Younger pa­tients are be­com­ing can­di­dates for hip re­place­ments

Wellness Update - - Meet Our Doctors -

Rob Ashurst has al­ways been an ac­tive guy. Into sports and ex­er­cise all his life, the 40-year old re­cently started do­ing a rig­or­ous cross-fit pro­gram at a lo­cal fit­ness club with some of­fice mates. One evening, af­ter a hard work­out, he felt a tweak in his hip. That tweak was his first in­di­ca­tion he had a de­gen­er­a­tive con­di­tion known as avas­cu­lar necro­sis, a dis­rup­tion in the blood sup­ply to the hip joint, caus­ing the head of fe­mur to die. That led to os­teoarthri­tis and pain that wors­ened by the month. Ashurst came to Univer­sity of Alabama at Birm­ing­ham or­tho­pe­dic sur­geon Her­rick Siegel, M.D., who told him that he was a can­di­date for hip re­place­ment, largely be­cause new ad­vances in ma­te­ri­als and tech­niques mean sur­geons are now able to of­fer hip re­place­ment to younger pa­tients. “There is grow­ing need for joint re­place­ment in gen­eral, es­pe­cially in the baby boomers and the week­end warriors,” said Siegel, as as­so­ciate pro­fes­sor of surgery in the Di­vi­sion of Or­tho­pe­dic Surgery. “We’ve im­proved the sur­gi­cal process and in­creased the life­span of the im­plants to a point where it’s now vi­able for a younger pop­u­la­tion and for older pa­tients who pre­vi­ously were not can­di­dates due to other med­i­cal is­sues.” One fac­tor is bet­ter ma­te­ri­als for the hip im­plants. Alu­minum ce­ramic and highly cross-linked poly­eth­yl­ene pro­vide harder, smoother sur­faces that cause less wear and last longer than more tra­di­tional plas­tic ma­te­ri­als. Other new ma­te­ri­als help bone grow into the im­plant, pro­vid­ing ad­di­tional strength. “Mod­ern hip re­place­ments are not the same hips that were put in in the 1980s and 1990s,” said Siegel. “Th­ese are hips that have the po­ten­tial to last a life­time in most pa­tients.” Rob Ashurst hopes so. Three months af­ter his hip re­place­ment he was back at the gym. He took the hard-core fit­ness in­tro­duc­tory class again and, to his sur­prise, scored bet­ter with his new hip than with his old one. “I really fig­ured I’d be one of the slow­est in the class,” said Ashurst, “but I beat ev­ery­one in the class the first day.” Siegel says that in some pa­tients, the new hip im­plants could last 40 years. He also touts an­other ad­vance, op­er­at­ing from the front of the leg rather than the back. The an­te­rior ap­proach, as it’s called, means a shorter re­cov­ery time “We come in from the front so we are di­vid­ing mus­cles rather than cut­ting through them,” Siegel said. “It pro­duces an ear­lier re­turn to full func­tion.” The an­te­rior ap­proach is best per­formed on a spe­cial op­er­at­ing ta­ble. UAB has two and con­sid­er­ing get­ting a third. First devel­oped for hip and hip joint frac­ture cases, the ta­ble al­lows sur­geons to ma­nip­u­late the pa­tient’s hip to pro­vide the ac­cess needed to use the an­te­rior ap­proach.

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