Bill DeCrick back on the golf course three weeks after second hip replacement surgery

By Glenda Sanders, Daily Sun Summerfield

Bill DeCrick was dreading the inevitable. He’d had hip replacement surgery for his right hip in 1998, and the time had come to do the same with his left. More than the hassle of the surgery and the pain afterward, DeCrick dreaded the total disruption to his life and routine. After his 1998 surgery in Augusta, Ga., he couldn’t drive for a month and had to use a walker for weeks. He was told he never again could ride a bicycle or cross his legs.

“Playing tennis was a dead issue,” DeCrick said.

He coped with the idea that he never could play tennis again as long as he could still play golf, but five agonizing months passed before he got the go-ahead to return to the golf course. For this golf lover, those five months seemed like five years. DeCrick, who now lives in Stonecrest, knew the day was approaching when he no longer would be able to put off his second hip replacement, but he was dreading being put out of commission again.

In that frame of mind, when he saw an ad about a seminar on a new procedure for hip replacement that promised a shorter recovery time and fewer restrictions after surgery, he went to hear what the doctors had to say. Just listening couldn’t hurt anything, he reasoned, and there might be something to this new procedure.

The informational program DeCrick attended was presented by orthopedic surgeon Joseph R. Locker, M.D., at West Marion Community Hospital.

What DeCrick learned was that the traditional side incision used in most hip replacement surgeries involves cutting through muscles, and much of the long recovery associated with the side approach is due to the incisions in the muscles, which require a long time to heal. Cutting through muscle also leads to restrictions in movement, which often become permanent. With the new procedure, appropriately named the anterior approach to hip replacement surgery, doctors make an incision in front of the hip instead of on the side, then work between muscles instead of cutting them.

Taking a chance

DeCrick was willing to give the new procedure a chance, even though he remained skeptical about some of the claims of a quick recovery.

“I didn’t believe when he said I’d be driving in less than a week and playing golf in less than a month,” DeCrick said. “I knew I’d be out of action four to five months, minimum.”

Four days after his June 14 surgery, however, he was driving a golf cart and walking up to 40 feet without a walker. Two weeks after surgery he was dancing, and a week after that, he was back on the golf course.

“I’m an advocate. People should know about this,” DeCrick said. “There are no restrictions whatsoever. It’s just so different. I can’t imagine anyone choosing the other method.”

He said a friend in Michigan who had surgery around the same time he did was still in therapy after two months. “I got rid of my cane in a week,” DeCrick said.

Locker, with Central Florida Orthopedics in Ocala, said the anterior approach is simply taking a surgery that improves the quality of life for many people “one step further.” “I’m not reinventing the wheel here,” he said. “The actual procedure — how we do it (implant the replacement hip) is all the same.”

During the surgery, in either approach, an artificial socket (acetabulum) with a metal liner is put in the hip bone, and a stem and head, or ball, is installed in the leg bone. Small holes in the liner of the socket allow the bone around it to grow into it to stabilize it. “It’s almost impossible to dislocate it,” Locker said.

Hip replacements generally are done to relieve the pain of arthritis which is caused by the wearing away of cartilage, the natural cushioning between the ball portion and socket portion of the hip. Often, the final factor in whether or not a hip replacement is necessary is how much pain the patient will tolerate.

“There’s no emergency to a hip replacement,” Locker said. “It’s a quality of life issue. No one’s ever died of hip pain. I never want a patient to feel I’ve pushed them toward hip replacement.”

Locker trained for the anterior approach procedure a year and a half ago in Arizona in a class offered by Johnson and Johnson, and has performed the surgery more than 120 times. Like his patients, he was drawn to the procedure by the quick recovery time and reduced pain associated with the anterior approach. In general, he said, it is just better for the patient.

“The anterior approach cuts no muscle going in, causes no restriction in range of motion afterward and allows a quicker recovery,” Locker said. Locker has found that the quicker recovery appeals to mature athletes like DeCrick. “They want to continue their sports and not have to modify their activity,” Locker said.

Some patients are not candidates for the anterior approach, including those who have unrelated health problems that would make the longer operating time — one and a half to two hours — inadvisable, patients who are obese or patients with osteoporatic bone. Ironically, Locker said while the procedure offers the patient a more streamlined recovery, it is more taxing on the surgeon because it is more tedious and takes longer to perform. Locker said the anterior approach is much more common on the West Coast than on the East Coast, but the demand is growing as more and more people learn about the new procedure.

“This kind of snowballed,” Locker said.

Ocala Regional Offers
Anterior Total Hip Replacement

Dr. Joseph R. Locker First in Marion County to Utilize

Minimally Invasive Technique

OCALA, FLORIDA- Faster recovery, a smaller incision and preservation of the muscles around the hip are some of the reasons a hip replacement candidate may consider the anterior surgical approach, currently being performed at Ocala Regional Medical Center. Following this surgery, patients are usually allowed full range of motion of the hip without the concerns of dislocation associated with standard approaches. The technique lets an orthopedic surgeon access the hip joint from the front of the leg rather than the side (lateral) or back (posterior). During surgery, the patient lies flat on his/her back on a specialized facture table. The incision is made on the front of the leg, typically four inches in length.

“When some people think of minimally invasive, they think cosmetically,” said Joseph R. Locker, MD, orthopedic surgeon with Central Florida Orthopedics and on staff at Ocala Regional and West Marion Community Hospital. “Though the incision is four inches or more depending on a patient’s size, what happens under the skin is much more important than the length of a scar.”

Hip muscles that attach to the pelvis and femur are not violated during anterior hip replacement surgery. X-ray is used during surgery to ensure perfect placement, sizing and fit of the new hip prosthesis. Leg length is also accurately controlled during the anterior surgical approach. Dr. Joseph R. Locker is the first orthopedic surgeon in Marion County to perform this technique.

Patients who have lateral or posterior surgery are given strict restrictions of their hip motion to prevent dislocation. They are told they can’t bend their hip past 90 degrees. “Patients with hip motion restrictions following lateral and posterior procedures have the possibility of dislocating following surgery simply by bending to tie a shoe or lifting up off a chair,” said Dr. Locker. Because no muscles are cut or damaged during the anterior approach, a patient does not have hip precautions and can start full range of motion immediately. Physical therapy begins the day after surgery and patients are typically discharged one to four days later, depending on a patient’s degree of independence with crutches or a walker. The level of disability prior to surgery may also be a factor in the amount of time needed in the hospital setting.

“This is an excellent opportunity for those patients needing hip surgery who may be a little more active and will push the limits of the range of motion of their hip,” said Dr. Locker. “The surgery may be a little more complex, but the shortened recovery times and lack of precautions are definitely worth it for the patients.”

Ocala Regional Medical Center is a 200-bed facility offering excellence in medical care to Ocala residents and visitors to Marion County with specialties in Bariatrics, NeuroScience, Cancer and Orthopedics. West Marion Community Hospital is an all-private 70-bed hospital located 1.5 miles west of Interstate 75 with a full-service emergency department and home to Ocala’s only inpatient Joint Care Center.

For more information about Ocala Regional Medical Center or West Marion Community Hospital, call (352) 401-1158 or visit www.OcalaRegional.com or www.WestMarion.com.