Hip, hip hooray for options in joint replacement

September 26, 2018 | by Edward-Elmhurst Health
Categories: Healthy Driven Heroes

In early February 2018 Elmhurst dentist Jeffrey Slovick gratefully joined his golf buddies on a 36-hole-a day golf trip to Florida. Just weeks before, pain would have kept him from playing even a nine-hole round.

Jeffrey Slovick walking down the hall in recovery hours after his total hip replacement surgery.

On Dec. 12, 2017, Slovik underwent a total replacement of his right hip. The surgery was performed by Jeffrey Meisles, M.D., an independent orthopedic surgeon and member of Elmhurst Hospital’s medical staff.

How it started: worsening pain

Slovik’s problem started in mid-2016 with a mysterious pain that seemed to travel from one part of his leg to another. It progressively worsened until he was having trouble cutting grass, walking uphill, even just fully raising his leg to climb stairs.

He asked his doctor if the pain could be related to a knee surgery he had in high school or his more recent hernia surgery. It was neither of those things. Imaging tests showed the cartilage covering the ball and socket of his hip joint had completely worn away. Cartilage is what normally helps the joint move smoothly. Slovik set out to consult an orthopedic surgeon.

He had friends who spoke highly of their hip replacements done with an anterior approach. This means the surgeon goes through the front of the hip, between the muscles, versus the more conventional posterior approach, from the back of the hip. Slovik’s friends recommended he look for a doctor experienced in the anterior technique.

Advantages of an anterior approach

Slovik learned Dr. Meisles has done hundreds of this type of hip replacement. He also works with a hip implant manufacturer to teach other surgeons the anterior approach through classes, observation of his surgeries at Elmhurst Hospital and on-site mentoring at other facilities.

Says Dr. Meisles, “By the time Jeff came to see me it was clearly time for a hip replacement. The problem was affecting his quality of life and ability to perform his normal activities.”

In a total hip replacement, the surgeon removes damaged areas of the hip joint and replaces them with parts made of metal, ceramic and plastic.

Dr. Meisles also concluded that Slovik was a good candidate for surgery with the anterior approach, which offers less risk of dislocation. It’s inherently more stable because there is no need to cut any muscles around the hip. In the posterior approach, some of the muscles have to be cut and reattached. This difference typically means a quicker recovery for anterior patients, as well as less pain and a minimized need for narcotics.

Another advantage: The patient will have few restrictions on activity after surgery.

“Patients who’ve had a posterior approach hip replacement will be asked to sleep initially with a pillow between their knees to reduce the risk of a dislocated hip,” says Dr. Meisles. “They also face weeks or months of restrictions on bending over or lifting their legs in certain ways. These limitations aren’t needed for patients who’ve had the anterior approach.

“Also with the anterior approach, the patient is lying on their back during surgery. This allows us to take X-rays during the procedure to verify the position of the components and ensure the leg isn’t excessively lengthened or shortened. With the posterior approach, the patient is lying on their side, making it very difficult to take X-rays until they’re transferred to the recovery room.”

Despite the advantages, Dr. Meisles says he doesn’t believe the anterior approach is appropriate for some patients, such as the very obese. Folds of flesh at the waistline may interfere with the incision and increase the risk of infection.

About anterior versus posterior hip replacements, Dr. Meisles concludes, “The ‘best’ approach is not the same for every patient and depends on patient preference and surgeon experience. Patients will want to talk with their surgeons about why they think a particular approach is best for them. If the patient is in doubt, it’s always a good idea to seek a second opinion.”

The surgery and rapid recovery

Two hours after Dr. Meisles performed Slovik’s surgery, he was walking down the hall of the hospital.

“I didn’t even need Tylenol for pain,” says Slovik. “I just took two aspirin and Celebrex to prevent blood clots.”

The surgery was on a Tuesday. He resumed driving on Thursday, worked at his dental practice on Monday and was hitting golf balls by Jan. 24, about a month and a half after surgery.

An avid bicyclist, Slovik credits his active lifestyle in part for his ability to recover rapidly from surgery. He calls the operation “life-changing.”

He says, “It was absolutely the best thing I’ve done in a long time. Even a day at work is less tiring. It’s silly to suffer when you’re relatively young and active.”

At 89, his mother was also able to benefit from a joint replacement (knee) by Dr. Meisles in May.

Says Dr. Meisles, “The risk goes up somewhat after 80, but many healthy older patients are better candidates for surgery than their younger, less healthy counterparts. Jeff’s mom was still healthy and independent.”

Learn more about orthopedic services at Edward-Elmhurst Health.

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