WAIMEA — A new approach to total hip replacement surgery at North Hawaii Community Hospital (NHCH) is revolutionizing patient recovery — shortening it from months to weeks and with far less pain.
Anterior hip replacement surgery, an alternative to the more traditional posterior approach, is now an option with the help of specially trained orthopedic surgeons who rotate at NHCH from Oahu one week each month.
That means patients don’t necessarily have to travel off island when they need a total hip replacement, according to Toni Kalauli.
“They can now have their surgery and recover close to home and family,” she said.
As nurse manager for NHCH’s Medical Surgical Unit, Kalauli oversees the hospital’s Total Joint Program. They began offering the anterior hip replacement surgery last spring and 15 have been performed since then.
“North Hawaii Community Hospital is the first on this island to offer the anterior hip approach,” she said. “These are evidenced based practices which improve a patient’s outcome.”
The surgery decreases the length of stay in the hospital, decreases the risk for a surgical site infection, increases or returns to baseline a patient’s mobility and function, and decreases the risk of blood clots, Kalauli said.
Although the surgery has been performed nationally since the 1980s, advancements in medical equipment and training have led to a renewed interest in hip replacements — especially the anterior approach. Last year, NHCH purchased the specialized equipment needed to perform it.
In traditional posterior hip replacement surgery, doctors cut through muscles to reach the hip joint.
During an anterior procedure, “We go between less muscles resulting in a much faster recovery,” Dr. Jason Kaneshige said, one of two doctors performing anterior hip replacement surgery at NHCH.
There’s far less pain after surgery with an anterior hip replacement and far fewer restrictions. Patients are up walking the day of surgery and are released from the hospital after one night. They’re usually walking without support in one to two weeks.
Suffering from back pain for more than a year, Joy Downey of Waikoloa — an avid hiker, conservation volunteer and high school teacher — had almost stopped moving.
“The pain was horrible all the time,” she said. “I didn’t want to walk anywhere and I didn’t want to get up.”
Her doctor attributed the pain to her back, as Downey was born with a vertebrae problem and X-rays showed she had a vertebra that was moved out about 1/8 inch.
But Downey’s physical therapist, Andrew Branchflower, had a different opinion. He felt it wasn’t her back, but her hip that was causing her problem. In delivering the bad news, he also had good news to share.
“He told me about these great Queens’ Medical Center surgeons that rotate here one week a month, and one young doctor in particular, Dr. Kaneshige, that his clients were raving about,” Downey said. “And he said the doctor was in that day.”
She didn’t hesitate, leaving physical therapy and heading straight to the doctor’s office.
“I walked up the desk and said, ‘Where’s that hip guy? I need to talk to him,’” Downey remembered. “I referred myself.”
X-rays and other tests revealed she had an arthritic hip that was pretty bad, much to her surprise.
After surgery July 24, Downey was up walking and going up and down stairs the next morning. She didn’t take any painkillers because she didn’t have pain, and she gave up her walker after four days.
Her sister, a recently retired nurse who specialized in working with knee and hip-replacement surgery patients on Oahu, came to stay with her and couldn’t believe it.
“It was my sister’s first time being involved with an anterior hip replacement surgery so she was just as intrigued about it as I was,” Downey said. “She was amazed at how fast the whole recovery was, and how quickly I could do things that a posterior patient would not have been able to do.”
Today, Downey is back to hiking three miles a day with her dog, Lani.
“I have days that are, maybe one on a 1-to-10 pain scale,” she said, but she attributes that more to old age than her new hip. “I forget it’s there. I don’t even think about it because I don’t have the horrible pain that I used to have.”
After 30 years as a history teacher at Honokaa High School, Downey decided to retire last fall due to her hip operation — not because it didn’t go well, but the opposite.
“I was doing well enough to go back but because I have this new hip, I decided I’d rather play,” she said.
Her results are typical. Besides less post-operative pain, shorter hospital stays and faster recoveries, patients who undergo anterior hip replacement surgery have found they have a better range of movement, and there’s a decreased risk of hip dislocation.
Dr. Kaneshige says anyone of any age with severe arthritis or other conditions impacting their quality of life can be a candidate for anterior hip replacement surgery. There are a few exceptions: obese or very muscular people are generally not considered to be good candidates.
Downey couldn’t be more grateful to Dr. Kaneshige for “getting me back out on the mountain.” She’s equally grateful for the level of care she received at NHCH.
“My educator nurse, Toni Kalauli, did a good job preparing me, and Cindy Shiraki, my pre-op nurse was amazing,” Downey said. “They treated me like family.”