Five Questions with

For at least the past 10 years I had been communicating with Marc Philippon and we have been professional colleagues and friends.  He has referred me patients in Santa Monica and conversely, I also referred patients to Dr. Philippon for the procedures in which he specializes.

 

So, we had some discussions over the past 10 years, just kind of casually.  “Why don’t you consider coming and joining us in Vail?” he would say.  And I would smile and say, “Why don’t you come out to Santa Monica? Santa Monica’s even bigger . . . “ 

 

Finally, I decided to come out here and talk. Actually, I had an invitation to go elk hunting in Eagle, Colo., so my wife and I made the trip.  I started talking with Marc and the others and it made sense. It looked attractive for several reasons. One is the model they have of providing top-level orthopaedic care with a group of high-level orthopaedic specialists. Beginning with Dr. Steadman, they have been very careful in the selection of who joins the group. Because of that they get referrals from a wide area, not only nationally but internationally, and it agrees with the practice I have been able to build in Santa Monica. 

 

Additionally, The Steadman Clinic has the relationship with the Steadman-Philippon Research Institute which is really a top university-level research institution. Research at that level is very unique for a private entity like this.

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.