Total Hip Arthroplasty
Total hip arthroplasty or hip replacement surgery may be recommended to treat a variety of disorders affecting the hip joint. Since it’s introduction in 1960, total hip arthroplasty has become one of the most successful procedures in medicine and is associated with high patient satisfaction rates.
Total hip arthroplasty is recommended for:
Osteoarthritis of the hip
Rheumatoid Arthritis of the hip
Post-traumatic Arthritis of the hip
Avascular necrosis of the hip
As a patient it is important to educate yourself on the type of hip replacement surgery you are planning to undergo. There are several surgical approaches to total hip arthroplasty.
Anterior Supine Intramuscular Total Hip Arthroplasty
*Performed by Dr. David Eichten D.O.
Dr. Eichten performs advanced minimally invasive techniques for total hip surgery, which includes the muscle sparing anterior approach. The benefits of anterior total hip approach include a faster recovery. Although it does take 6 weeks for the bone to integrate with the titanium stem and cup, when you don’t cut or release any muscles or tendons, the pain is less and the recovery is quicker.
This approach is done without the cumbersome Hana table, and is done on a regular operating room table. There is less stress on the extremities and less risk of fracture, because the patient is not locked into boots or a table. With the extremities free, this allows for a stability check with range of motion to ensure there is no dislocation, as well as a leg length assessment in the supine position. Radiographs with C-arm fluoroscopy are obtained during the surgery to ensure perfect placement of the total hip components and also to allow assessment of leg length. Dr. Eichten makes his incision slightly more lateral to avoid the lateral femoral cutaneous nerve. The hip is not surgically dislocated, which is less traumatic to the surrounding tissue and muscle. (With dislocation of the hip, some of the nerves or muscles can be stretched and cause injury).
Summary of Dr. Eichten’s Anterior Supine Intramuscular approach:
Muscle sparing approach, no muscle cut
Preserving muscles and tendons
Standard OR table
C-arm radiographs during surgery confirm position of components and leg length
Avoid lateral femoral cutaneous nerve
Do not need Hana table allows full ROM check and leg length assessment in supine position
Less risk of femur or ankle fractures
No surgical hip dislocation
Dr. Eichten also performs anterolateral approach if needed for difficult or revision total hip cases.
*Performed by Dr. David Eichten D.O.
This minimally-invasive approach to hip surgery has the advantage of not disrupting any tissue in the back of the hip joint. When compared to the posterior approach to the hip there is less risk of hip dislocation.
After surgery via the anterolateral approach patients can partake in any actives they wish and live without any hip precautions.
While still widely performed by many surgeons, this approach has the disadvantage of high rates of hip dislocation and a longer skin incision. The posterior hip is more likely to dislocate because the tissue at the back of the hip is cut in order to gain access to the hip joint.
Following a posterior hip replacement, patients must follow strict hip precautions for the rest of their life. These include not crossing your legs, bending forward or sitting in low chairs and can be extremely restricting to a patient’s lifestyle.
Total Knee Arthroplasty
Total knee replacement is an orthopedic procedure used to treat osteoarthritis of the knee. Osteoarthritis occurs when the surfaces of the knee wear out leading to pain, stiffness and loss of motion.
Fortunately, total knee arthroplasty can resurface these worn out areas of the knee and allow you to return to your normal, active lifestyle. Dr. Eichten is fellowship trained in total knee arthroplasty and practices some of the most advanced techniques including minimally invasive total knee replacement, and the XP Preserving Knee.
Minimally Invasive Knee Replacement
The decision to undergo total knee replacement should not be taken lightly. However, finding a surgeon that can perform your operation efficiently and with expert technique will make a world of difference. One such technique practiced by Dr. Eichten is Minimally Invasive Knee Replacement.
Minimally Invasive Knee Replacement has 3 major advantages over traditional knee replacement surgery:
1. The skin incision with the Minimally Invasive technique is typically 4 inches as opposed to 8-10 inches for traditional knee replacement surgery.
2. There is little to no disruption of the quadriceps tendon during Minimally Invasive Knee Replacement. In traditional knee replacement more exposure is needed resulting in quadriceps trauma or cutting. The quadriceps tendon and quadricep muscle allow you to straighten your knee. When this is undamaged your knee range of motion is regained faster after surgery.
3. Special instruments are used during Minimally Invasive Knee Replacement. These instruments allow proper implantation of the knee replacement components but cause less stretching and injury to the surrounding tissues. Because the muscles, tendons and soft tissue around the knee are not injured there is less post operative pain and a faster recovery time.
XP Preserving Knee
One of the most important structures in the knee is the anterior cruciate ligament (ACL). The ACL provides the knee with stability and control when walking, exercising, or playing sports.
During traditional knee replacement surgery the ligaments of the knee are removed and the implants are balanced without your anterior cruciate ligament (ACL).
With the XP Preserving Knee your ACL is not removed. When the ACL is retained during the total knee replacement the result is a more natural feeling in your knee post operatively. This allows you to return to your normal activities more rapidly.
Dr. Eichten is one of only two surgeons in Southwest Florida trained to implant the XP Preserving Knee.
Be sure to educate yourself prior to surgery and ensure that all of your concerns are addressed and answered. Dr. Eichten and his staff are always available to answer any questions you may have.
Can I have my total joint replacement procedure as an outpatient?
Dr. Eichten and Joint Implant surgeons are excited to announce the opening of their new state of the art Ambulatory Surgery Center. Dr. Eichten and team opened the Center in August of 2019 and are now Medicare certified outpatient center. There is an increasing trend in outpatient total joint surgery across the country. This has multiple benefits for this trend, including decreased cost for the health care system and patient, efficiency, high quality care with lower complications, lower infection risk including hospital acquired infections, better patient satisfaction, etc.
The surgery center is called Performance Health Surgical Center and is located centrally between both Joint Implant Surgeons of Florida Naples and Fort Myers offices, on Three Oaks Parkway north of Alico road off on Highway 75. The facility was built with outpatient total joints in mind with large operating room suites and two large instrument sterilizers, hospital grade. Some surgical centers were built for smaller procedures and do not allow for safe total joint surgery.
It is important to keep in mind that the outpatient surgery should be done on patient’s with minimal medical issues and have a safe home environment with help at home. Home Health Care is available after surgery as well as outpatient physical therapy. It is important for medical or cardiac clearance as well as evaluation by Anesthesiologist to allow outpatient surgery. The anesthesia team and post-operative scripts allow a multimodal pain management approach, including nerve blocks for quick and controlled recovery. After surgery the patients are seen by a Physical Therapist to ensure a safe discharge to home. We have performed multiple surgical procedures at this facility including partial knee arthroplasty, total knee arthroplasty, total hip arthroplasty anterior supine intramuscular, and total shoulder arthroplasty.