Hip replacement surgery can be long and complicated. What we’re offering at Vitosha Hospital is a new way of performing it, and our work’s sparked lots of interest here in Bulgaria. This is an interview our lead surgeon Dr Orlin Filipov gave to the daily newspaper Trud – one of Bulgaria’s biggest. The aim for orthopaedic surgeons these days is to make a smaller surgical incision, so the delicate structures around the hip can be protected from damage as much as possible, and the operation can be carried out without a blood transfusion. Dr Filipov tells Trud more about what this groundbreaking technique means for patients.

Dr Filipov, how do you do these operations, and what’s new about this treatment?

Traditionally there are lots of different ways of performing a hip replacement. They are complex procedures so different surgeons use different methods – there are different kinds of incision, different ways of reaching the hip joint, and different surgical processes to follow. One thing they nearly all have in common though is the incision is quite big. This means the trauma suffered by the body during the operation, and the blood loss, are significant.

Surgeons around the world are aiming now to reduce the size of the incision, as this protects the structures around the hip better, and reduces the need for a blood transfusion. But despite their best efforts they can’t always manage that. Another big disadvantage to current methods is impaired hip joint stability, and the risk that goes with that of dislocation of the prosthetic joint in the early days after surgery.

There’s a technique called Minimally Invasive Surgery (MIS) which seems like a good alternative to the traditional methods – but it has its drawbacks too. Because the incision is so small, and the bone can’t be prepared optimally, there’s a risk that the prosthesis components may be positioned incorrectly, and may come loose and need replacement earlier than they should.

The compromise between MIS and old, traditional methods is the direct-lateral access technique. That’s the one that’s preferred in leading clinics around the world. The technique we use at Vitosha Hospital is different, but still based on the direct lateral approach. We have special procedures to keep the joint stabilising structures strong and balanced. Our innovative technique results in a stable joint and less bleeding, so similar to MIS techniques, but avoiding the risks associated with MIS procedures.

Why do so many patients want to avoid blood transfusions?

When patients loses a lot of blood in an operation they need blood from a donor. In a way, it’s a transplant of foreign tissue – of 300 or 600 or even 900 millilitres of someone else’s blood. This blood is rigorously tested at transfusion centres for things like HIV and hepatitis before it can be released to hospitals, but it’s still not entirely without risk. Not everything can be tested for and ruled out – so it can’t be completely safe. Just think – if you practice safe sex and use a condom, you are protecting yourself from contaminated semen, and that’s just 2 or 3 mls – tiny, compared to 300 or 600 mls of blood injected directly into your veins!

You say your patients recover more quickly. How do they manage that?

Yes, our patients do start walking more quickly than at other places. I have experience of many hospitals around the world, and also follow the specialist literature.

After a hip replacement, patients normally need to avoid many things: lying on one side in bed, crossing their legs, and even moving their legs together – they need to keep their legs apart. Because of this, most hospitals put a wooden frame between the patient’s legs to keep them apart, and this is replaced by a pillow when the patient gets home. These patients also need to avoid sitting in a low position, like in the seat of a car.

These restrictions are necessary because of the high risk of dislocation of the prosthesis, which would be a serious complication. If this happens a long and painful convalescence would be necessary. The patient would be bedridden, keeping the wooden frame between their legs for a month. If it happens a second time, a new operation would be required.

The new method which we use at Vitosha Hospital achieves a high strength and stability of the prosthesis, which in itself shortens the recovery period, and drastically lowers the risks for the prosthesis. That’s why our patients don’t have to follow those restrictions described above.

Our patients are allowed normal weight bearing on the hip, they can lie on one side, they can hold their legs together. The only thing they should avoid is excessive bending of the hip for thirty days after the operation. Over five years we haven’t had a single case of dislocation of the prosthesis, unless it was due to an accidental fracture. That’s why patients recover more quickly in our hospital.

In the best case scenario, our patients recover fully within two months. One of our patients was featured on national TV performing yoga exercises just a few months after his hip replacement.

Arthrosis of the knee and hip are highly treatable conditions. With an operation lasting just over an hour, the patient is finally released from chronic pain, and can soon go back to living life to the full.