The Orthopaedic Hospital Brings the Future Here with Anterior Hip Replacement Approach

Anterior Approach Makes Major Surgery Less Invasive

Fort Wayne, Ind. (Thursday, April 9, 2009) — The next era of surgery for total hip replacement was unveiled at The Orthopaedic Hospital of Lutheran Health Network today. The Orthopaedic Hospital was among the first hospitals in the state to acquire a special PROfx® table that allows physicians to use an anterior approach, making total hip replacement surgery less invasive.

In May of 2008, Steven Fisher, MD, Fort Wayne Orthopaedics, performed his first of 38 anterior arthroplasties to-date at The Orthopaedic Hospital. He was among the first four doctors in Indiana to adopt the anterior hip approach.

"It's an obvious choice when the benefits for patients are so significant," said Dr. Fisher. "The one-year outcome of the anterior hip approach is similar to that of the conventional hip replacement, but the recovery time and restrictions are vastly different."

The anterior hip approach allows physicians access to the pelvis from a supine position, reducing the incision size and avoiding major muscle tissue trauma. Benefits include less pain, less scarring, fewer restrictions, reduced hospital stays, lower risk of dislocation and significantly faster recovery time.

After much research, former Miami Dolphin Doug Crusan, a member of the Super Bowl victorious, 17-0 undefeated team of '72, traveled more than 100 miles to have a total hip replaced by Dr. Fisher. Within two days Crusan was released from TOH and returned home to Indianapolis. He returned to work three weeks later without mobility aids. Crusan, age 63, and his wife Dianne are so passionate about the anterior approach that they want everyone to know about the option.

"Since Doug's surgery, I have been on a campaign to see that patients learn they do have a choice in the method used for hip replacement," said Dianne Crusan.

"When I faced hip replacement surgery, I left it to my wife to do the research and trusted her to find the right place for me," said Doug Crusan. "I only asked that, if possible, she find an Indiana University trained physician. Dr. Steven Fisher, a three-time graduate of Indiana University including medical school and residency, and Lutheran Hospital provided me with the latest state of the art procedure and a new lease on life.

"Family members have had surgeries at Vanderbilt Medical Center, Christ Hospital in Cincinnati and St. Vincent's in Indy," added Crusan. "I can say from experience that I have never witnessed more comprehensive care and caring than I had at Lutheran. Fort Wayne is fortunate to have such state of the art care and to have a physician who took it upon himself to train in the anterior approach to hip replacement."

Crusan is only one example of the difference the anterior approach can make in a patient's life. Carlos Espinosa, M.D., a general surgeon for more than 25 years, struggled with constant hip pain until he had his surgery last month.

"The evening after my surgery I walked down the hall unassisted," said Dr. Espinosa, medical director for General Motors through RediMed's Business Health Services. "The head nurse almost fainted. She couldn't believe it. Just 10 days after surgery, I hiked for nearly three hours in the woods because I wanted to measure my progress."

Norman Governale, a retired high school English teacher had his left hip replaced 11 years ago and said it took two years for the swelling to subside. Dr. Fisher replaced Governale's right hip in January of this year using the anterior approach. "It's virtually incomparable to the posterior approach," said Governale. "It's fantastic. I'm 76 and I'm glad I waited because I was driving just two weeks post-surgery."

The PROfx® table used for the anterior approach is manufactured by Mizuho OSI, Inc. It has traction-like boots that enable the surgeon to stabilize the patient's legs independently, as well as raise or lower the legs or the patient's upper body to maintain proper alignment. The table also allows the surgeon to x-ray during surgery to ensure proper implant placement and leg length.

"In less than a year The Orthopaedic Hospital has already set the bar for defining exceptional patient care," said Joe Dorko, CEO, The Orthopaedic Hospital and Lutheran Hospital. "I give credit to Dr. Fisher for his passion to improve patient outcomes with such an innovative procedure that significantly reduces recovery time. Constant improvement remains our primary focus."





Average hospital stay

2 to 3 days

3 to 5 days

Smaller incision

4 to 5 inches

10 to 12 inches

Less muscle trauma

No muscle detachment

Muscles cut detachment then repair

Faster recovery

2 to 4 weeks

6 to 10 weeks

Reduced pain



Reduced blood loss



Reduced tissue healing required



Reduced risk of dislocation



More accurate leg length control



More rapid return to normal activities



*Mizuho OSI, Inc. and The Orthopaedic Hospital

Conventional approaches require splitting and/or detachment of muscles that control motion of the hip and help prevent dislocation. Trauma to these muscles causes pain and swelling that takes time to heal in order to recover function. This requires six to 10 weeks of rehabilitation and restrictions of not flexing the hip beyond 90 degrees which affects basic activities like sitting, crossing the legs, putting on shoes and driving an automobile.

The new anterior approach avoids injury to muscles by dissecting between them. With less pain and improved function, most patients are able to return to normal activities, including work, sooner.

However, Dr. Fisher cautions that the approach is technically much more demanding and that it does have potential complications similar to any hip replacement procedure.  It is particularly difficult in heavy patients and those with distorted anatomy. 

"Although currently not all patients are candidates, I am optimistic that the indications will continue to grow and that more surgeons will become interested in learning the procedure," said Dr. Fisher.

Additional information may be found at For more information about The Orthopaedic Hospital of Lutheran Health Network, visit

A DVD of Dr. Fisher performing an anterior arthroplasty and still photos are available. Doug Crusan's sports biography is also available.

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