Nine years ago retired physician David Criswell needed his left hip joint replaced. He underwent hip replacement surgery using the posterior approach, where the orthopaedic surgeon makes an incision from the lateral (side) or posterior (back) to reach the hip joint. The surgeon must detach muscle and then repair it after the implant is placed. This traditional approach to hip replacement surgery leaves much to be desired for the benefit of the patient. Any muscle splitting or detachment increases post-operative pain and the healing of this repair takes several weeks. In addition, a posterior approach to the hip has some intrinsic and increased risk of dislocation that, although rare, is still a concern. Also, Dr. Criswell noticed that following his first surgery his left leg was 1 ½" longer than his right, owing to the placement of the prosthesis. "It's not an exact science," Dr. Criswell says of the posterior approach.

Therefore, when it became necessary to have his right hip joint replaced, the experienced physician began researching his surgical options. He read about an approach to hip replacement called the "direct anterior approach" whereby the surgeon makes an incision in the front of the hip. With this approach, the hip can be replaced without detaching any muscles. The surgeon can simply work through the natural interval between the muscles. The most important muscles for hip function are left undisturbed and, therefore, do not require a healing process to recover from surgical trauma.

Once Dr. Criswell decided he wanted this approach for his hip surgery, he turned his attention to the challenge of finding an orthopaedic surgeon experienced in the direct anterior approach. It has been recently estimated that only ~5% of orthopaedic surgeons nationwide are using the anterior approach to hip surgery due to the steep learning curve of this technique. "As a doctor, I am familiar with the usual reaction to new technology in the medical field. When a physician hears about a new technique, he or she typically stops using the old technique and adopts the newer procedure. If the physician decides not to learn the new technique, he or she stops practicing the procedure altogether and simply refers patients to a medical professional who does," explains Dr. Criswell. "I get very upset with physicians who refuse to make changes, and who also refuse to refer their patients elsewhere, continuing to practice older, inefficient methods."

A friend who had received a hip replacement using the direct anterior approach recommended the Zehr Center for Orthopaedics. "I looked up Dr. Robert J. Zehr and was impressed," says Dr. Criswell. "Even with more than 25 years of experience, Dr. Zehr still made the effort to learn the newest technique."

David Criswell, MD celebrates being Dr. Zehr's 1000th anterior approach THR patient

One of the first orthopaedic surgeons in Southwest Florida to offer the direct anterior approach to total hip replacement, Dr. Zehr is the area's most experienced surgeon in this technique, having recently completed 1,000 operations using this minimally invasive approach. "The whole experience was tremendous," says Dr. Criswell. "The difference in the two approaches is incredible. I had no post-operative pain and my recuperation was much faster than that of the patients around me who'd had the procedure done through the posterior approach. In rehab, on the same day post-op, I was doing things the posterior patients couldn't. They had a long list of restrictions, whereas there was nothing I could not do. There's just no question that the direct anterior approach gives the patient tremendous advantages."

In addition to being less painful, less restrictive and providing for a faster recovery, the direct anterior approach allows the surgeon to use a specialized X-ray machine known as a fluoroscope. With it, the surgeon can see the placement of the component parts of the hip prosthesis in real time and make adjustments immediately, resulting in more accurate placement of the implant. Remember Dr. Criswell's unequal leg length following his first hip surgery? "Dr. Zehr fixed the leg length!" Dr. Criswell announces proudly.

For more information on the direct anterior approach to total hip replacement and other groundbreaking orthopaedic procedures for hips and knees, contact the Zehr Center for Orthopaedics at 239-596-0100. Online at www.zehrcenter.com.