09/30/2023
So NO patient identifier for this total hip replacement story, but we did have a case this morning in Abbeville where our patient signed a social media release to share his case. This was a left hip replacement on a gentleman with a previous spinal fusion. The double edge sword when we perform bony fusions in the body is that the joints above and below the fusion typically MUST assume the lost motion which means MORE  stress on the joint picking up the slack. So, in this case, the hip and pelvis will see more stresses proportional to the amount of levels fused in the spine  This gentleman’s hip disease was probably a combination of degenerative joint disease accelerated by spjnal fusion. Or sometimes just a case of his hip warranty expiring.
Most humans fall within an anthropological size as far as their bone structure. For example, 80% of men and women will usually have a 48-52mm sized acetabulum.  We typically perform templating preoperatively to have an idea of what size implants, implant positioning, orspecial equipment which may be needed. In this gentleman’s case, he was an outlier with a 58 mm acetabulum. His femoral stem size was between 6-7 (I went with 6) which is in the high mean for men. . 
In this gentleman’s case, I performed an anterior hip replacement, preserving all muscle. In this country, most of us up until the past 15 years were trained to approach the hip from posteriorly (behind), laterally (side) , or anterolaterally (front/side). So when the European technique of a DIRECT anterior approach gained traction in this country, many of us went back to the drawing board, the anatomy labs, and took additional courses/training so we could offer this style of hip replacement. The truth about the hip replacement, is that no matter how you find yourself into the hip, this is the second most satisfactory surgery and return to quality of life out of all surgeries. Bypass surgery of the heart restores the most quality of life followed by the total hip and then the total knee. I tell patients that they will do tremendously with any hip replacement their surgeons knows how to do well. The anterior approach does have some IMMEDIATE advantages, but typically after a couple of months, those advantages match the other approaches.
When I began performing anterior hip replacements in 2011, a case typically took between 1.5-2.5 hours (and sometimes longer). Around 900 anterior hips later, we have an efficient recipe with times ranging between 35-50 minutes. And to let you know just how far joint replacements have come, MOST patients do go home within 23 hours. I typically have the patient walk an hour after the surgery.  This gentleman walked 400 feet on his first attempt and discarded his walker the last hundred feet. He ate lunch and then asked to go home. This is not uncommon with hip replacements.
 I am part of Louisiana Orthopedic Louisiana Orthopaedic Specialists and cover primarily the New Iberia and Abbeville communities. Hopefully this was informative and alleviate a little bit of the anxiety about hip replacement. 
