If your hip has been damaged by arthritis, age or for any other reason, common activities such as walking or getting in and out of a chair can be very painful.
Hendricks Regional Health orthopedic experts are highly skilled in diagnosing and treating a variety of hip injuries and concerns. Dr. Brad Prather with Hendrix Regional Health, is one of only a few surgeons in central Indiana performing the direct anterior hip replacement.
The Direct Anterior Hip Replacement can reduce trauma to the muscles and tendons surrounding the hip, and may reduce recovery time.
Listen in as Dr. Brad Prather explains Direct Anterior Hip Replacement and if it may be the right choice for you.
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Could Direct Anterior Hip Replacement Be the Answer For You?
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Learn more about Dr. Brad Prather
Brad Prather, MD
Dr. Brad Prather is one of only a few surgeons in central Indiana performing the direct anterior hip replacement. After completing his training as an orthopedic surgeon at the IU School of Medicine and University of Louisville School of Medicine, he completed a fellowship at Steadman Hawkins Clinic of the Carolinas to further develop his joint replacement skills. Dr. Prather’s enthusiasm for the anterior hip procedure developed because it offers patients a much easier, faster recovery.Learn more about Dr. Brad Prather
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Could Direct Anterior Hip Replacement Be the Answer For You?
OrthoMelanie Cole (Host): While your hips are strong and designed to support a fair amount of wear and tear, with age and use damaged cartilage, muscles, and tendons can result in mild to severe pain. Hendricks Regional Health orthopedic experts are highly skilled in diagnosing and treating a variety of hip injuries and concerns. My guest today is Dr. Brad Prather from Hendricks Regional Health. He is one of only a few surgeons in central Indiana performing the direct anterior hip replacement. Welcome to the show, Dr. Prather. Give us a little bit of the working anatomy of the hip and what would be some red flags for someone to consider a hip replacement?
Dr. Brad Prather (Guest): Thanks for having me. The basics of hip anatomy is it’s a ball and socket joint akin to something in your car or in your house. When the hip goes bad, typically that ball and socket joint loses its ability to rotate freely. There is a loss of tolerance within the joint. For the typical patient who starts having hip pain, it sometimes seems strange to them. It will be pain that usually appears in the groin area or they will find perhaps they can’t tie their shoes or put their socks on as easily. It’s often times not pain in your buttock or pain out to the side of your hip but it’s a true hip arthritis in the form that you are describing where the joint wears down and usually has pain that centers more around the groin itself.
Melanie: So, if somebody has this nagging hip pain and they come to see you, what’s the first line of defense? What’s the first thing you do for them?
Dr. Prather: We try and maximize conservative care. Hopefully, their family physician or even they themselves have taken the opportunity to utilize some over the counter kinds of medications or they’ve done some activity modification to try and get along better. This is in the instance where they do have hip arthritis. If those things have been done, then we just try to make sure they have been done to their maximum ability. If not, then it’s a lengthy discussion usually.
Melanie: If they’ve done all of those things, then what does the discussion entail? How do you explain to them what hip replacement is going to be like and discuss the anterior hip replacement?
Dr. Prather: Sure. I start off by trying to allay some of their fears because a lot of people, when they approach a joint replacement do have a lot of misconceptions about what it takes to go through the joint replacement, do the recovery and get back to life. Usually, the first thing I try to do is assess what is their activity level? What are they trying to get back to? Then, we go into how the joint replacement can fit into that. We describe the typical time for a hip replacement. During surgery, it’s perhaps 45 minutes to an hour, sometimes longer if it is a very muscular person, the time duration in the hospital being perhaps a day, sometimes longer if there are any potential medical side effects that we need to really monitor. Then, we describe what goes on with physical therapy. Some physicians that do anterior hip replacements don’t really advocate physical therapy but I am one that does because I want to drive home the point that we’re getting you back to life and we want to do that as fast as we can, safely. When I discuss the hip replacement itself, I try to stay somewhat mechanical in it because the hip joint really is a mechanism that is simple to understand as a ball and socket joint. We are going to return a freedom of motion in there by resurfacing that ball and socket.
Melanie: Tell us about the replacement itself. What kinds of material are you using and is this something that lasts for many years or might it have to be redone?
Dr. Prather: Dependent upon age, there is always a chance that it might have to be redone. We certainly try and tell the patients that if we do our job right, we are going to put that joint in a position where stresses are minimized. The type of joint replacement that I use 99% of the time, it’s going to be a type of ceramic that is called “oxinium” placed upon a plastic bearing. That joint replacement is good if put in the correct position for about 30 years. This is for normal stresses. This isn’t the person that comes in and says, “I’m going to run the next mini marathon” because that is the one where we are going to say, “You are probably going to wear this out shorter.” If normal tolerances are kept up, about 30 years is acceptable. Certainly, people have had joint replacements in for a lot longer than that. It’s not the technology of the implants placed today. Thirty years from now we may look back and see that these joints did last longer in the human body.
Melanie: Tell us a little about the difference between the direct anterior hip replacement and the way they have been typically done. What’s the benefit for the patient in terms of recovery and trauma to the muscle surrounding the hip joint?
Dr. Prather: The direct anterior hip replacement is something that has actually been around for a long time. It was never utilized as much as it can be today for hip replacement because of the difficulty in performing it. The window in which we work is a window between muscles. The typical posterior hip replacement or lateral hip replacement were approaches to the hip that went through muscle or perhaps even through bone. In those instances, if you are separating a muscle or perhaps even cutting it from the bone there is a much greater length of time for healing. You have to get that muscle to heal to the bone, then you can rehab it. You can’t immediately go with full walking. You can’t immediately go to walking without an assistive device. When we approach the hip from an anterior perspective which is what I do for almost all procedures, we’re sliding basically in a plane between two muscles that have different nerves that come to them. We come in and out of that plane without detaching anything. When the patient is done, if we’ve done our job right, they are basically going to complain about the worse soreness that they’ve ever experienced because of the stretch that occurs during the surgery but not because of something being cut away from the hip.
Melanie: That is absolutely amazing. Tell us a little bit about when they can get back to their normal activities--to walking, getting back to work. Is this something that you want them to do rather quickly or do you want them to rest it up for a while?
Dr. Prather: I do believe there is a point to something healing quietly but we certainly don’t let them rest after the surgery. If things are right immediately afterwards, you’re going to be standing and walking within hours of the surgery. I indicated that very frequently people will go home the next day; sometimes the same day after surgery. That’s done because their safety there. The patient feels confident that they can be in their home. The only way that you are going to do that is by having somebody up and walking and typically walking with a gait that is fairly normal afterwards. If we can normalize their gait within hours of surgery, we can certainly return them to work within weeks of surgery. My patients that have more sedentary jobs – office jobs, sitting jobs, even sometimes light standing jobs – I think that they can return to work within two to four weeks after surgery, which is much faster than the typical posterior hip replacement.
Melanie: Can they then go off of their anti-inflammatory meds that they were taking for their hip after this replacement?
Dr. Prather: I do use anti-inflammatory meds after the surgery but as part of their post-operative pain regimen. Can they go off of them? That is dependent upon what else is going wrong in the body. With a lot of people, we certainly seek to improve their medical condition and getting them away from medications.
Melanie: In just the last minute, Dr. Prather, please give your best advice for people that are suffering from hip pain and may be considering hip replacement surgery and why they should come to Hendricks Regional and see you.
Dr. Prather: I think that most people, once they’ve gotten to that point where their activity has decreased, their mobility has decreased, it’s really where their heart is behind a need to see a physician at that point. When they come in that fashion, often our first visit is the visit we decide on surgery which is not always the way I like it but it happens that way because once that joint has gone bad that feeling of pain that is there, that inability to move has gotten to such a degree that you are going to seek out a major surgery. That’s when the conservative measures have probably failed and it’s time to really have a serious discussion about it. When they come and see us here I think we do a good job of education with the patients in regards to what they need to know before and after surgery and really what to expect during it. If I have one point to make it is that it’s the person who has lost the real desire or the ability to be active that when they come, I feel for them and we go straight forward with surgery.
Melanie: Thank you so much for being with us today, Dr. Prather. It’s excellent information. You’re listening to Health Talks with HRH, Hendricks Regional Health. For more information you can go to Hendricks.org. That’s Hendricks.org. This is Melanie Cole. Thanks so much for listening.
Could Direct Anterior Hip Replacement Be the Answer For You?
OrthoMelanie Cole (Host): While your hips are strong and designed to support a fair amount of wear and tear, with age and use damaged cartilage, muscles, and tendons can result in mild to severe pain. Hendricks Regional Health orthopedic experts are highly skilled in diagnosing and treating a variety of hip injuries and concerns. My guest today is Dr. Brad Prather from Hendricks Regional Health. He is one of only a few surgeons in central Indiana performing the direct anterior hip replacement. Welcome to the show, Dr. Prather. Give us a little bit of the working anatomy of the hip and what would be some red flags for someone to consider a hip replacement?
Dr. Brad Prather (Guest): Thanks for having me. The basics of hip anatomy is it’s a ball and socket joint akin to something in your car or in your house. When the hip goes bad, typically that ball and socket joint loses its ability to rotate freely. There is a loss of tolerance within the joint. For the typical patient who starts having hip pain, it sometimes seems strange to them. It will be pain that usually appears in the groin area or they will find perhaps they can’t tie their shoes or put their socks on as easily. It’s often times not pain in your buttock or pain out to the side of your hip but it’s a true hip arthritis in the form that you are describing where the joint wears down and usually has pain that centers more around the groin itself.
Melanie: So, if somebody has this nagging hip pain and they come to see you, what’s the first line of defense? What’s the first thing you do for them?
Dr. Prather: We try and maximize conservative care. Hopefully, their family physician or even they themselves have taken the opportunity to utilize some over the counter kinds of medications or they’ve done some activity modification to try and get along better. This is in the instance where they do have hip arthritis. If those things have been done, then we just try to make sure they have been done to their maximum ability. If not, then it’s a lengthy discussion usually.
Melanie: If they’ve done all of those things, then what does the discussion entail? How do you explain to them what hip replacement is going to be like and discuss the anterior hip replacement?
Dr. Prather: Sure. I start off by trying to allay some of their fears because a lot of people, when they approach a joint replacement do have a lot of misconceptions about what it takes to go through the joint replacement, do the recovery and get back to life. Usually, the first thing I try to do is assess what is their activity level? What are they trying to get back to? Then, we go into how the joint replacement can fit into that. We describe the typical time for a hip replacement. During surgery, it’s perhaps 45 minutes to an hour, sometimes longer if it is a very muscular person, the time duration in the hospital being perhaps a day, sometimes longer if there are any potential medical side effects that we need to really monitor. Then, we describe what goes on with physical therapy. Some physicians that do anterior hip replacements don’t really advocate physical therapy but I am one that does because I want to drive home the point that we’re getting you back to life and we want to do that as fast as we can, safely. When I discuss the hip replacement itself, I try to stay somewhat mechanical in it because the hip joint really is a mechanism that is simple to understand as a ball and socket joint. We are going to return a freedom of motion in there by resurfacing that ball and socket.
Melanie: Tell us about the replacement itself. What kinds of material are you using and is this something that lasts for many years or might it have to be redone?
Dr. Prather: Dependent upon age, there is always a chance that it might have to be redone. We certainly try and tell the patients that if we do our job right, we are going to put that joint in a position where stresses are minimized. The type of joint replacement that I use 99% of the time, it’s going to be a type of ceramic that is called “oxinium” placed upon a plastic bearing. That joint replacement is good if put in the correct position for about 30 years. This is for normal stresses. This isn’t the person that comes in and says, “I’m going to run the next mini marathon” because that is the one where we are going to say, “You are probably going to wear this out shorter.” If normal tolerances are kept up, about 30 years is acceptable. Certainly, people have had joint replacements in for a lot longer than that. It’s not the technology of the implants placed today. Thirty years from now we may look back and see that these joints did last longer in the human body.
Melanie: Tell us a little about the difference between the direct anterior hip replacement and the way they have been typically done. What’s the benefit for the patient in terms of recovery and trauma to the muscle surrounding the hip joint?
Dr. Prather: The direct anterior hip replacement is something that has actually been around for a long time. It was never utilized as much as it can be today for hip replacement because of the difficulty in performing it. The window in which we work is a window between muscles. The typical posterior hip replacement or lateral hip replacement were approaches to the hip that went through muscle or perhaps even through bone. In those instances, if you are separating a muscle or perhaps even cutting it from the bone there is a much greater length of time for healing. You have to get that muscle to heal to the bone, then you can rehab it. You can’t immediately go with full walking. You can’t immediately go to walking without an assistive device. When we approach the hip from an anterior perspective which is what I do for almost all procedures, we’re sliding basically in a plane between two muscles that have different nerves that come to them. We come in and out of that plane without detaching anything. When the patient is done, if we’ve done our job right, they are basically going to complain about the worse soreness that they’ve ever experienced because of the stretch that occurs during the surgery but not because of something being cut away from the hip.
Melanie: That is absolutely amazing. Tell us a little bit about when they can get back to their normal activities--to walking, getting back to work. Is this something that you want them to do rather quickly or do you want them to rest it up for a while?
Dr. Prather: I do believe there is a point to something healing quietly but we certainly don’t let them rest after the surgery. If things are right immediately afterwards, you’re going to be standing and walking within hours of the surgery. I indicated that very frequently people will go home the next day; sometimes the same day after surgery. That’s done because their safety there. The patient feels confident that they can be in their home. The only way that you are going to do that is by having somebody up and walking and typically walking with a gait that is fairly normal afterwards. If we can normalize their gait within hours of surgery, we can certainly return them to work within weeks of surgery. My patients that have more sedentary jobs – office jobs, sitting jobs, even sometimes light standing jobs – I think that they can return to work within two to four weeks after surgery, which is much faster than the typical posterior hip replacement.
Melanie: Can they then go off of their anti-inflammatory meds that they were taking for their hip after this replacement?
Dr. Prather: I do use anti-inflammatory meds after the surgery but as part of their post-operative pain regimen. Can they go off of them? That is dependent upon what else is going wrong in the body. With a lot of people, we certainly seek to improve their medical condition and getting them away from medications.
Melanie: In just the last minute, Dr. Prather, please give your best advice for people that are suffering from hip pain and may be considering hip replacement surgery and why they should come to Hendricks Regional and see you.
Dr. Prather: I think that most people, once they’ve gotten to that point where their activity has decreased, their mobility has decreased, it’s really where their heart is behind a need to see a physician at that point. When they come in that fashion, often our first visit is the visit we decide on surgery which is not always the way I like it but it happens that way because once that joint has gone bad that feeling of pain that is there, that inability to move has gotten to such a degree that you are going to seek out a major surgery. That’s when the conservative measures have probably failed and it’s time to really have a serious discussion about it. When they come and see us here I think we do a good job of education with the patients in regards to what they need to know before and after surgery and really what to expect during it. If I have one point to make it is that it’s the person who has lost the real desire or the ability to be active that when they come, I feel for them and we go straight forward with surgery.
Melanie: Thank you so much for being with us today, Dr. Prather. It’s excellent information. You’re listening to Health Talks with HRH, Hendricks Regional Health. For more information you can go to Hendricks.org. That’s Hendricks.org. This is Melanie Cole. Thanks so much for listening.