Staying Active and Independent During the Golden Years With Modern Orthopedic Surgery Technology
Hip Replacement Surgery Latest Advancements
The goals of orthopedic surgery are simple: achieve excellent long-term results and minimize risk of injury or complication in the short or long term. Several innovations in operating room technology and tools as well as minimally invasive surgical techniques have helped improve outcomes.
Computer Navigation To be successful, an orthopedic surgeon must accurately align the knee replacement parts with the hip and the ankle. Replaced knees that are out of alignment are at risk for injury, and ultimately, failure. Traditionally, surgeons used rod-like instruments to measure the alignment of the hip, knee, and ankle. This was not an exact science and often led to guessing and error. Thanks to computer navigation, surgeons now have a minimally invasive tool in the operating room to calculate the exact center location of the hip joint and ankle. Computer navigation in the operating room is a lot like the GPS tracking systems available in cars or planes or boats. The software helps the surgeon know exactly where the patient’s body is in space. Minimally invasive wireless pointers and trackers send data pertaining to knee movement kinematics to the computer. This information is then translated into real-time images that provide the surgeon with a comprehensive understanding of the knee mechanics before any bone is cut. The trackers remain active throughout the surgery, providing the surgeon with feedback regarding the accuracy of bone cuts and overall alignment and balance prior to final implantation of the knee replacement prosthesis. Computer navigation leads to a safer, more accurate, and longer lasting knee replacement surgery.
Pelvic Alignment Level Total hip replacement has proved to be one of the most successful surgeries performed in modern medicine. More than 400,000 total hip replacement surgeries are preformed in the United States each year and it is predicted that the demand will continue to increase. Unfortunately, two common complications continue to occur. Occasionally prosthetic hip joint will dislocate and both of the patient’s legs may not feel equal in length after surgery. Proper positioning of the cup and the femoral stem are crucial in preventing these complications from occurring. Optimizing hip biomechanics and longevity is also dependent on proper component positioning. The PAL gives surgeons a powerful, new tool in the operating room to improve accurate component positioning and leg length. Historical data suggests that prosthetic joints with optimal component positioning may function longer in the body.
The Leone Center for Orthopedic Care and Stryker invented a new surgical instrument and technique called the Pelvic Alignment Level (PAL), which can play a key role in the success of total hip replacement surgery. The PAL has been designed to help reposition the patient pelvis into a precise anatomic alignment prior to prosthetic implantation. Precise pelvic positioning is critical for the surgeon to precisely position and implant the prosthetic acetabular cup in the hip joint. This new instrument also allows the surgeon to directly measure acetabular cup angles during implantation and measure leg length before and after the replacement surgery of see if leg length was changed and if these changes are optimal. The PAL includes a sterile bubble level, similar to what one might see used at a construction site and which attaches to a small pin which is anchored into the pelvis. The surgeon can easily see movement of the pelvis by looking at the bubble in the level and make necessary corrections. The surgeon can also place the PAL on the instruments used to implant the cup and directly measure acetabular cup position. It also has an out rigger’ to measure leg length.
Minimally Invasive Approaches There are many well-established surgical approaches to the hip. Two surgical approaches for total hip that have gained recent notoriety are the direct anterior approach and the minimally invasive or mini-posterior approach. The direct anterior approach involves splitting the fibers between the two main muscles located at the front of the hip and working through the natural interval between the muscles. The mini-posterior approach to hip replacement surgery involves dividing the muscle by separating – not cutting – muscle fibers at the side or the back of the hip. This method insures that muscle function is preserved. In the hands of an experienced surgeon, both the anterior and the mini-posterior approaches can produce excellent results, and the recovery time is the same for both approaches.
Meet Dr. William Leone
William Leone, MD has earned a reputation as one of the nation’s top orthopedic surgeons. He has practiced orthopedic surgery at Holy Cross Hospital in Fort Lauderdale, Florida for 20 years. He is a key part of the leadership team that has garnered Holy Cross Hospital numerous awards and honors, including HealthGrades Joint Replacement Excellence AwardTM and a Five Star Rating for Overall Orthopedic Services. In 2008 & 2009, Holy Cross Hospital was ranked by US News and World Report as the top orthopedic health care provider in Florida. He is a member of numerous professional associations, including the American Academy of Orthopaedic Surgeons, American Board of Orthopaedic Surgery, and American Association of Hip and Knee Surgeons.