Joey Wahler (Host): This is Health Matters, insights from WCH medical experts. Thanks for joining us. I am Joey Wahler. Our guest is Dr. Carlos Gomez. He's an Orthopedic Surgeon with Wood County Hospital. Hi, Dr. Gomez. Welcome.

Carlos Gomez, M.D.: Hi Joey. Thank you for having me.

Host: Great to have you aboard. Appreciate the time. So first, in a nutshell, what is anterior hip replacement and how does it differ from a traditional hip procedure?

Carlos Gomez, M.D.: Great question because mainly we discuss about a total hip replacement doing through the back, and that's the way we learned. That's the way it's been traditionally done. Approximately 10 years ago, we were able to do the hips through the front. There are different ways to do it.

So as I said initially from the back, or the side, but now we, for the past 10 years, been able to do it through the front, and that has made a big difference in the results that we have in our patients.

Host: And I'm going to ask you about those in a little more detail in just a moment. First, take a quick step back. Why do some people typically need hip replacement?

Carlos Gomez, M.D.: Mainly we see middle age patients. We have seen also some younger patients that have been very active throughout the years. Working in hard surfaces, labor work, and they started having pain. So pain definitely is the first cause to consult us for a hip problem. The pain that they be having because they, when they're sitting for long periods of time, and they stand up, they have pain when they're walking. They're also noticing some limping. They also are noticing they're not able to have the motion that they had before. So getting in and out of the car, going up and down steps are pretty much the main reasons why they're come to consult for pain.

Host: So mainly wear and tear. And you say not necessarily affecting only older people. Right?

Carlos Gomez, M.D.: Correct, correct. And it is important that I've seen patients that needed a hip replacement. They were 40 years old, or 94 year olds. So at this point, the limitation, the pain that is causing them, not being able to do their activities of daily living or either work or have fun in activities they enjoy in a regular basis.

Host: Gotcha. Is some of this genetic, is it sort of like there's only so much tread on the tire, and if you use it up faster than somebody else, you might need this procedure?

Carlos Gomez, M.D.: Yeah, so I have a lot of patients that said, well, my parents had a hip replacement or needed a hip replacement, but about 80% of the time is wear and tear. You know, there's so much that our body can take and it starts to wear off. So depending on the level of activity as well.

Weight plays a big role, so patients that are overweight also have more tendency, to patients that are diabetics as well. So those medical conditions also can predispose some patients to have a high risk for the need of a new hip.

Host: And a lot of patients that need this, am I right? Tend to be also, at least in part of course, former football players that at one time were big and in shape, but then over the course of their life have become still big, yet too big and not in such a good shape. Right? Now they're carrying too much weight.

Carlos Gomez, M.D.: You're right. Weight definitely plays a big role. And sports definitely a lot of trauma, repetitive trauma. There doesn't need to be a big, like an accident, but repetitive trauma in any sports can cause that. But definitely weight plays a big role in those patients, in athletes that can have a deterioration of their joint space there.

Host: Sure. So you touched on it. Give us some details, please. What are the biggest benefits of this anterior approach for patients?

Carlos Gomez, M.D.: Great question, and it is something that we like because compared to the posterior approach, we know that it's less invasive. We don't have to detach any muscles. We have an x-ray, so we can see, we can be more precise on the position of the components. We also can work on length discrepancy. If one leg, because its loss of the cartilage is a little shorter, we can immediately through the process, get that length and they have faster recovery with less pain.

Host: It seems like so many of the advancements in the medical world nowadays when it comes to all different kinds of surgery, really, it usually boils down to being able to be more precise, doesn't it?

Carlos Gomez, M.D.: Correct. And we have at Wood County Hospital the opportunity to offer patients the latest technology. This prosthesis that we use has been designed to be placed through the anterior approach. So we have the specific table where we can position our patients to do it, and the prosthesis that helps to achieve that goal as well.

Host: So who's an ideal candidate for anterior hip replacement? And on the other hand, is there anyone this procedure isn't appropriate for?

Carlos Gomez, M.D.: Again, I think every patient that has noticed pain, limitation of activities of daily living and have noticed deterioration of their quality of life and that have been through conservative treatment, including like some weight loss, some use of NSAIDs like Tylenol or ibuprofen or injections and none of that has worked; is probably a great candidate to do it. I always tell my patients, if you have a cortisone injection and that didn't work, probably is not going to work anymore and that's the time to do it. So quality of life, definitely after we've done some conservative treatment is the perfect time to do it. Sometimes for patients they're too old and they have a lot of medical conditions.

There's some other options and they're probably not the best. Having this prosthesis in patient, they have like, for instance, pelvic fusion or some stability of the lower back that it can cause a lot of stiffness, we have a variety of options that also can make them a good candidate for them.

Host: So that being said, what should patients in a nutshell know about the procedure itself? What are you actually doing?

Carlos Gomez, M.D.: Definitely as I was showing you here on the anterior approach, we make a small incision on the front. And we dissect the soft tissue and we're able to only spread the muscles. We don't have to detach them as we do when we do in the side or in the back. And that helps with pain on patients. We expose our capsule and the joint socket, and we're able to at that point, put a new socket with a new cartilage, if you will, which is a, a high link of polyethylene.

Put a stem that it has a new ball and a socket that is going to give us the mobility that the patient has lost because of the arthritic changes they had before.

Host: It's amazing that what you were just holding in your hand there can completely change someone's life, right?

Carlos Gomez, M.D.: Absolutely. And that's one of the things that when I said about having a patient recover so fast. I see my patients come in 10 days after surgery for their first follow up, and they're walking without any external device like any cane or any walker because they're feeling better, they're able to feel there are even on the length, there is minimal pain, and it's a small incision in the front of their thigh.

Host: How long does this typically take, the procedure itself and when can patients usually go home?

Carlos Gomez, M.D.: Usually it takes about a little over an hour. It takes a few minutes to position the patient in a special table for it. And once we prepped, we make the incision, we do our procedure. We have x-rays to verify the position of our components. And then we close, and they can go to the floor immediately.

I keep them overnight because I think it is important to give them first three doses of antibiotic for infection, make sure pain is under control and they can do therapy the next day, including some steps. By noon the next day, they're ready to go home.

Host: Wow. Barely enough time to try the hospital food, right?

Carlos Gomez, M.D.: Yes. And again, they'll be able to eat, they'll be able to do everything that they need to do before they go home. But definitely making sure that therapy has worked with them and they're able to walk without any limitations.

Host: Speaking of taking those next steps, both literally and figuratively. How about the recovery process? How soon can patients walk, drive, return to daily activities? I'm sure those are the first questions you get. Am I right?

Carlos Gomez, M.D.: Absolutely. And they walk right from their room to their car. If it's the right side, I always want to see them in 10 days to make sure they're able to do everything to get back to driving. But I'll say probably driving in a couple weeks, but they'd be able to do everything, you know, of their activities of daily living, going up and down steps and being very active. I have patients that play tennis, so they'd be back about three to four months later, they're able to play doubles. and, you know, they can golf in about three to four months as well. So try not to limit them, try to make sure that they can do what they enjoy doing.

Host: If you're back to playing tennis and golf, then the procedure went pretty darn well, didn't it?

Carlos Gomez, M.D.: Absolutely very happy. I think that, you know, we always show my patients, some videos of the patients that I've done before and the way they walk before and the way they walk afterwards, and it makes a big difference for them.

Host: A few other things, any common fears that patients have about getting this replacement surgery done, and how do you reassure them? Because it seems oftentimes you hear people say, oh boy, you know, I, I need hip replacement. And they're putting it off, aren't they?

Carlos Gomez, M.D.: Absolutely. And again, it depends what the experience has been with some friends or family members that've been through the process. If this is going to be their first surgery, definitely there's a lot of fear and fear it's something that we can help them with. I mean, they're here for us to show them where their problem is and what we can do for them to move to the next step.

We always tell them that we have everything to control the pain. We're going to work as a team to make sure that we achieve the goal that we set from the get go.

Host: You've told us how the procedure works and what specific benefits there are. What's the main advancement or two in technology or technique in recent years since you've been doing this that now make this procedure safer and more effective? What was the big turning point if there was one?

Carlos Gomez, M.D.: In the past 10 years, there has been an increase of surgeons doing total hip arthoplasty through the front. Using the technique that it was recommended to do it, having the latest bed, that is the one that we use to do the procedure as well as the prosthesis that was designed to do that helps.

We also have a device that helps us ream into the socket, into the femur to facilitate that instead of hammering a mallet through the process and having also the latest technology on materials. So we have plastic that will last longer and balls that are made of ceramic, which may can last that procedure a little longer as well.

Host: I would imagine you also get this question quite a bit when people go through this. I'm sure they say, doc, will I be like I was before I started having the pain. So what do you tell them?

Carlos Gomez, M.D.: They're gonna be better than that. Because again, those patients are very happy with their results. As I said, it's less invasive. It's a small incision. We don't detach any muscles and they get back to their activities in no time. So definitely they're very happy with this procedure.

Host: And so in summary here, what advice, Doctor, would you give someone that clearly needs this procedure, but they're still hesitant, they're still waffling, they're still putting it on the back burner when it really needs to be done soon. What do you tell them?

Carlos Gomez, M.D.: Yeah, I definitely say, stay active is important to maintain the muscles around the joint healthy. It is always good to watch the weight, try not to gain too much weight and have a good relationship with your doctor, with your surgeon, and make sure that they explain you exactly what your problem is and what they can do for them.

Because we work as a team, it's something that we do our part, we want our patients to do everything they need in order to get better and from then, they're going to be happy with the results.

Host: Is it safe to say in closing here that we don't want to diminish, hip replacement surgery is a big deal for people, but is it safe to say while it's a big deal, it's not as big a deal for the patient to go through as it was years ago because of all the great improvements you've been talking about?

Carlos Gomez, M.D.: Absolutely. That is a great point Joey. I think that we can assure patients they're going to be happy, that there are risks like anything in life, but we will do what is best for them and we want to make sure that in no time they can get back to the activities that they love.

Host: Absolutely. One quickie before we let you go. What's the number one thing, aside from the basics, walking, driving, et cetera, from a pleasure standpoint, what's the one main thing that's most rewarding for you to see people being able to return to after this is a success?

Carlos Gomez, M.D.: They're not limping anymore. No pain, and they're able to do all their activities with their family members, enjoy their family, and have fun.

Host: And perhaps they took some of those things for granted and appreciate it a bit more by the time they were in your hands. Right?

Carlos Gomez, M.D.: No doubts. No doubts. Very appreciative. They love it. And I actually do a seminar every other month here in the hospital and I bring some of those patients so they can give the patients that are potential candidates for surgery, their perspective and how they did during the process of the surgery.

Host: That's awesome. So you get that comradery going as well.

Carlos Gomez, M.D.: Absolutely.

Host: Well folks, we trust you are now more familiar with anterior hip replacement surgery. Dr. Carlos Gomez, keep up all your great work and thanks so much again.

Carlos Gomez, M.D.: Thank you, Joey for having me. Have a great day.

Host: You too. And for more information or to make an appointment with Dr. Gomez, please call 419-354-3072.

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