A Hip Idea Revolutionizes a Standard Surgical Approach

Jennie Fernandez is a peppy 89. The onetime World War II defense plant worker and widowed mother of four was in trim shape and still cleaning her own house, doing her laundry, and going grocery shopping. But through it all, she was in excruciating pain.

"I'd developed arthritis in my left hip," says Fernandez. Over the years, the thin, smooth cartilage that cushions the round head of the femur in the pelvic socket, allowing easy motion, had degenerated so badly that bone was grinding against bone. "The pain was like a sword going through me," she recalls. "It was there all the time. My doctor told me: ‘Jennie, you're in the market for a good new hip.'"

Her search brought her to Roy Davidovitch, M.D., head of the New York Hip Center at NYU Hospital for Joint Diseases. Dr. Davidovitch is one of a small number of orthopaedic surgeons in the United States skilled in using an innovative, minimally invasive approach to hip replacement surgery. Developed in France half a century ago by Robert Judet, M.D., one of the pioneers of modern orthopaedic surgery, the technique was introduced to American surgeons just a decade ago by Joel Matta, M.D., of Santa Monica, California, and is slowly gaining popularity.

Dr. Davidovitch, who trained under Dr. Matta, explained to Fernandez that the new technique has several advantages: rapid recovery, decreased pain, and superior stability of the hip, which lowers the risk of dislocation. "The newer technique cuts the time in hospital - for the operation and physical therapy - by about half, from an average of four days to two," says Dr. Davidovitch. "Patients have been able to walk unassisted within four days of the surgery, and most can abandon their cane after two to three weeks."

What makes the difference? It's the way doctors get to the hip joint. In the standard procedure, surgeons approach the joint through a long incision made in the patient's side or back, cutting through muscles and tendons that stabilize the joint and allow it to rotate. In the newer, anterior hip replacement surgery, they make a small incision (about four to five inches long) in the front of the body and follow a natural groove between muscles to reach the joint, leaving muscles and tendons intact. A special operating room table specifically designed for the anterior hip replacement facilitates the procedure. The rest of the operation is the same: surgeons cut off the head and neck of the femur, ream and shape the pelvic socket, and guided by X-rays, insert an artificial new head into the femur, positioning it to rotate comfortably in the socket.

Because muscles aren't disturbed, there's less pain, the hip remains stable, the leg lengths are equal, and patients can resume normal activities relatively quickly. With the traditional surgery, patients are normally told not to flex their hips beyond 90 degrees for two months or more, making it difficult for them to perform even routine motions like getting in and out of a car or sitting on the toilet. But no such restrictions are placed on patients who undergo the anterior hip replacement.

After hearing her options, says Jennie Fernandez, "I went for the new technique. I was through rehab and out of the hospital in just a few days. I've got no restrictions. I bend any way I want. And I've got no pain."

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Originally published in News & Views, November 2008