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Facebook Live: Dr. Cory Calendine on Anterior Hip Replacements

Dr. Calendine, can you tell us a bit about yourself? 

I’m a preacher’s kid, I think that is an interesting thing to note. I joined the practice under Dr. Farrell’s leadership back in 2007 and have been with the practice ever since. I do focus, almost exclusively, on hip and knee replacements. 

 

Can you tell me about what hip arthritis is and what can cause it? 

We say arthritis like you caught it, like you caught the flu, but the reality is that arthritis is the absence of something. Arthritis is the absence of normal cartilage. I always tell my patients that, much like tread on a tire, we’re born with thick cartilage, and overtime that can wear, and eventually you’ve worn through your cartilage and then you are bone-on-bone. 

 

As far as treatment, are there any non-surgical treatments, or anything that you would start with prior to considering surgery? 

Absolutely. Although I am an orthopedic surgeon, we do many, many things other than surgery. Surgery should never be the first option for you. The reality is that once you have that bone-on-bone arthritis, a joint replacement, or in this case what we’re discussing today a hip replacement, is the only cure. There are still many things that should be discussed before considering surgery, though. One of the simplest being staying active. I always tell my patients, motion is life and life is motion. Keeping the joint, whether that’s hip or knee, in motion is helpful. Weight management is also key. For every pound on your body, that is for additional pounds of pressure on your joints every time you take a step. From a treatment standpoint, we talked about Advil or Aleve, but not everyone can take those. You can take Tylenol, but Tylenol is not a true anti-inflammatory. It can be effective for some though and it’s one of the safer treatments that we have. There are also injections that we can do, you may have heard of a steroid injection. A steroid is a strong, powerful way to decrease the inflammation. That can give you some good relief from arthritis flare, but it’s usually not the “end all, cure all”. Physical Therapy can also be very helpful. 

 

When does surgery become an option? 

I always tell patients, they will tell me. The question that I always want people to focus on is quality of life. We only want to do surgeries when we have to, when other things have failed. When you start missing the ball games for the grandkids, or you can’t get on the floor to play with the kids, that’s when we would start looking at a quality-of-life issue, and where we would consider surgery. 

 

Can you tell us a bit more about anterior hip replacements? 

A hip replacement is really just putting metal and plastic in between the joints. Historically we would get there through the posterior approach. Some people just say hip replacement, and for a lot of time and in the past that meant the posterior approach, which is an incision on the side and back of the hip. However, now we’re using much more of the anterior approach. I would say about 95% of the hip replacements that I do are done anteriorly. They’re similar in the sense that they’re both still rebuilding with metal and plastic, but how you get there is different – you go in between two muscles instead of cutting the muscle. This allows for less pain and a faster recovery. There was a time, even when I started here back in 2007, where you would be in the hospital for 4 or 5 days following a hip replacement. Now with medical advancements like the anterior approach, better pain management, and sooner physical therapy, 70% of people go home after just one night in the hospital, but many patients are opting to go home the same day. The anterior approach and what we do to help with pain management are two keys to making that possible to go home the same day. 

 

With the anterior approach and with better pain management, what specific technologies are you using and what are the progressions there? 

Technology is advancing and we should leverage those better technologies to do surgery better too. With the anterior approach, we oftentimes use something called Orthogrid, which is live x-ray in the operating room to be sure we get the parts in perfectly. We also use CT scans and plan out the hip replacement with 3D scans. We then use a robotic arm during the time of surgery to put the parts in position. It is about accuracy. If we can do less soft tissue damage and be more accurate, that’s very beneficial to the patient. 

 

You mentioned getting into Physical Therapy earlier. What does physical therapy look like after this anterior hip replacement surgery? 

We have actually moved away from Physical Therapy following the surgery because we found that people move at different paces. The patient is actually the best indicator for that. We give them a list of exercises that they can do. Most of my patients who have the anterior approach are on a walker, but that’s usually only for about a day or two. Sometimes they will then switch to a cane, and you can drive once you can walk steadily with a cane. This is now getting closer and closer to surgery, oftentimes now within a week. We have found that because they are active so early on, a lot of the therapy they can achieve on their own. We definitely still use Physical Therapy when we feel like there’s some muscle weakness that we are still trying to overcome. Many times after hip replacement it’s pretty simple, get your balance accurate and then get back to exercise and doing the things that you love to do. 

 

Do you have any other tips or pointers as far as prevention? 

There’s some things that we have no control over and one of those things is genetics. There are people who tend to develop arthritis overtime and there’s nothing that we can do about that. The most important things that we can do are staying active and keeping our joints moving. People always say, “I don’t want to do too much pounding, running, or cycling, I’m afraid my joints will wear out.” I certainly understand that perspective, but the reality is that the benefits far outweigh the risk. There’s some evidence that over-the-counter treatments like glucosamine and chondroitin sulfate can support the cartilage. We talked about the steroid injections that we can do, but there are also hyaluronic acid injections that we can do as well. We get those ingredients from rooster combs, of all things. Nourishing the joints with these kinds of treatments can help as well. There’s a lot of talk out there about stem cells as well, but I want you guys to do a lot of thinking and a lot of research about that. The best things that we know about stem cells as far as growth of new cartilage are a little disappointing. That is not really something that we want to push right now, we are just not there technically to do that. Prevention is the key, because once that cartilage is gone, it is gone. 

 

How does the comprehensiveness of Bone and Joint help the patient get the best experience? 

If you haven’t been to the clinic, you should visit, it’s beautiful. We are surgeons, and all of our staff really enjoy coming to such a beautiful building. We really try to house everything that the patient needs under one roof. If you live close by, we do have physical therapy here, as well as at our Nolensville and Thompson’s Station locations. We also have our Ambulatory Surgery Center on the first floor, where we do outpatient surgeries, even joint replacements like we were talking about. The ability to have not only the physical space that is comprehensive, but also the relationships between the physicians, the clinical staff, the physical therapy team, and everyone under this roof, is extremely helpful to the patient experience. It helps with personalized, specialized care.

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