The ACTIS™ Total Hip System is a unique way for physicians performing hip replacement using the anterior approach to have better outcomes and it has shown to be more beneficial for patients.
In this segment, M. Scott True, MD discusses the The ACTIS™ Total Hip System for improved implant stability and patient satisfaction.
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ACTIS® Total Hip System
Featured Speaker:
He is certified by the American Board of Orthopaedics and is a member of the Arthroscopy Association of North America, American Academy of Orthopaedic Surgeons, Mid-America Orthopaedic Association, Ohio Orthopaedic Society, Cincinnati Orthopaedic Society, American Medical Association, Ohio State Medical Society and the Butler County Medical Society.
Learn more about M. Scott True, MD
M. Scott True, MD
M. Scott True, MD earned his undergraduate degree from Taylor University in Upland, IN and his medical degree from the University of Cincinnati, where he also completed his internship and residency.He is certified by the American Board of Orthopaedics and is a member of the Arthroscopy Association of North America, American Academy of Orthopaedic Surgeons, Mid-America Orthopaedic Association, Ohio Orthopaedic Society, Cincinnati Orthopaedic Society, American Medical Association, Ohio State Medical Society and the Butler County Medical Society.
Learn more about M. Scott True, MD
Transcription:
ACTIS® Total Hip System
Melanie Cole (Host): The Actis Total Hip System is a unique way for physicians performing hip replacement using the anterior approach to have better outcomes, and it has shown to be more beneficial for patients. My guest today is Dr. Scott True. He's an orthopedic surgeon with The Christ Hospital Health Network. Welcome to the show, Dr. True. So, explain a little bit about how hip replacement has been done in the past and what seems to be the changing trend now.
Dr. M. Scott True, MD (Guest): Historically, hip replacements were done either through a posterior approach which is kind of an incision back on the butt cheek, essentially, or lateral approach which is an incision directly over the side of the hip. Both of those approaches are good approaches and have been around for a long time and are still frequently used today, but they do cut through muscle and/or tendon and are therefore, more painful. There was also a historically an increased dislocation rate where the ball would pop out of the socket with those approaches, and those have been improved over the last probably five plus years, but still, is a slightly increased risk compared to an anterior approach.
Melanie: And what's changed as far as muscle preservation with the two approaches?
Dr. True: The anterior approach does preserve the muscle. You're going through an interval between the muscles instead of through the muscle itself. So, the muscle even though it gets tugged and pulled on to get into the hip joint, it's not cut. So, the ability of the muscle to rebound or recover is significantly quicker; therefore, patients have less pain, are up and active quickly, and back to work a little quicker, and the rehab in general is significantly shorter.
Melanie: And for surgeons, Dr. True, is it more technically challenging to use the anterior approach as far as intraoperative visualization? Is there a difference there?
Dr. True: After you've learned the technique, it is not necessarily. It's not -- the one thing it lacks is it's not what we call an extensile approach if there is a problem encountered during surgery for instance, sometimes, an additional approach may be necessary. That is extremely rare whereas the other two approaches are more versatile if there are problems encountered in the OR. Again, those are extremely rare, and there is definitely a learning curve with the anterior approach especially to surgeons who are trained with a different approach, but that once that learning curve has been passed by, then the exposure is really excellent.
Melanie: So, you're seeing an increasingly diverse patient population and even younger people which you didn’t used to see having hip replacements, yes? And with this increasingly diverse population and even younger patients getting their hips replaced -- tell us a little bit about the Actis Hip System and how that’s designed for this diverse population?
Dr. True: The Actis Hip System is from DePuy, which is a total joint company that has over 30 years of experience with these collared press-fit stems. Press-fit meaning no cement is needed, and that’s how virtually all hip replacements are done nowadays. They’ve – it was designed based off a couple of their hip stems which have been very good and kind of the work horses of hip replacement over the years, but neither of which were designed specifically for the anterior approach. So, they essentially took the major benefit of a couple of their other stems and incorporated it into this one stem. It's a little shorter, a little thicker or beefier up top so it has a good fit of the bone especially in someone who may be a little more osteoporotic, such as an older female in particular, and then the collar on it prevents it from settling, or we call subsiding. So there is a decreased risk of femoral fracture. There is a short-term stability for early weight bearing is increased and then again the potential for rotation or subsidence is reduced with that collar on it.
Melanie: Is it also compatible with other positioning approaches besides just –
Dr. True: Yes – it’s compatible with any approach. But this is the first that was kind of specifically designed with these muscle-sparing – or in particular – the anterior approach in mind.
Melanie: So, tell us about patient selection criteria. Elaborate on who can benefit from this procedure and the broad range of patient anatomies.
Dr. True: Yeah. Again, that’s the big benefit of the Actis Stem. For an anterior approach, you prefer a short curved stem and that gives you – that satisfies both of those criteria. But some of the short, curved stems are fairly thin, what we call blade stems, and there is a risk of those settling or causing an intraoperative or a postoperative fracture of the bone especially in someone who has some osteoporosis. So, by making it a little thicker and by making it – or giving it the collar to stop it from settling – they’ve attempted to at least significantly lessen those potential complications.
Melanie: What should patients expect regarding recovery time and post-procedure, and how long it's lasting?
Dr. True: The bearing surface which determines how long the implant lasts – I tell people now probably 25 or 30 years is…
Melanie: Wow.
Dr. True: …an expectation for a duration – or how long the hip will last. We get patients up the day of surgery. If their surgery’s in the morning, they're up that afternoon -- at least on the edge of the bed and hopefully up and walk to the chair. Most of them are going home the following day after they’ve passed all of their therapy sessions, including going up and down steps, and again probably within a few weeks, they're back to the majority of their normal activities. Not quite everything and certainly they don’t have all their endurance and stamina back, but from a functional standpoint within a few weeks, they're back to most of most of their normal daily activities.
Melanie: So, where are you performing this procedure?
Dr. True: This is done at Christ Hospital at the Joint and Spine Center.
Melanie: So, now, kind of wrap it up for us. Really tell other physicians what you'd like them to know about utilizing the Actis Hip System, and when you think they should refer to a specialist?
Dr. True: Hip arthritis doesn’t have all of the other non-operative options like knee arthritis has, for instance. Hip arthritis, you try the standard therapy – physical therapy – especially aqua therapy or low-impact therapies, the anti-inflammatory medications are all beneficial, but when the pain wakes them up at night, when the pain significantly alters their activities of daily living, or that they're to the point that they're requiring the use of a cane or a walker to get around, those are – that’s the time where probably a referral is recommended and because there are times where waiting too long could make the surgery, and then therefore the recovery, a little more challenging. So, you like to get the patient before they have a lot of muscle atrophy and have injured other surrounding joints by putting abnormal stresses on them.
Melanie: And speak just a brief moment about the implant’s stability with the Actis System, and how that’s different than what you were using in the past?
Dr. True: The Actis Stem again, two main things. It has what they call a triple taper – meaning it's tapered to fit the patient’s anatomy in three different planes, not just medial to lateral; it's also anterior to posterior, and then it also has a collar on it which prevents subsidence and makes it more rotationally stable and prevents, the like I said, fracture and subsidence are the two main things that you would see decreased with this stem versus others.
Melanie: And what about rotation and motion preservation of the hip? Is there a lot of scar tissue with the system?
Dr. True: There is. That wouldn’t necessarily be system-specific. The anterior approach in general there is less scarring because of again, you're not cutting through the muscle and tendons – you're just going through the capsule and therefore, there is less scarring, and post-op range of motion is usually excellent after an anterior approach total hip.
Melanie: Thank you so much, Dr. True for being with us today. You’re listening to Expert Insights Physician Views and News with The Christ Hospital Health Network. To learn more about Dr. True and all of The Christ Hospital physicians, please visit tchpconnect.org. That's tchpconnect.org. This is Melanie Cole. Thanks so much for listening.
ACTIS® Total Hip System
Melanie Cole (Host): The Actis Total Hip System is a unique way for physicians performing hip replacement using the anterior approach to have better outcomes, and it has shown to be more beneficial for patients. My guest today is Dr. Scott True. He's an orthopedic surgeon with The Christ Hospital Health Network. Welcome to the show, Dr. True. So, explain a little bit about how hip replacement has been done in the past and what seems to be the changing trend now.
Dr. M. Scott True, MD (Guest): Historically, hip replacements were done either through a posterior approach which is kind of an incision back on the butt cheek, essentially, or lateral approach which is an incision directly over the side of the hip. Both of those approaches are good approaches and have been around for a long time and are still frequently used today, but they do cut through muscle and/or tendon and are therefore, more painful. There was also a historically an increased dislocation rate where the ball would pop out of the socket with those approaches, and those have been improved over the last probably five plus years, but still, is a slightly increased risk compared to an anterior approach.
Melanie: And what's changed as far as muscle preservation with the two approaches?
Dr. True: The anterior approach does preserve the muscle. You're going through an interval between the muscles instead of through the muscle itself. So, the muscle even though it gets tugged and pulled on to get into the hip joint, it's not cut. So, the ability of the muscle to rebound or recover is significantly quicker; therefore, patients have less pain, are up and active quickly, and back to work a little quicker, and the rehab in general is significantly shorter.
Melanie: And for surgeons, Dr. True, is it more technically challenging to use the anterior approach as far as intraoperative visualization? Is there a difference there?
Dr. True: After you've learned the technique, it is not necessarily. It's not -- the one thing it lacks is it's not what we call an extensile approach if there is a problem encountered during surgery for instance, sometimes, an additional approach may be necessary. That is extremely rare whereas the other two approaches are more versatile if there are problems encountered in the OR. Again, those are extremely rare, and there is definitely a learning curve with the anterior approach especially to surgeons who are trained with a different approach, but that once that learning curve has been passed by, then the exposure is really excellent.
Melanie: So, you're seeing an increasingly diverse patient population and even younger people which you didn’t used to see having hip replacements, yes? And with this increasingly diverse population and even younger patients getting their hips replaced -- tell us a little bit about the Actis Hip System and how that’s designed for this diverse population?
Dr. True: The Actis Hip System is from DePuy, which is a total joint company that has over 30 years of experience with these collared press-fit stems. Press-fit meaning no cement is needed, and that’s how virtually all hip replacements are done nowadays. They’ve – it was designed based off a couple of their hip stems which have been very good and kind of the work horses of hip replacement over the years, but neither of which were designed specifically for the anterior approach. So, they essentially took the major benefit of a couple of their other stems and incorporated it into this one stem. It's a little shorter, a little thicker or beefier up top so it has a good fit of the bone especially in someone who may be a little more osteoporotic, such as an older female in particular, and then the collar on it prevents it from settling, or we call subsiding. So there is a decreased risk of femoral fracture. There is a short-term stability for early weight bearing is increased and then again the potential for rotation or subsidence is reduced with that collar on it.
Melanie: Is it also compatible with other positioning approaches besides just –
Dr. True: Yes – it’s compatible with any approach. But this is the first that was kind of specifically designed with these muscle-sparing – or in particular – the anterior approach in mind.
Melanie: So, tell us about patient selection criteria. Elaborate on who can benefit from this procedure and the broad range of patient anatomies.
Dr. True: Yeah. Again, that’s the big benefit of the Actis Stem. For an anterior approach, you prefer a short curved stem and that gives you – that satisfies both of those criteria. But some of the short, curved stems are fairly thin, what we call blade stems, and there is a risk of those settling or causing an intraoperative or a postoperative fracture of the bone especially in someone who has some osteoporosis. So, by making it a little thicker and by making it – or giving it the collar to stop it from settling – they’ve attempted to at least significantly lessen those potential complications.
Melanie: What should patients expect regarding recovery time and post-procedure, and how long it's lasting?
Dr. True: The bearing surface which determines how long the implant lasts – I tell people now probably 25 or 30 years is…
Melanie: Wow.
Dr. True: …an expectation for a duration – or how long the hip will last. We get patients up the day of surgery. If their surgery’s in the morning, they're up that afternoon -- at least on the edge of the bed and hopefully up and walk to the chair. Most of them are going home the following day after they’ve passed all of their therapy sessions, including going up and down steps, and again probably within a few weeks, they're back to the majority of their normal activities. Not quite everything and certainly they don’t have all their endurance and stamina back, but from a functional standpoint within a few weeks, they're back to most of most of their normal daily activities.
Melanie: So, where are you performing this procedure?
Dr. True: This is done at Christ Hospital at the Joint and Spine Center.
Melanie: So, now, kind of wrap it up for us. Really tell other physicians what you'd like them to know about utilizing the Actis Hip System, and when you think they should refer to a specialist?
Dr. True: Hip arthritis doesn’t have all of the other non-operative options like knee arthritis has, for instance. Hip arthritis, you try the standard therapy – physical therapy – especially aqua therapy or low-impact therapies, the anti-inflammatory medications are all beneficial, but when the pain wakes them up at night, when the pain significantly alters their activities of daily living, or that they're to the point that they're requiring the use of a cane or a walker to get around, those are – that’s the time where probably a referral is recommended and because there are times where waiting too long could make the surgery, and then therefore the recovery, a little more challenging. So, you like to get the patient before they have a lot of muscle atrophy and have injured other surrounding joints by putting abnormal stresses on them.
Melanie: And speak just a brief moment about the implant’s stability with the Actis System, and how that’s different than what you were using in the past?
Dr. True: The Actis Stem again, two main things. It has what they call a triple taper – meaning it's tapered to fit the patient’s anatomy in three different planes, not just medial to lateral; it's also anterior to posterior, and then it also has a collar on it which prevents subsidence and makes it more rotationally stable and prevents, the like I said, fracture and subsidence are the two main things that you would see decreased with this stem versus others.
Melanie: And what about rotation and motion preservation of the hip? Is there a lot of scar tissue with the system?
Dr. True: There is. That wouldn’t necessarily be system-specific. The anterior approach in general there is less scarring because of again, you're not cutting through the muscle and tendons – you're just going through the capsule and therefore, there is less scarring, and post-op range of motion is usually excellent after an anterior approach total hip.
Melanie: Thank you so much, Dr. True for being with us today. You’re listening to Expert Insights Physician Views and News with The Christ Hospital Health Network. To learn more about Dr. True and all of The Christ Hospital physicians, please visit tchpconnect.org. That's tchpconnect.org. This is Melanie Cole. Thanks so much for listening.