Orthopedic Hip & Knee

Anterior Approach Hip Surgery

Hip replacement surgery has historically been performed using a posterior-lateral approach, with the patient facing downward. The surgeon would need to make incisions into the large muscles of the pelvis or femur (thighbone) to access the hip joint. This type of procedure required larger incisions and caused associated pain. Patients faced longer recovery times and potential joint instability due to the nature of the surgery.

Our team uses a specially designed operating table that enables the surgeon to perform hip replacement surgery using an anterior approach, with the patient facing upward. Using this less invasive approach enables surgeons to replace the hip joint by working through the natural interval between muscles, using smaller incisions on the front of the upper thigh and without cutting into or detaching the important muscles at the side or back of the leg.

This approach enables surgeons to manipulate the leg more easily during surgery so they can properly position and evaluate the movement of the new hip joint. It allows for X-rays to be taken during surgery, further ensuring proper fit, leg length and optimal placement of hip joint components.

Benefits of the Anterior Approach

Because the surgeon moves muscles aside to access the hip joint, all muscles and natural stability are preserved. There are smaller incisions, and less blood loss and scarring. Since the incision is in front, patients avoid the pain of sitting on the incision site. Like similar minimally invasive procedures, this may decrease the average hospital stay to just two to four days. Patients can return to an active lifestyle more quickly.

Direct Superior Approach

The direct superior approach allows the orthopedic surgeon to spare muscles and tendons more than any other approach in town, primarily the piriformis muscle and the iliotibial band, which are not disrupted. The advantage is post-operatively, there are no hip precautions to avoid in case of dislocation, which you have to avoid in other approaches. Also with the minimal muscle disruption, you have less pain and get back to activities faster, needing less pain medicines, and rarely do you even need physical therapy after surgery.

Hip Pain

Living with painful, popping hips? Because the hip joint is the deepest in the body, and one of the most complex, diagnosing and treating this kind of pain can be challenging.

It’s often experienced by people under age 50 due to a sports or occupational injury, but it can also occur from normal wear and tear and mechanical/physiological abnormalities.

Treatment often starts with nonsurgical nonsteroidal medications, cortisone shots and physical therapy. When those do not bring relief, patients may be told nothing more can be done.

Unfortunately that means learning to live with pain that also decreases your ability to be active.

Diagnosis and Treatment through Hip Arthroscopy

Seeing an orthopedic surgeon who performs hip arthroscopy, a newer and highly specialized procedure, can result in definitive diagnosis and treatment of many painful hip conditions, including:

• Hip labral tear – Tear in cartilage around the hip socket
• Hip impingement – Pinching from irregular shape of hip bones Hip bursitis – Inflammation of fluid-filled sacs that cushion bones Loose bodies – Fragments of cartilage caused by injury
• CAM lesion – Extra bone on the head of the femur
• Snapping hip syndrome - Type of tendinitis caused by repetitive physical movements
• Synovitis – Joint lining inflammation that causes swelling

While arthroscopy has long been used for the knee and other joints, it is not commonly used for the hip due to the depth and shape of this joint. Relatively few orthopedic surgeons have focused their training to perform this highly specialized procedure.

Evaluation of Hip Pain

Because of the complexity of hip pain, diagnosing the cause can take time. It’s important to determine if the source is the hip, back or an intrapelvic problem.

Diagnosis starts with a thorough exam. An MRI is also often needed. A diagnostic injection may be performed to confirm the source of pain. This involves injecting numbing medicine and an anti-inflammatory into the joint. Experiencing temporary relief confirms the source of the pain.

Hip Arthroscopy Procedure

Hip scope or hip arthroscopy is a minimally invasive procedure, meaning it requires only a small incision and you can usually go home the same day.

• The orthopedic surgeon makes small ¼-inch incisions close to the hip and injects fluid to keep the joint open.
• A guide wire and then a small tube are inserted into the joint. An arthroscope with a microscopic camera goes through the tube into the joint.
  
• The tiny camera provides a view of the hip joint on a large monitor so the surgeon can identify the problem area.
• If the problem area or damage can be repaired, the surgeon will make additional small incisions to insert surgical tools.
• The instruments are then removed and the small incisions are closed.

The entire procedure can take two hours or less and involves one to four incisions. The advantages of this approach include less tissue damage, pain and scarring.

Risks of Hip Arthroscopy

Because this procedure is minimally invasive, the risks are generally lower than with open procedures that require a large incision and may include:

• Incision-site infection
• Tingling around the incisions
• Damage to hip, groin or thigh nerves or blood vessels
• Incomplete resolution of pain

Recovering from Hip Arthroscopy

Most patients go home the same day using crutches to keep pressure off the hip. Recovery over the next six weeks may include physical therapy as you return to bearing weight on the hip. Full recovery and a return to normal activity can take six months.

Are You a Candidate for Hip Arthroscopy?

CHI Health has an orthopedic surgeon who specializes in this procedure. The first step is a thorough assessment of your pain. Call CHI Health Orthopedics at (402) 717-0820 to make an appointment today.

Total Knee Replacement Procedure

If you're experiencing chronic knee pain and limited mobility due to arthritis or injury, knee replacement surgery may be the right solution for you. This procedure involves replacing damaged cartilage and bone in your knee joint with artificial components, allowing for smoother movement and reduced pain.

What Happens During Knee Replacement?

During the surgery, the damaged surfaces of the femur (thigh bone), tibia (shin bone), and often the patella (kneecap) are removed. These surfaces are then replaced with durable, artificial components made of metal and plastic. These components are carefully designed to replicate the natural function and movement of a healthy knee joint.

We offer several advanced surgical approaches to ensure the best possible outcome for each patient.

Robotic-Assisted Knee Replacement

This innovative technique utilizes a robotic arm to enhance precision and accuracy during surgery.

How Robotic-Assisted Knee Replacement Works

Robotic-assisted surgery combines 3D CT-based planning, AccuStop™ haptic technology, and data analytics. This allows our surgeons to create a personalized surgical plan based on your unique anatomy. The robotic arm provides real-time visual, auditory, and tactile feedback, guiding the surgeon with exceptional accuracy.

Benefits of Robotic-Assisted Knee Replacement

Studies have shown that robotic-assisted surgery can lead to more precise component placement compared to traditional manual techniques. The system also allows for intraoperative adjustments to optimize implant alignment, soft tissue balance, and address any flexion contractures. A built-in safety feature automatically prevents the sawblade from cutting outside the designated surgical area.

Mechanical Aligned Knee Replacement

This traditional approach focuses on achieving a straight mechanical axis in the leg.

How Mechanical Aligned Knee Replacement Works

The implant components are positioned to create a neutral hip-knee-ankle angle (HKA) of 180 degrees (with a tolerance of +/- 3 degrees) in the coronal plane, regardless of the patient's pre-existing alignment.

Benefits of Mechanical Aligned Knee Replacement

This method aims to create a stable and well-aligned knee joint.

Kinematic Calipered Alignment Knee Replacement

This personalized approach aims to restore your knee's natural alignment.

How Kinematic Calipered Alignment Knee Replacement Works

The implant is aligned to match your unique pre-arthritic joint line.

Benefits of Kinematic Calipered Alignment Knee Replacement

By restoring your natural knee joint alignment and kinematics, this approach may lead to improved patient satisfaction and function.

Choosing the Right Approach

Our experienced orthopedic surgeons will thoroughly evaluate your individual needs and anatomy to determine the most appropriate surgical approach for you. We will discuss the benefits and risks of each option to help you make an informed decision about your care.

Are You a Candidate for Knee Replacement Surgery?

Find an expert orthopedic surgeon at CHI Health to see if the procedure may be right for you.

About Knee Arthroscopy

Knee problems often can be diagnosed and treated with a technique called arthroscopy. This type of surgery is done using an instrument called an arthroscope (scope). Only a few small incisions are needed for this surgery. The procedure can be used to diagnose a knee problem. In many cases, treatment can also be done using arthroscopy.

The arthroscope

The scope allows the doctor to look directly into the knee joint. It is about the size of a pencil and contains a pathway for fluids. It also contains coated glass fibers that beam an intense, cool light into the knee joint. A camera is attached to the scope as well. It provides clear images of most areas in your knee joint. The doctor views these images on a monitor.

Preparing for the procedure

• Have lab or other testing done as advised.
• Tell your doctor about any medicines or supplements you take
• Your doctor will tell you if you need to stop medications, food or drink prior to the surgery.
• Once you arrive for surgery, you will be given an IV line in your arm or hand. This provides fluids and medicines.
• To keep you free of pain during the surgery, you’ll receive medicine called anesthesia. You may have:
  • General anesthesia. This puts you into a deep sleep during the surgery.
  • Regional anesthesia. This numbs the body from the waist down.
  • Local anesthesia. This numbs just the knee.

In addition to regional or local anesthesia, you may receive sedation. This medicine makes you relaxed and sleepy during the surgery.

The procedure

• A few small incisions (portals) are made in your knee.
• The scope is inserted through one of the portals.
• Sterile fluid is put into the knee joint. This makes it easier to see and work inside your joint.
• Using the scope, the doctor confirms the type and degree of knee damage. If possible, the problem is treated at this time. This is done using surgical tools put through the other portals.
• When the surgery is done, all tools are removed. The incisions are closed with sutures, staples, surgical glue, or strips of surgical tape.

Call (402) 717-0820 for more information about arthroscopy.