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Hip pain is usually caused by arthritis but can also be the result of injury or other medical conditions. The first therapies generally recommended for discomfort are anti-inflammatory drugs (or acetaminophen if there is no inflammation), exercise, and physical therapy. If pain becomes severe to a point where medication no longer provides relief and leads to lack of sleep or difficulty climbing up and down stairs, or if it hurts too much even to go for a walk, surgically replacing the joint can bring back enjoyment of everyday activities.
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Arthritis is a general term encompassing various conditions where the joint surface (cartilage) wears out. The cartilage is covered by a tough slick quarter-inch-thick tissue that allows the bones to glide over each other without painful friction. If the cartilage thins or wears out completely, the bone ends rub against each other. Pain results and the hip becomes stiff. This common type of arthritis is called osteoarthritis.
According to the Centers for Disease Control, one in four people may develop painful hip arthritis in their lifetime. A family history of arthritis increases the likelihood of developing it, and risk also increases with age, obesity or an injury that puts stress on the hip cartilage.
The first symptom of arthritis may be some discomfort and stiffness in the groin, buttock, or thigh upon wakening in the morning. The pain gets worse with activity and better with rest. As arthritis worsens, rest no longer provides relief, and the hip joint becomes more stiff and inflamed. Sometimes, people experience years of stiffness before the hip becomes painful.
When the cartilage wears away completely, bones rub directly against each other, making movement very painful. This may interfere with the ability to rotate, flex, or extend the hip. If the pain causes a decrease in activity, the muscles controlling the hip joint get weak and this may result in a limp.
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Hip replacement surgery, followed by physical rehabilitation, can relieve pain and restore range of motion and function of the hip joint. There are two methods of hip replacement — posterior and anterior approaches.
The traditional posterior approach, involves a 6- to 8-inch incision over the side or back of the hip through the muscles. The diseased bone tissue and cartilage are removed from the hip joint, and the ball and socket are replaced with a prosthesis.
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Anterior Approach Hip Replacement
The hip is one of our most stable joints, but excessive pressure from bearing the body’s weight makes it susceptible to arthritis. In addition to arthritis (osteoarthritis, rheumatoid arthritis or post-traumatic arthritis), other causes of hip pain include bone loss (avascular necrosis), bursitis or a hip pointer (bruise or tear in the muscle). While these conditions do not always call for a hip replacement, it is often the best choice. Close to 300,000 Americans undergo total hip replacement each year.
Phelps’ highly trained joint replacement surgeons perform hip replacement surgery with the most advanced techniques and technology in the region.
Anterior Approach hip replacement surgery: The Anterior Approach for total hip replacement is sometimes referred to as a “minimally invasive muscle-sparing alternative to traditional hip replacement surgery,” because the surgeon does not have to cut any muscles. An incision is made in the front of the hip, and the hip is accessed by going between two muscles, rather than by detaching and then reattaching a muscle. With this innovative approach, there is quicker recovery and improved mobility compared to the traditional method. Keeping the muscles intact can also reduce the risk of many complications, including dislocations. In addition, because the patient lies on his or her back, image guidance can be used, which allows for more accurate placement of the implants and restoration of leg lengths.
Posterior Approach hip replacement surgery: Phelps’ orthopaedic surgeons are experts at performing the anterior approach for hip replacement and consider it to be the preferred method. Occasionally there are cases when the traditional posterior approach is performed which involves accessing the hip joint through an incision close to the buttocks. Recovery time following surgery is typically longer than with the anterior approach.
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Advantages of the Anterior Approach
Compared to standard or min-incision total hip replacement, the anterior approach is proven to have fewer postoperative complications, considerably less pain, and quicker recovery, and it produces a more stable hip that is less likely to “pop out of the joint” with rigorous exercise or sudden movements.
The anterior approach is referred to as a muscle-sparing surgery because no muscles are cut to access the hip joint, enabling a quicker return to normal activity. Patients are not required to sleep in a special position and do not need an elevated toilet seat or special instruments to put on shoes and socks. They can return to driving as soon as they are comfortable.
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The hana Table
At Phelps, anterior approach hip replacement is performed on the hanaTM Table. The hana™ is the only surgical table designed exclusively for hip and knee arthroplasty and maximizes the benefits of the less-invasive anterior technique. With its unique capability to position the leg, the hana™ allows hyperextension, adduction, external rotation of the hip for femoral component placement, and lowering of the foot to the ground during surgery. This type of positioning is not possible with conventional tables.
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Corey Burak, MD
Orthopedic surgeon Corey F. Burak, MD, brought the minimally invasive anterior approach hip replacement procedure using the hana table to Phelps Memorial Hospital Center in 2006. He was the first in Westchester County, NY, to perform the anterior approach and has more experience in doing the procedure than any other orthopedic surgeon in the Northeast.
Dr. Burak is board certified in orthopedic surgery by the American Board of Orthopedic Surgery. He earned his medical degree from the SUNY-HSC at Syracuse College of Medicine in NY. He completed a general surgery internship at Saint Vincent’s Hospital and Medical Center, New York, NY, and an orthopedic surgical residency at Tulane University Hospital and Medical Center in New Orleans, LA, where he completed a research fellowship in adult reconstruction under the renowned Dr. Robert L. Barrack. Dr. Burak also completed a fellowship in hip and knee arthroplasty at the Dorr Arthritis Institute, Los Angeles, CA, and received the Rockwood and Green Award in 2002.
For Burak, orthopedic surgery runs in the family. His father, George Burak, MD, also an orthopedic surgeon, performed the first total hip replacement in Westchester County, at Phelps Memorial Hospital, in 1969.
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