Back in the Swing
Popular TV newsman John White got his groove back after undergoing anterior approach to total hip replacement at Desert Regional Medical Center
By Mona de Crinis
Photography by Elena Ray
TV NEWS ANCHOR JOHN WHITE leads a full and active life. He loves to golf, although concedes he’s hardly the world’s best. He likes to get out on the water, toss a line, and even race around on skis once in a while. He enjoys quiet strolls with his wife, puttering around the yard, and playing with his daughter. And he relishes the simple act of walking without a limp. Most of all, he’s elated that he is now able to be this active and pain free.
His renewed freedom was a few years in the making, since a freak accident left him with a broken hip — an uncommon injury for a 37-year-old otherwise healthy man.
In fall 2004, White was teaching his daughter to ice skate at the Ice Garden in Cathedral City. Once she was going solo, he decided to engage in some more ambitious athletics. “I started racing around the rink, and I caught an edge or something,” White recalls.“I went up in the air, came down on my hip, and had a right femoral fracture.”
Back then, doctors screwed his hip back together, and it felt fine for a while, he recalls. But the following year, he began feeling a lot of pain and was treated with ibuprofen and cortisone. “I was getting older by the day,” White says. “It got to the point where, going to a ballgame, I had to ask my family to drop me off at the door and have them park the car.” Walking had become difficult.
In October 2006, fed up with the chronic pain, White scheduled an appointment at Desert Regional Medical Center’s Institute of Clinical Orthopedics and Neurosciences (ICON).
John recalls how Dr. Stabile, his orthopedic surgeon, spotted the problem immediately. “He wasn’t even all the way in the room when he saw my X-ray and said, ‘Oh, that doesn’t look good at all! That’s a square peg going into a round hole.” Within 15 minutes, they had decided on total hip replacement. “John had broken the femoral neck and already had four screws in there,” Dr. Stabile says. “Sometimes when those injuries happen, the blood supply to the ball of the hip becomes disrupted, and occasionally that portion of the bone dies and causes what’s called ‘avascular necrosis.’ During the revascularization process, where your body tries to restore circulation, it weakens the bone, and the bone often collapses. You go from a spherical femoral head to a head that flattens. You end up with a flat head in a round socket.
White’s femoral head had already collapsed at that point. And that collapse can lead to arthritis and chronic pain.”
White received a hip replacement using the anterior approach — a minimally invasive procedure with far less downtime compared to the standard posterior approach.
The key to the anterior approach is that no muscles or tendons are split or cut during the surgery, thus reducing healing time. Using a special surgical table that precisely positions the patient — the PROfx table — surgeons can replace the hip through a single front incision without detaching the muscle.
There are minimal post-operative precautions or restrictions. Conventional hip surgery limits hip motion for six to eight weeks, in particular the flexing of the hip, which puts a decided cramp in daily activities.
Not so with the anterior approach, Dr. Stabile says. “You can bend and lean over. People tie their shoes the day after surgery,” he says. “Patients love that freedom where they can push themselves as far as their pain will let them.”
White knew only a few hours after the operation that he had made the right decision in choosing the anterior approach. “I could just tell getting out of bed, when I put my leg down and there wasn’t that ‘click.’ I knew right away, that first walk, that I was much better off,” he recalls.
White credits the pre- and post-operative care he received at Desert Regional Medical Center with making the procedure as palatable as possible. From preparation to discharge, doctors and staff considered his comfort. “The whole thing could not have gone more smoothly,” he beams. “I walked in and they were just waiting for me. It was like checking into a hotel.” Within 45 minutes of arriving, he was rolling into surgery.
A few hours later, around 1 p.m., they took him for a walk. “It was a walk with a walker and we just went up and down the hallway a little bit, but I was taking steps on my own weight within hours after the surgery. Everybody was very helpful.”
White even gives high marks to the physical therapist who made him go for a walk after a rough night. “It’s 6 or 7 in the morning and this physical therapist shows up,” he says. “I just looked at him and said, ‘No, we’re not going anywhere.’ But he had a good, positive approach and he got me up. That was probably the best walk I’ve ever taken in my life.”
After three days in Desert Regional Medical Center, White was released and continued physical therapy at home. He was on a walker for a few days, then on a cane for about a week. A month later, he was back on the golf links, as good as new — maybe even better. “I played well! I shot an 85. I’m not a great golfer, so that was a really good score for me.” It took about four to six months for his confidence to build to 100 percent.
“But the day I put down the cane, which was only a week and a half or two weeks after the surgery, I was already 10 times better than I was the day I walked into the hospital,” White says.
Today, nearly three years later, John can do anything that he could before the hip replacement surgery. “Ninety-nine percent of the time, I don’t even think about it,” he says, “unless maybe I’m ice skating.”
The Anterior Approach
Minimally Invasive Total Hip Replacement
Many people suffering with arthritis, hip pain, and stiffness, whether degenerative or due to injury, have the option of choosing a minimally invasive procedure when hip replacement is the treatment of choice. One of the least invasive surgical options is the anterior approach, a technique that results in minimal pain and reduced recovery time. Using a special surgical table called the ProFx table, the surgeon can minimize trauma to the skin and muscle with precise patient positioning.
- Allows surgeon to reach hip joint from the front (anterior) rather than the back (posterior) or side (lateral)
- No detachment of muscle from femur or pelvis
- Surgeon works through natural separation between muscles
- Gluteal muscles are left undisturbed and, therefore, require no healing process
Special Surgical Tables
- Used for anterior approach replacement of hips
- Allows frontal access to hip with minimum tissue damage
- Allows X-ray imaging during surgery for accurate control of implant placement and leg length
- Total hip resurfacing
- Hip pinning
- Supine and lateral positioning
Advantages of the Anterior Approach
- Average hospital stay: two to four days (conventional requires three to eight days)
- Smaller incision: four to five inches (conventional requires 10 to 12 inches)
- Less muscle trauma: no muscle cut from bone (conventional requires muscle cut from bone)
- Faster recovery: two to eight weeks (conventional requires two to four months)
- Reduced blood loss
- Less trauma; faster healing time
- Reduced risk of dislocation
- More accurate leg length control
- More rapid return to normal activities
A Physical Therapist’s View
The Anterior Approach
Lilia Angel Singh, PT, is a lead physical therapist at Desert Regional Medical Center who completes the initial evaluation on about 90 percent of total hip replacement patients at DRMC. In the four years she has worked at DRMC, she has witnessed firsthand the remarkable difference in ambulation and recovery time in patients who have undergone the anterior approach to total hip replacement as compared to conventional methods.
Singh’s detailed observations and treatment plans for post-operative hip replacement patients include the following points:
Treatment Plan and Observations for Anterior Approach
- Patient seen three hours post-op, assisted out of bed, and allowed to perform as much as possible independently
- On average, patients need minimal assistance to manage the hip
- Sometimes able to lift legs off bed with minimal supervised assistance
- Patient is walked as far as tolerated, usually from 50 to 300 feet, often with minimal pain
- Patient is instructed in active range of motion
- By day two, patient is almost off assistive devices
- Patient works with therapist on training to walk with a normal gait
- Patient is seen by an occupational therapist for training in activities for daily living
- Patient is sent home usually with only a walker as an assistive device
Treatment Plan and Observations for Conventional Approach
- Patient generally experiences greater pain in bed the day of the surgery due to extensive tissue trauma
- Patient requires total to maximum assistance in getting out of bed, sometimes requiring two therapists
- Day two, usually needs moderate to maximal assistance to manage the hip
- Patient receives education on hip precautions
- Abductor pillow is required; patient is advised to be extra cautious when getting to the edge of the bed
- Patient is often only able to walk to door and back initially — perhaps 40 to 150 feet by the time of discharge
- Patient often transitions from hospital to skilled nursing facility prior to going home
- Patient requires several assistive devices at home
Post-Op Precautions for Anterior Approach
Post-Op Precautions for Conventional Approach
- No crossing legs
- No internal rotation of leg
- No sitting on low surfaces or putting the hip at an angle greater than 90 degrees
- Must use a special pillow while sleeping for up to three months