Inside The Operating Room For A Total Hip Replacement

April 15, 2015

Stephen Murphy is one hell of a sculptor. His powerful, almost violent strikes are methodical and impossibly precise.

His workspace is his temple, and cleanliness an imperative. Assistants clear his path of debris and clean his tools as he works so as not to slow him down.

Those tools, many of which he designed and built, are themselves a work of art, laid out before him, gleaming and varied. Some as small as a tweezers, others a bit more … well, hefty, like a power saw.

Watching him work, you’re entranced by the intricate choreography of it all — you almost even forget that he’s doing all of this through a six-inch incision in Laurie Thornton’s hip.

Standing inside this New England Baptist Hospital operating room, just feet from Thornton’s left leg, which pokes out from beneath a canopy of thin, blue, paper-like cloth, I keep thinking to myself, “this is a minimally invasive total hip replacement?”

"In learning surgery, traditionally people say that the key to surgery is exposure, exposure, exposure," said the surgeon, Dr. Stephen Murphy, who developed this minimally invasive technique back in the early 2000s. "And that’s true, but I think a new corollary to that is that you should only see exactly what you need to see to accomplish the task."

So where a traditional hip replacement calls for a 12-inch incision along the posterior, the one I watched Dr. Murphy make was just six inches along the top of the hip.

"We can do more accurate surgery in a smaller incision with enhanced technology than you can do through a larger incision without it," he said.

That enhanced technology, developed by Murphy, is on full display on a big screen in the room.

"We take a pre-op CT scan of the patient," said Pete Caraviello, who works for Doctor Murphy, and is my guide here in the OR. "We then plan the surgery virtually in the 3D, so we reconstruct the pelvis and plan where this mechanical smart device will dock to that specific patients pelvis.

That orients Murphy as he works in this smaller space. Then there’s the issue of the soft tissue.

"In terms of cutting structures or tissue, he’s just cut the only thing he will in the whole operation," Caraviello said. "It’s a small piriformis tendon."

That’s a huge contrast to a traditional surgery, where not only would more tissue be cut, but the hip joint would be dislocated, too. The upshot of all this is a speedier recovery, and a shorter hospital stay. Thornton, right now in the midst of surgery, is scheduled to be resting in her own bed — at home — by the end of the night. That’s thanks in part to Murphy’s method, but also a whole host of other factors.

"It’s a preoperative, perioperative and postoperative approach that allows these patients to go home," said Dr. Jay Leiberman, president of the American Association of Hip and Knee Surgeons. "It’s a comprehensive approach to the patient including the anesthetic the pain management, aggressive physical therapy."

When Murphy began pioneering his technique, it was pretty cutting edge. Today, Lieberman says minimally invasive hip replacements have become common in the U.S. But he also points out that every patient is different. And sometimes, traditional methods are still preferred for any number of reasons — from a patient’s physical build to their underlying health at the time of the surgery.

"The most important thing is doing it well," he said. "When done well, in randomized trials, most people are pretty much the same by four to six weeks."

With joint replacements on the rise and patients looking increasingly like Laurie Thornton — under 60, active, and looking to stay that way — those first four to six weeks can be a big deal. So doctors like Murphy, who’s now performed his surgery more than 2,000 times, should expect no trouble finding his next 2,000 patients.

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