Minimally Invasive Hip Replacements Are Just the Latest
Innovation in Orthopaedic Surgery at UAMS
Minimally Invasive Hip Replacements Are Just the Latest Innovation in Orthopaedic Surgery at UAMS
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 LITTLE ROCK – His courtly respect for his patients and his reputation for hip replacements that leave patients pain-free and walking unassisted in a short time make Carl L. Nelson, M.D., of the University of Arkansas for Medical Sciences (UAMS) popular among Arkansans with arthritis. But many of his patients don’t realize that Dr. Nelson, chairman of the Department of Orthopaedic Surgery in the UAMS College of Medicine, also is widely admired by his peers in and outside the United States for three decades of steady innovations in orthopaedic surgery, including minimally invasive hip and knee replacements. Minimally invasive surgery, the newest improvement in hip replacements, involves one or two very small incisions rather than the 10-inch to 12-inch incision of traditional surgery. Surgeons are able to cut less muscle, tendon, and ligament to gain access to the hip. They use smaller instruments to operate and x-rays to see areas that are not visible because of the smaller openings. This approach, in use for only a short time, has a cosmetic benefit because of the smaller scar and involves less blood loss and shorter hospital stays and rehabilitation. ”The minimally invasive procedure is a good option for patients who are in generally good health and don’t have a weight problem,” Dr. Nelson explains. “Patients who have the minimally invasive form of hip replacement can even go home the same day. The recovery time is usually quicker than with the traditional incision, which is longer and typically requires a longer healing and recovery.” One of Dr. Nelson’s former colleagues at Nuffield Orthopaedic Center in Oxford, England, Dana C. Mears, M.D., Ph.D., of Pittsburgh, Pennsylvania, developed the minimally invasive approach to hip replacement in the United States. Dr. Nelson was a Nuffield Fellow at Oxford, England, at the same time Dr. Mears was a medical student there. Dr. Mears went on to specialize in orthopaedic surgery and has been a guest lecturer in the Department of Orthopaedic Surgery at UAMS in 1990 and 2003. After testing at three medical centers in the U.S., minimally invasive hip replacement became more widely available only in the last year. Hip replacements are a common surgical procedure. At UAMS, Dr. Nelson and his orthopaedic surgery team perform about 150 of the procedures per year, as well as about 150 knee replacements. After studying under the orthopaedic surgeon Sir John Charnley of England, who invented total hip arthroplasty, or replacement, in the 1960s, Dr. Nelson brought total hip replacements to Arkansas when he joined the faculty of the College of Medicine at UAMS in 1974. Since then, Dr. Nelson has led or participated in a series of improvements in orthopaedic surgery, including: • “Bloodless” surgery, in which the patient’s own blood, rather than a donor’s blood, is transfused during surgery • Use of a clean air system for operating rooms • Use of short-term preventive antibiotics to control infection in joint replacement patients • Creation of surgical skills laboratories to teach surgery • Non-cemented implants for joint replacement • A robotic surgical device that uses computer imaging to match the surface of implants to the interior surfaces of the hip socket and thigh bone for a more perfect match UAMS is one of three medical centers in the U.S. where orthopaedic surgeons are conducting a Phase V study of “Robodoc,” a robotic system for creating a better fit of implants with patients’ natural bone, for the U.S. Food and Drug Administration. Dr. Nelson inserts a tiny camera into the patient’s hip area. The camera is hooked to a computer that views the interior of the patient’s hip socket and thigh bone and then sends instructions to a robotic tool with a tiny high-speed burr that buffs and polishes the implant to fit perfectly against the patient’s bones. Although the Robodoc procedure is not yet available to every patient at UAMS, it is another example of UAMS’ national leadership in orthopaedic surgery.
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