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Surgical Hip Procedures

Northern (MIS) Approach for Total Hip Replacement

Features:

  1. Hip Replacement Surgery | Manhattan | New York City (NYC)Incision is above the tip of the hip.
  2. Complete preservation of the posterior muscles of the hip.
  3. No disruption of the anterior capsule and muscles of he hip.
  4. Piriformis Release Only (PRO) technique.
  5. No need for a special table.
  6. Combines the pioneering advances of the Path® technique for the socket and Supercap® technique for the femur.
  7. No dislocation technique. The femur is prepared in a natural state. This greatly reduces the risk of a spiral fracture of the bone from torque and dislocation.
  8. Potential decrease in swelling and risk of venous thrombosis. The avoidance of dislocation and compression of the femoral vessel should help reduce vascular related complications.
  9. The technique is a generic adaptation of the principles of the SuperPATH™ surgical technique.

Advantages:

  1. Faster recovery by virtue of preservation of the key anterior and posterior structures, and decreased swelling of the thigh and leg.
  2. Greater flexibility because of rapid and aggressive physiotherapy with minimal hip precautions.
  3. Functional return: cane by 2 weeks, no assist device typically by 3 weeks.
  4. Decreased risk of transfusion by avoidance of dissection of the vascular posterior and anterior elements.
  5. Decreased risk of excessive lengthening. The in-situ (no dislocation) technique leaves all hip restraints in place. This prevents inadvertent gross lengthening, a common risk in traditional approaches.

Added Risks:

  1. None. The northern approach can effortlessly be converted to a traditional posterior approach with no penalty. This is in contrast with the anterior approach, which in case of trouble requires closure, repositioning and re-operation through a separate posterior approach.

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Robotics: Makoplasty Hip Replacement

Hip Replacement Surgery | Manhattan | New York City (NYC)
This technique is a further refinement of computer-assisted surgery. In addition to visual feedback as in a GPS navigation system, the pioneering science of haptics allows for direct robotic instrumentation by means of a mechanical arm, handled by the surgeon and based on a virtual model created by a preliminary CAT scan of the knee. A virtual firewall or electronic fence boundary ensures both accuracy and safety. Mako Corp. has developed this application for hip surgery. The superior accuracy of the instrumentation afforded by this technique is very promising and should yield improved function, durability and a decreased in the risk of instability or leg length discrepancy.

Hip Implant Salvage Surgery

For multiple reasons hip implants can fail. Some failures are the product of prolonged use with mechanical breakdown of the more fragile elements such as the polyethylene plastic liner, which substitutes for the cushioning of natural cartilage, while some other failures are the product of instability or infection. It is important for patients with hip replacements to visit their surgeon on a regular interval even if fully functional and without symptoms. The process of degradation is often silent and insidious. When caught in time by radiographs, the damage can be prevented by a simple intervention, whereby the plastic line and modular bearings can be replaced without sacrificing the key ingrown hardware. Cases that would traditionally require a full revision with dismantling of the hard metallic components from the bone, with commensurate risk of fracture and damage, can then be successfully revised with preservation of the implant and recalibration of the soft tissue envelope. This naturally provides a much shorter and less painful recovery.

Revision Hip Replacement Surgery

Total hip replacement is successful in over 95% of well-selected patients. On average, replacements last 15-20 years. With the advent of improved wear properties of modern materials it is anticipated that many if not most patients will enjoy full use of their prosthesis for years longer. Occasionally however, an implanted prosthesis does not function as well as anticipated. This can be traced back to older materials, trauma, or unforeseeable infection. In such cases revision surgery may be performed to adjust or replace the implant. Dr. Meere specializes in such cases, which can be quite complex, involving removal of failed or infected implants, cleansing of the joint and reconstruction with more elaborate implant designs.

Click here to link to the educational material on Joint Revision Surgery provided by the American Academy of Orthopaedic Surgeons

Complex Hip / Leg Deformity Surgery

Complex deformities are typically referred to tertiary university centers. Over the last twenty years Dr. Meere and other seasoned colleagues in pediatric and plastic reconstructive surgery have had the opportunity of handling these very difficult, yet so rewarding cases. Typical examples include pediatric deformities and their adult consequences, severe bone destruction though osteomyelitis infections, and traumatic injuries.

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