I.B.: Revision Total Hip Replacement – Both Hips
On October 18, 2014, at age 74, I tripped on the street and cracked my left femur. I also did damage to my double hip replacements (2001) and was unable to stand or walk. I was brought by wheel chair to NYU hospital, near my home and down the street from my accident. After tests, I called my surgeon at Hospital for Special Surgery, Paul Pellicci, who had operated on my hips, and asked if I should be transferred to him. I told him that the surgeon that was scheduled to perform surgery on me at this time at NYU was Dr. Scott Marwin. Dr. Pellicci said that he knew of Marwin’s reputation, that it was of the highest caliber, that a transfer might be difficult and recommended I stay with Dr. Marwin at NYU. I did, and am grateful I did. With Dr. Marwin, I underwent a seven-hour surgery to correct my left femur and revision to my left hip. Six months later I underwent a four-hour surgery to tighten my right femur and had my right hip revised. I am now walking easily, without pain, and take walks of three to four miles several times a week. I still shoot baskets, travel and live a full and healthy life. Rarely a day goes by that I don’t I stop to think of my good luck, that I’m back to the good life, and that I had Dr. Marwin for my surgeon. He has also been accessible and helpful in follow-up visits, with a welcome bedside manner. I don’t recommend anyone falling and doing the damage to themselves that I did, but if such misfortune should strike, I strongly suggest a swift call to Dr. Scott Marwin. You could not do better.
R.K. Hip resurfacing
To all potential patients:
I began my training in Karate at the age of 9, and continued training at a high level my entire life. I fought competitively and ran my own school. At the age of 33 I began training in Brazilian Jiu Jitsu under the legendary Renzo Gracie, where training was at the absolute highest intensity. I competed, did well was awarded my Black Belt by UFC welter weight Champion Matt Serra in 2007. That same year I opened my own Brazilian Jiu Jitsu Academy and was on the mats 7 days a week! Two years later I started noticing pain in my groin and lower back area, I went to a Neurologist for the back pain and was given a diagnoses of osteoarthritis of my right hip. I asked about my options and was told I needed a hip replacement. This was unacceptable to me as a hip replacement wouldn’t hold up to the training and teaching I put in. So I began researching my options and came across “Hip Resurfacing”. I read as much as I could to educate myself on the subject, both the good and the bad. It sounded like what I was searching for, now I needed the “RIGHT” Doctor to perform the procedure. Again I researched heavily as I knew Hip Resurfacing couldn’t be performed by just any surgeon, it’s a specialty, it’s a procedure that has to be learned and perfected over time. As I searched, the same name came up Multiple times, Dr. Scott Marwin. I made an appointment and saw Dr. Marwin. He answered all my question and was confident that I could continue my lifestyle after the surgery. In March of 2010 I had a hip resurfacing done by Dr. Marwin. After rehabbing and following all directions I was back on the mats teaching and training with no pain!! The thing about hip resurfacing is if your active, keep your weight down and work at your fitness your affected hip continues to improve as time goes on. Now six years after the surgery I honestly have no difference between my right and left hip! Both are equally strong, I train hard with all my students and continue to teach 6 to 7 days a week!
Dr. Marwin is a master at his craft, I believe if there was any flaw in his work it would have been evident long ago by the amount of pressure I put on the implanted device on a daily basis. All I can say is Thank you! For giving me my life back! I will be forever grateful!
NYU News and Views, 11/2012, MacGyver in the OR
“I don’t wanna know nothin’. I don’t wanna see nothin’,” insists the patient, a woman in her 70s – eyes tightly shut, head moving rapidly from side to side – as she’s wheeled into an operating room at NYU Langone Medial Center’s Hospital for Joint Diseases (HJD). Her fear of the unknown – and her embrace of blissful ignorance – are totally understandable. The procedure she’s about to undergo, a revision total hip arthroplasty, is one of the most complex, ambitious, and challenging of all orthopaedic surgeries. The procedure is more commonly known as hip revision surgery, so called because the previously implanted artifical hip joint must be replaced with a new prosthesis.
In another sense, however, the patient’s fear is unfounded, for she’s in the best of hands, in the best of hospitals. Her surgeon, Scott Marwin, MD, clinical associate professor of orthopaedic surgery, has personally performed hundreds of hip revisions, and HJD performs some 200 of these procedures per year. As Joseph Zuckerman, MD, the Walter A.L. Thompson Professor and chair of the Department of Orthopaedic Surgery, explains, “The results of revision surgery are very much dependent on experience and volume.”
An initial hip replacement is considered one of the most beneficial orthopaedic operations, with 97% of patients reported to have a good outcome and improved lifestyle. The second time around, however is not quite as simple or straightforward. Over time, hip replacements wear out. A prosthesis is either press-fit into the bone or cemented into position. Either way, it’s fit snugly into the femur and pelvis so that the implant can’t move. After years of constant force and friction, however, the implant eventually loosens within the bone. It begins to move slightly, but enough to cause increasing pain and reduced range of motion.
According to the American Academy of Orthopaedic Surgeons, hip replacements function well for about 15 years in some 90% of all cases. But as active baby boomers age, they are getting joint replacements at younger ages than ever before – and requiring revision surgeries in record numbers. “The demand is growing at an exponential rate,” explains Dr. Marwin. “About 650,000 hip replacements and 900,000 knee replacements are performed in America annually. In just five years, there will be a severe nationwide shortage of surgeons properly trained to replace all of these artificial joints.”
Watching Dr. Marwin at work, it’s no wonder that so few surgeons are willing to choose this subspecialty, despite the projected demand for their expertise. “This is a big deal,” says Dr. Marwin,” a risky, rigorous, stressful ride. It’s one of the most invasive procedures you can subject the human body to, requiring one of the greatest amounts of anesthesia – and its all improvisation.” What makes that improvisation possible, of course, is meticulous, methodical preparation. A revision surgery is a masterpiece of choreography and logistical planning. For Dr. Marwin, one of several surgeons at HJD who specialize in revisions, the surgery begins long before the day of the operation. “The most important factor is the quality of the bone surrounding the implant, but scans tend to underestimate the mount of bone deficit. Going in, I have three general plans: A, B, and C. But as I move along the implant highway, I do whatever I need to do. There is a series of algorithms in the decision-making process, and all solutions must be available to ensure success.”
Dr. Marwin spends much of his surgical time preparing the site and reconstruction the joint with “trial implants,” only installing the final implant (usually made of cobalt and chromium) when he’s convinced that fit and function are just right. Clad in ventilated “space suits” to shield them from airborne blood and bone, the surgical team may spend up to eight hours on a case involving severe bone loss. For all the high-powered, high-tech equipment at their disposal, much of the work demands old-fashioned elbow grease and a surgeon who is as strong-willed as he or she is strong-bodied. “I thrive on challenges,” admits Dr. Marwin, “But sometimes when it’s all over, I just need to go lie down.”
Having all solutions available means having a wrench for every conceivable kind of socket. For complex cases, that means having up to 40 trays of instruments and devices from three different manufacturers – as many as 2,000 pieces of hardwares – sterilized, unpacked, and within reach, though only 25 to 30% of them are typically used. “Very few hospitals are capable of materials management on this scale,” notes Dr. Marwin.
As mighty as the tool kit may be, however, he emphasizes that the people on the team, and the various departments that support them, are what really makes him feel equipped and empowered. “They know all the widgets,” he says, “and just how to respond to my improvisation. The beauty of HJD is that there’s a concentration of effort here like nowhere else. Everyone in this building is oriented to orthopaedics.” He has equal admiration for his patients. “It’s amazing what the human body can tolerate,” he marvels. “My career is based on the fact that people can bounce back from this. And they do.”