Orthopedic Surgeons Gravitate to New hana® Table for Revolutionary Approach to Hip Replacement
Golfing icon Tom Watson almost made history at the British Open in July, with only an 8-foot putt standing in the way of becoming the game’s oldest major champion by more than 11 years. (See related story
Two remarkable footnotes: One, Watson was six weeks shy of his 60th birthday at tournament time. His performance—placing second to Stewart Cink in a 4-hole playoff—prompted The Royal & Ancient Golf Club of St. Andrews to make an exemption to the game’s oldest championship. The “Watson Rule” allows former Open winners who finish among the top 10 to be exempt for five years. The new policy is particularly enticing to older golfers still at the top of their game, especially because the same club had changed the age of exemption for past champions from 65 to 60 in 2008.
Two, and more importantly, Watson’s stellar performance was made possible because of a hip replacement done less than six months before the Open, with his orthopedic surgeon using the Mizuho OSI hana® Hip and Knee Arthroplasty Table for a direct anterior approach to hip replacement that, among other benefits, greatly reduces down time for patients.
The hana table allows orthopedic surgeons to position the hip to an extent impossible with conventional tables. It features hyperextension, abduction, adduction and external rotation of the hip for femoral component placements. The lack of disturbance to the lateral and posterior soft tissues allows immediate post-surgery stability of the hip. Also, the potential for infection risk is decreased because the hana table doesn’t require additional personnel in the operating room.
For patients, the advanced technique for hip replacement shortens hospital stays, requires a smaller incision, significantly decreases postoperative pain, expedites the recovery process, and reduces muscle trauma, blood loss, tissue healing required, and risk of delocation.
“It allows minimally invasive techniques without disruption of important muscles that have to be cut during traditional hip replacement methods,” said Andrew J. Cooper, MD, an orthopedic surgeon with Orthopaedic Associates of West Florida in Clearwater. “It’s truly a muscle sparing approach, unlike traditional methods.
Also, because the anterior approach allows the patient to be positioned supine (on their back as opposed to being on their side as in traditional approaches), it’s easier to sense the position of the pelvis for improved accuracy of component placement. The supine position also facilitates intraoperative real time imaging for component placement. All these benefits translate into a much quicker recovery for the patient with reduced risks of complications, mainly dislocations of the prosthetic hip. Also, it improves the ability of the surgeon to place the components in the perfect position.”
The nuts and bolts: With the direct anterior approach to hip replacement, a small incision is made on the upper part of the thigh over the hip instead of the lateral or posterior approach.
This way, the hip can be replaced without splitting or detaching tendons or gluteal muscles from the pelvis or femur—the most important muscles for hip function—as the surgeon works through the natural interval between muscles. As a result, the muscles don’t require the typical healing process to recover from surgical trauma.
Cooper, a primary and revision hip and knee specialist who completed an Aufranc fellowship in adult reconstruction at New England Baptist Hospital in Boston, Mass., in 2009, had performed hip replacements on the hana table at outside institutions before relocating to the Tampa Bay area last year. His first case performing a hip replacement on the hana table at Bay Care Health System’s Morton Plant Hospital was scheduled for earlier this month. The hospital acquired the orthopedic tool in late summer at Cooper’s request.
“The hospital needed a new fracture table (because) we do a lot of hip fractures at our hospital and the old tables were getting dated,” he explained. “I told the hospital I wouldn’t … perform these surgeries on patients without the table. There are well documented struggles in performing this surgery without the table, with higher complication rates, et cetera.
With the table and proper training, combined with my experience and training, the complication rate is minimized. The table has distinct advantages for this approach, allowing safe exposure and the ability to use intraoperative imaging to ensure precise component positioning for better results.”
Conventional hip replacement surgery accessed from the lateral or posterior involves a 10- to 12-inch incision and cutting muscles from the bone. Postoperative care commonly requires strict precautions for the patient, such as limiting flexing the hip to 60 to 90 degrees, which complicates normal activities like sitting in a chair, on a toilet seat, putting on shoes, or getting into a car. Simply climbing stairs may be more difficult during recovery. The average hospital stay is typically three to 10 days; recovery time may take four months.
Anterior hip replacement surgery involves a 3- to 5-inch incision and no muscle detachment. As a result, the patient may immediately bend the new hip freely and bear full weight when comfortable, resulting in a more rapid return to normal function without cumbersome restrictions. Many times, the patient may be released the following day; recovery time may be as short as two weeks.
Candidates for the direct anterior approach are typically patients with arthritis or other similar, painful conditions in the hip.
The direct anterior approach to hip replacement has been continually refined with advancing medical technology since it was pioneered in Europe in 1947. Joel M. Matta, MD, chair of orthopedic surgery at Good Samaritan Hospital in Los Angeles, Calif., brought the technique to the United States in the late 1990s. Matta further advanced the technique by co-designing a special high-tech surgical table with Mizuho OSI—the hana table—and improving many surgical protocols for the hip replacement procedure that led to this important minimally invasive approach.
Patients in need of bilateral procedures also benefit from the anterior approach to total hip replacement.
“It’s the ideal approach for replacing both hips at once,” said Cooper. “Since the recovery is quicker and the patient is positioned on their back, bilateral hip replacement is greatly facilitated. With traditional methods, two separate positionings are required, with the patient having to lie on their recently operated hip when they are switched to the other hip. Since the anterior approach is performed in a supine position, the positioning facilitates bilateral hip replacements. Lastly, the quicker recovery makes the surgical recovery of two hip replacements much more manageable for the patient.”
Morton Plant Hospital Sets National Precedent for Heart Care
A week before Thanksgiving, Bay Care Health System’s Morton Plant Hospital leaders received gratifying news. Thomson Reuters named Morton Plant in its annual study to identify the nation’s top 50 hospitals for inpatient cardiovascular services. By itself, the recognition is a feat. The second piece of the news set a national precedent for heart care: Morton Plant became the only hospital in the United States to make the Thomson Reuters list all 12 years the study has been conducted.
“What's most important to understand about this recognition is that one of the best performing hospitals for heart care in the country is located right here in Clearwater,” said Mahesh Amin, MD, cardiologist and Morton Plant Mease cardiology section chairman. “Additionally, we’ve been able to achieve a national level of excellence in heart care for more than a decade. No other hospital in the U.S. has been able to achieve those results.”
For the first time, the study singled out 50 top hospitals rather than the traditional 100 winners. Of six Florida hospitals that made the list, the 687-bed facility established in 1916 is the sole hospital in the Tampa Bay area to be identified as a Thomson Reuters Top 50 Cardiovascular Hospital.
The Thomson Reuters study reviewed more than 1,000 hospitals across the country by analyzing results for patients with heart failure and heart attacks and for those who received coronary bypass surgery and percutaneous coronary interventions such as angioplasties.
The study reveals that 96 percent of cardiovascular inpatients survive and approximately 93 percent remain complication-free, indicative of improved cardiovascular care across-the-board over the past decade. The 50 top hospitals’ performance surpasses these high-water marks by better risk-adjusted survival rates (33 percent fewer deaths than non-winning hospitals), lower complications indices (21 percent lower for heart failure complications), fewer patients readmitted to the hospital in the 30 days following discharge, and shorter hospital visits and lower costs. Top hospitals discharge heart patients 12 hours sooner and save roughly $1,300 per case.
Thomson Reuters researchers analyzed 2008 and 2009 Medicare Provider Analysis and Review (MedPAR) data, Medicare cost reports, and Centers for Medicare and Medicaid Services (CMS) Hospital Compare data. They scored hospitals in key performance areas: risk-adjusted medical mortality, risk-adjusted surgical mortality, risk-adjusted complications, core measures (a group of measures that assess process of care), percentage of coronary bypass patients with internal mammary artery use, procedure volume, severity-adjusted average length of stay, and wage- and severity-adjusted average cost.
“To achieve this recognition for so many years requires team work among physicians, nurses and all of the hospital staff,” said John Ofenloch, MD, cardiothoracic surgeon and medical director of cardiac surgery for Morton Plant Hospital. “Without a cohesive approach to heart care, we wouldn’t be able to achieve consistent results for so many years.”