@!c GaztttDSeruing Residents of Northern Westchester

A special reprint from a recent issue

'The thigh bone's connected to... my aftificial hip'Robert Scott

Behold a martyr.Not someone out of the past memori-

a l i zed in Fox 's "Book o f Mar ty rs " o rButler 's "Lives of the Saints."

Me.For years I foolishly suffered from

a p a i n f u l h i p c o n d i t i o n c a l l e dosteoarthri t is-chronic degeneration ofthe cart i lage of the joint.

Pain had begun in the right buttock,then traveled to the right thigh and seemedto be sciatica. Eventually, it concentrateditself in the area of the hip. X-rays showedmy hip joint to be disintegrating.

By last winter, getting around at homehad become a problem. To walk, I held onto walls and furniture. The pain was so in-tense i t interfered with my abi l i ty to sleep.Various arthritis drugs afforded no relief.

A surgical procedure, total hip replace-ment, was my only recourse.

What fol lows is al once a cautionarytale fbr others suffering from the same con-dit ion, an account of an odyssey of discov-ery. and a tribute to a talented orthopedicsurgeon and a dedicated community hos-pital and staff. It is also a success story.The first step-research

I began by interviewing local residentswho had undergone jo in t rep lacement .Their surgeries had taken place in New YorkCity hospitals.

All had been discharged four or l'ivedays afier the operation-but not becauseof insurance requirements. The hospitalslacked special ized rehabil i tat ion faci l i t ics.

Al l provided me with the namcs oftheir surgeons in the City, each a dif fbrentname. Faced with an embarrassmcnt ol 'r iches, I decided to continue searching un-l i l one name came up tw ice .

Someone suggested a highly recorn-rnended local orthopedic surgeon, J. Rob-crt Seebacher. One person interviewed wasuniquely able to make a comparison. Hchad one knee replaced by a surgeon in NewYork and the o ther knee la te r by Dr .

Seebacher: "I saw the surgeon in the Cityonce before the operation-and I never sawhim again. I was much more satisfied withDr. Seebacher, who performed the opera-tion at Phelps."

He added, "After the first operation atherapist came to my home and flexed myknee a few times. The therapy was a joke.Phelps handled my rehabilitation profes-sionally. The facility there is great."

Dr. Robert Seebacher with Marie andRudolph Foglia of Greenburgh, NY;Dr. Seebacber recently replaced both hipson both Mr. 6 Mrs. Foglia.

The next step----consultationI decided to start by consult ing Dr.

Seebacher. His off ice mailed me an in-teresting video cassette describing theprocedures and their benefi ts. I set up anappolntment.

He is powerfully built, with an assuredmanner and a commanding presence. In

movies and on TV, surgeons unfailinglyhave sensitive hands, as able to finger avirtuoso Paganini violin concerto as tostitch up a beating heart.

Orthopedic surgeons are different.They need finesse in performance. ofcourse. But they also need brawn to moveand restore a limb to its original position.They work not only with scalpels, but withsaws, dri l ls, and hammers and chisels.

After examining X-rays of my hip, Dr.Seebacher said, "I won't mince words. Thiswon't be an easy procedure. You may havewaited too long."

I could offer no excuses."Is this beyond your capabil it ies?" I

asked."Not at a l l . I f I thought I couldn ' t

handle it, I 'd send you to a specialized cen-ter in the City."

His candor and lack of pretense wererefreshing. Obviously, he does not patron-ize patients.

A retired doctor friend had cautionedme to be sure to select a surgeon who didthe hip operation frequently. Last year, Dr.Seebacher performed more than 150 jointreplacements.

Curiosity impelled me to ask him howlong I could expect to be hospitalized.

"Ten to twelve days," was his answer.I pointed out that those who had hips're-placed in New York City stayed only fouror five days.

"I can discharge you after four or fivedays," he said, "but you won't l ike it. It 'slike going to boot camp. We have a state-approved facility right in our hospital andcan begin your rehabilitation immediately."

Our conversation turned to books. Imentioned Dr. Hans Zinsser, an erudite andwitty author who is l i tt le rememberednow-but still worth reading. Zinsser, abacteriologist and authority on typhus fe-ver, died in l940. An imposing glacial boul-der about the size of a Volkswagen Beetlemarks his grave in Sleepy Hollow Cem-

etery. The single word, ZINSSER, is chis-eled in its side.

Dr. Seebacher astonished me by re-membering Zinsser's books: the classic"Rats, Lice and History" and a delightfulmemoir. "As I Remember Him." both ofwhich he had read. Few people I know inthe world of publishing could recognizeZinsser's name today. Even fewer couldidentify the titles of the books he wrote.Making the choice

Conventional medical wisdom holdsthat a second opinion is always advisable.But I never looked farther than J. RobertSeebacher, M.D. Alier all, who better totrust one's fate to than a skilled professionalwho shares your interests and values'l

Two dangerous pulmonary embolismsI had suffered-one in 1984 and another in199O-became immediate concerns forhim. This common but unpredictable prob-lem affects two mill ion Americans eachyear, especially after surgery. Death canoccur when blood clots form in leg veinsand dislodge, traveling up veins to andthrough the heart, clogging the lungs.

An estimated 600,fiD patients developpulmonary embolisms annually. Each year60,00O die of this complication-more thanthe number of American women who suc-cumb to breast cancer.

Given these incidents, Dr. Seebacherinsisted I undergo a precautionary proce-dure before he would operate. At Phelps aweek before my scheduled hip operation avascular surgeon, Dr. Pravin Shah, inserteda fi l ter in the inferior vena cava, the largevein leading from the legs to the heart.

The device resembles a tiny closedumbrella without any cloth. The surgeoncarefully snaked it upwards through theveins from a tiny puncture in my groin.When it reached the proper point below myheart, he popped it open. Tiny hooks at theends of the umbrella's ribs anchored it per-manently in the vein. Called a Greenfield[i lter for its inventor. it serves as a sl.rainerto block wayward clots from making theirway to my heart and lungs.A brief history of hip replacementsurgery

The hip is a ball-and-socket joint. Toget an idea of how such a joint works, makea fist with one hand and twist it into thecupped palm of your other hand.

When healthy, the ball of the joint isglassy smooth. It sits at the end of the thin"neck" of the femur, or thigh bone-thelargest bone in the human body. It is thispart of the bone that so often breaks in afall and is termed a "hip fracture."

The ball fits neatly into a socket, a cav-i ty in the pelv is cal led the acetabulum(Latin for "vinegar cup," a Roman vesselancient anatomists thought it resembled).A leathery capsule surrounds thejoint andholds it together.

As operations go, total hip replacementis a comparatively recent procedure. Start-ing in the 1930s, surgeons implanted metalor plastic artificial hips in patients, but earlyprostheses offered only brief and incom-plete relief from pain.

A breakthrough came in England in1961. An orthopedic surgeon, John Charnley,had spent the war years in the Middle Eastrestoring the shattered bones of British sol-diers. He concluded that the development ofa successful hip prosthesis lay in the appli-cation of engineering principles.

C o n v i n c e d t h a t f r i c t i o n w a s t h ev i l l a i n i n e a r l i e r a t t e m p t s , C h a r n l e yd e c i d e d i t c o u l d b e r e d u c e d b y u s i n gd iss imi la r mater ia ls and a smal le r ba l l tb rthe femoral head.

Charnley made his bal l of stainlesssteel and formed the socket from Teflon.the same slippery substance used to coatcooking utensi ls. To anchor the femoralstem in the hollowed marrow canal of thefemur, he used a newly developed acrylicdental cement. The May 21 , 1961 , issue ofthe respected British medical journal, TheLancet, carried an account ofhis procedure.

Chamley soon discovered that the Teflonwas causing problems and replaced it with an e w p l a s t i c l i k e p o l y e t h y l e n e u s e d i nnonlubricated machine bearings. Althoughproducing f ive t imes more fr ict ion thanTeflon, it is a thousand times tougher. Intro-duced in 1963, Charnley's new combinationof materials was an immediate success.Queen Elizabeth rewarded him with a knighrhood. SirJohn Charnley died in 1982.

For nearly ten years, Charnley's pro-cedure ior total hip replacement was un-available in the United States. Its use heredepended on approval by the Food andDrugAdministrat ion, which was concernedabout the safety of the cement. Trials be-gan in 1969 in several teaching centers.

T h e m a t e r i a l s r e c e i v e d F . D . A .approval in late 1970. Since then, surgeonshave performed well over a mil l ion hipreplacements in this country. Over half ofthese have been fbr osteoarthri t is; about20%ct were because of fractures of thefemoral neck.

Recipients of artificial hips invanablydescribe the operatron as "a miracle." Totalhip replacement is one of the most success-ful surgical procedures performed today.

More than three decades later. it is atr ibute to Charnley's genius that hip re-placements are st i l l based on the principlesof his low-t i ict ion design.A full-service community hospital

My choice of Dr. Seebacher made rtpossible for the surgery to be performed atPhelps Memorial Hospital Center in SleepyHollow. Opened in 1956 and named forthefamily who donated the land, it replacede x i s t i n g h o s p i t a l s i n O s s i n i n g a n dTarrytown. With 235 beds, it is the only full-service communrty hospital in WestchesterCounty.

The hospital recently remodeled a partof one wing and dedicated it to the care oforthopedic and rehabiIitation patients. Eventhe rooms were made larger to fit the spe-cial needs of such patients. The staff, in-cluding doctors Anthony Infantino, M'D',and Joseph Annichiarico, D.O., rehabilita-tion nurses directed by Ellen Yaeger, R.N.and the physical and occupational thera-pists, are al l special ists. The money for re-modeling this wing was generously donatedby Dr. Seebacher's mother.

A local hospital like Phelps offers pa-tients many advantages. Not the least is prox-imity to home, enabling relatives and friendsto visit. And Dr. Saleem M. Mir, the Crotoninternist lamiliar with my medical historyover many years. could attend me.

Familiar f'aces greeted me at Phelps.When I needed tests. amon-q the self lessvolunteers who so t irelessly pushed me ona gurney or wheelchair turned out to befiiends liom Croton-John and Bob Grantand Bob Reibel. Volunteer MargaretAlbert,a tennis partner of my wif 'e, brought thehospital's book cart to my room regularly,keeping me supplied with reading matter.The anatomy of a hip replacement

Paradoxically, preparation for a totalhip replacement takes longer than the op-eration i tself . Recording my medical hrs-tory in detai l rs the f irst step. lbl lowed by athorough medical examination. Next comesophisticated computer-analyzed X-rays ofmy severely worn hip socket, and routineheart. blood and urine tests.

N o t h i n g i s l e f t t o c h a n c e . A t t h ehosp i ta l ' s b lood bank . I g ive two p tn tso f b lood to rep len ish losses dur ing theoperau on.

On the appointed day, I rePort to thehospital at 6 a.m. fbr the operation sched-u led to s ta r t a t u a .m. Th is w i l l be Dr .Seebacher's l.026th joint replacement. It willbe my first. Another orthopedlc surgeon. hrspartner, Dr. George Burak, will assrst.

The operation itselftakes about an hourand a half. Lookin-e as i f they stepped outof a spacecrafi, surgeons and nurses havebecome blue scrub-suited f igures rn bubblehe lmets . The opera t ing room ls sc rupu-lously clean, its temperature surprisinglycool. Precautions are taken to assure thateverything near the incision is completelysterile. I lie on my left side on the operat-ing table, my knees bent almost in a fetalposition.

First, an anesthesiologist fusses overme, placing a blood-oxygen sensor on anindex finger, an IV line into an arm, EKGleads on my shoulder and back, and a needlecatheter between two vertebrae. A sedativeand an anesthetic are administered. Duringthe operation, I will be in a dreamlike state,awake but unaware of any of the details ofthe operation.

Using a felt tip marker, the surgeondraws a foorlong line along the upper part

of my right thigh. Cutting through skin andfat, he reaches underlying muscles. He doesnot cut these. Instead. they are separatedand pulled aside. He must divide the threeligaments wrapped around the head of thefemur, however. They will be rejoined later.

A total hip replacement has been de-scribed as an internal amputation. By ro-tating my leg, the surgical team forciblyseparates the femoral head from the ac-etabulum. With the upper portion of myfemur now completely exposed, the sur-geon uses a power saw to remove the dis-eased femoral headjust below the neck.

Next . us ing a d r i l l and a ser ies o fspherical cutters, the acetabulum is grounddown to reach healthy bone. The surgeonpounds a titanium cup into the recess andscrews it in place. He places the tough poly-ethylene liner inside it.

Turning his attention again to my fe-mur, he hollows it out to receive the metalstem. It resembles nothing more than anold-fashioned tent peg. Attaching the shinyba l l to the s tem. he pushes i t in to i t s cup .

F i n a l l y , t h e m o t i o n o f m y l e g i stested. I f movement is satisfactory, thetask o f s t i t ch ing l igaments and s tap l ingthe wound beg ins . When the sh iny min-iature staples are later removed from thenow a lmost - inv is ib le scar on my s ide , Icount them. There are 36.

With my leg cradled in a sling, I ammoved to the recovery room. Here nursescarefully monitor my vital signs and re-flexes for about an hour. I feel euphoric.Hip, hip, hooray

Rehabil i tat ion begins almost immedi-ately with simple exercises performed inbed. A few days after the operation, I trans-fer from my postoperative hospital roomto a room in the nearby rehab section. Heretherapists give me daily instruction in tech-niques for household activi t ies, such asdressing and negotiating stairs. Initially, hippatients must observe certain precautions:bending over, rotating the pelvis and cross-ing the legs are al l taboo.

Having the operation performed atPhelps may have been a lifesaving decisionon my part. A Doppler study of the circula-tion of my legs made in the hospital a weekafter the operation revealed a large clot ina deep vein near the site ofthe replaced hip.

With the Greenfield filter in place justbelow my heart, however, the clot was notregarded as a serious threat. Had I chosen asurgeon who might not have insisted on theprotection of the filter or a short-stay hospi-tal without rehabilitative care, I would alreadyhave returned home unaware of the clot.

Once discharged from the hospital, Icontinued rehabil i tat ion three t imes a weekas an outpatient in the recently opened fa-ci l i ty of the Phelps Physical Medicine andRehabil i tat ion Department. Completelyequipped with every conceivable physicaltraining device and staffed by ski l led and

compassionate professionals, rehabil itationthere becomes something to look forwardto. Phelps is the only community hosprtali n W e s t c h e s t e r o f f e r i n g s u c h a f u l l yequipped rehabil i tat ion center.

Progressing fiom a walker to a pair ofcrutches, then a single crutch and later acane. I now walk unaided and have resumedmy former activities. From the moment ofthe operation, I have experienced absolutelyno pa ln .

The miracle of hip replacement hasbecome almost commonplace-but i t is amiracle nonetheless to those who benefi tfrom it.

Beho ld now one on whom such amiracle has been worked.

Copyright O 1998 Robert Scott

About the Writer

Robert Scott has been writ ing ar e g u l a r c o l u m n , " P o s t s c r i p t s , "since 1995 in The Gazetfe, a week-l y p a i d - c i r c u l a t i o n c o m m u n i t ynewspaper with editorial offices inCroton-on-Hudson. His columnappears in two edit ions, Ossining/Briarcl i f f Manor and Croton-on-t h e H u d s o n / C o r t l a n d t . " T h eThigh Bone's Connected to . . . MyAr t i f i c ia l H ip"appeared in theMay 28, 1998 issue o{ Tbe Gazette.

"Three 'Women Named Mollie,"one of Mr. Scott's 1997 Gazettecolumns about three RevolutionaryW a r h e r o i n e s , w a s a w a r d e df i rs t p lace in the Feature Storyca tegory in the New York PressA s s o c i a t i o n ' s a n n u a l B e t t e rNewspaper competition.

His 1984 book Office at Home,among the first to explore the homeoffice phenomenon, was named oneof the ten best business books of theyear by Library Journal.