Improving Your Health Just a Hip or Knee Away

For months, Ellen Lariscy lived in pure misery as she battled the pains of a deteriorating right hip.  The 52-year-old had always been active, but her energetic lifestyle came to a halt when the pain left her using a walker and climbing up steps on her hands and knees.
       “I grew up as a tomboy playing tackle football, baseball, softball, falling out of trees, falling off horses, crashing on ski slopes and ice skating rinks…how much abuse can a body take?” said Ellen.  “Obviously, sooner or later, our lifelong joys and activities catch up with us.”
       In a healthy hip joint, cartilage cushions the surfaces of the bones and provides a low-friction bearing.  When the cartilage wears away due to arthritis, overuse or trauma, the bones rub together and become painful and inflamed. 
       The debilitating pain became too much for Ellen and she knew surgery was her only option.

Meet the Team
Physicians with the Southern Maryland Orthopaedic & Sports Medicine Center in Leonardtown, Maryland, which consists of Dr. Daniel Bauk, Dr. Lloyd Cox, Dr. Mark Henderson, Dr. Michael Travis and Dr. Patricia Turner, perform approximately 250 to 350 total joint replacements each year for patients with osteoarthritis, rheumatoid arthritis, gout or avascular necrosis of the hip, which is the loss of blood supply to an area of the hipbone.  The majority of the total joint replacements are for knees and hips, but the group members, who are all part of the St. Mary’s Hospital Medical Staff, also operate on shoulders, wrists and elbows.
       Each physician in the practice chooses his or her own surgical techniques with the goal always focusing on the long-term benefits to the patient.  The group performs surgeries at St. Mary’s Hospital, which offers many tools to make safe, less invasive surgery possible.  Joint replacement operating rooms boast ultra-clean air systems, surgeons wear NASA-inspired “space suits” and the latest wound irrigation systems are utilized to speed tissue healing.

Minimally Invasive Hip Replacements
For decades, orthopaedic surgeons have developed different techniques to hip replacement surgery to provide a more rapid recovery for patients.  In fact, in recent years, minimally invasive hip replacements provide a new method of accessing the hip joint, which is not easily approached and is covered with layers of muscle and tendon.  Some of these minimally invasive surgeries are now available at St. Mary’s Hospital.  In fact, Ellen underwent a hip replacement surgery that put her on a PATH to wellness. 
            Percutaneously Assisted Total Hip Arthroplasty, or PATH, is a minimally invasive hip replacement surgery that utilizes a small incision site, about 3 to 6 inches.  The procedure is soft tissue sparing, which may reduce the possibility of dislocation and allows for accelerated recovery for most patients.  The hip socket is resurfaced and an artificial socket, as well as an artificial ball and stem, are inserted.  The incision is made just over the buttocks with a slight incision a few inches down the leg, serving as the “portal” that allows for precise control when preparing the area for the new titanium hip replacement.
       For Ellen, the path to recovery has been short.  She had the surgery in late May and was up and walking the next day with the help of the hospital’s dedicated physical therapy team.  By that afternoon, Ellen climbed up four steps and down again with only the assistance of the railing.  By the next morning, Ellen was ready to leave the hospital — less than two days after the surgery — using a cane instead of a walker.  Her quick recovery time is not necessarily representative of all patients — results vary for each patient based on how active the person is, his or her attitude and physical health.
       “I’m excited about it,” said Dr. Cox.  “I think it has been worth the sweat and the stress to do something that is, at least in the beginning, more difficult.”
       The physicians at Southern Maryland Orthopaedic & Sports Medicine Center, in connection with St. Mary’s Hospital, also offer a minimally invasive hip replacement strategy called the Microplasty Anterior Supine Intermuscular Hip Procedure.  This strategy is designed for patients without significant deformities and is a procedure that goes between the muscles rather than through the muscles to replace the hip.  Less trauma to the muscle means faster recovery and less pain felt by the patient.
       As with all new procedures, there is no long-term evidence to prove that the minimally invasive techniques have any advantages over other total hip replacements, but there is sufficient data to move forward with the procedures.  The ability to perform several minimally invasive surgeries close to home is superb.  Over the past months since embarking on these new procedures, patients at St. Mary’s Hospital have recovered quickly with excellent results.
       But hip replacements are only the beginning when it comes to procedural advancement.

Knee Replacements
The Southern Maryland Orthopaedic & Sports Medicine Center team began offering the Simultaneous Bilateral Total Knee Arthroplasty procedure, which is a same-day double knee replacement, about 12 years ago.  The procedure provides patients increased convenience and saves time.
“The advantage is you have one hospitalization and one round of physical therapy,” said Dr. Henderson.  The ideal patient for this procedure has a positive outlook, is otherwise healthy, does not have anemia and is compliant with physician instructions.  It is up to the doctor to determine who is eligible for the surgery. 
       Both knees are replaced within a two-hour time period.  Before this procedure, patients usually waited two or three months between knee replacements.  As with all knee and hip replacement techniques, it is about function for the patient, meaning the procedures are designed to get people up and moving.  Patients have even come from Kuwait and Italy for this surgery in Southern Maryland.    
       Another new procedure is a computer-guided knee replacement surgery that utilizes an MRI scan of the lower extremity weeks prior to the surgery.  A 3-D model of the knee is created and the computer sets the size of the implant and the size of the cuts.  A guide is then issued for use during the surgery, which speeds up surgical time and increases accuracy.
       The key to a successful surgery and recovery is how well the pain is managed during the surgery and controlled after.  State-of-the-art anesthetic techniques have reduced post-surgical pain.  A lot of patients put off the procedure for too long because they anticipate being in a lot of pain.
“They waste years of their lives that they can’t get back,” said Dr. Bauk.  Having joint replacement surgery is “a life-changing event; it allows them to play with their grandkids, go to work, play golf.”

Future of Orthopaedics
The outlook is that people are living longer and will need more surgeries in years to come.
       “Keeping up with new technology is essential and these orthopaedic surgeons, in partnership with St. Mary’s Hospital, offer cutting-edge surgical procedures to keep quality orthopaedic care close to home,” said Regina Steele, director of Perioperative Services at St. Mary’s Hospital. 
            If you are tired of constant joint pain, check out what Southern Maryland Orthopaedic & Sports Medicine Center has to offer by calling 301-475-5555.