Advancements in hip replacement ease the way for patients
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Maureen Moslow-Benway and I sat on my screened porchin Northampton on a warm summer day, catching up. We were fast friends who had run, biked and hiked together until she moved to Virginia.
I told her my big news: I was getting my hip replaced. "I've been limping for almost a year," I said.
"Deb, you've been limping since I left," she said. "That was six years ago."
I could be forgiven for wildly underestimating the length of my decline. It seems I'd been fibbing about my aching right hip for years, making excuses for it as a mother might for a misbehaving child. In hindsight, I understand the artifice - at 58, I still consider myself an athlete. Hip pain and steadily decreasing range of motion on my right side were tethering me to gentler endeavors. I didn't like it. I felt weak. I felt old.
It's not as though my condition is rare. In the United States, some 250,000 people had total hip replacements - called hip arthroplasty - last year, according to Dr. Henry Drinker, a Northampton orthopedic surgeon. By the year 2030, that number is expected to increase 180 percent, he said, as irrepressible baby boomers, emboldened by the broad success of hip replacement surgery that's getting people on their feet faster than ever, switch out aching parts.
Many people, like me, need hip replacements because of a condition called osteoarthritis, which is a wearing out of cartilage of the hip joint. The condition usually develops with age, and mostly is genetic, according to Drinker, although lifestyle can be a contributing factor.
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Most people can tell you exactly when their hip started going to hell.
My problem began around 10 years ago, with a niggling pain that eventually sent me to Northampton orthopedic surgeon Jonathan Kurtis. X-rays revealed mild arthritis. Saying "this is not good news," he suggested an over-the-counter anti-inflammatory, and advised me to stop running and to avoid "herky-jerky" movements - a veiled reference, I was certain, to the aerobics classes he had seen me teach at a local gym. I pared my running schedule, but stubbornly made few other adjustments.
Over several years, alarming flashes of groin pain joined the pain in my hip. New X-rays revealed that the condition had progressed. I asked why I had no pain on some days, while on others I had to nudge my right leg forward by grabbing my pants leg. Kurtis explained that arthritic conditions don't necessarily follow a linear path. He traced a wavy line with his hand to indicate ups and downs. That line, I noticed, had a downward cant.
I pursued conservative treatments, like physical therapy and anti-inflammatories. A cortisone injection to relieve inflammation in the joint worked with astonishing swiftness, though Kurtis cautioned it would not slow the progression of the disease, and eventually wouldn't work at all.
In 2006, a few months removed from an injection, I cycled with my husband to the top of Mont Ventoux in France. I felt great. But by the summer of 2010, as Kurtis had predicted, nothing eased the pain. On a short bike ride, I pulled up at the base of Chesterfield Hill in Leeds. That hill, a mere knot in the road compared with Ventoux, seemed like Everest. I turned back, tearing up from frustration.
On my next visit to Kurtis, he told me I was a candidate for total hip replacement.
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Hip-replacement surgery, in general, involves replacing the cartilage with an artificial liner and replacing the top of the thigh bone. The new top has a stem, which is anchored into the thigh bone. It takes time for the bone to adhere to the new part.
For orthopedic surgeons, accessing the joint is like charting a course to a snowy peak - there are various routes, all carrying risks and rewards. Part of the challenge is navigating the formidable terrain of muscles and soft tissue, including the thick hip joint capsule, with as little disruption as possible.
One widely used, time-tested procedure, called the "posterior approach" because of the point of entry, compels a couple of months of limits on movement postoperatively, while the muscles and soft tissue heal. Newer surgeries, broadly referred to as "minimally invasive," have reduced or eliminated those restrictions, meaning less chance of complications, less time in the hospital and faster healing. According to Drinker, all surgeries, even the posterior one, are less invasive than in the past, and have the same end result - a sturdy hip free from arthritis pain, that can last for more than 20 years. For those who have hip replacement, "it is life-changing," Drinker said.
Drinker works at Hampshire Orthopedics & Sports Medicine Inc., in Hatfield. He also is medical director of Cooley Dickinson Hospital's joint replacement center. Drinker and Dr. Robert Krushell of New England Orthopedic Surgeons in Springfield use versions of the posterior approach. Krushell calls his a "mini-posterior that creates relatively little disruption of tissues around the hip. It doesn't compromise muscle strength."
Baystate Medical Center in Springfield performed 1,200 joint-replacement surgeries last year, Krushell said.
At CDH, joint-replacement patients recover in an eight-bed ward dedicated to joint replacements, and with staff trained to care for them. Last year, 270 joint-replacement procedures, including hips and knees, were performed at the hospital.
Ed Shaughnessy of Northampton, athletic director at Smith Vocational and Agricultural High School for 17 years, went for X-rays when his hip didn't feel quite right. "I could tell there was something wrong," he said. He was right. After reviewing the images, Drinker, referring to the joint cartilage, said, "There's nothing there."
Now there is, because Drinker replaced Shaughnessy's hip. He went home after three nights in the hospital and got off crutches after a month. By week 7, he said, he was walking comfortably. "You're way ahead of everyone else," he recalls his physical therapist telling him.
He heeded precautions that come with this procedure - not to cross his legs or turn the toe of his operated leg inward while healing, and declared himself ready for his golfing date with the guys at Myrtle Beach at the end of February.
"I did well because I'm so active," said Shaughnessy, who is in his 44th season coaching boys baseball at the school. "I walked my nine holes (of golf) this morning," he said last week. "If I hadn't gotten it done, I wouldn't be playing nine holes."
He vowed to be more mindful of one physical therapy edict: stretching. "I just do it. I don't take it for granted."
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New England Baptist Hospital in Boston, where I had my hip replaced, is a research hospital known for joint replacements. I had heard from several local people that orthopedic surgeon Stephen Murphy in 2002 had developed a technique called a "superior capsulotomy" (meaning the incision is above the hip joint) that had people on their feet, and back to active lifestyles more quickly than with other procedures. I wanted that.
With the help of surgical tools he developed, Murphy can access the joint with a single, small incision. Guiding him there is a computer-assisted navigation system, loaded with data from a computer model he has made of the patient's joint through three-dimensional scans. That helps him precisely place the new parts through a tiny incision (my scar is under 3 inches).
Other unique features of his technique, seen in this fascinating eight-minute simulation on YouTube, aim for a new standard in preserving muscle and soft tissue, while ensuring a well-fitted prosthetic.
Many of Murphy's patients go home the day after surgery.
Sheryl Stoodley went home the next day. Stoodley, 62, of Haydenville, teaches at Holyoke Community College and is the artistic director for the Serious Play Theatre Ensemble. Word of mouth sent her to Murphy after a long siege with pain. "I kept bumping into people (who had had surgery with him)," said Stoodley, who tours internationally. "I teach physical theater discipline. There's a lot of footwork. I want to be able to demonstrate it."
She had hip replacement surgery in May 2010. The following morning, she recalled, "Murphy said, 'Do what you feel like.' I said I would rather be home."
Stoodley said she was well-prepared for surgery, watching the procedure on the Internet. Afterward, she walked twice a day and got off crutches quickly. Now walking without a limp, Stoodley said, "I wish I had gone three years sooner."
Of Murphy, she said, "He personalizes the operation. He listens to you."
Tom Quinn went a different route with his hips when both began to fail. The Northampton cardiologist's research led him to orthopedic surgeon Ivan Tomek at Dartmouth-Hitchcock Medical Center in New Hampshire. Part of what attracted Quinn to Tomek's "anterior exposure" is that the patient is on his back during surgery, rather than his side. That meant both hips could be replaced at the same time. He went home with no restrictions on movement.
"I was back to work in less than three weeks, and riding a stationary bike in four weeks," said Quinn, who is 59. He was back on his road bike in two months, riding flats comfortably after a small setback he suffered when he felt so good that he tackled a hill.
"You're going to find what you can do," he said.
Quinn said he likely won't return to running. He likened his new hips to "a nice car - you're not going to take it off road."
John Brady, three years removed from hip surgery at New England Baptist with Murphy, is back to favorite pursuits like backpacking, hiking and tennis. "I play tennis better than I did (before surgery). I don't know I have an artificial hip," said Brady, 62, who is a professor of geology at Smith College and co-author of "50 Hikes in Massachusetts."
"It's high-quality work," he said of Murphy's surgery and of New England Baptist in general. "(Joint replacement) is what they do."
As for me, I am six months removed from surgery. I blame my delayed recovery on my dog. Pearl, a year-old golden retriever, joyfully leaped onto my bed and plied me with kisses while stomping the hell out of my four-day-old hip back in November. The ensuing pain and an ugly welt drove me to make a desperate call to Murphy the next day, fearing that I had damaged my new hip. He calmed my fears, saying, "These hips are pretty indestructible."
Recovered from that weeklong setback, I am pedaling 25 miles on my road bike, doing intervals on my bike trainer and swimming. For now, I am forgoing the "herky-jerky" movements that contributed to my problem. I stretch and do strength exercises. On a follow-up visit to Murphy, I complained that my thigh muscles ache from time to time. He smiled. "It's been only 12 weeks, right?"
Deborah Oakley is an assistant editor at the Daily Hampshire Gazette. She can be contacted at doakley@gazettenet.com.
