Home / Winter 2011 / Freedom of Movement

Freedom of Movement

By Amy E. Hamaker

USC surgeons help hip replacement patient Chuck Lerette return to an active lifestyle.

Imagine leading an active life: participating in sports, hiking, kayaking, snowboarding and running on trails. Now imagine hip pain becoming so severe that activities are no longer possible – even standing for a short time has suddenly become a form of torture. That’s exactly what happened to Chuck Lerette, 53, of Moorpark, Calif.

He found himself in extreme hip pain and acutely felt the loss of mobility. Osteoarthritis runs in his family.

Lerette’s son, a doctor, referred him to Daniel A. Oakes, associate professor of clinical orthopaedics at the Keck School of Medicine of USC and director of the Joint Replacement Program at Keck Hospital of USC. That meeting changed Lerette’s life for the better.

Between January 2010 and March 2011, Oakes replaced both of Lerette’s hips using a hip resurfacing technique.

The Joint Replacement Program at Keck Hospital is a regional center of excellence for hip- and knee-joint replacement surgery. Oakes, a nationally recognized joint replacement specialist, along with colleagues Donald Longjohn, assistant professor of clinical orthopaedics, and Lawrence Menendez, professor of clinical orthopaedics, are dedicated to providing patients with outstanding, compassionate care.

The program offers minimally invasive hip and knee replacement, hip and knee surgery, and total joint replacement. “Our surgeons do 300 to 400 hip and knee replacements per year, and we offer a coordinated patient experience from door to discharge – a team of skilled individuals who are committed to getting patients back to an active lifestyle as quickly as possible,” Oakes says. “Essentially, we want you to get back to being you faster.”

Replacement and resurfacing

Among the largest joints in the body, the hips and knees can become weakened from repetitive wear, causing pain and loss of mobility. Arthroplasty – any surgery that relieves pain and restores mobility through repairing, reconstructing or realigning a joint – is often the best choice for people who suffer from hip and knee wear problems.

“The goal [for any arthroplasty] is to restore patients’ mobility and function,” Oakes says. “As the population ages, they put wear on their hips and knees, and it’s adversely affecting their quality of life. Our older patients are more active than prior generations, and they’d like to stay active. With the right treatment, people can maintain their activity level and do what they like to do without pain, including hiking, biking and travel.”

The most successful and common of all orthopaedic surgical procedures is total joint replacement – specifically, total hip replacement. The operation dates back to the early 1920s, although widespread success in outcomes was not seen until the early 1960s. In general, hip replacement surgery can help patients with debilitating pain that is not alleviated by using other control methods, such as pain medications, weight loss and exercise.

During total joint replacement, a prosthetic cup (the “socket” portion of the joint) is secured in place, then a metal head and stem (the “ball” portion of the joint) are secured into the femur. The surgeon then places the ball into the socket and makes sure that the new hip joint will cover a reasonably wide range of motion and be stable enough to withstand weight and some stress. Incisions can be made in a posterior approach, which curves backward toward the buttocks, or in a lateral approach, which goes over the front of the body to the bony prominence on the side of the hip bone.

After a few days of hospital care, patients receive physical therapy that may last several weeks to several months, depending on the extent of the surgery and the condition of the joint. There are some risks associated with total hip replacement, including infection, bleeding, dislocation, nerve injury and blood clots. Patients also need to follow some precautions and may need to make lifestyle changes to accommodate the new prosthetic hip, including avoiding high-impact exercises such as running and jumping.

Another option for relieving pain and restoring mobility is joint resurfacing, a form of joint replacement. During resurfacing, the ball and socket are not completely replaced and no extra pins are used. Instead, the surface of the joint where the bones meet is replaced with a prosthesis, often made from a porous metal. These metal prostheses, usually made of pure titanium, have “pores” that are set into them to help stabilize the bone, making them rough and pitted, the same as natural coral. Bone cells also can interact with the rough surface of the metal, helping the bone adhere better to the metal’s surface and, in effect, extend the life of the replacement.

Oakes believes that hip resurfacing is a good alternative for patients like Lerette who are younger and more active. The technique features greater stability and less risk of dislocation than total replacement. “Joint resurfacing conserves bone,” Oakes explains. “The data show that males who are less than 60 years of age who have a degenerative joint disease or osteoarthritis are the best candidates. These tend to be patients who desire a slightly higher level of activity.”

Patients who have struggled with pain may be surprised at how quickly the pain is relieved after surgery. “I had the operation done and, in a way, it was like having a root canal,” Lerette says. “The hip pain I’d lived with was instantly gone.”

Rehabilitation may take less time for resurfacing than for replacement, and proper preparation can make a difference in recovery time. Lerette learned the importance of physical preparation after his first hip resurfacing.

“I lost a lot of muscle mass in my legs during recovery,” Lerette says. “Before I had the second hip done, I worked out a lot. I told my [physical fitness] boot camp instructor about the operation. I had to stop doing long-distance workouts, but I did a lot of squats and other exercises to build leg muscle.”

His plan worked. Immediately after his second surgery, Lerette was able to lift his affected leg. “I was only off of crutches for three weeks when I asked Dr. Oakes if I could ride my motorcycle,” Lerette recalls. “He said ‘yes’ because I’d done one hip already and knew how to care for myself.”

However, joint resurfacing is not without its drawbacks. The same risks associated with total hip replacement also are associated with hip resurfacing, and the implants, particularly those made of porous metal, lack complete long-term data on longevity and side effects, Oakes says.

“We don’t yet know the 20-year survivorship of these types of implants,” Oakes cautions. “We have some data that survivorship is comparable to hip replacement, but this technique requires a metal-on-metal articulation [using porous metal prosthetics], and we don’t know the long-term impact of metal ions in the bloodstream. Some patients have developed adverse reactions to metal debris.”

Minimally invasive options

At Keck Hospital, both hip replacement and hip resurfacing can be done using minimally invasive techniques. These techniques involve creating a much smaller incision – 4 inches to 5 inches long, compared to 8 inches to 12 inches long for traditional joint surgery. Special instruments are used to make the small incisions, and fluoroscopy, the use of X-rays in real time, is used to help guide surgical instruments. This approach leads to fewer cut muscles, less pain and faster rehabilitation. “You can also avoid the side effects of general anesthesia,” Oakes adds.

Patients who have minimally invasive hip arthroplasty are encouraged to become mobile much earlier than they would be with standard methods of hip arthroplasty. Many patients find that they are able to get out of bed either the same day or the next day following surgery with the help of a physical therapist.

Moving forward

Oakes believes that the need for hip replacement and resurfacing is not likely to decline anytime soon. “It’s hard to improve on the surgery. There is ongoing research to regenerate cartilage and bones, but it’s a long way to being applicable in a clinical setting,” he says. “For some patients, these are truly life-changing operations. Patients who haven’t walked in three to four years are now walking. As our patients continue to demand to be more active, we’ll develop implants that will allow them to continue their high activity levels.”

Although Lerette is less than a year out from his surgery, he has already started walking and hiking, and will soon participate in a physical fitness boot camp. “My friend wants me to learn tennis, but Dr. Oakes is making me wait a year after surgery,” he says. “I do power walks, mountain bike and ride my motorcycle, but I think I’ll drop snowboarding.”

Would Lerette recommend the surgery for others? Absolutely, he says. “I really don’t even notice I had it done,” he adds. “I’m not at 100 percent yet because of having my second hip go out, but I’m almost completely rehabilitated. It’s like getting your freedom back.” 

For more information or to make an appointment with the orthopaedic surgeons of the Keck Medical Center of USC, call (323) 442-5860 or visit keckmedicalcenterofusc.org/jointreplacement