Steven Barnett, MD, an Orthopedic Surgeon at Hoag Orthopedic Institute explains how the OPS works.
Interview conducted by Ivanhoe Broadcast News in April 2018.
Let’s talk a little bit about this laser assisted hip replacement surgery, what makes this one different than the standard hip replacement surgery?
Dr. Barnett: The technology that we’re using is called the Optimized Positioning System. And we know that when we do hip replacements it’s imperative that we get the socket and the femoral ball lined up correctly. And this system allows us to use a patient’s specific guide that’s manufactured prior to surgery that we use intraoperative to help us position the acetabulum component, which is the socket.
How does it work, how is it patient specific?
Dr. Barnett: We know now that in certain patients who have hip arthritis they also have corresponding arthritis in their lower back. And this can alter how their pelvis moves from going from a seated position up to an upright position. It can impact how the two prosthetic implants articulate with each other. What we do is we identify a patient that we want to use this technology on and then we get preoperative imaging, some plain radiography from them sitting, standing and lying supine and identify how their pelvis moves relative to these positions. And then with the use of a CT scan of their pelvis we can create this patient specific block that exactly matches the bony morphology of their pelvis.
All these images are used to actually create the hip and socket itself, is that right?
Dr. Barnett: They don’t create the actual implant, all it does is create a mockup of the patient’s pelvis with a special guide based on the angles that we want to put that implant in, in surgery based on the angles that we identify preoperatively of where the component should be.
How much of an improvement do you think this is for outcomes for the patient?
Dr. Barnett: I think it can impact not only whether or not the hip is unstable but also maximize the wear characteristics of the implant which will impact the longevity in years.
So it lasts longer basically?
Dr. Barnett: Potentially.
Who is it for, it sounds like what you’re saying it’s not for everybody.
Dr. Barnett: Surgeons can use this for every single patient. In my practice I kind of reserve it for those patients that either have some altered spinal deformity such as the patient that we’re doing today. Or patients that have significant lumbar spine degenerative disc disease which will impact how the pelvis and the spine move with respect to each other.
Is there anybody who it wouldn’t be for?
Dr. Barnett: Not really, you could use this for any patient as long as you can obtain those preoperative imaging studies.
Once in the OR, do you actually have a screen that you are working off of?
Dr. Barnett: The way this works in the OR is we have this plastic patient specific guide block that we actually put in to the socket once we’ve exposed the hip. And then attached to that is a special laser pointer so that we mark either on the wall or with the marker where the guide block is oriented. And then when we put the implant in we just match up our laser point so that we know that we’ve recreated the exact angles that we planned for preoperatively.
You use the lasers in there too obviously?
Dr. Barnett: Yeah.
Does it add any extra time?
Dr. Barnett: It does add extra time throughout the whole episode of care. The patient has to get preoperative imaging which is different than what we do for a non OPS case. And I think intraoperatively it maybe adds three or four minutes so not anything that’s significant.
For Barbara, she was talking about pretty significant pain that’s limiting her day to day activity, what can she expect after the surgery?
Dr. Barnett: Hip replacements are one of the most successful medical interventions that we can do. And these patients recover very quickly. Her arthritic pain will be gone this afternoon once the surgery is over and she’ll be up walking. We send patients home on the day of surgery if not the following day. And their pain relief is marked very early after surgery.
Lots of people put off surgery like this thinking I only want to do it once in my life, it’s going to lay me up for a long time. What would you tell them now with this new technology?
Dr. Barnett: The new technology helps me as a surgeon with component placement but hip replacement in general what I tell all my patients is, is when your hip pain is impacting your quality of life that is the time to do the surgery. And like we just discussed it can be markedly life changing for these people when it comes to pain relief and activity related pain.
What haven’t I asked you about this specific technology that you think I should include in this story?
Dr. Barnett: I think you got it.
It’s only forty five minutes compared to when you were doing this twenty years ago? The surgery itself.
Dr. Barnett: Yeah, so one of the big changes in joint replacement here in two thousand eighteen is our rapid recovery protocols like we touched on. These patients often times will go home the day of surgery which is significantly different from even ten years ago when patients used to stay you know three or four days in the hospital. And it’s not just the technology and the technique with the surgery but it’s what’s changed with anesthesia, you know all taken together it just has allowed us to mobilize these patients very quickly.
Three unrelated questions
What are some things that people should do to prepare for a surgery like this if anything?
Dr. Barnett: I think the most important thing is we want to make sure the patient is in maximum health leading up to surgery. Balanced diet, it’s not a time to be on a strict diet. Trying to lose weight before one of these surgeries because we rely on patient’s overall medical status to heal. And we don’t typically send patients to organized therapy but we do provide them with instruction on stretching and strengthening exercises for the lower extremities that they can do leading up to surgery which will help expedite their recovery.
Is there some of the after too like PT?
Dr. Barnett: PT is a very important component of the success of this. The patients start physical therapy on the day of surgery and they’re up walking immediately.
Are there questions that patients should ask or consider before getting their hip replaced?
Dr. Barnett: Well I think the main questions to ask and what we all need to remember is that joint replacement surgery although very successful is really a last resort in the whole spectrum of treatment of osteoarthritis. A main question that patients should ask their surgeon is, what are my options for treatment realizing that surgery may be an option. But there is a lot of other nonsurgical treatments that can put off surgery for periods of time for these patients.
After surgery are there things people can do to make recovery quicker and easier?
Dr. Barnett: Just follow the advice of the physical therapy that they’re getting.
Barbara mentioned her spine and they thought that maybe the spine was related to her hip, do you have anything to say about that?
Dr. Barnett: We touched on many of these hip arthritis patients also have corresponding lumbar spine disease. As the hip gets stiff with the arthritic process it transmits more of your mechanics with locking and that load to your lumbar spine. It can flair up pain in the lumbar spine. We will see patients that have both of these processes going on. Typically we’ll do the hip replacement before any work on the back just because it’s very predictable. And a lot of these patients will get some relief of their back pain just by fixing the hip and getting their walking mechanics closer to normal which takes some of the load off the lumbar spine.
END OF INTERVIEW
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