New Article Highlights the Value of Anterior Hip Replacement Surgery

Patients have been asking us about an article recently published in Forbes Magazine about hip replacement surgery using the anterior approach.

Chronic hip pain—often caused by a condition such as arthritis or a physiological irregularity—used to mean limited mobility and perhaps the use of a cane, walker or wheelchair later in life. The first modern surgical intervention technique to treat hip joint pain occurred in the early 1960’s, when Sir John Charnley of the Manchester Royal Infirmary, designed a low friction arthroplasty that became the blueprint for modern hip replacement surgery. Charnley’s design allowed surgeons to replace a poorly-functioning human hip joint with a manmade femoral stem, acetabular component and acrylic bone cement. The result is an artificial extension of the patient’s femoral bone that attaches to the hip socket.

Several different surgical techniques have been developed to replace the hip joint with prosthesis. One popular technique, known as the posterior approach, involves making an 8-10 inch incision next to the hip, splitting the gluteus muscle, and cutting muscles connected to the top of the femur. Many surgeons have relied upon this technique as it provides an excellent view of the patient’s hip joint.

A newer technique, the anterior approach, involves making a much smaller incision (generally one to two cuts ranging from 2-5 inches long). Proponents of the anterior approach favor it over other techniques: smaller incisions reduce blood loss, result in less pain, shorter hospital stays and faster healing times as well as NO dislocation precautions. No muscle cutting is required with the anterior approach.

“I started performing anterior hip replacements in 2006,” said Dr. Michael Bollinger, an orthopaedic surgeon at Sebastopol Orthopaedics. “At that time, I wasn’t aware of any other surgeons in Northern California […]

Osteoarthritis: Causes and Treatments

As we age, our bodies may not recover as quickly from strenuous activity or long periods spent sitting or standing in a single position. On those occasions, some people may feel stiffness or discomfort, but it usually passes in time. If you’re feeling chronic pain in your joints, hands, hip, knee, lower back or neck, however, you may be suffering from a condition called osteoarthritis (OA).

Causes and Risk Factors

According to the Arthritis Foundation, osteoarthritis is a disease of the joint, and is the result of a variety of factors – some that can be controlled and some that can’t.

Osteoarthritis generally occurs when there is an absence of cartilage, the important connective tissue that cushions the bones in our joints. When that cushion is removed, bones meet, causing pain, stiffness, swelling and reduced mobility. While it is a rare, some patients’ bodies do not produce an adequate amount of collagen, the protein that creates cartilage. Other patients may have a bone structure that breaks down their cartilage cushion more quickly.

Those factors are generally hereditary and not preventable. Other factors, however, can be managed to help prevent OA from occurring.  For example, being overweight or participating in activities that encourage repetitive movements, can increase a person’s risk of developing osteoarthritis.  The Arthritis Foundation explains:

Weight: Being overweight puts additional pressure on hips and knees. Many years of carrying extra pounds can cause the cartilage that cushions joints to break down faster. Research has shown there is a link between being overweight and having an increased risk of osteoarthritis in the hands. These studies suggest that excess fat tissue produces inflammatory chemicals (cytokines) that can damage the joints.

Injury and overuse: Repetitive movements or injuries to joints (such as a fracture, […]

Using Diet to Reduce Rheumatoid Arthritis Symptoms

In recent years, you may have heard discussions or read articles about “inflammation” in the body and its connection to autoimmune diseases such as rheumatoid arthritis, lupus, multiple sclerosis, and psoriasis. “Inflammation” is a real issue for many of our patients, especially those who suffer from rheumatoid arthritis, a condition we see quite frequently where the patient’s overactive immune system is attacking his or her joints, causing pain. Anti-inflammatory and immune-suppressing medications can and are often used to treat such conditions. However, a patient’s diet can also play a part in reducing inflammation in the body.

A growing number of nutritional and medical experts suggest that a body’s autoimmunity problems are caused by tiny holes in the gut that allow particles of food, bacteria and other substances from inside the intestines to escape into the rest of the body. This is important because a “leaky gut”, and more specifically, an invasion of foreign substances into the body, can trigger the body to respond by producing inflammation – the same process used to fight any other bacterial infection. Over time, that chronic inflammation can cause tissue damage, resulting in an autoimmune disease such as the ones listed above.

Enter the Paleo autoimmune protocol (a stricter version of the more popular Paleo Diet). The Paleo autoimmune protocol seeks to seal the holes in the gut wall by eliminating the foods thought to cause them, namely:

Processed, fried and high fat foods (especially those that contain high amounts of salt, preservatives, additives, or sugar)
Alcohol
Breads & Grains (including whole and heritage grains)
Potatoes
Legumes
Dairy
Eggs
Nightshade vegetables such as tomatoes, eggplant, and peppers
Nuts and seeds
Certain spices such as curries, paprika and chili powder
Refined sugar

Those who follow this protocol typically eliminate the trigger foods mentioned above for […]

Minimally-Invasive Hip Arthroscopy May Be a Good Option For Sonoma County Hip Patients

Many patients may be aware of arthroscopy – or the process of using a camera to see inside of a joint without having to make a large incision – as a good option for repairing knees and shoulders.  What many may not know is that this technique may also be used effectively on hips.

The Procedure

During the arthroscopy procedure, not only can your surgeon look inside your hip joint to see what’s causing problems, he or she may also be able to fix common hip injuries such as labral tears (where a torn fragment of tissue can get pinched between the ball of the hip joint and the socket, causing a lot of pain to the patient).  Surgeons may also be able to fix impingements – a condition that occurs when your hip’s ball (femoral head) and socket (acetabulum) don’t fit well together and cause pain by pinching surrounding soft tissue.  Impingements are fixed by removing bone spurs and/or re-contouring your hip bones to create a more perfect fit between your hip’s ball and socket.

Recovery Time

The incision made during surgery is small.  While experiences vary from patient to patient, recovery after a hip arthroscopy procedure, often involves only 1-2 hours in the recovery room before being discharged home.  Patients will often require assistance at home during the first night and should expect to use crutches or a walker for a period of time after the surgery.  In many cases, your surgeon will also prescribe a physical therapy regimen to help you restore your strength and mobility after surgery.

Dr. Michael Bollinger is an expert in the North Bay on this procedure and one of a limited number of surgeons in Sonoma County to perform it.

“Hip arthroscopy is a […]

Beware of Herbal Supplements if You’re Having Surgery

It’s not unusual to see patients in our practice taking herbal supplements.  We don’t weigh in one way or another on the efficacy of “natural” vitamins and supplements but we do caution our patients who are considering having a surgical procedure done against taking them prior to and after their surgery.

While every patient experience is different, what many may not realize is that these supplements may cause abnormal blood pressure, heart rates, and bleeding.  They may also interfere with other medications, including anesthesia during your surgery.

We generally recommend to our patients that they disclose any “over-the-counter” medication they are taking (including aspirin, herbs, vitamins and dietary supplements) to their physician.  We also ask patients to stop taking them one week prior to surgery to reduce their risk of excessive bleeding, or negative interactions with other medications that we prescribe to treat orthopaedic problems and manage pain.

Not sure if your supplement may be a problem?  Here’s a list of common herbal supplements that we recommend against:

  Dong Quai
  Gingko Biloba
  Ginger
  Ginseng
  White Willow Bark (salix alba)
  Devil’s Claw (harpagophytum procumbens)
  Turmeric (curcuma longa)
  Boswellia (bosellia serrata)
  Stinging Nettle (urtica dioica)
  Cat’s Claw (uncaria tomentosa)
  Quercetin
  Reservatrol
  Cayenne
  Omega-3 FA
  St. John’s Wort

If you’re a patient and have questions about how a supplement you may be taking may interact with your prescribed medication, please contact our office.

Dr. Bollinger Featured In Washington Post Article About Anterior Approach Hip Replacement Surgery

In March, Dr. Michael Bollinger was featured in a Washington Post article* discussing the benefits of the anterior approach method used for replacing hips.  The article mentioned that the number of Americans having total hip replacements over the past two decades has risen to more than 300,000 per year (more than doubling the figures from 20 years ago), and that patients are eventually able to walk again without pain or the aid of a cane, but only after a lengthy, rigorous and sometimes painful recovery and rehabilitation period.

From the article:

The surgery is extensive: As its name suggests, it involves removing the joint — the damaged bone and cartilage — and replacing it with prosthetic parts made of metal, plastic or ceramics. Typically, surgeons enter the joint from the rear, which requires cutting through muscle and cartilage. But with a relatively new procedure, surgeons enter from the front and only stretch the muscles aside, avoiding the cutting and minimizing pain and recovery time. According to those who use this anterior technique, the benefits are substantial.

The article goes on to say:
Anthony Unger, medical director at the Institute of Bone and Joint Health at Sibley Memorial Hospital and a clinical professor of orthopedic surgery at George Washington University Hospital, says the anterior approach is “truly minimally invasive.” Unger, who has done about 4,000 hip replacements over 26 years and has used the anterior technique for the past eight years, says “patients have better overall functionality, can sleep on their sides and be confident the new hip won’t dislocate.”

But, as with many transitions in medical techniques, some surgeons have been reluctant to change. Although agencies and hospitals don’t track hip replacements by the type of procedure used, Unger says […]