May 24, 2012 — Orthopedic surgeon Jeffrey Anderson, M.D., meets with each patient at least twice before hip replacement to carefully consider the options for people who no longer can do what they want in their lives because of pain.
“Hip replacement is a life changing operation that makes people mobile again,” says Anderson. “But each patient is unique and there are many options we consider, ranging from when is the best time, if any, to proceed with surgery.” Other variables include the selection of several potential prosthesis materials — ceramic, metal or a combination — that can vary, depending on many factors including patient age, health and overall damage to the hip.
Anderson, who practices at O’Connor Hospital, is scheduled to provide a road map for patients and families that will help them make the best choices to attack hip pain and regain an active life. The UC San Francisco-trained surgeon with 27 years of practice in the South Bay is scheduled to speak and answer questions as part of the Living Well Community Lecture Series. No reservations are required for the free presentation from 6:30 to 7:30 p.m., Thursday, June 7, in the Medical Office Building (MOB) Auditorium at O’Connor Hospital, 2101 Forest Avenue, San Jose.
“The journey starts during a conversation with your family physician or directly with an orthopedic surgeon,” explains Anderson. “When should you have that conversation? A good rule is to seek help when walking a block causes significant pain or you are having trouble sleeping at night because of lingering hip pain,” Anderson said in an interview.
The conversation typically starts with whether lifestyle changes, including use of aspirin or other analgesics or weight loss or diet, have been tried to relieve hip pain and increase activity. “For some, particularly elderly patients, something as basic as a properly fitted cane may, in fact, be the treatment of choice. We keep an open mind.”
Anderson personally performs about 40 hip replacements a year (in addition to about 50 knee surgeries), about twice the minimum recommended by Anderson and his orthopedic peers to ensure that each surgeon will have the volume needed to sharpen his or her skills and provide optimal performance.
Anderson says a key priority is the need to provide personal service. “Both my physician assistant (PA) and I sit down and discuss options with each patient.” In addition to the level of physical damage to the hip, Anderson and his team must take into account each patient’s age and aspirations and other factors, a time intensive experience that never seems to reveal the same story. “To be able to take the time to hold the quality discussion we need, I’m comfortable with the select number of patients I’m able to serve,” he says.
Most hip replacement candidates are 50 years or older, since age-related osteoarthritis and its accompanying pain and joint damage is the most common reason people need hip replacement. But physical injuries and some less common conditions can affect both young and old.
“Artificial hips, whether made of metal, plastic or ceramic, like natural hips suffer over decades from potential wear and tear. My goal, certainly for younger patients, is a 30-year-life for the replacement,” he says. Currently, Anderson favors the most modern prosthesis material, ceramics, for most patients, because it offers the best combination of longevity, flexibility and safety. Multiple factors can affect the choice of the prosthesis. Examples include the need to correct for a right or left leg that is longer or shorter than the other, or the need for greater than normal durability of special concern to some athletes or persons who do a lot of bending or twisting on the job. Sometimes, based on anatomy and activity, combinations of ceramic and other materials are the best choice, he says. For some patients, cement is used to anchor the implant, while other times, particularly for younger patients, the prosthesis can be carefully positioned so the patient’s bone and surrounding tissue and cartilage will grow around and anchor the replaced hip.
To duplicate the normal strength and motion of the hip, a total replacement implant has three manufactured components. The parts include the stem or anchor, which fits into the thighbone or femur; the ball, which stands in for similarly shaped head of the femur; and the cup, which replaces the worn out hip socket. Patients are measured and sizes of each component are carefully customized.
During his talk, Anderson plans to discuss potential risks, such as rare occurrences of infection, and preparations for surgery day and the recovery at home.
“Patients are always interested in how long they must remain in the hospital – usually several days, although some patients can go home within a day or two, while other, particularly older patients with multiple health issues, might need a stay of a week or so,” explains Anderson. The National Institute of Health reports patients in this country usually do not spend more than three to five days in the hospital and full recovery takes about three to six months. Patients who are candidates for minimally invasive hip replacements, a technique that allows surgeons to perform their work with the smallest possible surgical cut or incision, typically will have hospital stays at the lower end of the spectrum.
Patients are naturally interested in how soon they will be back to the lifestyle they had hoped for.
“Most patients are pain free as soon as their surgery begins to heal and are able to return to the activities we had agreed as their goal within a few months,” Anderson says. “Again, the timetables are quite individual, but one of the satisfactions I enjoy from my profession is the high percentage of patients who are satisfied with the improvement hip replacement has brought to their lives. And I’m not alone: I’ve seen surveys showing 95 percent of hip replacement patients nationally report satisfaction with their procedure three months after surgery,” he adds. “As I tell, friends, patients and colleagues, ‘this is life-changing surgery’.”
To register for the Living Well Community Lecture “The Latest Developments in Hip Replacement”, please call 800 220-0182 or register online.
For further information about hip replacement surgery, see the National Institute of Arthritis and Musculoskeletal and Skin Diseases’ hip replacement Q and A.