Dr. Trevor Pickering with a patient, using the hana table at Baptist.

Baptist Acquires hana® Table for Direct Anterior Approach to Hip Replacement

Baptist Medical Center in Jackson recently acquired a unique instrument that allows orthopedic surgeons to take a direct anterior approach to hip replacement that, among other benefits, greatly reduces down time for patients.

The Mizuho OSI hana® Hip and Knee Arthroplasty Table at Baptist—the only hospital in Mississippi to use one for hip replacement—allows orthopedic surgeons to position the hip to an extent impossible with conventional tables. The hana table features hyperextension, abduction, adduction and external rotation of the hip for femoral component placements. The lack of disturbance to the lateral and posterior soft tissues allows immediate post-surgery stability of the hip. Also, the potential for infection risk is decreased because the hana table doesn't require additional personnel in the operating room.

Patients recognize it as an advanced technique for hip replacement that shortens hospital stays, requires a smaller incision, significantly decreases postoperative pain, expedites the recovery process, and reduces muscle trauma, blood loss, tissue healing required, and risk of delocation.

Here's how it works: With the direct anterior approach to hip replacement, a small incision is made on the upper part of the thigh over the hip instead of the lateral or posterior approach. This way, the hip can be replaced without splitting or detaching tendons or gluteal muscles from the pelvis or femur—the most important muscles for hip function—as the surgeon works through the natural interval between muscles. As a result, the muscles don't require the typical healing process to recover from surgical trauma.

"Traditionally, the surgeon had to detach muscles for hip replacements, and afterward, the patient had to take certain precautions and avoid certain positions or movements—no deep bending, no crossing the legs, and so forth," explained Trevor Pickering, MD, joint replacement specialist at Baptist's Joint Replacement Program, and an orthopedic surgeon on staff at the Mississippi Sports Medicine & Orthopaedic Center in Jackson. "Conventional surgery requires a long recovery. This particular table makes hip replacement minimally invasive. With this direct anterior approach, we can get to the hip directly. For most patients, depending on their health, there are no precautions afterward. They can move how they want after surgery—bend over, cross legs, crouch."

Conventional hip replacement surgery accessed from the lateral or posterior involves a 10- to 12-inch incision and cutting muscles from the bone. Postoperative care commonly requires strict precautions for the patient, such as limiting flexing the hip to 60 to 90 degrees, which complicates normal activities like sitting in a chair, on a toilet seat, putting on shoes, or getting into a car. Simply climbing stairs may be more difficult during recovery. The average hospital stay is typically three to 10 days; recovery time may take four months.

Anterior hip replacement surgery involves a 3- to 5-inch incision and no muscle detachment. As a result, the patient may immediately bend the new hip freely and bear full weight when comfortable, resulting in a more rapid return to normal function without cumbersome restrictions. Many times, the patient may be released the following day; recovery time may be as short as two weeks.

Candidates for the direct anterior approach are typically patients with arthritis or other similar, painful conditions in the hip.

"The cartilage in the joint wears out and starts to break off, leaving the patient with a painful, stiff hip," said Pickering. "When people get up, they feel pain in the groin or buttocks regions, which tends to get worse in different stages. They might feel significant pain while walking, but the biggest complaint is stiffness in the hip. Once it gets to the point where people cannot comfortably move, it impacts their quality of life. That's when we start talking about hip replacement." The direct anterior approach to hip replacement has been continually refined with advancing medical technology since it was pioneered in Europe in 1947. Joel M. Matta, MD, chair of orthopedic surgery at Good Samaritan Hospital in Los Angeles, Calif., brought the technique to the United States in the late 1990s. Matta further advanced the technique by co-designing a special high-tech surgical table with Mizuho OSI—the hana table—and improving many surgical protocols for the hip replacement procedure that led to this important minimally invasive approach.

Patients in need of bilateral procedures may benefit from the anterior approach to total hip replacement.

"When replacing both hips, the patient usually has to come back later for the other hip," said Pickering. "With this procedure, we can easily replace both hips with one visit to the operating room."

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