Alon Antebi, D.O., orthopaedic surgeon, is now offering the latest technique in hip surgery, exclusively at Antelope Valley Hospital (AVH).

The new procedure - called the anterior (front) approach hip replacement surgery -allows the surgeon to access the hip joint from the front of the hip, where there is a more direct approach and less muscle and tendon to dissect through.

"In order to get access to the hip joint to insert the prosthesis, a highly specialized operating table only available at AV Hospital is required," Antebi said. "This specialized Mizuho OSI HANA™ table allows me to raise and lower the operative leg while the patient is lying flat on their back."

For the anterior approach surgery, both legs are put into stirrups on the HANA table's two long "arms." A specially-trained nurse moves the operative leg into the correct position to provide the best exposure for the surgeon while he inserts the femoral and acetabular prosthesis. After placing the prosthesis, the surgeon then checks the leg lengths to ensure they are even.

With its unique capability to position the leg, the HANA table enables the surgeon to replace the hip through a single and truly minimally-invasive 4" incision without detaching muscles or tendons from the pelvis or femur.

The table allows hyperextension, adduction and external rotation of the hip for femoral component placement - a positioning option not possible with conventional tables.

The lack of disturbance to the lateral and posterior soft tissue provides immediate stability of the hip after surgery and minimizes the risks of post-operative dislocations and pain.

By performing the surgery from the front of the body, the hip can be replaced without detachment of muscle during surgery. The surgeon can simply work through the natural interval between the muscles - "spreading muscle, not cutting it." Dr Antebi explained that the most important muscles for hip function are the gluteal muscles (gluteus maximus, medius, and minimus) which attach to the pelvis and femur and are left undisturbed, therefore leading to a faster and less painful recovery.

"Minimally-invasive" surgery is a relative term. The typical posterior approach may be performed through a small incision, however underneath this incision is where the majority of the hip stabilizer muscles are detached resulting in more pain and longer recovery.

In addition, the cup portion of the hip replacement is more difficult to position correctly increasing the chances for hip dislocation.

Dr. Antebi explained another benefit of doing this surgery at AV Hospital is that he can use fluoroscopy (live X-ray) during the surgery to help identify the precise positioning of the prosthesis and to help determine if any adjustments need to be made during the surgery.

"By using the real-time x-rays, I can put the prosthesis in position and make sure that everything is positioned perfectly before I close the wound," he said.

Typically, traditional hip replacements are done with patients lying on their side for surgeons to access the gluteal muscles. Spot x-rays are done during surgery, but because of the position of the patient, they are less reliable. It is not until the patient is in the recovery room and positioned on their back that the surgeon can get true hip x-rays to analyze if everything lines up correctly.

However, if anything is not correct, the patient would need to return to the operating room to correct the problem. With the new anterior approach hip replacement, the patient is lying on their back the whole time in surgery.

This positioning enables the surgeon to use fluoroscopy (real time x-ray), allowing for optimal visualization of implant placement before the patient leaves the operating room and goes to recovery.

"The CEO was very enthusiastic when I explained to him that I wanted to offer this innovative approach in hip replacement surgery at AV Hospital," said Dr, Antebi.

In addition, specialized equipment including the table necessary to perform the surgery was purchased as well as training staff members. With Antebi performing this innovative hip replacement surgery, AV Hospital is the only hospital in northern Los Angeles County that is able to offer this surgery for its patients.

"We want to provide our Antelope Valley patients with the latest orthopaedic procedures so that they don't have to travel to Los Angeles for their orthopaedic care. Surgery, recovery and therapy can all be provided right here at home," said Edward Mirzabegian, AVH Chief Executive Officer. "When Dr. Antebi came to me requesting this table and showed me all of the benefits that it had for the patient, it was clear that it was a good investment in our future and for our patients.

"We are working toward becoming an orthopedic center of excellence," said Mirzabegian. "By encouraging our physicians to learn and perform the latest techniques in orthopedic surgery, we'll create a destination healthcare facility for our patients in the area, as well as other communities."

One other very important advantage of the anterior hip replacement approach is the recovery time is typically cut in half and the pain is significantly less.

Patients are usually up and walking before they leave the hospital, as opposed to using a walker for six-twelve weeks after a posterior hip-replacement surgery.

"My patients are up and walking the same day of surgery, hospital stay is two to three days rather than the usual five to six days, and patients use less pain medication allowing them to return to their daily activities much faster," said Antebi. "It is truly a thrill to see my patients walk into my office a few days after surgery for their first post-operative checkup. That makes the additional training necessary for this surgery all worth it!"

For more information about this innovative, anterior hip replacement surgery, please call Dr. Antebi at Antelope Valley Orthopaedic and Rehab Specialists (A.V.O.R.S.) - 661-726-5005 or visit http://www.myorthorehab.com/