“I cannot thank Dr. Puri and his team enough. They made the entire process painless and quick. After only three weeks I’m back at work, able to climb stairs and return to many everyday activities at home. I still cannot believe how quickly I am recovering.”
First performed in 1960, hip replacement surgery is one of the most important surgical advances of our time.
Since then, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of this surgery. And Dr. Puri has been instrumental in bringing those technologies, such as robotic surgery, to Endeavor Health.
Many different types of designs and materials are currently used for artificial hip joints. All of them consist of two basic components: the ball component (made of either ceramic or metal) and the socket component (an outer metal shell with a durable plastic cup).
In a robotic total hip replacement, Dr. Puri will remove the damaged cartilage and bone, then position new metal and plastic joint surfaces to restore the alignment and function of your hip.
Preparing the Bone
Dr. Puri will cut a portion of your thighbone and smooth the surface of your old socket. A new press-fit metal socket is then placed into your pelvis, which may be held in place with screws. The surface of a press-fit prosthesis has tiny pores that your bone will grow into. A press-fit femoral stem is then inserted into your thighbone and once secured, the new ball and socket are joined.
DIRECT SUPERIOR Hip Replacement
With robotic assistance, Dr. Puri uses the direct superior approach (DSA) — an evolution of minimally invasive surgery that may help get you back to the everyday activities you enjoy faster. Dr. Puri performs this approach in conjunction with Mako Robotic-Arm technology.
Patients frequently ask about the direct superior hip replacement, and Dr. Puri is happy to offer this approach to patients who qualify.
The direct superior approach is a muscle sparing approach for total hip replacement, developed to minimize damage to the soft tissues and muscles that are critical to the proper function of your hip and leg. With the direct superior approach, Dr. Puri avoids cutting key muscle groups, the most important being the iliotibial (IT) band and muscles referred to as external rotators. Did you know that these muscles play an important role in your ability to perform everyday activities? For example, the IT band is a large muscle that extends down the outside of your leg from the pelvis to the knee. If you injure this muscle, it could impact activities such as walking and bending.
The single incision on the outside of the hip creates an entry point that preserves key muscle groups and other soft tissues around the hip joint, causing less trauma to the area than traditional hip replacement. With the patient lying on their side, Dr. Puri uses specialized instruments and retractors to manipulate the hip joint without interfering with the nearby muscles.
Benefits of the direct superior hip replacement approach include:
Preservation of muscles, tendons, and hip’s natural alignment
Greater stability after surgery
Fewer complications during and after surgery
Less blood loss
Mobility sooner after surgery
Faster, more comfortable recovery process
Minimized pain medications
Following a direct superior hip replacement, patients typically spend one night in the hospital, though some do go home the same day. Many patients are up and moving on their own, without assistive devices, within four hours of surgery. They also report less pain after surgery.
Yet, even though patients tend to get on their feet more quickly, physical rehabilitation plays a key role in continued recovery and success. Dr. Puri’s team will connect with your physical therapist to create a customized therapy plan and exercises to restore your strength and increase your range of motion.
Implants
Please speak with Dr. Puri regarding the choice of implant that he uses. He will select the appropriate implant based on your needs.
Femoral stem: In the overwhelming number of cases, Dr. Puri uses an un-cemented, femoral component. It is designed for active people and allows for bone to grow into the stem and become a permanent part. There are certain situations—albeit rare—that require cemented stems or the use of "glue" to affix the femoral component. This, however, is not the norm in the practice.
Bearing Surface: Dr. Puri also encourages you to discuss with him in detail the choice of bearing surface. You want the implant to last as long as possible and withstand as much activity as possible. In the vast majority of cases, metal or ceramic bearing against a technologically advanced, highly cross-linked polyethylene will be the bearing of choice. Dr. Puri does not use metal on metal implants because of a growing number of concerns across North America with regard to its safety.
Your Surgery
You’ll be admitted to the hospital the day of your surgery, and a member of the anesthesia team will evaluate you. The most common types of anesthesia for hip replacement surgery is a spinal anesthesia with sedation (which allows you to be awake but anesthetizes your body from the waist down). In certain cases, it may be necessary to perform a general anesthetic, which puts you to sleep through the procedure. The team will discuss these choices with you and help you decide which type of anesthesia is best for you.
During surgery, Mako technology transforms how joint replacement procedures, including hip replacement, are done by integrating 3D modeling and robotic-arm technology into the process. It’s an innovative solution that has been helping joint pain sufferers for more than a decade. Dr. Puri utilizes Mako robotic-arm technology in combination with the direct superior approach to hip replacement.
In clinical studies, Mako for Total Hip demonstrated:
More accurate placement and alignment of hip implants based on the surgical plan
Less likelihood of hip dislocation
Reduced blood loss
Replication of the feeling of a natural hip
Preservation of healthy bone
How does Mako technology work?
Personalized surgical plan: Prior to surgery, a CT scan of your hip joint is taken to generate a 3D virtual model of your unique anatomy. The 3D model allows Dr. Puri to know more about your joint and see things he can’t typically see with an X-ray alone. This additional information helps him determine the desired size, placement and positioning of your implant.
Range-of-motion assessment: Throughout your surgery, Dr. Puri guides Mako’s robotic arm to remove the arthritic bone and cartilage from the hip. Mako’s AccuStop haptic technology provides tactile resistance that guides Dr. Puri to precisely cut only what is defined in your surgical plan to help protect your healthy bone.
Arthritic bone removal: As Dr. Puri prepares to place the implant into its final position, the robotic arm guides the implant at the desired angle defined in the surgical plan. This helps ensure placement and alignment of the implant are performed according to Dr. Puri’s plan.8Throughout your procedure, Mako provides real-time data to Dr. Puri. This allows him to continuously assess the movement and tension of your new joint and adjust the surgical plan if desired.
Your Stay in the Hospital
After surgery, you’ll be moved to the recovery room, where you will remain for 1-2 hours so that your care team can monitor your recovery from the anesthesia. You’ll then be transferred to a private room.
Expect to start walking with an assistive device (crutches or walker) on the day of surgery. You’ll either stay in the hospital for 1-2 days or, if you qualify, return home same day.
Are you a candidate for outpatient surgery?
After surgery, you’ll feel pain in your hip, and pain medication will help make you as comfortable as possible while you heal and adjust to your new hip joint.
Walking and light activity are important to your recovery and will begin the afternoon of surgery. Most hip replacement patients begin standing or walking with the help of a walking support device and a physical therapist the day of or after the surgery. The physical therapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.
Robotic Hip Replacement FAQ
How long will I be in the hospital?
You will be in the hospital for 1-2 days. Most of Dr. Puri's patients are discharged home and set up with a home health agency, whereby a nurse will come to your home 2x/week and a physical therapist will come in 4-5x/week. You may be discharged at an earlier time, at which point you will be ready to do outpatient therapy.
Am I a candidate for outpatient surgery?
You and Dr. Puri will discuss. He uses techniques that make outpatient surgery possible, but some patients benefit more from a hospital stay. Find out if you qualify for outpatient surgery.
Who can I contact to schedule surgery?
You can contact Marie Albarillo, Dr. Puri's physician assistant or Kim Prado, Dr. Puri's nurse, at (847) 86-ORTHO to schedule surgery.
How long does surgery take?
A robotic total hip replacement will take approximately 1 hour, depending on the severity of the disease.
What happens during robotic total hip replacement surgery?
During a robotic total hip replacement, the arthritis portion of the hip joint is removed and replaced with metal parts as well as a plastic portion, that is made of a high polymer polyethylene material. Dr. Puri will use a robotic system to help realign the knee.
How is pain managed after hip replacement Surgery?
The Endeavor Health Orthopaedic and Spine Institute manages pain through a multi-modal approach and dedicated pain team. This management enables patients to participate in physical therapy. The full-time pain team led by Endeavor Health anesthesiologists will customize a protocol for each patient dependent on individual needs.
Does Dr. Puri do hip resurfacing?
Dr. Puri does not practice hip resurfacing. Metal on metal bearings have been associated with a significant increase in failure of the implant as well as problems with rejection, hip abscesses, and other complications. Furthermore, in the overwhelming majority of cases, hip arthroplasty has the potential to be a more permanent solution than a hip resurfacing. It also eliminates the concern of metal on metal implants.
How long will I be in the hospital?
You will go home either the same day or the next day. Dr. Puri and his team will work with you to customize what is best for you.
When will I be able to drive after hip replacement?
You can drive after hip replacement when you are off narcotic pain medication and when Dr. Puri lifts your hip precautions, typically 2.5 to 4 weeks after surgery.
When can I return to work after hip replacement?
Depending on the type of work you do, most of Dr. Puri's patients may resume work within 2-3 weeks.
When can I swim after hip replacement?
You can swim once your incision is fully healed. Dr. Puri will assess the integrity of your incision at your one-month mark and the decision to get the incision wet/soaked will be made.
“Dr. Puri had been highly recommended by my physiatrist. I also knew at least a dozen people who had knee or hip replacements done by him. All of them were delighted with the process and the result. I visited Dr. Puri and was similarly impressed. Everything was flawless. I would go to him again in a heartbeat. And thank you, Maria and Kim, for your terrific and devoted attention to your patients.”