Hip replacement surgery was once considered invasive and had longer recovery time.
Dr. Thomas Fox, orthopedic surgeon, discusses the anterior approach to hip replacement and its improved patient outcomes.
Anterior Approach to Hip Replacement
Featuring:
After graduating from Saint Joseph’s University he went on to complete his medical degree at Philadelphia College of Osteopathic Medicine. Dr. Fox went on to complete his general surgery residency at Abington Memorial Hospital in Abington Pennsylvania. After completing his general surgery residency he went on to complete his orthopedic surgery residency at Memorial Hospital in York Pennsylvania.
In his free time he likes traveling with his wife, attending football games, Go Saints! Boating, playing golf, spending time with his 4 children and 2 grandchildren. Help me welcome Dr. Thomas Fox
Thomas Fox, MD
Dr. Thomas Fox started in Niceville, FL in 1993, after finishing his Sports Medicine Fellowship Training at Union Memorial Hospital in Baltimore, Maryland. Dr. Fox is a board - certified orthopedic surgeon, specializes in joint replacement, hip, knee, shoulder, sports medicine, direct anterior hip replacement and arthroscopic rotator cuff repair.After graduating from Saint Joseph’s University he went on to complete his medical degree at Philadelphia College of Osteopathic Medicine. Dr. Fox went on to complete his general surgery residency at Abington Memorial Hospital in Abington Pennsylvania. After completing his general surgery residency he went on to complete his orthopedic surgery residency at Memorial Hospital in York Pennsylvania.
In his free time he likes traveling with his wife, attending football games, Go Saints! Boating, playing golf, spending time with his 4 children and 2 grandchildren. Help me welcome Dr. Thomas Fox
Transcription:
Prakash Chandran (Host): Hip replacement surgery has typically been considered a serious and invasive surgery, but did you know there’s now a minimally invasive procedure available for hip replacement? Let’s talk about it today with Dr. Thomas Fox, an orthopedic surgeon at Twin Cities Hospital. This is Helmet of Health, the podcast from Twin Cities Hospital. I'm Prakash Chandran. So first of all Dr. Fox, let’s talk about the basics here. Why do people end up needing hip replacement in the first place?
Thomas Fox, MD (Guest): Well Prakash, most patients who require hip replacement have degenerative arthritis. Mostly it’s from an age related wear. Sometimes we also see patients with other conditions that require a hip replacement, but most commonly degenerative arthritis.
Host: Okay. Degenerative arthritis. So this means like people above the age of 60/70 years old? Is that correct?
Dr. Fox: Correct, yeah. Most commonly aged 70 and above for hip replacement.
Host: Okay. Tell us about how hip replacement is traditionally done.
Dr. Fox: A hip replacement used to be more commonly done from a posterior or lateral approach. We would lay the patient on the table and make an incision along the side of the hip or into the back of the buttock region. Now we’re doing things a little differently and less invasive with smaller incisions and intramuscular incisions rather than releasing muscles that have to be reattached. The reattachment of the muscles sometimes was the weak link that would sometimes lead to persistent limping afterwards or some weakness.
Host: This is what is called the anterior approach, right? It’s the minimally invasive way to do the hip replacement. Is that correct?
Dr. Fox: That’s correct. It’s not a new technique, but it’s a technique that’s just been revisited and has gained a lot of popularity throughout the country and internationally as well. I think it’s here to stay and I think that’s probably gonna be the way hip replacements are being done in the future.
Host: Okay. So let’s talk about some of the differences between the two approaches. Like I imagine with the minimally invasive approach, obviously the incision is small. Maybe talk a little bit about the recovery time and some of the other benefits.
Dr. Fox: Sure. The incisions are made between the muscles. So there’s nothing disrupted, and everything is reattached appropriately. We also do it under x-ray guidance so that the components are most properly aligned. We do intraoperative fluoroscopy or x-ray. We used to do x-rays in the recovery room, and I will admit that sometimes that was a little late because the components weren’t exactly aligned. Most times it would be okay. Now they're perfect every time. The recovery is actually remarkable. When I first started doing these five or six years ago, the patients would come walking in mostly just using a cane or not even using a cane. It was like how long ago did you have surgery? It was only two weeks and they would act like they had it done two or three months ago. So the early post-operative recovery is the most remarkable thing. For working people that have jobs and can't take that much time off for vacation it really is pretty important for people to get back to their active lifestyles and work.
Host: Yeah. That is pretty incredible how quickly they can get back to a sense or normalcy there. Is there a rehabilitation plan that is required after an anterior hip replacement?
Dr. Fox: There is, but I stress to my patients there’s really no precautions. So most of the time the patients just have to walk. So recovering after hip replacement is a bit easier than recovering from knee replacement because you don’t have worry about the motion so much. We often do send these patients for physical therapy to regain their strength and balance. Some of the patients that we start with have poorer balance. Some older folks, their coordination is poor. We try to get them back to a better balance with core strengthening and gait training so that they are less of a fall risk following up after the surgery.
Host: Are there certain candidates that are better than others for anterior hip replacement, or do you pretty much perform this on everyone?
Dr. Fox: Pretty much perform this on everyone. In the early stages—The one problem with this surgery, it’s a rather steep learning curve and a reason why a lot of surgeons shy away from it. It took probably 50 operations to get this down, and that’s a lot for a qualified surgeon to do to learn an operation that would only usually take a handful of times. 50 is quite a bit. There is a steeper learning curve, and a lot of doctors don’t want to endure that. It’s worth it because the results, I think are ultimately more predictable and better. At least in my hands and that works for me.
Host: Dr. Fox, just to wrap up here, when do you think patients should get a hip replacement?
Dr. Fox: Basically when they have pain with walking and standing and also pain awakening them at night. It’s hard to live with. Hip pain is really difficult to live with, so most people proceed with it pretty quickly.
Host: Alright Dr. Fox. Really appreciate your time today. That’s Dr. Thomas Fox, an orthopedic surgeon at Twin Cities Hospital. Thanks for checking out this episode of Helmet of Health. Head to tchospital.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.
Prakash Chandran (Host): Hip replacement surgery has typically been considered a serious and invasive surgery, but did you know there’s now a minimally invasive procedure available for hip replacement? Let’s talk about it today with Dr. Thomas Fox, an orthopedic surgeon at Twin Cities Hospital. This is Helmet of Health, the podcast from Twin Cities Hospital. I'm Prakash Chandran. So first of all Dr. Fox, let’s talk about the basics here. Why do people end up needing hip replacement in the first place?
Thomas Fox, MD (Guest): Well Prakash, most patients who require hip replacement have degenerative arthritis. Mostly it’s from an age related wear. Sometimes we also see patients with other conditions that require a hip replacement, but most commonly degenerative arthritis.
Host: Okay. Degenerative arthritis. So this means like people above the age of 60/70 years old? Is that correct?
Dr. Fox: Correct, yeah. Most commonly aged 70 and above for hip replacement.
Host: Okay. Tell us about how hip replacement is traditionally done.
Dr. Fox: A hip replacement used to be more commonly done from a posterior or lateral approach. We would lay the patient on the table and make an incision along the side of the hip or into the back of the buttock region. Now we’re doing things a little differently and less invasive with smaller incisions and intramuscular incisions rather than releasing muscles that have to be reattached. The reattachment of the muscles sometimes was the weak link that would sometimes lead to persistent limping afterwards or some weakness.
Host: This is what is called the anterior approach, right? It’s the minimally invasive way to do the hip replacement. Is that correct?
Dr. Fox: That’s correct. It’s not a new technique, but it’s a technique that’s just been revisited and has gained a lot of popularity throughout the country and internationally as well. I think it’s here to stay and I think that’s probably gonna be the way hip replacements are being done in the future.
Host: Okay. So let’s talk about some of the differences between the two approaches. Like I imagine with the minimally invasive approach, obviously the incision is small. Maybe talk a little bit about the recovery time and some of the other benefits.
Dr. Fox: Sure. The incisions are made between the muscles. So there’s nothing disrupted, and everything is reattached appropriately. We also do it under x-ray guidance so that the components are most properly aligned. We do intraoperative fluoroscopy or x-ray. We used to do x-rays in the recovery room, and I will admit that sometimes that was a little late because the components weren’t exactly aligned. Most times it would be okay. Now they're perfect every time. The recovery is actually remarkable. When I first started doing these five or six years ago, the patients would come walking in mostly just using a cane or not even using a cane. It was like how long ago did you have surgery? It was only two weeks and they would act like they had it done two or three months ago. So the early post-operative recovery is the most remarkable thing. For working people that have jobs and can't take that much time off for vacation it really is pretty important for people to get back to their active lifestyles and work.
Host: Yeah. That is pretty incredible how quickly they can get back to a sense or normalcy there. Is there a rehabilitation plan that is required after an anterior hip replacement?
Dr. Fox: There is, but I stress to my patients there’s really no precautions. So most of the time the patients just have to walk. So recovering after hip replacement is a bit easier than recovering from knee replacement because you don’t have worry about the motion so much. We often do send these patients for physical therapy to regain their strength and balance. Some of the patients that we start with have poorer balance. Some older folks, their coordination is poor. We try to get them back to a better balance with core strengthening and gait training so that they are less of a fall risk following up after the surgery.
Host: Are there certain candidates that are better than others for anterior hip replacement, or do you pretty much perform this on everyone?
Dr. Fox: Pretty much perform this on everyone. In the early stages—The one problem with this surgery, it’s a rather steep learning curve and a reason why a lot of surgeons shy away from it. It took probably 50 operations to get this down, and that’s a lot for a qualified surgeon to do to learn an operation that would only usually take a handful of times. 50 is quite a bit. There is a steeper learning curve, and a lot of doctors don’t want to endure that. It’s worth it because the results, I think are ultimately more predictable and better. At least in my hands and that works for me.
Host: Dr. Fox, just to wrap up here, when do you think patients should get a hip replacement?
Dr. Fox: Basically when they have pain with walking and standing and also pain awakening them at night. It’s hard to live with. Hip pain is really difficult to live with, so most people proceed with it pretty quickly.
Host: Alright Dr. Fox. Really appreciate your time today. That’s Dr. Thomas Fox, an orthopedic surgeon at Twin Cities Hospital. Thanks for checking out this episode of Helmet of Health. Head to tchospital.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.