Dr. Matta and Anterior Approach

The Steadman Clinic takes great pride in knowing that it has some of the world’s finest orthopaedic surgeons in place at its state-of-the-art facilities in Vail, Colo.  From specialists of the knee, shoulder, hand, hip, ankle, etc., the doctors at TSC are not only globally regarded as among the finest, they are universally acknowledged as such by the patients who have come to them.

Dr. Joel Matta, one of TSC’s most recent additions, comes to Vail as one of the world’s most-recognized names in the field of hip surgery.  And he brings with him a distinction as the North American leader and innovator regarding Anterior Approach Hip Replacement.

Dr. Matta moved to Vail this past March and has made an immediate impact at The Steadman Clinic and the Steadman Philippon Research Institute (SPRI). In June, he and the organization he founded – the Anterior Hip Foundation – completed a highly-successful innovation symposium in Las Vegas.

“Nine months ago, the Bellagio Hotel in (Las) Vegas had my credit card reserving 140 rooms for this first – and hopefully annual – symposium.  Needless to say, I had some concerns but the turnout ended up exceeding all expectations,” said Dr. Matta. “We had significantly more attendees than expected and also more presenters. We were most grateful to our corporate sponsors and were very fortunate to have some of the anterior approach’s biggest names listed among our speakers.”

What is the anterior approach and why is it so significant in today’s hip replacement technology?  The answers go back a long way and involve the last 20 years of Dr. Matta’s professional life.

“I went to Paris in 1981 to study acetabular and pelvic fracture surgery, with Prof. Emile Letournel,” said Dr. Matta. “While there I saw an anterior approach hip replacement performed by Dr. Letournel. At that time Dr. Letournel was the number one authority in the world on acetabular fractures but he had also studied under Dr. Robert Judet.”

Judet was the founder of the anterior approach method and performed the first hip replacement of that kind in Paris in 1947.  His innovative and specially-designed table – the Judet Table – was first made for this new and unique approach to hip replacement.

“My main focus in 1981 was the surgical treatment of acetabular and pelvic fractures, essentially hip preservation following severe fracture and after my return from Paris I continued with posterior approach hip which was the most popular method and advocated by my department chief Dr. Sarmiento at the University of Southern California.”

Fifteen years later, in 1996, an American patient who already had one hip replaced in France via the anterior approach was searching the US for someone who had been taught by Letournel to replace his other hip.  “His enthusiasm for anterior approach led me to reconsider what I had seen in Paris in 1981 though not adopted.”

 “I explained to the patient that though I normally did posterior approach, I did have one of the few Judet Tables in the U.S., knew the anterior approach and if he agreed he would be my first hip replacement from anterior,” said Dr. Matta. “Beginning with that patient I began a series of anterior approach hip replacements because I wanted to reduce the risk of hip dislocation which is one of the main problems associated with posterior approach.  But as I got into it, I started to notice that people were recovering more quickly and not feeling as much pain.  This was something that I really didn’t expect but it clearly became one of the benefits of the anterior approach as well as almost eliminating dislocations.”

Perhaps that finding over 20 years ago was a foreshadowing of Dr. Matta’s future relationship with The Steadman Clinic.  After all, TSC’s mission centers around helping people recover better, faster and with less pain and return to normal activities as quickly as possible.

Dr. Matta’s use of the anterior approach started to become popular in the ensuing years.  And development of the HANA Table helped spur that growth by its capability to facilitate access to the acetabulum and femur.

“By 1996, the Judet Table was out of production. By 2000 I was convinced that anterior approach was a superior method and I wanted to create teaching courses for surgeons facilitated by the special table,” said Dr. Matta. “I met the president of the company that manufactured it in France and suggested a restart of production, however the answer was no because of past lack of commercial success.  Later, MizuhoOSI in California agreed to work with me on a design which became the HANA Table.  When the new table became available in 2003 I organized my first surgeon course on anterior approach in Los Angeles.  The HANA Table became a successful medical innovation that facilitated anterior approach hip and was innovative enough to warrant U.S. and international patents.”  The innovative HANA table was pictured on the front page of the Wall Street Journal Personal Section on February 2, 2016.

Dr Matta’s first course in 2003 was attended by about 20 surgeons.  Through 2016, courses sponsored by DePuy Synthes entitled “Anterior Approach as Described by Joel Matta, MD,” have educated over two thousand surgeons.  During this period, the percentage of surgeons performing anterior approach has grown from less than 1% in 2003 to over 30%.

The significant growth, though, has not come without some challenges.

“In the last 20 years, there has been quite a bit of pushback from hip experts around the world,” said Dr. Matta. “Hip replacement by any approach has been a successful procedure and surgeons are reluctant to abandon a known technique for something new, particularly when it requires some retraining.”

“What has really driven the move for many doctors to the anterior approach is the will of the patients,” continued Dr. Matta. “Thanks to the Internet, the patients have read more and learned more about the successes others have had with anterior approach replacements.  Along with clinical data, and opinions of orthopaedic surgery leaders, it is often the opinions and desires of patients that now drive trends in medical innovations.”

Prior to joining the Clinic team this spring, Dr. Matta was the founder and director of the Hip and Pelvis Institute at St. John’s Health Center in Santa Monica, Calif.  A veteran of over 35 years in the practice of orthopaedic surgery, Dr. Matta also previously served as founder and director of the Anterior Total Hip Arthroplasty Collaborative and director of The Emile Letournel Institute in Santa Monica.  Dr. Matta is a member of several professional organizations, including being elected to The Hip Society and The International Hip Society. He has authored more than 30 peer review articles and studies regarding advancing hip and pelvis surgery.

And, as mentioned earlier, he also started the Anterior Hip Foundation.  The recent symposium in Las Vegas was judged to be a huge success and plans have been made already for the second annual event in 2018.  Dr. Matta envisions the next event as a continuation of the topics they discussed and debated at length at the Bellagio in June.

“We wanted to achieve several things with the first event,” said Dr. Matta. “Part of the reason for the symposium was to bring together surgeons who routinely perform the anterior approach and discuss potential solutions to current problems or issues with the practice. How can we improve anterior approach? What innovations are each of us working on? What are the current controversies in the anterior approach? What are the different types of artificial hips available today that best suit our patients’ needs?

“Are the specialized tables really necessary?  Most surgeons use some type of special table.  Some use a standard table.  These are the types of controversies discussed.  It is truly a learning center, a forum for stimulating ideas from the surgeons that are performing the anterior approach.”

“We also look at the clinical data and combine all the collected data on anterior approach and see how that information can help us devise new and better methods and procedures,” added Dr. Matta.

“And, just as importantly, the symposium also helps to increase public awareness of the anterior approach.”

Two individuals were recognized at the symposium for their contributions in advancement and education of the anterior approach.  Dr. William Hamilton from the Anderson Clinic in Virginia received the Matta Award and Dr. Frederick Laude from Paris was given the Judet Award, its European equivalent.

Will there be any similar events sponsored by or hosted at The Steadman Clinic?

“I have planned at some point for an instructional meeting on anterior approach at The Steadman Clinic,” said Dr. Matta. “Sometime in the next 12 months we will have a teaching session here and further discuss the benefits of the procedure.

“The Fellows at TSC spend time with me on anterior approach, just as they do with Dr. Philippon and the others in their specialties.  There is one Fellow per year primarily devoted to learning from me and that position is designated as ‘The Matta Hip Fellow.’  I have had different Fellows every year since 1990 and look forward to continuing that practice here at TSC.”

Dr Matta’s database on hip and pelvis patients including both hip preserving and hip replacement procedures will be integrated into SPRI data base to facilitate future clinical research.

When asked about what one thing stood out the most for him at the recent AHF symposium, Dr. Matta responded immediately by mentioning a picture that was taken.

“I had the rare opportunity to pose for a photograph with two of the premier names in the history and growth of the anterior approach method of hip replacement,” said Dr. Matta. “I stood side-by-side with Dr. Thierry Judet, the son and successor of the originator of the anterior approach Dr. Robert Judet, and also Dr. Frederick Laude, who remains one of the most influential surgeons in the anterior approach field today.  Dr. Laude was one of the last surgeons to work closely with our mutual mentor Dr. Letournel.

“It was a great way to cap off a productive conference and gave me a photo that I will treasure for years to come.”