I'm John Burch and I'm an orthopaedic surgeon, I do general orthopaedics here at WKONA.
My name is Kirk Fee and I'm an orthopaedic surgeon here at Western Kentucky Orthopaedics
and Graves Gilbert Clinic.
Well myself and my partners together combine to provide everything that can be required
of orthopaedic surgeons.
We see a wide variety of patients here.
We see children, we see elderly patients, we see weekend warriors.
We see a lot of patients with hip and knee arthritis.
The incidents are increasing in our population.
People are getting older; people are trying to stay active longer.
If you look at patients, I see people all the time at the restaurant, grocery, my wife
says, "Someone must have a bad hip or a bad knee because you're looking at them funny"
and I say, "Yeah" and I'm thinking yeah I could fix that.
It's very very common and a lot of people don't realize they've got the issue they just
know that they've got difficulty walking, but 9 times out of 10 it's a problem with
their hip or their knee.
Hip arthritis itself is something that often times is mistaken for having come from the
knee itself when it's really coming from the hip.
It's interesting that people say, "My hip hurts" and that can mean a lot of different
things to a lot of people.
Sometimes it means their buttock; sometimes it's around the top of the thigh.
A very classic finding is pain in the groin sort of in the front of the hip and people
point to that spot, it's a pretty clear indication there's a problem with the hip joint, but
they may complain of things like, "I can't climb the stairs anymore", "I have trouble
getting my shoes and socks on because I can't pull my foot up to reach it", "I have difficulty
climbing the stairs", "Difficulty getting up out of the chair".
Those are all things which are common to patients that have bad hips.
Physical therapy can help in the early stages of hip arthritis.
We tell people to really make sure that they're stretching as much as possible.
Weight loss can help, anti-inflammatory drugs can help and you certainly want to try all
of those things first.
If we have objective evidence of arthritis in the hip, if we have objective evidence
of necrosis of the hip or other diseases of the hip and we've failed conservative management,
then that's when we start thinking about hip replacements.
Traditionally whenever hip replacements were started in orthopaedics, the surgical approaches
went from the back of the hip.
It's a traditional approach; it is still used in many many centers across the country.
As with any surgery there are advantages and disadvantages of that.
One of the disadvantages of the posterior approach is that it splits muscle and so we
think that they do have a tendency, slightly higher tendency, to come out of socket.
So what some very forward thinking surgeons started thinking about, actually in California,
was is there a way to get into the hip from the front and leave all of the muscles intact
and actually they came up with a beautiful approach that's used very very commonly now
and it's something that we started looking at about 6-7 years ago where we basically
come in from the front and it leaves all the muscles intact around the hip.
The red line indicates the typical incision for the posterior approach and there's not
many people making one too much smaller than that, but when you do that you've got to cut
all these muscles away from the back of the pelvis.
The anterior approach is this dotted blue line and that's even longer than most of us
do.
It's about 3/4 of that size typically and the difference though is like we said; the
muscles are split from the front side.
We can get right to the hip by going through this interval and not have to cut anything,
just kind of opened up like this and there's the hip joint.
It's so good because you're not cutting any muscles.
You're going between muscle layers and because of that all those nice posterior elements
that are there to stabilize the hip, they're all kept preserved, intact, and normal and
so the chance of popping it out is extremely small.
In my now 12 years of doing it, I've had 0 dislocations.
Ordinarily it's about 1 out of 50 and I've done hundreds and hundreds since then and
have not had one and that's just a testament to the approach.
It's a very good procedure.
Doesn't mean I'm a great surgeon; it means it's just a good approach to the problem.
Secondarily because you're not cutting all those muscles it just doesn't hurt as much.
With a lower rate of dislocation; with shorter hospital stays and quicker recovery; we think
all of those things combined have what let us to embrace the anterior approach of the
hip.
I think the biggest compliment that I can say about my partners is that if my father
broke his hip, if my mother needed a knee replacement, that there's unequivocally I
would bring them in here for their care and that's how much I trust my friends and my
partners.
Our hospitals do a very good job and I think pride is taken here in Warren County to try
to provide state of the art care.
I can't begin to list all of the positives about what I do for a living.
It's things like seeing the fella who came back at 2 weeks and was working in his garage
after hip replacement and the family saying, "Thank you so much.
You've changed his life".
That's priceless.
That does so much for me on a daily basis.
My real goal is to get to where they don't think about their hip at all and that's my
question.
I'll see them back usually at 6 months and then a year and that's one of the first questions
I ask, "How's it doing?" and if they say, "Fine", I'll say, "Do you think about your
hip?" and it's a success in my mind if they say, "No I don't think about it too much".
No comments:
Post a Comment