Father-son orthopedic team gets leg up on hip replacement with special table
Published: Friday, January 18, 2013 at 7:30 p.m.
Last Modified: Friday, January 18, 2013 at 7:30 p.m.
Imagine a scuffed-up billiard ball.
Dr. William Petty, an orthopedic surgeon, holds up the arthritic ball of a hip joint, pointing out the rough patches where the osteophytes, commonly known as "bone spurs," have formed over what was once white, glistening cartilage.
The patchiness represents the body's ill-fated attempt to heal itself. But the reality is bone-on-bone inflammation.
"You can imagine how painful that would be," said Petty, who assists his son, Dr. Mark Petty, also an orthopedic surgeon, with anterior hip replacement surgery.
The procedure isn't new, but certain tools — namely a "table" that patients lie on, their legs resting on what looks like sophisticated stilts that move up and down and sideways — have emerged in the past few years to facilitate it. The table helps surgeons make smaller and more precise incisions and cut less leg muscle as they remove and replace patients' hip joints.
The Pettys are a rare father-son team of experts who have honed the art of operating with the table. Mark Petty works at the Orthopedic Institute at North Florida Regional Medical Center, and his father is CEO of the Gainesville-based company Exactech, which makes implant devices and surgical instruments. Forbes Magazine named it one of the 200 best small companies.
William Petty helps his son out once a week with surgery at NFRMC.
"Mark and I have always gotten along," William Petty said.
"Our roles are reversed," said his son, adding that, in part, he learned the trade from his father, as a medical student at the University of Florida when his father was chair of the orthopedic surgery department there.
"Now I have the best assistant in the world," Mark Petty said.
The art of orthopedic surgery
Orthopedic surgery is an art as much as a science.
The drilling, pounding and use of tools that look like the hammer resemble carpentry — of a very high order. "Orthopedic surgeons have the reputation for being big, burly guys, but I don't think that's necessary," said Mark Petty. Both he and his father are lithe runners.
"You do have to understand angles and mechanics, and you have to be handy and good with your hands," Mark Petty said. "We put together a bed when I was in college."
That was in a pre-IKEA era, when they actually bought and cut their own wood.
"I think most surgeons enjoy surgery," William Petty said. "It's not enjoying like watching your football team win. It's much more in the satisfaction that you are using your skills to help people."
For Buddy Crevasse, that help was an imminent need. The 67-year-old from Gainesville had such severe pain in his left hip that he no longer could go for long walks, go fishing, or even put on his own socks without his wife's help.
Crevasse has arthritis, and it runs in his family — his father had both of his hips replaced, and Crevasse would have a similar fate. Eleven years ago, he had his right hip replaced.
"I worked for the Alachua County Sheriff's Office for 37 years, and (the bad hip) put a crimp in my style," Crevasse said. The doctors told him then that it was only a matter of time before his left hip started hurting too.
"They told me ‘You'll know when it's ready,' " explaining that Crevasse would feel bone on bone.
That's exactly what happened, and it was Crevasse's arthritic ball from his left hip joint that William Petty held in his hands after helping to remove it last week.
Later, Petty got ready to implant the replacement steel socket, explaining that it is covered with a fibrous texture into which the bones grow.
During the procedure, surgical technicians manipulated the table so the Pettys could access Crevasse's hip joint more easily without cutting into leg muscle. This approach, they say, usually minimizes patients' post-operative pain and quickens the rehabilitation process.
"I've had several people feel like they get better faster, and they tend to be happier with their result," Mark Petty said.
"It's not as bad as I remember it being last time," Crevasse said. He spent two days in the hospital after surgery instead of five after his first hip replacement. He said his post-operative therapy is less painful this time, too. He said he expects to spend a few weeks on crutches or a walker.
A surgery in high demand
Crevasse is emblematic of a rising demand in orthopedic surgery. Hip replacements are on the rise as people live longer and want to live better, too.
"People are demanding more function out of their joints," Mark Petty said.
According to the Organization for Economic Cooperation and Development, hip replacements in the U.S. have doubled since 2000. They are expected to increase 174 percent over the next 20 years, while knee replacements will surge 673 percent, according to the American Academy of Orthopedic Surgeons. The procedure costs about $35,000 without insurance, according to AAOS.
The table the Pettys use is called a Hana Table, manufactured by the Japanese company Mizuho Osi, but there are several manufacturers of the tables. Many experts have said that using one lowers the risk of dislocation, which William Petty said is already quite low, happening after 1 to 2 percent of hip replacement procedures.
One complication of the procedure is sometimes increased bleeding, but both Pettys said this is more of a "learning curve" issue that can be overcome with more training. Not all orthopedic residency programs teach the anterior hip replacement procedure using the tables.
Nor do all surgeons think it is the best approach to hip replacements.
"I think there are many surgeons who are still very satisfied with results they get with other approaches," William Petty said, referring namely to the posterior approach that has dominated the field. "I think it's unusual for any approach to become gold standard."
Dr. Hari Parvataneni, the division chief of adult arthroplasty and joint reconstruction at UF, said he doesn't do as many anterior hip replacements using the table as he did when the technique first emerged.
"What the literature has found is that the recovery is not as dramatic as expected," Parvataneni said. "Pain relief, discharge time and the time for getting off a walker or cane was pretty much the same."
Parvataneni said whatever type of procedure is used, though, hip replacements remain one of the most successful procedures in medicine.
"Hip replacement is the most cost-effective, durable procedure that provides pain relief, and lasts long," he said.
William Petty agreed. "Hip and knee replacements are so successful because of what they do for people ... they are able to do what they were doing before."
Contact Kristine Crane at 338-3119, or firstname.lastname@example.org.