“A New Route To A New Hip”
Steven Sanders, MD
Steven Sanders, MD, who specializes in Orthopedic Surgery at the Baylor Health Care
System, talks about an innovative hip replacement, which can save doctors from cutting
muscle or tendon.
How long have you been replacing hips?
Dr. Sanders: I have been replacing hips for the past 16 years.
How many hip replacement surgeries do you do in a day?
Dr. Sanders: It is variable, but it may be three to four a day.
That seems unreal that many people are getting hips replaced.
Dr. Sanders: Well, arthritis is very prevalent now and as our population is aging we are
seeing much more of that.
Why do you think that is? Is it just that we are more active and wearing them out
more?
Dr. Sanders: I think patients are more active now and have busier lifestyles, and people
are living longer too; they are healthier in many regards.
How have you seen hip replacements change from 16 years ago to today?
Dr. Sanders: The way most surgeons still perform hip replacement surgery is entering
the hip joint either from the side of the hip or from the back of the hip, and that is the way
I was trained several years ago as well. The disadvantage in that is that tendons and
muscles have to be cut in order to access the hip joint. That leads to more pain, it leads
to more potential swelling, a potential risk of transfusion, and it also leads to a risk of the
hip dislocating after surgery. So, all of those patients are always taught how to sit
properly, how to turn, how to not turn, in order to protect the hip until everything heals.
That leads to a much lengthier recovery.
This new hip replacement; what is different about it?
Dr. Sanders: The way I perform hip replacement is a very innovative technique, a few
surgeons around do it, and we actually approach the hip from the front side of the hip.
The advantage in that is we do not have to cut any muscles or tendons. We can just
work around the muscles and tendons and so therefore, we are able to preserve the
anatomy there. Patients do not have that risk of dislocation and they recover much
quicker. It is very amazing that with traditional replacement, most patients would be
using a walker around six weeks after surgery. Now with anterior hip replacement, most
patients use it maybe a week, ten days.
When are they back to normal?
Dr. Sanders: Normal is a whole different definition. It depends on what your goals are
with lifestyle, but I would say patients are doing more than they could do before the
surgery at around six weeks.
Is the incision smaller too?
Dr. Sanders: The incision is actually about the same, and the incision is not what is
important. What is important is what is done underneath the skin.
So explain that just a little bit more in detail.
Dr. Sanders: The difference is not necessarily the size of the incision, but it is the ability
to not cut those muscles and tendons that lead to increased functional compromise after
surgery, pain, swelling, bleeding, etc.
When you are cutting those muscles and tendons, how many would you be
cutting?
Dr. Sanders: Typically, there are around three to four that are cut in order to access the
hip.
You have to think those are probably pretty strong, well-developed ones too?
Dr. Sanders: They are. I mean, they are not major muscle groups but they are important
in the stability of the hip joint.
How long have you been doing this type of surgery?
Dr. Sanders: I have been doing this surgery now going on four years, regarding anterior
hip replacement.
Are there any risks that are different than the traditional ones?
Dr. Sanders: No. There are no different risks.
Is there anybody that you would not do this type of hip replacement?
Dr. Sanders: I have expanded my indications to virtually almost all patients. There are a
few exceptions. If a person has a certain disease or certain problems with the hip that
just have to be approached from the backside of the hip, then we’ll do it the more
traditional way, but most people with routine hip arthritis, we do the hip from the front
side.
We are talking to a patient, Mrs. McKenzie. Do you remember her?
Dr. Sanders: Yes.
What was she like when you first saw her?
Dr. Sanders: She was really having severe problems. She had lost most of her function
regarding her ability to do the things that she enjoyed. She was having daily pain, she
was having pain that woke her at night, and she was having very restricted movement.
Have you seen her after the surgery?
Dr. Sanders: Yes.
What is she like now?
Dr. Sanders: She is very happy. She says this has changed my life forever. Within two
weeks after surgery, she was dancing at a wedding.
What about that? We take it for granted that we are going to be in pain, but you
see people every day that it is like their whole life has changed.
Dr. Sanders: One of the things that I love about hip replacement surgery is the dramatic
change it does make in a patient’s life. They go from being severely restricted and
almost immobile to some degree to a whole new quality of life, and it is very satisfying to
me as a physician and surgeon.
Why did they start the hip replacements going in through the back or side?
Dr. Sanders: With the history of hip replacement, it all began in Europe mainly dealing
with pelvic fractures, and so the hips actually were approached from the front side. That
became abandoned in the United States. The first hip replacements were done around
1960 in the United States and it evolved into different techniques in performing the hip
surgery. The preference in the United States was approaching the hip either from the
side or from the back side.
Why is that though?
Dr. Sanders: There was thinking that it was an easier way to do it.
So when people come in and you start talking hip replacement, is there one
question everybody has that you can put to rest right now?
Dr. Sanders: Most patients ask how painful it is, and I can tell you without exception
every patient is pleasantly surprised that it is not near the expectation that they had and
that they are much more comfortable after surgery. They are surprised at how quickly
they are up and walking and they are surprised how immediately that pain they had
before surgery is gone.
After doing all these hip replacements and being with patients all day long, is
there anything you have changed in your life that you do not do now that you
used to do when it comes to hips and knees?
Dr. Sanders: It’s a hard question to answer. What I personally do? At my age now I do
not run for exercise. I used to several years ago, but I think that most patients or most
people in general after about 40 years old are really not designed to be able to do that
and so our joints begin braking down. For us older folks, I think low impact exercise is
very effective and very efficient too.
How can you be more accurate with this surgery?
Dr. Sanders: With traditional surgery, typically the patient is laying on their side on the
operating table. The surgeon’s technique and making sure that the implants are properly
positioned so that the legs are exactly the same length after surgery is all really based
on experience and feel, and sometimes that accuracy can be difficult to achieve. When
we do the hip replacement from the front side, the patient is lying on their back on the
operating table and that gives us the ability to use an x-ray machine as we do the
procedure to actually visualize the implants, make sure the position is perfect, and that
the leg lengths are perfect as well. So, that has greatly been an improvement in the
patient’s overall longevity of the implants and of their function afterwards as well.
A problem area that doctors have is not getting the socket in correctly, and then
that kind of changes everything when you do not do that, right?
Dr. Sanders: Correct. The socket or the cup position is very critical to the longevity of
the implants. If the cup position is not properly positioned, then that can lead to
accelerated wear and tear of the implants which can result in implant failure. Also, it
could increase the risk of dislocation as well.
What percentage experience dislocation?
Dr. Sanders: Overall in the literature, the risk of dislocation after a traditional posterior
approach surgery or lateral surgery is around 3% to 4%. With anterior hip replacement it
is less than 0.1%.
Is this easier if the person is heavy?
Dr. Sanders: Anterior hip replacement can be easier actually to perform on larger
patients because there is less tissue on the front of the hip than there is on the back or
the side of the hip. The way the patient is positioned on the operating table actually lets
any excessive adipose tissue fall back out of the way and it does become an easier
operation to perform on larger patients.
This information is intended for additional research purposes only. It is not to be used as
a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional
interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or
accuracy of physician statements. Procedures or medicines apply to different people and
medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Susan Hall
Baylor Health Care System
214.820.1817
susanh@baylorhealth.edu
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