- Associated Press - Sunday, May 25, 2014

SIOUX FALLS, S.D. (AP) - Doug Willemssen spent a week in the hospital when a surgeon gave him a new right hip 11 years ago.

He received a new left hip in another surgery earlier this month and went home the next day.

The problem was familiar.

“Arthritis,” he said. “The hip was rubbing bone on bone.”

But the solution was seven times faster.

Willemssen, 65, is a retired phone company worker living in Clear Lake, a community north of Brookings in eastern South Dakota. His experience illustrates how the streamlining of orthopedic surgery and recovery time has become one of the most practical recent changes in medical care.

“For patients to go home the next day used to be unthinkable. Now it’s a pretty common thing,” said Dr. Michael Adler, a surgeon at Orthopedic Institute in Sioux Falls.

Average length of stay for orthopedic surgery has fallen from 3.1 days in 2012 at the Sanford Medical Center in Sioux Falls, where Willemssen had his procedure last week, to 2.4 days today.

At Avera McKennan Hospital, length of stay averaged 5.0 days for a total hip replacement in 2001, an average that fell to 2.9 days last year for hips, knees and other joint replacements.

“Historically, physicians wanted patients to rest. Now, through technological advances, they know it’s safer for patients to be up and moving,” said Nancy Klinkhammer, joint and spine care coordinator at Avera McKennan. “For the patient who lives an active lifestyle, they get out of the hospital more quickly and return to their activities.”

Several factors contribute to a shortened stay, said Adler, who said he does five or six hip procedures a week at Orthopedic Institute.

One is the science. A hip procedure involves replacing natural bone with titanium metal parts at one of the body’s major junctions - where the legs attach to the pelvis and upper body. The surgeon removes the natural hip socket and replaces it with a titanium cup that sits like half an orange peel next to the pelvis. The surgeon also inserts a metal stem, which has a ball on top to fit into the metal cup, providing a bridge between leg and pelvis. The stem also has a shaft to be driven downward into the remaining bone in the leg.

The metal parts have a rough surface to create friction that assists bonding. The metal also has tiny perforations, allowing the remaining bone to grow through the holes and interlock with the metal.

“The body thinks it’s a broken bone and heals over the metal,” Adler said.

That technique has been around for years, but the engineering has been fine-tuned.

Surgeons also have shifted strategy. They make an anterior entry to cut into the front of the hip instead of the back. They push the hip muscle aside rather than cut through it, then reposition the muscle after inserting the metal. Sparing the muscle reduces the pain, damage and recovery time.

“We’re definitely more aggressive to get people moving around faster,” Adler said. “Part of that is better technology. Part of that is we don’t cut the muscles. Part of it is … we know it’s important to get patients moving quicker.”

Spencer Zielenski, 66, had the same favorable outcome with knee surgery at Avera McKennan. He was wounded as a Marine in the Vietnam War when enemy gunfire tore up his left leg.

“In combat, I was hit by the North Vietnamese regular army, May 20, 1969, a full automatic burst,” he said.

His left leg was shattered and treated medically, though not with modern therapy. He spent the next 45 years compensating for his wounds by putting too much weight on his right leg, requiring, finally, a right knee replacement in early April.

“I couldn’t walk a half block without being in tremendous pain,” he said.

He went in for surgery on a Monday and was out by Wednesday. He now works with an Avera therapist three times a week and goes in for water therapy two more days each week.

“I’m doing fantastic,” he recently said.

Willemssen has three sessions a week with Casey Meier, a physical therapist at Sanford’s hospital and clinic in Clear Lake. She leads him through the paces to flex, contract and relax the ankle, knee and hip as part of proper stretching and rebuilding his leg.

She credits advances in surgery for faster recovery and said patients have much to do with their own swift progress. A person who stays healthy always is in better position to recover from surgery, she said.

“It really depends on the patient, and on the physician, as long as there aren’t other complicating factors,” Meier said.

“How he was doing before surgery I think is going to have a lot to do with how he comes out of surgery.”

Willemssen was persistent. He went in on a Monday for his operation that afternoon. About noon Tuesday, he was speaking with his surgeon at Sanford, Dr. Jason Hurd.

“‘I think I’m going home today,’” Willemssen said he told Hurd. “He said, ‘You really want to get out of here. I think I could arrange that.’ They let me out.”

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Information from: Argus Leader, http://www.argusleader.com

Copyright © 2016 The Washington Times, LLC.

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