Separate names with a comma.
Discussion in 'Hip Replacement Recovery Area' started by george58, Feb 21, 2011.
Has anyone had THR surgery with Dr. Michael Alexiades in NYC? How was your experience and recovery?
Welcome to BoneSmart, George. I'm glad you joined our forum. Is this a surgeon you are considering?
HI there - don't know how reliable this site is but I found this ratings site for doctors. He looks to have pretty good scoring healthgrades.com. And then there's his bio which also looks good although he's a bit too much of a generalist for my tastes. Hip, Knee, Shoulder and Elbow - that is uncommon in my experience - mostly they tend to specialise in either the upper or lower limb. Doesn't necessarily mean he's not good but you should check how many hips he does per year. Anything above 400 is good.
Make sure you read this thread How to choose a surgeon and a prosthesis and print off the questions to ask him.
I live on Long Island and used http://lihipandknee.com/about/, he is an excellent surgeon. I'm not sure how far you are from Stonybrook University Hospital, but it may be worth the trip.
i just had a LTHR on 2/2. I used dr. padgett at the hospital for special surgery (NYC). I can not say enough great things about dr p and the whole team at hss.
he is known for doing lots of the hips of ballet dancers... he is just amazing.
my recovery has been swift and pain-free.
i was so impressed with the whole process at HSS (including a pre-surgical workshop) and the kindness and expertise of all of the people who cared for me.
if I can tell you anything else, don't hesitate to contact me.
I want to have the surgery at the Hospital for Special Surgery in NYC since it is rated as the #1 hospital for orthopedic surgery in the US. From my research, it seems that Dr. Alexiades is the only doctor who performs the anterior approach at HSS. I do not want posterior surgery. Does Dr. Padgett perform anterior surgery?
I saw Dr. Nicholson for a consultation but he only performs the posterior approach. Anterior seems to be the way to go and there is a dearth of surgeons performing this approach. Nevertheless, he has a good reputation and is an excellent surgeon.
I think Alexiades is known for doing the direct anterior approach at HSS. I don't know more than that but I do know that HSS has an extremely low infection rate. Very important when you're having any kind of surgery.
Dr Alexiades is one of the Drs I "interviewed" before my surgery. Dr. Alexaides does do the direct anterior approach at the Hospital for Special Surgery (HSS) and HSS is the number one hospital for joint replacement in the United States. However, Dr Alexiades does not use the special Hana operating table developed specifically for the direct anterior approach. He said the tables are very expensive and they only have one use. So hospitals are reluctant to purchase such equipment. I thought Dr Alexiades was a very nice man, conscientious and smart. In fact, I would have selected him to do my surgery except NYC was a little too far away for my tastes (2.5 hours from home) and the wait for a surgical appointment was 5+ months.
If you want your surgery done on the Hana table you'll need to go to NYU. Dr. Roy Davidovitch at NYU uses the Hana table and Dr Davidovitch worked with Dr Matta in CA. Dr. Matta was instrumental in bringing the direct anterior approach to the United States and in designing the Hana table.
Unless your insurance prohibits it, why not make an appointment with both men and see what you think?
Re: OS's who do Direct Anterior Approch
Go to newhipnews.com click on "patients" and you'll get list of most of the Doc's in US who do the Direct Approch.
Had mine 1/31/11 in Houston, Dr Stefan Kreuzer, and can't believe the speed and how problem free my recovery has been. Can't say enough about the Technique. Check my thread "Report from the Otherside" for details. If you can find an OS that also uses Computer Navigation that's even better. Almost guarantees perfect placenent of the prosthesis.
If your able to travel to get your Op check out Houston. One of the largest concentrations of World Class medicine in the country.
Best of Luck
I had the lateral approach with Dr. padgett. I assume your research is correct, but, certainly worth reaching out to him / his office to confirm.
As I mentioned before, I was so impressed with Dr. P and HSS. I am three-weeks today - walking without a cane, on the elliptical machine 45 minutes a day, virtually pain-free. I would highly encourage you to consider HSS, even if you use a different surgeon. They were amazing at treating me throughout.
All the best to you!
Brad - You answered the question I was going to ask Dr. Alexiades - use of the Hana table. Just how necessary is it to anterior surgery? Can one get good results without it?
NYU has a very poor rating for orthopedic surgery - very high infection rate, so I am hesitant to go there.
Suzanne - Does the lateral approach require cutting through muscles, tendons, etc.? Do you have restrictions such as bending, toilets, etc as with the posterior approach?
Dr Alexiades has some other type of special table that he uses. In fact, I think he said the hospital has two of them, but I cannot remember what he called it. The table did have more than one function though, unlike the Hana table, which is only used for direct anterior hip replacement. I got the distinct impression Dr Alexiades knew what he was doing and you can't go wrong with the Hospital for Special Surgery. Without question, HSS is the best in the country. If Dr Alexiades and HSS take your insurance, why not make an appointment with them and see what you think?
There are several variations on that table. In fact, Mr Mckee used an early type for this back in the 60s when I was his scrub nurse! So it's not exactly new. The key things are that it helps with dislocating and reducing the joint which is somewhat restricted with a small incision like DAA. So yes, I would say such a table is helpful although there are plenty of surgeons who do an anterior approach without it, with the patient simply laying flat on the table. They probably wouldn't use such a small incision though.
The Hana table is not specifically required to do a DAA. However, some degree of articulation in the table is required. The incision is small compared to other techniques( mine is just over 4") and the surgeons view into the abyss is very limited as is hie working room. The patient needs to be moved about during the Op. Per my surgeon, no qualified OS would attempt a DAA without an articulated table. My hospital is equipped completley with Stryker gear. Their website has photos, descriptions of all this hardware.
My surgeons website, stefankreuzermd.com has a lengthy video of an actual DAA. Better to see the real thing than rely on second hand info, including mine.
Personally, I believe that the availability of Computer Navigation is more important than the mechanics of the table. Most PostOp "mechanical" problems are a result of inaccurate placement and alignment of the implant components. The surgeon has to work in 3 planes simultaneously, all while insuring the repaired leg comes out the same length as the other. Obviously, a skillful experienced OS can do it by eye, but the Computer Navigation takes almost all the human factor out of the equation. In my case the first step after I'm on the table was to insert 2 small removable metalic markers or surveyor stakes in my thigh and tummy. Doesn't much matter where they are located.....they provide the reference points in space from which the computer maps the position of the existing bone in 3D. Much like an Auto Cad projection. After the bone has been hacked out , the socket scrapped clean and the femar drilled out, the surgeon uses the"3D map" to place the new bits and pieces in precisely the same original location...up, down, angular and rotational alignment. Later the markers are removed. Mine took 1 stich each to close the punctures.
You might consider the availability of this equipment when evaluating hospitals.
As to infection: each hospital has it's own anti-infection protocols, but your surgeon has the option of imposing his own more stringent procedures. Ask him and express your concerns. My PreOp protocol took 4 days and is based on a research project reported in the NewEngland Journal of Medicine. If interested, I'll be happy to send it to you. This protocol continues for a week PostOp. I'm almost 4 weeks PostOp and have no problems.
Hope this is of some help. Based on my personal experience I am a great advocate of the DAA. If you have it available and you qualify for it I strongly suggest you pursue it
Yes, the lateral approach (at least for my experience) does require restrictions (the 90 degree rule) and yes, i am pretty sure it required moving the muscle (although not sure about cutting it)... Now, I am three weeks and with the supervison of my PT I am sitting in normal chairs and toilet seats and bending a bit past the 90 degree rule. But, I wasn't allowed to do so for the first couple of weeks.
hope that helps,
Jack - It sounds like you had the perfect surgery = anterior with computer guidance. That is the ideal surgery that I want. Believe it or not, it seems to be impossible to find a surgeon who operates this way in the NYC area! Posterior surgeons are a dime a dozen. Anterior in a major hospital - almost none.
Dr. Corey Burak in Tarrytown, NY (near west Chester)) has patients who sing his praises on the internet. He does the DAA at Phelps Memorial. My sister is considering using him. You can check him out on the web.
I think Jack was very fortunate to be in Houston and near Dr. Kreuzer. He is, indeed, the perfect surgeon for the DAA. . I considered using him, actually, but in the end I wasn't up to the travel and surgery combo, especially with two hips needing doing. Good Luck!!