Innovative hip replacement surgery helps Wilmington ‘institution’ get back to his life

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Dr. Henry Hawthrone

WILMINGTON – “I was bone on bone,” said Dr. Henry Hawthorne, “There was no cartilage left at all.”

At 76, Hawthorne was quite active, enjoying fishing and golfing, but the deteriorated cartilage in his hips were making everything from sitting in his car to playing golf painful. Hawthorne, who was a pediatrician in Wilmington for many years, still provides pro-bono service to the community. But that was getting more difficult as his joints deteriorated. “I was mobile,” said Hawthorne, “but it was a very limited mobility. I could walk but there was definite discomfort and pain.”

Hawthorne had tried steroid injections, which he said brought him limited relief for three to six months, but ultimately knew he would have to replace the joints. Hawthorne planned the surgeries for the summer months, but it was a considerable undertaking. “One hip replacement is a big operation,” said Dr. John Liguori, medical director of the New Hanover Regional Medical Center Rehabilitation Hospital. “Two hips is a huge operation.”

Approximately 2.5 million people have the surgery every year, according to the Journal of Bone and Joint Surgery, but recovery can be painful and take time. Many people put off the surgery, relying on steroid treatments or simply trying to cope with the pain.

“This is not something you would put yourself through prophylactically,” said Hawthorne. “It’s not like a woman with a family history of breast cancer opting for a radical mastectomy. If your father had osteoarthritis and his hips replaced, you wouldn’t automatically go ahead and get this done.”

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Hawthrone with Dr. Frueh.

Hawthorne had committed himself to the replacement surgeries, but he also knew he wanted a specific type of surgery, called the direct anterior approach. Dr. Walter Frueh specializes in this procedure, performing these joint-replacement surgeries at the NHRMC Orthopedic Hospital (you can watch an animated overview of the procedure at Dr. Frueh’s practice.)

“It’s a newer, innovative approach to hip replacement,” said Dr. Frueh. “It’s much less invasive – and less traumatic – to the surrounding tissues. The reason it’s different is that the major incisions are between muscle groups.”

Dr. Frueh, who has been practicing since 2005, began offering the procedure to his patients in 2010. “That’s when the safety data came out, from the institute where I studied,” Dr. Frueh said, referring to an article in the Journal of Arthroplasty. The article showed those who underwent the anterior procedure “demonstrated significantly better improvement in both the mental and physical health dimensions.”

The procedure relies on an incision along the front of the leg and moving muscles away instead of cutting through them. The procedure is less traumatic and it also allows recovering patients to sit comfortably without resting their weight on the incision site of a traditional posterior surgery. Dr. Frueh told Port City Daily he has performed about 2,500 anterior surgeries, about 450 a year.

Dr. Frueh told Port City Daily he was happy to have the opportunity to help Hawthorne. “He’s not just a Wilmingtonian, he’s an institution. He’s probably treated half of the town as a pediatrician. And, though he never tells people about this, he still does a lot of pro-bono work. He’s really great.”

Hawthorne’s surgery and recover were both dramatically quicker than expected.

“I went in at 5:30 a.m. and I was in surgery by 7:30, 7:45 a.m.,” said Hawthorne. “They gave me a spinal anesthetic and then I was out of surgery by 10. By lunchtime I was eating and drinking, and then up and moving around a few hours later. I was home by 4 p.m.”

Hawthorne and Dr. Frueh credit this in part to Hawthorne’s pre-surgical preparation.

“I pre-worked out,” said Hawthorne. “I was in good shape and I wasn’t overweight. But I was exercising more ahead of the surgery. And that really reduced my physical therapy. I was released about two weeks ahead of time.”

Dr. Frueh added, “he may be 76, physically, but mentally he’s about 34.

Still, the overwhelming decrease in rehabilitation time – when compared with traditional hip replacement – are largely due to the surgery’s dramatic reduction of soft-tissue trauma. Hawthorne, who had no questions about choosing the anterior approach for his surgeries, says the people he knows who have also had the anterior surgery are “pretty good to go after two weeks.”

The cost of Hawthorne’s surgery was covered by Medicare and supplemental insurance. However, it is worth noting that while the cost of anterior surgery is not significantly different than other hip replacement surgeries, the decreased rehabilitation time can drastically reduce the overall cost of the procedure.

As for Hawthorne’s recovery, he is quite pleased with his own results. “My golf game is a lot better now,” he said.