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A New Wave of Knee and Hip Repairs

John C. Lincoln's orthopedic surgeons lead the way with new techniques

We live in a world of action. Multi-tasking at work, working out at the gym, running marathons of family activities on weekends – life today is a whirl of nonstop exertion. It’s no wonder that after a while, our joints are bound to protest!

When our hips or knees first ache, there are a variety of noninvasive therapies which can help relieve pain and restore mobility. But when joint problems persist and become serious, John C. Lincoln’s orthopaedic surgeons have the answers. They tell their patients that joints usually hurt because the cartilage which originally cushioned and protected bones from rubbing directly on each other has been destroyed. The friction of bone rubbing painfully on bone causes the ends of both bones to wear down, eventually making joint replacement surgery necessary.

Most of the 500,000-plus Americans who get joint replacement surgery each year have degenerative joint diseases such as osteoarthritis, rheumatoid arthritis, post-traumatic arthritis or avascular necrosis. But joint degeneration can also develop in younger people as a result of sports-related injuries or trauma from car crashes.

For orthopaedic patients of all ages, there is good news on the medical front.

Hip Repairs for Baby Boomers

Hip repairs—once seen as just for seniors—are no longer the sole province of the elderly. Weekend athletes and Baby Boomers who’ve pushed themselves into orthopedic problems once had to wait to get the surgeries to fix them because implants or prostheses had a limited life span.

But no longer do they have to wait. New procedures and improved implants are making hip replacements and hip repairs practical for younger people. A European hip repair procedure—known as the Birmingham Hip Resurfacing (BHR) System—is quicker, easier, safer and longer-lasting than the traditional hip surgery.

Wade Shrader, MD

Traditional surgical treatment involved replacing the head of the thigh bone with an artificial knob which fit into a metal socket implanted in the pelvic bone. The procedure is routine, but it is also a lengthy and complex surgery. Patients must spend several days in the hospital followed by monthly and annual check-ups.

In contrast, the Birmingham Hip Resurfacing System involves far less bone surgery. Instead of surgically removing the knob at the top of the thigh bone, the Birmingham Hip conserves a patient's natural bone. After the thigh knob and the hip socket are minimally resurfaced, they are coated with a high-carbide cobalt chrome.

This new, long-lasting metal is shaped in the form of a ball head, a cap with a small stem that is inserted into the top of the thighbone to hold it securely in place. The other part of the BHR System is a shallow cup that replaces the damaged surface of the hip socket. The cap covering the top of the thigh moves smoothly within the cup implanted in the pelvic bone.

One of the few surgeons in Arizona who is qualified to do the "Birmingham hip" procedure is board-eligible orthopedic surgeon Wade Shrader, MD, from the CORE Institute, who is on staff at John C. Lincoln Deer Valley Hospital.

This high carbide cobalt chrome cap fits over a patient’s resurfaced thigh bone and fits into the hip socket.

In February 2007, Dr. Shrader performed a Birmingham hip procedure on former college athlete Tony Jones, Sr., whose premature arthritis had left him unable to run, play basketball or wrestle with his school-age sons.

"My 14-year-old is pretty tall and, of course he wanted to challenge me," Tony says. "It got to the point where he could outrun me. I couldn’t even run drills with my boys when I was coaching them in football—I had to just try to direct them from the sidelines, which isn’t nearly as effective as showing them what to do."

Now, however, just three months post-surgery, Tony is pain free for the first time in five years, and is back to doing everything he could do at age 20-something, "except for those lateral football movements. I'm still going through physical therapy to help me get that back. But I'm playing basketball with the boys twice a week and running three times a week—and I’m outrunning the 14-year-old again!"

Hip Repairs: Looking Up

One factor that adds risk and lengthens recovery time to hip replacement surgery has been the way surgeons traditionally have reached the hip joint. A new approach—from the front instead of from the side or back—is called the "anterior" approach. It reduces post-surgical pain, risks and recovery time for the patient.

One of the few surgeons in the country who is performing this new Anterior Total Hip Replacement is Neal Rockowitz, MD, a fellowship-trained joint replacement specialist and board certified orthopedic surgeon on staff at John C. Lincoln North Mountain Hospital.

Neal Rockowitz, MD

The most significant difference with anterior surgery, Dr. Rockowitz says, is that surgeons can reach the hip joint without cutting or disturbing tendons or muscle. Instead, they slide between the muscle groups, through what is called the inter-nervous plane.

Operating in this inter-nervous plane also means that there is less risk to the nerves that surround the hip. Because tendons are never detached, there is no need to recover from tendon reattachment. For the same reason, the risk of post-surgical hip dislocation is reduced.

All together, this means that there is less post-surgical pain and patients' recovery time is much shorter.

"My husband noticed the difference even faster than I did," says Leona Voss, who had her right hip replaced through a lateral approach in January and her left hip replaced through the new anterior approach in March. "He said he could tell right away that I was doing everything earlier than I did after my first surgery."

Recounting the differences, Leona says she was in the hospital one day less for the second surgery, that her recovery was at least a week quicker, there was less pain and "the incision was much smaller, which made it easier to heal. In fact, it was just easier all the way around."

Even little things were notably different, she adds. "I noticed at night I can lie on the side where I had the surgery so much more comfortably than I could after my first surgery."

Leona, who’s 67, needed the surgery because, like so many members of her family, arthritis had "just eaten my joints away."

Leona's mom had surgery for both hips, and her brother had surgery on both hips and both knees. In Leona's case, "My hips really hurt and I just couldn’t do the things I used to do."

Leona now says she can be on her feet and get around without pain, just like she did before arthritis set in. "There’s been a bit of challenge, getting coordinated, getting my hip joints to play nice together, but they’re coming right along. Even though it doesn’t hurt any more, I do have a tiny fear factor that’s still holding me back, but I think that will go away fairly quickly.

"Also, I do get a little tired a little faster than I did when I was young, but after a brief rest I’m ready to go again," she says. "Dr. Rockowitz is a really good doctor and he did a great job taking care of me!"

Knee Repairs that Last

There's good news for Baby Boomers with painful knees. Often, these are the patients who've made up for their sedentary work week by climbing Piestewa Peak or playing a friendly game of touch football on the weekend.

Over the years, this otherwise healthy activity takes its toll, especially on knees. With years of wear and tear, degenerative conditions develop in weight-bearing joints, leading to pain, swelling, stiffness and, ultimately, decline in function.

Younger patients who developed chronic knee pain were traditionally told to tough it out and put off surgery until they were older, because artificial joints have a limited life span.

Although knee prostheses still wear, today’s implants are much improved. Board certified orthopedic surgeon Stephen Kurtin, MD, who specializes in hip and knee arthritis, says that gives patients more options.

"When conservative therapies no longer provide adequate relief, and joint pain impairs the patient’s quality of life, surgery should be considered," says Dr. Kurtin, who is on staff at John C. Lincoln North Mountain Hospital. "These surgeries can often be performed through minimally invasive techniques—smaller incisions and less trauma to underlying soft tissues."

Innovations in joint replacement surgical techniques have reduced anesthesia and surgical time, length of hospital stay and time required for overall recovery, he adds.

Stephen Kurtin, MD

"The surgical goal is to restore alignment to the arthritic joint while relieving pain," Dr. Kurtin explains. "A common misconception is that a knee replacement removes the entire knee joint, and with it, a large portion of bone. That is not so. A knee replacement retains the functional ligaments of the knee and resurfaces the worn out bony surfaces while substituting for the worn cartilage."

Testifying to the benefits of Dr. Kurtin’s surgical technique, Christine Reece says "He has my indebtedness forever!" Christine, now in her mid-50s, played softball until she was 50 even though she had problems with her "bad knee" for almost 15 years.

This sleek, longlasting implant makes surgical knee repairs practical for younger patients.

Things took a turn for the worse three years ago when she twisted her "good knee" coming down the stairs at work. When physical therapy and arthroscopic surgery under a different doctor’s guidance proved ineffective, a change in insurance plans brought Christine to Dr. Kurtin.

"That was awesome!" she says. Dr. Kurtin replaced Christine’s twisted knee joint in February 2006. Her recovery was "so wonderful," she says, she returned to let him replace her "bad knee" in March 2007.

Not only was he a terrific surgeon, she adds, but "Every time I had surgery, he sent a rose in a bud vase, that extra little wonderful touch. I never had another doctor do that!" Moving around now "is a world of difference," she says. She’s functioning without pain, "climbing stairs like a normal person for the first time in years!"