Exhaust Options Before Joint Replacement Surgery

21 Dec 2011 Doctors, Edward Petrow, Media , , , ,

Non-steroidal anti-inflammatory drugs (NSAIDs) acetaminophen, glucosomine and chondroitin nutritional supplements, cortisone injections and rooster cartilage – yes, rooster cartilage – may help avoid the need for hip and knee joint replacement surgery.

About 65 people came to the East Social Center on Thursday to hear Dr. Edward Petrow, a surgeon at the Tucson Orthopaedic Institute, talk about remedies for stiff and weak joints before considering joint replacement surgery.

Dr. Edward Petrow speaks to members of the audience after his talk.

Petrow explained that osteoarthritis is the wearing down of articular cartilage of the joints and begins at 25. As one ages, symptoms of the wearing down may result in joint soreness, stiffness and pain caused by weakening of the muscles surrounding the joint due to inactivity.

Acetaminophen doesn’t decrease or reduce inflammation, but will reduce pain, he said.

Glucosomine and chrondroitin, a food supplement not regulated by the Food and Drug Administration, doesn’t work for everyone and usually takes three months to determine whether it is effective.

Cortisone injections can reduce swelling and discomfort, and if effective may be repeated every three months.

Hyaluronic acid injections, which comes from the cartilage of rooster combs, is said to restore lubrication and fluid in joints and can last six to 12 months.

Weight loss can affect joints in a positive way.

“Lose one pound and it reduces three to four pounds of pressure on your knees,” Petrow said.

If All Else Fails

Though he advises trying non-surgical remedies first, Petrow said the time to consider joint replacement is when there is loss of function.

About 500,000 hip replacement surgeries are done annually in the U.S. Though knee replacement is the gold standard of care, minimally invasive knee surgery will result in less trauma, less bleeding and pain and a smaller scar,

Exhaust all non-surgical options. Minimally invasive technology reduces complications, Petrow advised.

New advances include computer-assisted surgery where a computer makes a model of a patient’s hip or leg, and intra-operative imaging is now available for more accurate leg length with hip replacement surgery.

For an appointment with Petrow, call the Tucson Orthopedic Institute at (520) 382-8200.

Written by Ellen Sussman, Special to the Green Valley News

As published in the Green Valley News, Wednesday, December 21, 2011

Anterior Hip Replacements Are the Future: 5 Points from Dr. Edward Petrow

11 Jul 2011 Doctors, Edward Petrow, Media , , ,

A growing number of joint replacement surgeons are beginning to perform hip replacement surgery using an anterior approach instead of the traditional posterior approach because of the benefits it has for the patient as well as the provider. It can be safely performed on many patients, as long as they have a low risk of fracture and normal anatomy.

Edward Petrow Jr., DO, an orthopedic surgeon at Tucson Orthopaedic Institute, discusses five points on performing anterior hip replacements and what it can mean for the future.

1. Difference in surgical technique. The traditional approach to hip replacement surgery is going through the back, splitting the buttock muscles and peeling back the hip muscles to access the joint. When surgeons employ the anterior approach to hip replacement surgery, they enter the hip through the front part of the joint. “When we take the anterior approach, we don’t detach or remove any muscles,” Dr. Petrow says. “From a recovery standpoint, that means less pain and quicker return to function.”

The anterior approach is a minimally invasive surgery because you can perform the whole procedure through a 10 centimeter or less incision. When surgeons eliminate the muscle disruption, patients don’t have to go on hip precaution, as other hip replacement patients do, and they can return to regular activity quicker.

2. Imaging technology allows for greater precision. In addition to providing a quicker recovery, the anterior approach can also allow surgeons to more precisely place the implant because they can use real-time X-ray guidance perioperatively. “With this equipment, you are watching the procedure on X-ray as you go in so you can see where the implant is going and get it exactly where you want it,” says Dr. Petrow. “This gives you better control of their leg length.”

Experienced surgeons know how to closely reproduce the patient’s leg length, but with the real time X-ray, they can measure both sides to make sure they are the same length. There have been many cases of hip replacement failures due to leg lengthening issues, but with the minimally invasive anterior approach those complications become nearly extinct.

3. Why the procedure isn’t more widespread. While the anterior approach may be less invasive and associated with fewer complications, surgeons without extra training in the technique will not be able to perform in a safe and effective manner. “You have to be committed to doing some extra training to be able to perform it safely,” says Dr. Petrow. “The other issue is that you have to have specialized table to allow you to get to the hip from the front. The hospital has to be committed to getting the table and the surgeon has to commit to the extra training, but it’s a better treatment.”

It’s often hard for surgeons to stay abreast of the most recent treatments and techniques, but it can be worthwhile. The anterior approach may be different, but surgeons can still use the same instrumentation they’ve always used during the surgery. “Just because you’ve done hip replacement surgery the same way over your career doesn’t mean you can’t change,” he says. “Some surgeons won’t and that’s fine, because the posterior approach can still provide a good outcome.”

4. Hospitals benefit from the technique as well. From his perspective, Dr. Petrow says the extra time and financial investment in the anterior approach is worthwhile because he hasn’t experienced any complications, nerve problems or dislocations from patients undergoing anterior hip replacements. It’s also been his experience that these patients are up walking faster, off pain medication sooner and discharged from the hospital sooner.

“We’ve experienced a whole day decrease in the length of stay, from three days to two,” says Dr. Petrow. “All the way around, the short-term recovery has been quicker and there haven’t been any complications.”

5. Anterior hip replacements are the way of the future. As patients find out more about the advantages associated with anterior hip replacements, they will demand that type of procedure and drive it forward, says Dr. Petrow. The technology developed in the past few years has made it an easier and more accessible procedure for surgeons to perform. However, in the future he doesn’t see the procedure becoming much less invasive than it is now, which means further innovation will come from implant design and placement.

“You don’t want to sacrifice good results, and there needs to be a balance between minimally invasive techniques and achieving durable, reproducible results with implants,” he says. “I know the implants I use are durable and I can see patients have a good outcome. It’s the next step forward in what we do as far as hip replacement surgery.”

Written by Laura Dyrda

As published in Becker’s Spine Review, Tuesday, July 26, 2011

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