Maggie McKay (Host): Most people don't think they're going to need anterior hip replacement surgery, but if you do, there are a lot of questions and things to know.

So today, Dr. Cameron Yau, Board Certified and Fellowship Trained Orthopedic Surgeon, will familiarize us with the process. Welcome to the Beebe Healthcare Podcast. I'm Maggie McKay. So great to have you here today, Dr. Yau. Can you please start by introducing yourself?

Cameron Yau, MD: Sure. Thanks Maggie. My name is Cameron Yau and I'm an Orthopedic Surgeon here in Lewis, Delaware with the First State Orthopedic and Orthopedic Associates of Southern Delaware Group. I've joined the group earlier this year in May of this year. And I was brought in because I am a hip and knee replacement surgeon who specializes in anterior hip replacements as well as general orthopedic replacement, hip and knee replacement surgeries, in general. I've been in practice in the United States, for the last, approximately nine years.

I was in Michigan prior to moving to Delaware, but I moved here earlier this year, as I previously mentioned, and I'm really happy that I joined the group. Prior to moving to Delaware, I was in Michigan, as I previously mentioned. And, my residency training was in Canada, followed by a fellowship in New York City at Lenox Hill Hospital, where we focused primarily on complex hip and knee reconstruction. So this is what I've been doing for the last almost a decade now.

Host: And what types of surgeries do you perform? Is it primarily anterior hip replacement?

Cameron Yau, MD: So, when it comes to hip replacement surgery, I almost exclusively perform an anterior hip replacement. If I have to do a revision surgery, which I do do, redo operation of a hip or a knee replacement, then I sometimes will do a posterior approach as it's more appropriate for the type of surgery that's required. But for most elective hip replacements, I do almost exclusively the anterior replacement. That is correct.

Host: So do people come to you, with jobs that weren't done so well, and that's why you have to do a revision?

Cameron Yau, MD: Sometimes, I mean, there's different reasons why a hip or a knee replacement may fail. Common things include, you know, the hip replacement is kind of worn out, or if there is some instability that is occurring, or infection. These are some common causes for hip and knee replacements to fail. But most people are coming to see me because they're having hip pain or knee pain that requires some surgical intervention.

Host: That brings me to symptoms and injuries. Could you talk more about anterior hip replacement and what those are? How would someone know if they needed it? And what about preventative measures like exercise and physical therapy?

Cameron Yau, MD: Sure. Classically, when someone comes and sees me for hip pain, the main location of pain typically is in the anterior groin. A lot of individuals come to see me and they have either buttock pain or lateral hip pain, but classically, hip arthritis presents with anterior groin pain. And so that's kind of the first symptom that someone may be having an issue in regards to their hip joint.

When it comes to hip replacements, there's a number of non-surgical things that should be attempted prior to engaging with surgical intervention. Things like anti-inflammatories, maybe some physical therapy, sometimes injections, or even some weight loss may be appropriate in terms of the non-surgical management of hip arthritis.

But if someone has failed those, those treatment modalities, or if their hip arthritis is very severe, the only option left is going to be some form of hip replacement, and although there's different types of, there's different ways to perform a hip replacement, the way, the one I perform is an anterior replacement, which is classically considered to be the less invasive, uh, minimally invasive, easier recovery way to perform a hip replacement.

Host: So, when it comes to injuries, is there one thing that you see the most? Why people would, like, let's say somebody doesn't have arthritis, and they just, I don't know, fall on the pickleball court or something that.

Cameron Yau, MD: Yeah, so the majority of hip replacements performed in North America are performed for arthritis of some form or another, either rheumatoid arthritis, or osteoarthritis, any of the kind of inflammatory joint conditions that cause hip pain. When it comes to more traumatic injuries, like a hip fracture, which may indicate someone for a hip replacement, those happen less frequently.

The majority of individuals are coming to see me with progressively worsening anterior hip pain that is starting to interfere with their quality of life, and are having more and more issues just living their day to day lives. But when it comes to injuries, you know, hip fractures occur, unfortunately, very commonly and typically, depending on the hip fracture type, there's different treatments that can be performed, including hip replacement, which typically, if it's a good indication for surgery, can be the best way to recover from a hip fracture.

But most individuals come in to see me with progressively worsening hip pain. When their hip pain is severe and the non-surgical management isn't really providing any relief anymore, then hip replacement surgery is really, an excellent way to treat the ongoing pain and disability.

Host: Dr. Yau, you touched on this a little bit, but what are some other treatment options and how do they compare to anterior hip replacement?

Cameron Yau, MD: Sure. The non-surgical management typically is going to be symptom management because the problem with hip arthritis is that it's progressively deteriorating joint. So the hip will be progressively, over time, worsening in terms of pain and disability. And so we're just trying to limit how much that pain and disability is affecting your patient's quality of life.

So we'll do things like pain management with pills such as Tylenol or anti-nflammatories. We'll do some things like physical therapy to work on range of motion and make sure that the hip is adequately strong. Hip injections can be utilized as well, which can provide a temporary relief of hip arthritis symptoms.

But unfortunately, the hip arthritis doesn't improve with that injection. It only helps limit the symptoms temporarily. And then at some point, when those, those modalities fail, the only option left is going to be an operation like a hip replacement. When it comes to the anterior hip replacement versus other forms of hip replacement surgery, we're referring specifically to the technique that is utilized to install the implants.

So classically in North America, the approach that has been utilized has been something called the posterior hip replacement. The posterior hip replacement is an excellent procedure. It works very well at eliminating hip pain, but the main issue with posterior hip replacement is that the recovery can be quite long and there are some associated complications.

So specifically with, with the posterior approach, some individuals may suffer instability of the hip replacement and have dislocations of, of the joint. So the main benefit, one of the main benefits of going through the front, through an anterior hip, is that the rate of instability is almost considered to be zero.

There are some case reports of dislocated hips with an anterior hip replacement, but the frequency is extremely small and more of like a very rare occurrence. So through the front, typically with an anterior approach, the recovery tends to be that much quicker. But the other benefit is that the rate of dislocation is almost zero.

There's no limitations on what the patient can do with hip replacement. You can move it anywhere you want. There's really a less, significantly less risk of dislocation and so people tend to just bounce back that much quicker, getting back to routine of day to day activities and whatever else keeps them healthy and happy.

Host: That sounds very encouraging. Dr. Yau, I think a lot of people associate hip replacement surgery with older people, maybe the elderly. So who is at the highest risk for these injuries? Because I know people my age, I don't consider myself elderly yet, who have had hip replacement surgery.

Cameron Yau, MD: Right. Joint replacement in general was invented in the 60s and 70s. And before that operation, those operations were invented, our surgical options were very limited. We used to do things like fusions. And really the quality of life that was given to patients who suffered from hip arthritis or knee arthritis was very limited.

And so the development of these joint replacement surgeries has been really revolutionary in terms of giving people back their quality of life. In fact, hip replacement is considered to be one of the most powerful interventions that we have in medicine for improving people's quality of life. People can have significant pain and disability. They can have a hard time just doing basic things like grocery shopping, mowing their lawn, going to the beach, going on vacation, because hip arthritis can be so significant. And what we're seeing now is that hip arthritis is a huge issue. Hip and knee replacements are some of the most commonly performed procedures in North America.

So, frequency that we see hip arthritis pain in our practice is only going up. And fortunately we have excellent surgeries that are available now to help people regain their sense of activity and quality of life that they've lost through their, their pain and disability.

Host: So who is at the highest risk for these injuries? Someone with arthritis?

Cameron Yau, MD: Yes, typically. So, individuals who present with hip arthritis pain tend to be later on in life, although it can occur in any age. Someone who has rheumatoid arthritis may have significant hip pain earlier on in their life. But typically we think of the average patient as between the age of 60 and 75, and that would be the most common kind of age group that we would see.

Host: And can anyone receive this treatment? Are there any genetic or predisposed causes for needing hip or knee replacement?

Cameron Yau, MD: Hip arthritis can occur in anybody. Basically what happens is that the hip can undergo damage over a lifetime. And that damage does not heal. Cartilage damage associated with joint injury, is progressive and deteriorative. And so as people get a little bit older, the lifetime that they've enjoyed their hips and their knees, the wear and tear has taken a toll. And so it depends on how severe that damage is. Arthritis does run in families and diseases like psoriatic arthritis or rheumatoid arthritis also runs in families. But osteoarthritis, which is the general wear and tear type arthritis, unfortunately, is extremely common. It can occur to anybody.

Host: Do you have any specific success stories that come to mind?

Cameron Yau, MD: I'm very fortunate in my career choice in that I have this ability to take someone who comes and sees me for the first time and has, you know, significant pain and disability. Someone's using a cane or a walker and they just want to get back to their quality of life.

And, every patient that I see who has a successful operation, who comes in walking without any limp or with any kind of walking aid, I consider every, every one of those a great success story. I'm very fortunate in that the vast majority of my patients are very happy. And, I live a very, a satisfied life in that way.

Host: I'm sure that's really rewarding. How does partnering with Beebe allow you to do your work?

Cameron Yau, MD: It's really great working with Beebe. First off, the team is very dedicated to patient outcomes. We have in home physical therapy, which makes the recovery that much quicker earlier on in the recovery period. The new surgical center that is located over on Route 24 is an excellent, beautiful location to have your hip replacement surgery. It makes the recovery that much easier. I'm really happy with the quality of service that we're able to provide for patients with their hip replacements and knee replacements.

Host: And I bet the patients really trust you when, you know, you're talking about that facility and the team and the nurses and the support staff. It's, uh, it's a big effort, right? What are you most excited about when it comes to the future of your field?

Cameron Yau, MD: I'm really happy that the anterior hip replacement is becoming more of a common thing. In my hands, in my experience, the recovery is that much quicker, patient satisfaction is that much better. The fact that this operation is becoming more widespread and available to individuals is really a great thing.

So, you know, I'm very happy that the skill and the technique that we can provide to patients care is, is just becoming more of a common thing, but it's still new. So I'm really happy that I'm here and able to provide that service for my patient population.

Host: Thank you so much for being here today. It was a pleasure meeting you and hearing more about what you do.

Cameron Yau, MD: Thank you very much. Appreciate it.

Host: Again, that's Dr. Cameron Yau. And if you'd like to find out more, you can go to beebehealthcare.org/services/orthopedics. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is the Beebe Healthcare podcast.