Newer, hipper hip replacement in Victoria

Elena Watts By Elena Watts

Aug. 22, 2013 at 3:22 a.m.
Updated Aug. 24, 2013 at 3:24 a.m.

David Maxey, 81, of Victoria, worked as a supervisor for DuPont for 30 years before he retired to the golf course.

A painful hip has recently kept him from his favorite hobby and prompted him to make an appointment with an orthopedic surgeon.

"I don't know exactly what happened," Maxey said. "I played golf a couple of weeks ago and was fine, but my hip started bothering me the next day."

Until last year, only lateral and posterior hip replacement surgeries were performed in Victoria. Residents who wanted the less invasive anterior approach hip replacement had to travel out of town.

"Most patients traveled to Houston or Austin for this procedure, which is costly, inconvenient and creates hardships for rehabilitation and follow up," said Dr. Douglas Matey, the only orthopedic surgeon in Victoria who performs the procedure.

The necessary table and precision equipment for the anterior approach hip replacement were not available until last year at DeTar Healthcare Systems and Citizens Medical Center.

Matey, with the Victoria Orthopedic Center, performed the procedure for the first time in Victoria on July 16 at Citizens.

"The first patient is recovering well, and his new hip is stable and functional, and the hip is painless," Matey said. "It was a successful surgery by all accounts."

Qualified and appropriately trained orthopedic surgeons can perform the refined surgical approach to accomplish the standard total hip replacement, he said.

"I have performed surgery with two different hip sub-specialists in both Houston and Cincinnati," Matey said. "Since the completion of my training, I have participated in live surgery and have gone to a dedicated anterior hip course at the Houston Medical Center."

The total hip replacement with the use of the table requires training of the entire operating room team as well as finding the right patient for the procedure. Not all patients are great candidates for the anterior approach.

Other Victoria surgeons use the lateral and posterior approaches, which have a long history of good to excellent long-term results, Matey said.

"I perform lateral and anterior hip replacement surgeries on the appropriate patients given their age, body habitus, bone quality and extent of hip deformity," he said.

Maxey's surgery is scheduled for Tuesday. The cartilage around the ball of his right hip joint has hardened with arthritis and broken off in places, which allows the ball to slip further into the socket. This has resulted in pain and loss of left-to-right motion in his right leg.

A nonsurgical approach, shots that oil the joint, was offered as an option, but Maxey wants to play golf again without gritting his teeth.

The components of the total hip replacement are identical in all the approaches, but the incisions are in different places.

The anterior approach enters near the front of the thigh through a 3- to 4-inch incision, while the lateral and posterior approaches enter through the side or buttock region through 5- to 6-inch incisions.

Lateral and posterior approaches also require incisions through tendons, which potentially slow recovery.

Generally, recovery after anterior approach surgery takes about a month, or half the time of a standard approach, Matey said.

Hospital stays can also be reduced from three to two nights with the anterior approach.

The anterior approach, which has been utilized in the U.S. for about a decade, is the only truly minimally invasive total hip replacement technique available.

Total hip surgery complications include the risk of blood clots, infection, dislocation, malpositioned or loosened components and nerve injury, Matey said. But these are very rare.

Blood loss requiring transfusion and leg length discrepancy are more common issues, Matey said.

In the last year, Matey has performed about 500 surgeries, including knee reconstructions, rotator cuff repairs and total shoulder, knee and hip replacements.

Maxey would have opted for one of the more invasive procedures had the anterior approach not been available in Victoria.

Traveling out of town would have been too difficult for his daughter, who already cares for her mother who has Alzheimer's.

Maxey was told he could golf again six weeks after the surgery.

"That's what I wanted to hear," he said.



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