Chapter 701

Mar 17, 2026

Hip

double the pleasure

Three days post op with my new right hip (two fake hips total) grandson Lucas visited like he did 10 years ago (ch402). This time he is recovering from slight fracture in right shoulder (humerus) from ski jump adventure at Bromley Mt, Vermont. Double the pain.

My old surgeon Dr Fletcher who did my left hip replacement 10 years ago would have done my slightly dysfunctional right one 5 years ago but I tried the conservative approach with a lot of physical activity. It was functional during the last 5 years with intermittent pain and ache but it wasn't killing me. This last year it has been inhibiting my movement significantly.  Should have pulled the trigger earlier but always hoping against hope.

By the time I did contact Fletcher's office this year, he had retired. By chance a neighbor and a couple other friends had used Dr Roberts, so I was able to get an appointment with him. Lucky to get him, did not realize how highly regarded he was in this field. Dr Jared Roberts at the Bone & Joint Center was the first to perform the anterior hip replacement with use of the Hana table at Albany Med in 2011. Although young, he even taught my Dr Fletcher the anterior approach who did my left hip in 2015 (ch401). In fact Roberts is in the photo I used for that chapter  as he taught my Dr Fletcher. 

The new procedure is outpatient. Dr Roberts was the first to accomplish that in the Capital District in  2018. I'll be in their Malta facility in the morning and out in the afternoon to recover at home. In 2015 I was ready to go home the day of the operation. They kept me overnight (against my will) so they could wake me up every hour for useless things. 

Above is a testimonial sucess story from the DePuy hip replacement web site where Ernie touts the expertise of Dr Roberts. Dr Roberts of the Bone & Joint Center uses the Johnson & Johnson's DePuy Synthesis ACTIS and PINNACLE Acetabular Hip System.  Hunter Mt ski patrolman Ernie had great success with  Roberts in 2018 documented here. DePuy ranks among the top hip replacement  companys in the world.

They wanted me to go to PT so I did one session 3 days post op then quit to proceed on my own.

Part of my home PT regimen was exercises and walking around the house. Schatzie thought it was great fun to follow.

I chose the  Center Advanced Ambulatory Surgery in nearby Malta. Went into the Operating Room at 9am and discharged home by 12:30pm. Anesthesiologist injected a spinal nerve block of lidocaine etc, then IV intravenous with propofol anesthetic to relax me, and was wheeled in to OR on a regular hospital bed. Believe a young 2026 Albany Med Orthopedic surgeon was attaching ski boots so they could manipulate my legs via the HANA table. Nurse PA swabbed the general surgical site with a bedadine anesthetic solution place a sterile antimicrobial incise drape over the surgical site that the surgeon cuts thru. Anesthesiologist increased the PENG Percapsular Nerve Group Block local ultrasound guided hip capsule nerves block. I could feel it go a nice numb. I was still looking around the operating room as they put on the oxygen mask for breathing on my own as I passed out. 

Had expected to see a vertical incision in the recovery room but was surprised that I had the bikini cut incision. It has apparently become more popular in the last few years. 

Johnson & Johnson DePuy Synthes ACTIS 2026 web page describes my hip joint, the most used product line in the U.S. It is also the oldest (1895) orthopaedic company in the U.S. 

The day prior to surgery they created a game plan using a template to design the hip components. See  Actis surgical guide. That basically ended up with  hardware dimensions similar to my first hip replacement to get the proper vertical leg length, center of head rotation and horizontal offset from pelvis for a natural post op walking gait. So cool. Note the variable triple taper technology for immediate and long term stability and prevents subsidence.

Specs: High Offset 6mm collared size 8, 145mm length 135 degree neck -48mm offset coupled with +5 mm head yielding 53mm total offset. proximal porous coating, distal grit blasted,  triple tapered to fit femur canal. Neck 12/14 mm taper. The Duo Fix HA coating allows for biological bone growth fixation with the femur bone. Thirty percent fixation in 3 months, 90 percent in 9 months.

Proceedures:

This brief animation shows without gore how they get the above hardware in to replace the natural faulty hip joint. 

More in depth grapic technical videos here for actual operations. A good presentation of the bikini incision procedure by JB & JS.  Another link to 11 videos covering the Direct Anterior Hip Arthroplasty Bikini-Style Incision . A Carolina  presentation  of the pros and cons of bikini. Quoite a good DePuy's actual surgery training video from a few years back.

A live video surgery using the DJO Enovis attachments from Austin TX using only standard OR table.

My Hip Images:

The image 1 is the original pre op bad right hip. Image 2 is their template plan prior surgery of what they think will fit. Image 3 is the radiograph taken during surgery from their mobile C-arm fluoroscope. It shows the trial broach of 2 increased sizes with teeth malletted in to create space and compacting the bone marrow.  It checks for fit and correct body geometry. A plastic trial head is used and doesn't show up on xray. Image 4 is the final fitted stem with collar tab.

EMPHASYS Acetabular Solution   Shell three hole 60mm (2mm larger than templated) titanium cup with GRIPTION coating, and polythylene cup liner60mm shell. Although the shell is malletted into the acetabulum pelvis, one 30mm titanium screw adds additional fixation as was done in my first hip.

The Depuy Pinnacle Altrx Poly acetabular liner +4 mm 36mm ID 60mm OD malletted inside the shell. 

This combination yields the best geometry for correct body alignment leg length and range of motion along with plus + dimensions which minimize bearing stress within the finished joint.

DePuy Biolox Delta Ceramic femoral head.  Sized 36mm diameter ball with +5mm on the 12/14mm taper to match the femoral neck.

Failures a decade ago were primarily from choice of steel ball on steel liner with squeaking , grinding, corrosion and release of metals into blood stream and law suits. The industry standard now is ceramic on polyethylene, which I also got 10 years ago. 

Now failures can result equally from cups or stems. My cementless stem has high sucess. Years ago cemented implants were favored more for elderly patients. Doesn't seem to be the case now although everyone is different. 

You certainly want to avoid revision surgery, especially for infection problems.

Still using the HANA operating table (ch403) to get good access to the femur. There are alternatives like the postless distraction Pink Table Kit and the DJO Enovis Adaptable Arms , a simpler technology that seems to work well. 

Summary:

Stopped narcotic pain meds in few days. I'm walking in moderation without a cane after 3 weeks. Sometimes I overdo it (several miles) and have to back off.

Goals at 80:  don't rush

currently walk dog up the street one mile - done, 

4 months  hike Walden Pond like before, stop feeling handicapped

1 -1/2 year hike ADK high peak like before, maybe

at least  I should be better off than if I had not got the operation.