Turning the table on hip replacement

Behind the double doors of Oak Hill Hospital’s operating room No. 4 a surgical team led by Dr. Fady Zeidan is replacing someone’s hip – a common procedure done over 190,000 times a year in the United States. But this surgery is different and in this area, Oak Hill is the only place it’s being done.
The procedure is called the anterior approach to hip replacement. It’s less invasive than the traditional and widely used posterior approach and different in that the patient is lying on his/her back on a specially designed table. The surgeon accesses the hip joint though an incision in the front as opposed to the side or the back. The damaged joint is removed and replaced without cutting through any muscles.
“The table is a positioning device which is going to be able to place the leg in a way to expose the femur independent of the patient’s size, height and weight,” explains Zeidan. “The advantage to the patient is because you are not cutting any muscle, they recover much faster, they can be back on their feet much faster and they can go back to their normal routine faster.”

Traditional hip replacement

Hip replacement, also called arthroplasty, is an operation in which the diseased/damaged parts of the hip joint are removed and replaced with new, artificial parts which can be plastic, metal or ceramic.
Osteoarthritis is the most common reason for hip replacement and as the population ages, the need for it is expected to rise.
The replacement of a hip requires a surgeon to remove the ball at the top of the femur (femur head). Cartilage and surrounding bone are cleaned out of the socket where the femur head was. A cup shaped implant is put into that space. A stem is placed in the femur. It is either held in place with bone cement or “press fit” which means it’s pressed firmly into the femur and bone grows around it. A ball is attached to the top of the stem. The ball fits into the cup (socket) and the patient has a new hip. Depending on the type of prostheses, a spacer may also be used.
The procedure is complicated. It involves a fair amount of manipulating of the femur and pelvis. In the traditional posterior approach the hip is accessed from the side or back with an 8 to 10 inch incision. The muscles and tendons are detached while the surgeon maneuvers the damaged hip out and puts the artificial hip in. At the end, the muscles are sewn back into place.
Because the muscles have to heal before the patient can fully enjoy the relief their new hip provides, the recovery period is about 6 months, During that time a patient’s mobility is restricted to avoid the most common complication – dislocation of the new ball from the socket.
Because of the stress put on the femur and the pelvis during the procedure some people whose bones are severely weakened by osteoarthritis may not be good candidates for hip replacement. Overweight and obese people are also at high risk for complications and they, too, are often turned away.
Over the years, doctors and researchers have been working to improve the prosthesis and the procedure to shorten recovery time, reduce the risk of dislocation and make hip replacement available to more people.
The special surgical table recently purchased by Oak Hill achieves at least one of those goals.

Technique is tied to the table

The $100,000 table is called the hana or PROfx table and has been called a “breakthrough” in the field of hip replacement. It has carbon fiber spars that support and manipulate the leg during surgery. It has a sterile robotic attachment that can reach inside the incision and lift the femur so that it is more easily accessible to the surgeon. Throughout the procedure the patient’s feet are in the table’s compression boots, which prevent clotting.
Because it can create traction, torque and mobility, the table itself is a surgical instrument. And because it allows the patient to be positioned on their back the surgeon can get to the hip more directly through a 4 to 6 inches incision in front of the hip. Going in that way allows the surgeon to take advantage of a natural pathway between the muscles and tendons so instead of detaching them to access the hip, they are simply moved out of the way.
“You don’t cut anything so you’re not sewing anything back in place as far as muscle,” says Zeidan. “That’s why people can go back to their routine because they have good control of their legs. They feel confident because the muscles have been left in tact.”

Not a new technique

The technique for this procedure has been around in France since 1947. In the late 1990’s Dr. Joel Matta who trained in France, brought it to the United States and started teaching it. Matta is also credited with co-designing the table, which makes the less invasive anterior approach possible.
Although its use is growing, the procedure is not being done everywhere. Zeidan tells Hernando Today that to his knowledge, he is the only one in the area using it and Oak Hill is the one of the few hospitals in the state with the table. “There are very few in the Florida area – maybe 4 or 5. There’s another one in Ocala and I think there’s one in Naples and Jacksonville.
The technique has obvious advantages for the patient and Zeidan believes there are two main reasons its not being done more widely. “Number one, it’s technically hard to do. The learning curve is slow so it takes somebody who’s really committed to learning it. Number two, only a few hospitals are willing to spend the money on the table.”
Another advantage of the patient being on their back is that the surgeon sees real-time X-rays during the procedure.
“When you do a routine hip replacement, the patient is on their side and it’s very hard to do the X-ray,” Zeidan explains. “Sometimes you get a patient who has longer legs. You can really recreate the anatomy which you cannot do all the time with patient on his/her side.” The surgeon can also check placement of the parts during the surgery to insure absolute accuracy.
The table and the technique also make it possible for overweight and obese people to have the surgery. Since the muscles are not cut there’s less risk of the new hip popping out of place. Also the position makes it easier for the surgeon to cut through the additional adipose (fat) tissue between the skin and the muscles. The ability to use the X-ray in the case of obese people is very helpful in placing the parts of the replacement hip.

Seeing is believing

As opposed to the three to six month recovery period for traditional hip replacement, most people who have the anterior approach are out and about in six weeks or less. It’s an outcome most patients find hard to believe, even after they’ve been through it.
“It went better than I thought,” says Dona Treager of Hernando Oaks. Treager had her left hip replaced on Jan. 5 of this year. After three weeks she went to have Zeidan check her incision. She was using a walker, “He said what are you doing with the walker?” Treager recalls, “He said get rid of it, you don’t need it.”
Treager said she’d been using the walker because no one told her not to and she wanted to be cautious. She had been concerned about dislocating her new hip. When she went back to Zeidan for her 6-week (and final) follow up, she was surprised again.
“I had this whole list of questions and I started to get through the first and he says no restrictions,” says Treager. “I wasn’t really expecting that and my husband wasn’t expecting it.”
Three days after seeing Zeidan, Treager, an avid golfer, played nine holes. A week after her visit she played 18 holes in a ladies tour.
“The quality of life is wonderful. It’s nice to be pain free. You forget how miserable that is over the long haul because you’re dealing with it on a daily basis.”
Treager is also an educated medical consumer. She knew she was going to need hip replacement and before she saw Zeidan she had begun researching techniques. “I looked up hip replacement surgery on the internet. I got into all kinds of Web sites and I found out the different types of surgery and anterior, from what I read, cut no muscles,” she said. Treager was ready for Zeidan. “I asked what approach are you using, anterior of posterior? He said how’d you find out about that. I said I looked it up. I wanted to know what was going to happen.”
“It’s driven by patients,” says Zeidan. “I saw a guy who told me everybody’s asking him who was his surgeon. Patients, sooner or later, will say I want to do it that way. I’ve had quire a few patients come in from Tampa and St. Pete and Clearwater.”
Treager is certainly a fan. “Had I known that I could have gotten as much relief as I did I probably would have done it sooner, ” she says. “I would say that if anyone is really incapacitated for something like this, the procedures they’re doing these days – it’s a miracle what they can do now. My grandmother had arthritis so badly she was confined to a wheelchair. It’s a different world today.”

For More Information
If you’d like some more information about this technique or have any questions about hip replacement surgery in general, here are a few of many Web sites that may help. If you’re interested, there are also live videos of the procedure available on the Internet.
Medline Plus – www.nlm.nih.gov/medlineplus/hipreplacement.html
Mayo Clinic – www.mayoclinic.org/hip-replacement
Total Hip Replacement by Dr. Joel M. Matta, M.D. – www.hipandpelvis.com
DupuyOrthopaedics – www.or-live.com/depuy/2051

Virginia Diaz writes regularly for the Hernando Today Health Today section. She lives in Brooksville and can be contacted at virginia.diaz61@gmail.com.

Pit Bulls Are Shaped By Their Environment

OK, now it is time to take the test. Would you know a pit bull if you saw one? If you look to the right of this article, you will see a pit bull recognition test – the answers are in the box below.

Here are the facts about pit bulls: They are not a specific breed of dog. This is a term usually used to describe dogs from the heritage of three different breeds: American Staffordshire Terriers (AKC), Staffordshire Bull Terriers (AKC) and the American Pit Bull Terrier (UKC).

The public is consistently exposed to the negative stories in the media. Pit Bulls in loving families who are raised as any other pet dog would be, are wonderful companions. The problem dogs are the ones that are poorly bred and/or raised by irresponsible or unscrupulous owners.

It is true that pit bulls have been bred for decades, if not centuries to fight other dogs; a reprehensible practice. But, in all these years of dog fighting, these dogs were not documented as being human aggressive. This has evolved from human irresponsibility. Dog fighting needs to be stopped, there is no question about this, but this still does not equate to human aggression.

While these dogs have been bred for strength and endurance, there other qualities are immense loyalty and gentleness. Even the terrible people who fight these poor dogs would not tolerate human aggression. While these dogs were used for fighting, they were also the family pet. Dogs that exhibited human aggression were destroyed and only the human friendly dogs were allowed to continue breeding.

Dog aggression does not translate to human aggression. Pit bulls being human aggressive is a myth. Poorly bred and poorly treated dogs, of any breed, leads to aggression towards humans.

Pit bulls by nature crave human companionship. Their whole body will quake with excitement at the approach of someone who will pet them and they love human contact and affection. Many of these poor dogs have endured physical abuse due to the myth that they are human aggressive. Even after abuse, they want nothing more than to be part of a family to love and play with.

As with all breeds there are exceptions to the expected behavior and temperament of the nature of the dog and this is true of humans as well. There are good people and bad people, acceptable behavior and unacceptable behavior.

The other myth is that all pit bulls are animal aggressive. This is also false. It is how any animal is trained and treated that will trigger aggression. This is a human failing, not the failing for the poor animal.

We, as owners, need to be responsible in our treatment of all animals. That is the solution to any aggression issues with pets.

Joanne Schoch is the executive director of the Humane Society of the Nature Coast. Got a pet-related question? Send it to For Pet’s Sake, c/o the Humane Society of the Nature Coast, Inc., P.O. Box 10328, Brooksville, FL 34603.

A Psychic Fair And Innovative Plans

Do you want some unique enjoyment with personal readings by psychic specialists?

Would you like to know if a special angel could relay a message to a loved one who has passed away?

You might bring along an object of special meaning for a psychometrist to intuit its importance to shed new light in your spiritual journey.

Perhaps you’d like to buy the newest book on building your own healing through raw foods nutrition, meditation or view a DVD on Buddhism. The select shelves of new and used books and videos range from religion, self-help, theology, philosophy, nutrition, exercise, astrology and many others. New and used books can be ordered, too, as the bookstore is open weekdays from 3-6 p.m. or by appointment.

Or sign up for a gentle beginner’s yoga or Reiki clinic to ease your creaky knees …

Tomorrow from 1-4 p.m., you can experience such expertise at a Psychic Fair at Inner Peace Church of the Spirit.

Before the Psychic Fair you can attend the regular Christian-interfaith service at 11 a.m. Bring a healthy dish for the potluck.

Since the last interview in 2004, much growth and innovation has happened in this Christian and metaphysical church and bookstore, with much more to come, said its leader/facilitator the Rev. Maria Male-Basile.

“My brother has a gift for dancing. I was thinking about the healing power of laughter, and asked him about teaching a one-time-only line dance to people with two left feet. We’d wave colorful scarves in our twirls and fall on the carpet laughing at ourselves in a fellowship gathering designed to just have fun,” the cancer survivor said. “In other such gatherings, what if we did improv skits with props and clown makeup, or watched comics in some old tapes of Groucho or The Three Stooges and re-enact some lines?”

Describing the healing power of prayer, the pastor told of a woman named Mary, who joined the church when Maria was first diagnosed with cancer. “Mary became a good friend and supporter. She insisted on volunteering to chauffeur me back and forth to Moffitt. She had experienced cancer treatment herself, and was in remission. Much prayer was offered by church members to help myself and others. Later when her cancer came back, we were able to help her. She did pass on, and had hoped for no pain, which she was granted. The power of prayer in healing is very instrumental to one’s well-being.

” My main inspiration as the church founder and leader comes from the example of Jesus in the New Testament,” Maria continued. “His ministry was about love. Unconditional love. Love in service to others, giving back, and belief in a spiritual healing and communications – prayers – to confirm the continuity of life.

“Seven years ago when I moved to Florida, I couldn’t find a church like this nearby, so I started this one based on my experience in the Indiana church and my training and studying over the past 25 years. ”

What happens at the Psychic Fair?

“Many people come from curiosity or entertainment. We hold them on the third Sunday of each month usually following the worship service and lunch, although many people just come for the Psychic Fair readings and book browsing and fellowship. Four different psychic leaders or teachers come. We’ve had Tarot card readers, readers from Casadaga, Reiki, astrologists, numerologists and Native American teachers. It does cost one dollar per minute for the private reading or consultation, and a reading typically takes 15 minutes. Private readings are available throughout the month by appointment.

“Our new expanded facility has five specialty rooms for the readings. One has an Asian calmness in decor, one has pink fabrics with angels. Another is for Reiki. One is for readings I may do, and I like angels and to light candles for those in need.

“The reader who uses pyschometry tomorrow doesn’t require that a person bring a special object either. It just often brings her intuitive powers into focus sooner.

“We also have a licensed massage therapist who does chair massages for those who care to relax and enjoy themselves while participating in the fair tomorrow.”

What classes and events are in planned?

“Meditation and Intuitive Development classes start at 7 to 9 p.m. July 22,” Basile said. Rev. Maria Greene, a graduate of the Fellowships School of Spiritual Healing and Prophecy in the renowned spiritual community of Lily Dale, N.Y., will teach the four weekly sessions. Rev. Greene is author of many related books and a practicing psychic for 15 years, a marvelous teacher.

“Other classes include one starting in August, in Yoga, especially for beginners and the older person, taught by Rachel, a young woman from USF, dates to be determined. Meditation classes will begin in August. A Reiki clinic meets each Wednesday at 7 p.m.

“We’re readying a large room with a good-sized foyer to use and also rent out for groups who need such space. This will encourage other mind, body and spiritual classes. We hope to have it ready in September.

“Also, some people have expressed interest in the Inner Peace Foundation’s “A Course in Miracles,” with workbooks and journaling based on Scriptures in the Bible.

“So this is a center for spiritual enlightenment and healing. We look forward to meeting you tomorrow and sharing the blessings of God’s love for us.”

When do they meet?

Psychic Fair: 1 to 4 p.m. Sunday July 20

Sunday Worship Service: 11 a.m.

Potluck lunch: tomorrow, noon to 1 p.m.

Bookstore: weekdays 3 to 6 p.m. or by appointment

Inner Peace Church of the Spirit and Inner Peace Bookstore: 421 W. Jefferson St. (in the plaza by Dominoes Pizza), Brooksville. Phone: 352-544- 0305. E-mail: mariamb@aol.com.

Bayflite’s Chief Nurse: ‘School For The Rest Of Your Life’

His job is to walk that fine line between life and death. So Will Schroeder does everything he can to make sure the balance will tip on the side of life.

Schroeder is the Bayflite chief flight nurse at Community Hospital of New Port Richey.

Community is one of four bases of Bayfront Medical Center’s emergency aeromedical program. Bayflite transports trauma patients by helicopter to the closest available trauma center.

Last year, Bayflite flew almost 4,000 patients to trauma centers.

In addition to Community Hospital, Bayflite has bases in Hillsborough, Hernando and Sarasota counties.

Recently, in his gray flight suit, Schroeder sat in Bayflite’s tiny headquarters at the hospital. He was free to talk, Schroeder said, but warned he might be called away by an emergency at any time.

A small black radio on which the call would come rested on the table in front of him, a few inches away.

He was on his weekly 24-hour shift. He also works a 16-hour shift that rounds out his 40-hour work week.

Staff members have bedrooms in the Bayflite quarters in which they can rest between flights.

Each Bayflite crew consists of a nurse, paramedic and pilot. Schroeder is one of four Bayflite full-time and four part-time employees at the Community Hospital center.

When not in use, the Bayflite helicopter rests on part of the hospital’s western grounds.

Schroeder and his Bayflite colleagues provide more than just an airlift ambulance service. Crews have the training, equipment and experience to perform medical procedures in the field beyond the capabilities of those of standard ambulance crews.

According to the Bayflite Web site, flight nurses have to be certified as paramedics and hold a certification in emergency, flight registered or critical care nursing.

“This job is nothing but school for the rest of your life,” Schroeder smiled, explaining employees get annual training focusing on advanced skills and also are required to take continuing education courses.

With his direct gaze and unflappable manner, Schroeder appears to have the ideal temperament for his high-stress occupation.

“I come to this job knowing I do all I can for my patients,” he noted.

He started out as a Bayflite paramedic and was impressed with the high quality of medical service on the flights.

He went back to school and got a nursing degree from Hillsborough Community College, in Tampa.

The flights are short but intense. The human element is always present, Schroeder said.

“Because I have a short time with the patient, it doesn’t mean I don’t develop a relationship with them,” he noted. That relationship can be as simple but as important as explaining to the patient what is happening, he said.

Requests for Bayflite services must come from an emergency medical service, such as Pasco County Fire Rescue, Schroeder explained. “They call. We go.”

At 36, Schroeder, a resident of New Port Richey, is still unmarried, but he has a girlfriend. He explained the realities of his schedule when they first met.

He has no intention of changing the job he loves, he said.

“It is something to strive for,” he observed. “I’m very lucky to be where I am.”