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Clarence's Left Hip to be Replaced--In Albuquerque

Search for Surgeon Doing the Anterior Approach

A few stops and starts. But we found a surgeon in Albuquerque experienced in doing the frontal approach; the procedure which worked so well a decade ago when Clarence had to go to Houston to have his right hip replaced. At that time, he was out of the hospital the day after the surgery and going up and down stairs unassisted in the first week. It was wonderful--practically a miracle. He was a little sore, but required no pain medication.

We had hoped that his other hip would outlast him, but the joint space has narrowed over the years and is beginning to interfere with day-to-day activities--and his training. He learned last time that hip replacement before his muscles began to atrophy and become unbalanced speeded recovery. Many people, perhaps most, come to hip replacement in a debilitated condition. Understandably, they avoid movements that hurt. This makes rehab take longer. In addition to recovering from the surgery, they have to spend time regaining strength and correcting the imbalances; they have to relearn how to walk and move normally. Clarence managed to avoid that problem almost entirely last time and hopes to do it again.

He learned about the anterior approach from Louisiana Judge Dan Sawyer, who had had both hips replaced, first the traditional way and two years later using the anterior approach. The difference was like night and day. After the posterior approach, he couldn't turn over in bed without help for over a week. With the new method, he went to the hospital on Thursday morning and was released around noon on Saturday. "With the new approach," he told Clarence, "you have so little pain you forget to complain."

The new approach causes less tissue damage, making recovery faster and less painful. The surgeon goes in from the front through a natural opening; no major muscles are detached. The traditional way goes in through the buttocks cutting through more tissue and detaching more muscles.

No one in New Mexico was doing the frontal approach a decade ago. Clarence was fortunate to find an open minded sports medicine orthopedist willing to buck majority opinion and encourage him to see Stefan Kreuzer, a Houston surgeon who (along with Joel Matta and few others) pioneered the new approach in this country. He also wrote Kreuzer suggesting that Clarence was an ideal candidate for the anterior approach. (For full details and eight years of follow-up, see Miracle in Houston: http://www.cbass.com/Hiprep.htm )

Unfortunately, the sports medicine doctor retired shortly before Clarence found himself in need of a new left hip.

An orthopedic surgeon in the same group confirmed that Clarence needed his other hip replaced, but discouraged him from having the anterior approach. He called it a "terrible procedure," dangerous and discredited. He wasn't interested is hearing about Clarence's earlier experience or his fitness background. He said he wasn't aware of any New Mexico surgeon doing the anterior approach.

The traditional approach is used far more often than the anterior approach.

A Google search produced the following results regarding the two procedures.

A study comparing the two approaches found the anterior approach to be "a safe and efficacious means of reducing morbidity and accelerating functional recovery." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163771/ 

A video taking you through the anterior approach and explaining the advantages, all in less than 5 minutes: http://www.sutterhealth.org/orthopedics/hip/anterior-hip-replacement.html

A pro and con report from a surgeon who has stopped doing the anterior approach: http://holycrossleonecenter.com/blog/the-pros-and-cons-of-two-approaches-to-hip-replacement-mini-posterior-and-direct-anterior/

Only 30 percent of the hip replacements done nationwide use the anterior approach. Reasons include the steep learning curve and the special table required to do the procedure properly. (The table can run up to $150,000.)

*  *  *

You and a surgeon you trust should decide which approach is best in your case. Many surgeons do both approaches. A key factor is lifestyle. Are active living and exercise important factors in your life?

It is beyond dispute that recovery is faster with the anterior approach. After six months or a year, the results are apparently about the same. While that may not make much difference to many people, it is important to the fitness minded. The results of sedentary living can be devastating.

In one of the most famous fitness studies of all time, Dallas researchers found that three weeks in bed decreased fitness twice as much as 30 years of aging; see "Exercise Overcomes 30 Years of Aging." http://www.cbass.com/ExerciseAgingIntensity.htm 

Another study found that only three days of reduced activity—on par with the activity level of most Americans—put healthy young adults on track to develop type 2 diabetes; see "Another Reason to Keep Moving." http://www.cbass.com/AnotherReasonPsyActivity.htm

You'll find many more articles on the miracle of movement in our Fitness and Health category: http://www.cbass.com/fitness_health.htm

Find an Experienced Surgeon You Trust

Stefan Kreuzer won us over in our first meeting. He sat down and listened to us like we were his one and only concern. That would be hard to match, but we wanted a surgeon with a good reputation and lots of experience. Ideally, one doing 2 or 3 hips a week.

While NM is still a little behind, the word on anterior hip replacement is spreading.

ABQ Health Partners (now DaVita) has led the way in Albuquerque, with (we believe) Dr. Thomas McEnnerney the first to do anterior hip replacement.

The surgeon we have chosen is McEnnerney's young associate Mark Werner (53). We thought the younger hands would be to our advantage. In addition to young hands, he has big arms and looks fit. (Important in Clarence's case; see below)

We asked lots of questions and he had the right answers. 

Matta trained, he averages about 3 anterior hips a week, with a total between 750 and 1000.

Confidence inspiring manner. Like Stefan, he took time to listen to our story. He understands that Clarence's muscularity makes hip replacement more challenging. He told us about replacing a power lifter's hip.

He seemed pleased to receive a copy of our book Great Expectations, with the hip incision scar visible on the cover. He'll enjoy the chapter about Clarence's earlier experience with hip replacement. Jokingly, he requested that we spell his name correctly in future books or writings.

The staff was also friendly and accommodating. Pleasant atmosphere, uplifting. Part of the DaVita group spread far and wide.

A great weight off our shoulders to find an acceptable way forward. Clarence is looking forward to a pain-free left hip and getting on with his life.

The replacement is scheduled for April. We'll tell you about it in our next May 1 Update.

April 1, 2016

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 or street address: 528 Chama, N.E., Albuquerque, New Mexico 87108,
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