Limited incision hip replacement surgery reduces risk to patient

Philadelphia 14 January 2003Orthopaedic surgeons at the Rothman Institute at Thomas Jefferson University Hospital have demonstrated a surgical technique that may be quicker, better and safer when it comes to having a hip replaced. Less invasive total hip replacement surgery in 35 to 45 minutes was demonstrated on the Internet during a Webcast from the operating rooms at Thomas Jefferson University Hospital, Philadelphia. This was the fourth procedure to be broadcast on the Internet by Jefferson in the last year.


In recent years, less invasive hip replacement surgery, using a four-to six-inch incision depending on the size of the patient, has become the standard for performing hip replacements and has been well received by patients, according to nationally-recognised orthopaedic surgeon Richard Rothman, M.D., Ph.D., James Edwards Professor and chair, Orthopaedic Surgery, Jefferson Medical College (JMC) of Thomas Jefferson University.

"The procedure, as performed at Jefferson, may reduce the risk of infection for patients because of our team's experience", stated Dr. Rothman. The surgery takes less time than those done at many other medical centres so the incision is open for a shorter period."

"In addition, depending on the individual patient, our procedure may also result in a shorter hospital stay, less blood loss, less post-operative pain and easier rehabilitation for the patient", explained William Hozack, M.D., professor of Orthopaedic Surgery, JMC, who performed the limited incision hip replacement operation during the Webcast with Dr. Rothman.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, hip replacement surgery used to be an option primarily for people over 60 years of age. Now surgeons are finding that the surgery is very successful in even younger people.

"When you have a bad hip, you have trouble walking or standing. Gradually, your whole world shrinks", stated Dr. Rothman, director of the Rothman Institute at Jefferson. "For most patients, hip replacement surgery provides a prompt relief of pain. Within a day or two, you have less pain than before the operation."

Reasons for needing a hip replacement include osteo-arthritis, a degenerative joint disease that causes the breakdown of joint cartilage and adjacent bone in the hips, rheumatoid arthritis - inflammation in the lining of the joints and/or other internal organs - and traumatic arthritis, arthritis due to injury of the articular cartilage of the hip.

"Jefferson Hospital surgeons feel that less invasive single incision total hip replacement surgery is also safer than the mini hip technique currently being advertised to patients in newspapers and on television", stated Dr. Hozack, director, Joint Replacement Service, Thomas Jefferson University Hospital. "It is generally agreed among hip replacement specialists that the smallest incision surgery is technically more difficult and should not be used in situations where the surgeon does not perform hip replacement on a frequent basis."

U.S. News & World Report has ranked Thomas Jefferson University Hospital as the best hospital in Philadelphia and among the top 50 hospitals in the nation for orthopaedics. U.S. News also ranked Jefferson as among the top five hospitals nationwide with the largest volume of orthopaedic procedures.

In comparison to other medical centres around the nation with orthopaedic programmes, a high volume of hip replacement procedures is performed at Jefferson Hospital, namely a total of 1500 annually. As a result, Jefferson Hospital has one of the shortest lengths of stay and lowest complication and readmission rates for the procedure.

During hip replacement surgery, the orthopaedic surgeon makes an incision along the joint, moves aside muscles and removes damaged bone and cartilage. The remaining bone is prepared to receive the prosthesis and the new plastic and metal joint is placed in position. The technique developed by Jefferson surgeons over the past 15 years involves fixation of the prosthesis to bone without the use of cement. The incision is closed with stitches or staples, which will be removed in about two weeks.

For more than a quarter of a century, Dr. Rothman has dedicated his career to research, teaching, and surgery. He has also worked toward realising his vision of an institute, dedicated to the treatment of skeletal diseases that is performing among the largest number of joint replacements in the city and nation.

Dr. Rothman is regularly listed by national publications as one of the premier orthopaedic surgeons, as well as one of the best doctors in the country. He has received numerous awards for his research contributions to the study of orthopaedics, including FDA-approved studies on hip replacements and arthritis of the hip. Dr. Rothman has also published extensively on his findings, and has 13 textbooks and more than 200 original research papers to his credit.

Dr. Hozack has specialised in hip and knee replacement surgery over the past 15 years. He is currently focusing his efforts on improving the longevity of joint replacement, especially in active, healthy people. He is also developing and improving techniques of limited incision hip and knee replacement as well as the use of computer-assisted surgery of the hip and knee.

Leslie Versweyveld

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