BLOOMINGTON - A hip replacement surgery now available in Bloomington is resulting in quicker recovery for patients, according to surgeons and nurses.

What makes the anterior hip replacement even more noteworthy is that the surgery may benefit the majority of patients who need hip replacement, said the surgeon who performs the technique. About 250 total hip replacement surgeries are performed each year in Bloomington-Normal. In addition, a few area residents have gone elsewhere for the procedure.

"The anterior approach is applicable to 90 percent of the patients, who then experience a quicker recovery," said Dr. David Dodgin, the orthopedic surgeon who performs anterior hip replacements at OSF St. Joseph Medical Center in Bloomington.

"It's really an approach that's meant for everyone," he said. Exceptions would be some people with significant congenital (birth) deformities and people who are morbidly obese.

Since his arrival in Bloomington-Normal last fall, Dodgin - who also performs other orthopedic surgery and joint preservation work - has performed 13 of the procedures. He hopes the procedure will mean fewer patients leaving Bloomington-Normal for hip replacement.

He is performing the procedure at St. Joseph because that hospital purchased an orthopedic pelvic fracture table specifically designed for patients undergoing anterior hip replacement surgeries. The surgical table cost $80,000 to $90,000, he said.

"The recovery is amazingly different (from traditional hip replacement surgeries)," said Jan Weaver, a registered nurse and St. Joseph's clinical manager of surgery.

"The patients are up and walking around and ready to go home the next day," Weaver said. "It's just unbelievable."

Even some other orthopedic surgeons are impressed. Dr. Lawrence Li, who is among Dodgin's colleagues at Orthopedic & Sports Medicine Center in Normal and Pontiac, is not performing anterior hip replacements because he's busy with other orthopedic surgeries.

"But I would love to learn," Li said. "The procedure performed this way results in a much faster recovery for the patient - getting up and walking around earlier, less pain, more stability and fewer restrictions on the patient's movement."

Ninety-five percent of patients have restrictions following hip replacement - such as not being able to cross their legs or sit in a low chair for six to 12 months.

"With this approach, they don't have these restrictions," Li said.

Dodgin, a Los Angeles native, graduated from medical school in California and did his orthopedic residency at Rush University Medical Center in Chicago.

Dodgin was bothered by patients' long recovery after hip replacement. For weeks after traditional surgery, patients must limit flexing of the hip more than 90 degrees, which makes it difficult to sit in a chair, on a toilet seat, put on shoes and socks and get in and out of a car.

In addition, many patients following hip replacement must be discharged to a nursing home for additional therapy prior to being allowed to return home, he said.

Even the minimally invasive hip replacement surgery that has become available in the past few years has its limitations. That procedure involves two small incisions - one on the front of the hip and one on the buttock - rather than one long incision on the side. But it is specifically for younger patients who are willing to work hard at rehabilitation, meaning fewer than one in four hip replacement surgery candidates.

"Everything was less than perfect. I was searching for the ultimate hip replacement procedure," he explained in an operating room at St. Joseph recently.

He knew about anterior hip replacement, and in 2003, he was trained in the procedure by Dr. Joel Matta, the orthopedic surgeon in Los Angeles who brought the procedure to the United States from Europe in 1996. Matta had advanced the technique by helping to design the special surgical table.

In 2004, Dodgin set up the anterior hip replacement program at John Muir Medical Center east of San Francisco.

"In three years, I did 600 (hip replacement) cases and 95 percent of them were this (the anterior approach)," he said. Only 10 percent of those patients were discharged to nursing homes, compared to half of the patients after traditional hip replacement, he said.

Last fall, he and his wife relocated to Bloomington-Normal.

"We are here for family reasons," he said. He and his wife have two boys, ages 7 and 6, and want to raise them in a family-oriented community, he said.

Dodgin has trained seven other orthopedic surgeons in Illinois to perform anterior hip replacement. Among them is Dr. Chip Rowe at Gibson Area Hospital in Gibson City.

Anterior hip replacement allows the surgeon to reach the hip joint from the front of the hip rather than the side or the back, according to the Dodgin and the Web site, www.newhipnews.com. Patients are placed on their back rather than side, as with traditional hip replacement.

The patient is placed on the special surgical table, which has a hydraulic lift, allowing Dodgin to lift the patient to a level where it's more comfortable for him to work. The table also allows him to adjust the height and rotation of patient's legs, allowing him better access to the front of the hip.

Dodgin makes a four- to six-inch incision, depending on the size of the patient. He goes between muscles rather than cutting muscles from the pelvis and femur, which allows the patient to maintain stability and strength, decreasing pain and hastening recovery.

A broach - the tool used to shape the cavity of the femur to accept the implant - was redesigned for anterior hip replacement, Dodgin said. The new broach is curved, allowing easier access to the femur.

A computer navigation system allows Dodgin to use a computer to measure angles and leg lengths.

"The computer knows where the femur and other things are in 3-D space," Dodgin said.

The average time of the procedure isn't that much less than traditional hip replacement - 70 minutes versus 90 minutes - nor is the average hospital stay - 2½ days versus three days, Dodgin said.

But more patients go home immediately rather than having a stay in a nursing home. When patients can resume their normal activities varies - but it's within weeks rather than months, he said.

---

'This surgery is just incredible'

By Paul Swiech | pswiech@pantagraph.com

BLOOMINGTON - David Hoeper is an upbeat person who has faced several medical trials in the past few years. But he believes his pain has been with a purpose.

"I'm still here for some reason," Hoeper, 60, of Hudson, said with a smile. "I call 'em grace days."

Hoeper, a Christian, believes one of his roles now is to inform people about the anterior hip replacement surgery now available in Bloomington.

Hoeper, vice president of ancillary services for Heritage Operations Groups in Bloomington, had the new type of hip replacement surgery performed by Dr. David Dodgin at OSF St. Joseph Medical Center on March 31. He stood at bedside that evening, stopped using a cane two weeks later, returned to work a month later and has resumed playing golf and reasonable activity.

He walked around his office for a reporter and photographer July 7 and his gait gave no indication of a total hip replacement three months before.

"This surgery is just incredible," he said. "It's another example of the evolution of medicine and science."

Hoeper is a licensed physical therapist who was director of therapy for Heritage Enterprises before being promoted to oversee all Heritage ancillary services, including rehabilitation services, pharmacy, lab, X-ray and respiratory services.

He and his wife, Carla, have been married for 36 years and have three grown children. He is an active member of Christ Church in Normal.

Hoeper has been physically active his entire life; he was a runner for years. His medical trials began in 1997 when doctors discovered that he had an acoustic neuroma - a tumor growing on the acoustic or hearing nerve. The tumor was removed.

In 2002, he was diagnosed with Burkitt's lymphoma, a cancer of the lymph tissue. He spent six weeks in the hospital and underwent chemotherapy.

In 2006, he contracted spinal meningitis, an inflammation of the membranes enclosing the brain and spinal cord. While searching for the cause of the inflammation, doctors discovered a cerebral spinal fluid leak related to the 1997 surgery when his skull was opened and closed.

The leak was closed early in 2007. A year later, he developed pain in his right hip.

Hoeper had developed avascular necrosis of his right femur head. Avascular necrosis is a disease resulting from the loss of blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse, as well as nearby joint surface. The disease is common in the femur, the bone extending from the knee joint to the hip joint, according to the Medical College of Wisconsin.

The avascular necrosis apparently developed from the high doses of steroids Hoeper was given in his chemotherapy in 2002, he said.

"Dave is a typical guy who faced an unfortunate set of events," Dodgin said. The medication caused his avascular necrosis, the surgeon said.

"Exercise and medicine couldn't make it better," Dodgin said.

Knowing he needed hip replacement surgery eventually, Hoeper elected to move sooner rather than later. His wife, a home health therapist, had heard of Dodgin and they met with the surgeon. He answered Hoeper's questions and all three concluded the new hip replacement surgery would be good for him.

The surgery was March 31. Hoeper stood at bedside that night and was home two days later. After two weeks, he stopped using a cane. He would have returned to work then, but he got sick, which delayed his return to work by about a month.

He's back at work full-time, has returned to mowing the lawn and is back to reasonable activity, he said. He plays nine holes of golf and will be back to 18 holes soon. His running days are over but he plans to bike and swim.

"There must be a reason for this."