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New technique reduces ordeal of hip surgery

Procedure lets patients go home within 24 hours

A 79-year-old Winthrop retiree last week became the first New Englander to undergo an innovative new version of hip replacement surgery, the common — and dreaded — procedure that can disable seniors with a painful, weekslong recovery period.

The new technique, called minimally invasive hip replacement, requires only a pair of 2-inch cuts instead of the foot-long incision and muscle tearing necessary in the standard procedure.

Surgeons at Massachusetts General Hospital, where the surgery took place, plan to aggressively seek new patients in the coming months, making Boston one of the few cities in the world where the procedure is performed.

Just three other hospitals nationwide are now able to regularly perform the procedure, but surgeons at dozens more are learning it, and orthopedic specialists say that minimally invasive hip replacement could transform the battle against the effects of aging for thousands of Americans.

Patients "just do better faster" after the new surgery, said Dr. Andrew Freiberg, chief of Mass. General's arthroplasty service, who performed the operation on Anna Brack earlier this week.

After a hip replacement done using the new technique, patients typically return home the next day, sometimes even the same day, compared to five days after the standard procedure, according to data compiled by the Chicago surgeon who pioneered the procedure. On average, they can resume driving within a week rather than a month, and walk up steps a day after discharge instead of a week.

"It took me a while to get over the fact that I wasn't in pain," said Brack, in an interview less than 48 hours after her surgery.

About 300,000 Americans get hip replacements each year. In addition to helping those patients, the new technique could help what doctors say is an equal number of people who choose to endure the pain caused by their deteriorating hip joints rather than undergo the traumatic standard procedure. Their isolation resulting from immobility often triggers a steep mental and physical decline, studies have shown.

The technique was introduced two years ago by Dr. Richard Berger, a Chicago-based surgeon who had worked almost a decade to develop it with assistance from an Indiana company that specializes in surgical tools for hip and knee replacements. Freiberg said it would not enter the mainstream of orthopedic surgery right away, because the complex procedure takes considerable time to learn and only a handful of surgeons are qualified to teach it.

"I don't know if it will be the norm in the next few years," he said, "but there will eventually be a lot of patients."

Freiberg's team, the only local doctors currently offering the procedure, will pick patients on a case-by-case basis. Patients cannot be obese, he said, and must be generally healthy.

In standard hip replacements, surgeons cut a large opening along the thigh, then through the thigh muscle, to get to the bones. The tip of the femur is replaced with an artificial ball joint, and the socket is ground down and coated with a synthetic surface. The massive incision and the damaged muscle cause considerable bleeding and a complicated, painful recovery.

Berger, working with engineers at Zimmer, a surgical-instrument company in Warsaw, Ind., found that two small incisions, one above the hip joint and one on the thigh, would suffice. Using ultrathin surgical tools and tiny fiber-optic lights, Berger found he could do the entire procedure through the two slits. The tools can thread between muscles. Even the artificial ball implant fit through the tiny cuts.

"It's very surprising when people see it. You're not tearing the skin, you're just stretching it," he said.

Berger said his team has trained about 100 surgeons in the method, and has a nine-month waiting list for classes.

"It's a hard process to learn," said Berger.

predicting it would be years before the procedure would account for even 1 percent of hip replacements, because precision use of the cutting-edge tools necessary takes numerous, lengthy practice sessions to master. The new surgery costs the same as the standard operation, about $40,000, though surgeons hope to charge more in the future for the more complex procedure. Most insurance companies cover it.

Brack's operation required no blood transfusion. Afterward, oral pain pills rather than injected narcotics sufficed. Her recovery has been slightly slower than expected; she spent two more days in the hospital than most patients who undergo the new procedure. But her doctors said her rehabilitation would be as speedy as expected and she that would not need supervision at her Winthrop home, where she lives alone.

Rehabilitation from the new surgery requires about four weeks of muscle-strengthening exercises at home, whereas standard surgery patients must get supervised physical therapy for up to six weeks and at least a month more of exercise on their own.

"Here I come!" Brack said, standing in her hospital room. Four gingerly steps later, she was all grins: "I can't wait to get back to Harvard Square."

Then, resting back on her bed, Brack said of it all, simply: "I feel very fortunate."


Raja Mishra can be reached at rmishra@globe.com.