Susan Jo Paquin – Hip Replacement

Susan Jo Paquin speaking to a medical professional.

How do you perform a hip replacement for less pain and for a faster recovery? That’s the question that orthopedic surgeon Dr. Douglas Roger asked himself. As the Director of the Joint Replacement Program at Desert Regional’s Institute of Clinical Orthopedics and Neurosciences, Dr. Roger has been performing minimally invasive total hip arthroplasty for many years. In his quest to provide even better results for his patients, he developed a new technique called the Direct Superior Approach.

To achieve less pain and a faster recovery, he focused in on the trauma produced during surgery. “The way to achieve this is by decreasing muscle trauma and soft tissue trauma during the surgery while still being able to fully visualize the hip to complete the surgery successfully,” he said.

Dr. Roger has been exclusively performing the Direct Superior Approach for hip replacement for the past five years. To date, he has performed more than 600 hip replacements with this new minimally-invasive approach. But his own surgeries are only the beginning. Dr. Roger also teaches this technique to other surgeons around the country.

There are many benefits of the Direct Superior Approach including:

  • Less muscle/tendon damage
  • Lower dislocation rate
  • Lower dislocation rate
  • Less blood loss compared to traditional hip replacement
  • Faster recovery
  • Shorter hospital stay
  • No post-surgical precautions

The Direct Superior Approach involves one small incision, minimal muscle trauma, and one small tendon detachment – the conjoined tendon – which is then reattached, to obtain access to the hip socket. This procedure spares the iliotibial band (IT band) that runs from the iliac crest of the pelvis along the lateral part of the thigh to the outside of the leg. The access point to the hip is through separation of the fibers of the gluteus maximums. Compare this to traditional hip replacement where all six of the external rotator muscles are cut.

“You have to be able to get in and out of the hip joint by disturbing as few of the important structures as possible,” said Dr. Roger. “We’re trying to preserve the tissue which makes the hip more stable and virtually eliminates hip dislocation.”

In developing this technique, Dr. Roger worked with a biomechanical engineering company to design and patent about a half dozen curved retractors, angled reamers and other instruments. According to a 20ll article in Clinical Orthopaedics and Related Research, the average postoperative Harris Hip Score was 96.5, there were no dislocations, no sciatic nerve palsies, no wound complications and low transfusion rates (8%).
Following development of the instrumentation, Dr. Roger began collaborating with Dr. Anthony Hedley of the Hedley Institute in Phoenix, AZ. Soon, surgeons from around the country became interested in learning his technique – including surgeons from the University of California at San Francisco, the Mayo Clinic in Rochester, MN, and Washington University in St. Louis, MO.

Another relatively new minimally-invasive approach to hip replacement that has gained popularity over the past decade is the Direct Anterior Approach. In 2014, an assessment of the two approaches was done by an independent evaluator from the Mayo Clinic, and the findings showed that the Direct Superior Approach produced 60 times less muscle damage during the surgery compared to the Direct Anterior Approach.

Susan Jo Paquin of Palm Springs has seen the results firsthand. She had her left hip replaced via a traditional open procedure by another surgeon in October 2013. She had her right hip replaced by Dr. Roger via the Direct Superior Approach just a few months later in June of 2014.

“It’s interesting to have this other surgery and the comparison to this one,” said Paquin. “I woke up and asked, ‘Did he do the operation?’ I had no pain.”

“In 10 days of this recovery, I am feeling better than four months of my other hip,” she said.

“I was up and walking the next day after the surgery,” she said. “I was thrilled.”

Paquin also appreciated that the right hip only has a small scar on the right buttock. “The other scar was vertical and goes five inches below the panty line. It’s not that I’m a Victoria’s Secret model, but I swim and I’m not at the skirt stage of bathing suits.”

Desert Regional Medical Center has received Joint Replacement Certification by the Joint Commission – an independent organization that accredits and certifies more than 20,000 health care organizations and programs in the United States. The hospital also received a specialty award from Healthgrades as one of America’s 100 Best in Joint Replacement.