far as hip replacement, we are kind of in a tuning up and improving phase of Anterior Approach surgery. At some time there will probably be another paradigm shift in hip replacement but I would not expect this for at least 10 years.

At the Vail Scientific Summit I heard many talks on subjects in the basic science that I’m not involved in on a daily basis. Discussions about the connective tissue, the cartilage, the basic muscle and bones. I work with these issues all the time, not from a researcher’s lens but from a surgical point of view and I solve practical problems for patients.  I think as I discuss more and more with the basic science researchers as I did during this conference, we are going to find very useful ways to collaborate and move the subject forward.