Looking at hip replacement differently

Hip surgery is a serious decision for many people. While hip replacement is considered one of the most universally successful operations and is very effective at relieving pain, it is usually considered an elective procedure. Patients often struggle with being physically and emotionally ready for the operation. But once performed, it’s a lifechanger.

“I gain great satisfaction from helping people get back to living. When someone tells me their surgery gave them back their life and saved them from years of pain, I know I’ve made a difference,” said Dr. Myerthall, participating physician with the Banner CORE Center for Orthopedics. “Hip replacement is somewhat elective. It’s about quality of life, not quantity, so the patient really has to make the decision for themselves.”

Total hip replacement surgery, at its core, relieves pain and restores function to patients whose joints have been destroyed by trauma or disease. But it tends to be a last resort for many patients. With recent current technological approaches, it needn’t be as debilitating as it used to be. Unfortunately, recent studies show more than 50 percent of patients delay joint replacement by up to 9 years.

“When approximately 85-95 percent have good results for 1215 after surgery, surgeons wonder if the unhappy patients are telling the story of hip replacement, which is unfortunate,” Dr. Myerthall said. “There’s no need to give up on all the things you love doing because of fear of healing or a limp. The techniques we use are incredibly advanced.”

Many surgeons use what’s called a posterior approach for hip replacement surgery. Dr. Myerthall and many of his colleagues use a direct anterior approach, a viable option for more than 95 percent of patients. In hip replacement surgery, the joint is reached through the back of the hip, (posterior approach), the side of the hip (lateral approach) or the front of the leg (anterior approach).

In total hip replacement, the cupshaped hip socket and the ball of the thigh bone are replaced. The posterior approach, the main hip replacement method for many years, involves accessing the hip joint through an incision in the back of the leg – near the top of the femur.

The anterior hip replacement allows the surgeon to access the joint through the front of the leg, rather than the back. Entry through the pelvis area on the front of the patient’s body makes it possible to reach the hip joint by separating the muscle and going between the fibers rather than cutting and reattaching muscles.

Dr. Myerthall has found anterior hip replacement results in faster recovery and shorter hospital stay for patients, perhaps due in part to less muscular damage. “About 25-30 percent of my patients go home the same day as the surgery because of the anterior approach. There’s less waiting period to resume normal activity, and when I visit patients after their surgery, they are much more comfortable that posterior hip replacement patients. By six weeks most are ready to return to full activities,” he said.

The anterior technique hip replacement is Dr. Myerthall’s preferred approach primarily because of the lower risks associated with it, which may occur more often with the posterior approach. “When I don’t need to cut muscle, and instead am able to thread between the muscle, it shortens healing time, lowers patient pain levels and reduces risk of dislocation because the body isn’t having to heal both bone and muscle. The anterior approach allows me to have a good view of the hip socket while preserving the muscles,” Dr. Myerthall said.

Steven L. Myerthall, MD is an internationally fellowship-trained and board certified specialist of the hip and knee reconstruction.

While roughly 98 percent of Dr. Myerthall’s patients have the anterior technique for hip replacement, it’s not for everyone. Usually patients who have had previous hip implants or metal hardware or who are obese may not be well-suited for this procedure. “If someone has had a previous hip surgery that didn’t go well, chances are, that surgeon approached the joint from the back or side of the leg, so I approach the joint that same way to remove all the old hardware,” Myerthall said.

Obese patients may not be able to receive hip replacement using the anterior approach because of complications of healing. An incision in the front of the pelvis where the stomach may overlap, creates the perfect place for a bacterial infection.

“It’s important for patients to find an experienced surgeon,” Dr. Myerthall said. “I found my passion for hip replacement many years ago after working in the physical therapy field, interested in sports medicine. Hip replacement is all I do, specializing and honing that practice,” Helping active people embrace life again is what draws Myerthall forward – even teaching other surgeons how to do the anterior approach. He performs hip replacement surgeries at The CORE Institute 2-3 times a week averaging four a day, on patients ranging in age from 20-80 years old.

Knowing hip pan is a large impediment for lifestyle enjoyment, Dr. Myerthall’s advice for preventative measures to avoid or delay hip replacement is:

1. Carry your body’s appropriate weight. Extra weight is hard on your joints.

2. Keep your joint muscles strong by keeping active (exercise actually keeps bones strong).

3. Avoid activities that are hard on your joints such as running or jogging and instead swim, bike or use the elliptical machine for cardio.

Most patients want to avoid downtime from their favorite hobbies or exercises, but Dr. Myerthall says, “When pain begins to limit your activities; if you have trouble sleeping at night; and if you find yourself taking progressively stronger pain management methods, it’s time to talk to a surgeon to restore your hip joint.”

To find an Orthopedic Doctor near you, call 602.346.9827 or visit www. bannercorecenter.com/patients

“When pain begins to limit your activities; if you have trouble sleeping at night; and if you find yourself taking progressively stronger pain management methods, it’s time to talk to a surgeon to restore your hip joint.” - Steven L. Myerthall, Banner CORE Center for Orthopedics hip and knee replacement surgeon at Banner Good Samaritan Medical Center in Phoenix, Ariz