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By NANCY YOUNG, The Virginian-Pilot
© July 24, 2006
One week after a total hip
replacement, Charles Nuttycombe was given the all-clear from his doctor.
"I could go to the mall this
afternoon," the retired Newport News coach and teacher said with wonder in
his voice.
Not that he wanted to, but
the point is Nuttycombe, 76, could take his new right hip anywhere. Use a
walker or a cane or nothing at all. No need for more physical therapy. No
worries about dislocating his hip while crossing his legs or bending too
much or rolling over in his sleep .
Best of all, no more constant,
sleep-depriving pain from a hip joint that had lost its cartilage and had
become bone on bone. It's a pain more people are experiencing as they're
living longer or wearing their hips out sooner - and that has made hip
replacement one of America's fastest-growing surgical procedures.
A week before, Nuttycombe was getting that hip fixed in an operating room
filled with the noises of hammers, saws and drills. While it may not have
sounded like it, he was having a "minimally invasive" procedure that's new
to Hampton Roads.
Dr. Anthony Carter, Nuttycombe's surgeon, prefers to call it "a
tissue-sparing technique." There's no way to take a damaged hip joint out
and put in a replacement without invading the body, said Carter, who does
the surgery at Mary Immaculate Hospital, a Bon Secours facility in Newport
News.
Still, the procedure promises quicker,
less complicated recoveries than is generally the case with other
techniques, Carter said.
When operating on Nuttycombe earlier this month, Carter cut out the bone
ball of the hip joint and prepared the femur and the socket for the implant,
which includes a cup, metal ball and post that connects the joint to the
leg. All of that would be done in a traditional hip replacement as well.
The difference was how the hip was approached: through one small incision -
Nuttycombe's was about 5 to 6 inches - that allowed Carter to get to it from
the front. The muscles are then spread apart along their grain, so the work
is done without cutting any muscles or tendons, as they would be in a
traditional hip replacement, Carter said.
The work is done on a special surgical table which has attachments that
allow each leg to be manipulated into various angles while the feet are
immobilized in what look a little like ski boots. At times, Nuttycombe's
legs were at angles only a yoga master could achieve.
At a few points during the surgery, X-rays of the hip were taken. Carter
said some see the radiation exposure as a downside, but the X-rays allow him
to make sure the hip implant is exactly the right size and in the perfect
position. Taking one after the surgery is " kind of too late," he said.
"Now there's no guessing," Carter said as he was about midway through
Nuttycombe's surgery, which took just over an hour.
Several months ago, Nuttycombe felt the first sign of trouble in his back.
In November it went out, as it had done before, but this time it didn't get
better on its own. Tests showed the real problem might be his hip.
The pain was frustrating for a man used to walking several miles at a
stretch and for whom athletics have always been a central part of life. Last
year, Nuttycombe was inducted into the U.S. Track & Field and Cross Country
Coaches Association Hall of Fame.
"I'm... I don't want to call it hyper," Nuttycombe said a couple of days
before the surgery. "The thing I want to do more than anything else is to
walk."
He was a little nervous. His wife of 55 years, Betsy, had had two knee
replacements and "I saw the pain she went through."
Still, he forged ahead with the surgery as an increasing number of people
have done. In 2004, the last year for which statistics are available, there
were about 234,000 total hip replacements nationwide, up almost 40 percent
from 168,000 five years earlier, according to the Centers for Disease
Control and Prevention.
The surgery is still most common in people 65 and older, but it's growing
even faster among baby boomers. In 2004, 83,000 people between ages 45 and
64 had hip replacements, 54 percent more than in 1999 for the same age
group.
Lise Chandler White, 50, became part of that boomer trend this year. In
January 2005, the Virginia Beach resident noticed the pain in her right hip
that she would eventually learn was caused by avascular necrosis. In people
with the condition, bones crumble because of a depleted blood supply to
joints.
During the spring of 2005 she had a procedure done that relieved some of the
pain, but it returned. By January she was debilitated.
"I tried a yoga class. Mistake," White said. "I couldn't do a minute on the
treadmill." White eventually had to get a handicapped parking pass because
the walk to her job in the Virginia Beach city manager's office was too
much.
In February, Carter's office called and said it had an opening for surgery
the next day. Could she come in?
"I said, 'Yes! Yes! Yes!' " White said. "I cried, I was so happy... It was a
very good experience, if you can say that about a surgery."
Now, she is walking three miles several times a week, taking salsa dancing
lessons, and trying out kayaking. "I got another 50 years," she said.
Though Nuttycombe and White attribute their outcomes to Carter and the
procedure, there's more than one way to fix a hip, said Dr. Thomas S.
Thornhill, a professor at Harvard Medical School.
Like Carter, Thornhill is leery of the term "minimally invasive" and said
that too often it is used as a marketing pitch. A good surgeon, no matter
what the approach, will seek to minimize the damage to tissues, he said.
"Regular hip replacement is done with a much smaller incision than was done
10 years ago," said Thornhill, who is chief of orthopedic surgery at Brigham
and Women's Hospital in Boston.
Quicker and less painful recovery times often ascribed to minimally invasive
procedures could also be the result of improvement in such things as
rehabilitation techniques, pain management and anesthetic, Thornhill said.
It's important for patients to ask questions of their doctors, such as how
experienced they are at doing the procedure recommended, he said.
While there may be less risk of hip dislocation early on with the procedure
Carter does, Thornhill said, it's not clear yet that the technique yields a
better outcome for patients in the long run.
What Carter likes about this procedure, which he has been doing since
January, is that because the muscles aren't cut, there's less blood loss and
less healing to do.
"They're off their walkers, they're off their canes much quicker," Carter
said.
" 'Do anything you want. You're well.' That's what he told me," Nuttycombe
said gleefully of his week-after checkup with Carter last Monday.
Nuttycombe was already plotting a strategy to build up his walking mileage.
"And then we're going to Acapulco, right?" his wife, Betsy, joked. "Or at
least Buckroe."
Reach Nancy Young at (757) 446-2947 or
nancy.young@pilotonline.com.
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