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The BIRMINGHAM® HIP Resurfacing System

As Dr. Daniel Boyd begins his career as an orthopedic surgeon, he'll need the head start he gained from his fellowship to stay ahead of the curve in a rapidly evolving specialty.

Joining Dr. Cooper Terry in his Oxford Orthopaedics and Sports Medicine practice in July, Boyd brings with him the experience of a year's training at the San Antonio Orthopaedic Institute in Texas. The institute has been a training site for use of the BIRMINGHAM® HIP Resurfacing System, which gained approval by the USFDA in May.

"It's a new thing to the United States and we're going to try to bring it to little old Oxford," Boyd said.

The prosthesis, a metal-on-metal artificial hip replacement system, requires the removal of only the surface of the femoral head to fit the resurfacing component like a cap. As a result, Boyd said, patients experience less pain after surgery and can continue with many of the same activities they enjoyed before.

"The key is that in previous years, for our more active patients who want to continue to jog or ski or play tennis, those types of activities were nearly impossible with regular total-hip arthroplasty," Boyd said. "Or if they were able to perform those activities, it was at a decreased performance rate, and there was always a major concern that they could damage the joint."

Helping patients to recover more quickly and completely from joint-replacement surgeries has been the goal of a recent movement among some orthopedic surgeons toward fewer — and minimally invasive — surgeries, a movement which continues to be weighed in peer journals, operating rooms and medical schools around the country.

"We had probably half of our surgeons perform less-invasive joint replacement, and the other half continued to do traditional joint replacement," Boyd said of his training experience in San Antonio. "There continues to be debate as to whether the improvement you seem to attain with the less-invasive techniques outweighs the potential risks with things such as malpositioning of the prosthesis or wound complications."

Although the trend toward less-invasive procedures in orthopedics began a quarter century ago with arthroscopy, the push to apply that concept to total joint replacements has gained speed only during the past few years, said Dr. Gary McCarthy, a member of the Central Mississippi Medical Center orthopedic staff in Jackson.

"Over the last two or three years, it's been the trend to try and do procedures — and total joint (replacements) specifically — through smaller incisions," he said.

According to the American Academy of Orthopaedic Surgeons, traditional open surgery involves a 6 to 10 inch incision where muscles are cut to allow surgeons to fully visualize and operate on the joint. Minimally invasive surgery incorporates an incision of 3 to 4 inches wide.

In McCarthy's practice, a new application of the minimally invasive approach has been his use of the Oxford® Unicompartmental Knee System in partial-knee replacement surgeries. The only free-floating meniscal partial-knee system available in the United States has been a new option for McCarthy's patients since he began offering it in January.

Candidates for the device — some 30 percent of all the people who need knee replacements, McCarthy estimates — are those who suffer from limited osteoarthritis in the interior side of the knee. Unlike with other similar devices, the patient's weight and activity level need not restrict them from being candidates, McCarthy said.

The procedure, he said, offers an alternative for patients who as part of total-knee replacement would lose parts of the knee that work just fine.

"I would often think to myself in these surgeries, 'There's got to be a better way,'" he said. "Why are we destroying normal parts of the knee when we might not need to?"

As part of addressing critics' concerns about imperfect placement of prostheses, orthopedic surgeons who support the concept of minimally invasive joint replacements are using computer-assisted navigation tools to make up for the field of view they lose with smaller incisions.

In Hattiesburg, Dr. Richard Conn of Southern Bone and Joint Specialists, PA, began this summer using Stryker's surgical navigation system.

Similar to the global positioning system used in cars and ships, the system uses infrared sensors in the operating room as satellites to monitor the location of markers and instruments during surgery. The information is displayed as an interactive model, offering the surgeon the best angles, lines and measurements to place the implant.

"My position has been: don't make a hole so small you can't see what you're doing," Conn said. "But with the advent of navigation, it's certainly possible we will shrink it even further."

Conn, who has performed some 600 partial-knee replacement surgeries through minimal approaches, believes the minimally invasive approach isn't likely to go away as the baby boomers age into "senior zoomers" — less willing to settle for treatments that will curb their activity in retirement.

"Now, we're taking conventional implants and figuring new ways to get them in folks," he said. "But the future will be a combination of navigation, smaller implants and ultimately, I think, robotic assistance for computer-driven cutting and precision implant placement."



ie.
October 2006

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