From Wheelchair To Walking—

Danbury Orthopedics Pioneers Hip Replacements

By Jeff White

DANBURY — Dr Craig Foster, towering in his white lab coat as he enters a conference room, chose to concentrate on orthopedics because of the immediate, fulfilling rewards of improving a patient’s life in a few hours on the operating table. When he sets out to perform a total hip replacement (THR), he knows there is one thing he can guarantee a patient: the pain will end.

Dr Foster is chief of orthopedics at Danbury Hospital, and a member of Danbury Orthopedic Associates. US News and World Report recently ranked the hospital’s orthopedics department first in Connecticut, ahead of such institutions as Yale and the University of Connecticut. Overall, the department was ranked thirty-fifth in the country.

“It was surprising that we were the second non-teaching hospital ranked,” Dr Foster confides, pleased overall that Danbury outranked many widely recognized teaching centers across the country.

Dr Foster is likewise proud of the staff he has assembled, many of whom arrived in Danbury with fellowships under their belts—an extra year of training where they can focus on a specific area of orthopedics. Currently there are nine doctors on staff at Danbury Orthopedic Associates that can perform a THR, and Dr Foster is one of two doctors on staff who used his fellowship to study the procedure.

It is a procedure that is more common than many people realize. In the United States alone, Dr Foster estimates that in the neighborhood of 80,000 THRs are performed every year; Dr Foster guesses his staff performs between 200 and 225 operations per year.

In a THR, the top of the thighbone is removed and its shaft is made hollow. A metal or plastic prosthesis is then fashioned into the empty shaft while a ball at the top of the prosthesis is fitted into a cup, which is subsequently fitted into the hip socket. Dr Foster assembles a cast of prostheses on the conference table, some dating almost 40 years, in such a way as to suggest an evolution.

Indeed, the operation has come a long way from when it was first developed by a British surgeon named Sir John Charnley in the 1950s.

The Evolution Of The Procedures

The first joint to be replaced in the human body was the hip, and Dr Foster explains that much of what doctors now know about other joint replacements have their genesis in the principals of hip replacement.

When Dr Foster explains the evolution of THRs, the focus rests primarily on the material used in constructing the prosthesis used in the procedure. When Sir Charnley performed the first THR, the prosthesis was made of Teflon, which did not stand the test of time.

Seeing this, Sir Charnley started experimenting with constructing prostheses out of high density polyethylene, seeing that its high molecular weight allowed an inert and longer-lasting fit. Most of these early hip replacements were subsequently cemented into the hip socket and thighbone.

But doctors continued to look for replacements that would wear better over time, that were stronger and smoother, and that were lighter in weight. Many of the prostheses today are made from ceramics, especially the “head,” the ball that is fitted into the hip socket.

The most modern material from which prostheses are made is titanium, which offers superior lightness and strength. Another advance has been the move to non-cemented prostheses, which are fitted into the hip socket in such a way as to promote natural bone growth and attachment to the prosthesis, which theoretically can last forever.

However different the materials with which a hip is replaced are today from forty years ago, little has changed in how doctors diagnose osteoarthritis and move a patient from the initial stages of groin pain through the operation and out to a rejuvenated life.

The Multiple Stages Of THR: From Diagnosis To Recovery

It might surprise some when Dr Foster comments that a THR is absolutely a last resort procedure, when the pain is such that it hinders the enjoyment of life.

“I like to use Pain with a capital ‘P,’ because it is the most important criteria,” says Dr Foster of what he looks for when deciding if a patient needs to undergo a THR.

Typically, the pain starts deep in the groin, a persistent pain that Dr Foster describes as akin to a tooth ache—always there, though varying in intensity. The pain often translates into difficulties walking, climbing stairs, putting on shoes and socks, and overall stiffness.

Usually, sufferers of this arthritis seek therapy first, undergoing various strengthening exercises that might help to ward off the stiffness and pain. Doctors might prescribe non-steroid anti-inflammatories or sufferers might seek recently recommended over-the-counter drugs like glucosamine or chondroitin sulfate.

But usually the pain persists and a THR is the only remaining option. “When they reach that stage [when pain restricts lifestyle], they get a new lease on life,” remarks Dr Foster. “You can virtually guarantee them relief from the pain.”

Once the procedure is completed, the deep toothache pain is gone, says Dr Foster. The patient is left in the hospital for two or three days, after which they move on to a nursing home to undergo therapy twice a day, or home where they train with a visiting nurse.

Patients over the age of 60 are usually fitted with a prosthesis that is cemented into place, allowing weight to be put on the hip as soon as the operation is completed. Patients under the age of 60 are fitted with a press fit (non-cemented) prosthesis, and are forced to stay on crutches for one month, to allow the bone to grow into the prosthesis.

Most people are walking normally within three months, says Dr Foster, and 80 to 90 percent of the rest are walking within 10 months.

Although being recognized as a state and national leader in orthopedic procedures such as THRs is based on myriad criteria, the reality of excellence serves as affirmation for Dr Foster. It reinforces the fact that he and his staff are maintaining a department that has benefited from the improvements in orthopedics and that is looking to the future.

The future for THRs will look to advancing ceramics as the building material for prostheses, says Dr Foster. Moreover, robots will start to become common aides in the operating room, actually doing the work of fitting the prosthesis into femoral bone so precisely that the goals of replacement – stability of hip and matching leg lengths – will become almost guaranteed.

The Norwalk native and Yale graduate smiles when he explains the power of taking a patient’s pain away. “It really is a wonderful operation, to go from a wheelchair to walking,” he says. “It’s very fulfilling.”