@!c GaztttD
Seruing Residentsof Northern Westchester
A special reprint from a recent issue
'The thigh bone'sconnectedto... my aftificialhip'
Robert Scott
Behold a martyr.
Not someone out of the past memorialized in Fox's "Book of Martyrs" or
Butler's "Lives of the Saints."
Me.
For years I foolishly suffered from
a painful hip condition called
osteoarthritis-chronic degeneration of
the cartilage of the joint.
Pain had begun in the right buttock,
then traveled to the right thigh and seemed
to be sciatica. Eventually, it concentrated
itself in the area of the hip. X-rays showed
my hip joint to be disintegrating.
By last winter, getting around at home
had become a problem. To walk, I held on
to walls and furniture.The pain was so intenseit interferedwith my ability to sleep.
Various arthritis drugs afforded no relief.
A surgical procedure,total hip replacement, was my only recourse.
What follows is al once a cautionary
tale fbr others suffering from the same condition, an accountof an odysseyof discovery. and a tribute to a talented orthopedic
surgeonand a dedicated community hospital and staff. It is also a successstory.
The first step-research
I beganby interviewing local residents
w h o h a d u n d e r g o n ej o i n t r e p l a c e m e n t .
Their surgerieshad taken place in New York
City hospitals.
All had been discharged four or l'ive
days afier the operation-but not because
of insurancerequirements.The hospitals
lacked specialized rehabilitation facil itics.
All provided me with the namcs of
their surgeonsin the City, each a diffbrent
name. Faced with an embarrassmcnt ol'
riches,I decidedto continue searchingunl i l o n e n a m ec a m e u p t w i c e .
Someone suggesteda highly recornrnendedlocal orthopedic surgeon,J. RobOne personinterviewedwas
crt Seebacher.
uniquely able to make a comparison. Hc
had one knee replaced by a surgeon in New
York and the other knee later by Dr.
Seebacher:"I saw the surgeon in the City
once before the operation-and I never saw
him again. I was much more satisfied with
Dr. Seebacher, who performed the operation at Phelps."
He added, "After the first operation a
therapist came to my home and flexed my
knee a few times. The therapy was a joke.
Phelps handled my rehabilitation professionally. The facility there is great."
Dr. Robert Seebacher with Marie and
Rudolph Foglia of Greenburgh, NY;
Dr. Seebacber recently replaced both hips
on both Mr. 6 Mrs. Foglia.
The next step----consultation
I decided to start by consulting Dr.
Seebacher.His office mailed me an interesting video cassette describing the
procedures and their benefits. I set up an
appolntment.
He is powerfully built, with an assured
manner and a commanding presence.In
movies and on TV, surgeonsunfailingly
have sensitivehands,as able to finger a
virtuoso Paganiniviolin concertoas to
stitchup a beatingheart.
Orthopedicsurgeonsare different.
They need finesse in performance.of
course.But they also needbrawnto move
and restorea limb to its original position.
They work not only with scalpels,but with
saws,drills,andhammersandchisels.
After examiningX-raysof my hip, Dr.
Seebacher
said,"I won't mincewords.This
won't be an easyprocedure.You may have
waitedtoo long."
I could offer no excuses.
"Is this beyondyour capabilities?"
I
asked.
" N o t a t a l l . I f I t h o u g h tI c o u l d n ' t
handleit, I'd sendyou to a specialized
center in the City."
His candorand lack of pretensewere
refreshing.Obviously,he doesnot patronize patients.
A retireddoctor friend had cautioned
me to be sureto selecta surgeonwho did
the hip operationfrequently.Last year,Dr.
performedmore than 150joint
Seebacher
replacements.
Curiosityimpelledme to askhim how
longI couldexpectto be hospitalized.
"Ten to twelvedays,"was his answer.
I pointedout that thosewho had hips'replacedin New York City stayedonly four
or five days.
"I can dischargeyou after four or five
days,"he said,"but you won't like it. It's
like going to boot camp.We havea stateapprovedfacility right in our hospitaland
immediately."
canbeginyourrehabilitation
turnedto books.I
Our conversation
mentionedDr. HansZinsser,aneruditeand
witty author who is little remembered
now-but still worth reading.Zinsser,a
bacteriologistand authorityon typhusfever,diedin l940.An imposingglacialboulder aboutthe size of a VolkswagenBeetle
markshis gravein SleepyHollow Cem-
etery.The singleword,ZINSSER,is chiseledin its side.
me by reDr. Seebacher
astonished
memberingZinsser'sbooks: the classic
"Rats, Lice and History" and a delightful
memoir. "As I RememberHim." both of
which he had read.Few peopleI know in
the world of publishingcould recognize
Zinsser'snametoday.Even fewer could
identify the titles of the bookshe wrote.
Making the choice
medicalwisdom holds
Conventional
thata secondopinionis alwaysadvisable.
But I never looked fartherthan J. Robert
M.D. Alier all, who betterto
Seebacher,
trustone'sfateto thana skilledprofessional
who sharesyour interestsand values'l
pulmonaryembolisms
Two dangerous
I hadsuffered-one in 1984andanotherin
199O-becameimmediateconcernsfor
probhim.Thiscommonbutunpredictable
lem affectstwo million Americanseach
year,especiallyafter surgery.Deathcan
occur when blood clots form in leg veins
and dislodge,travelingup veins to and
throughtheheart,cloggingthe lungs.
An estimated600,fiD patientsdevelop
pulmonaryembolisms
Eachyear
annually.
60,00Odieof thiscomplication-morethan
the numberof Americanwomenwho succumb to breastcancer.
Giventheseincidents,Dr. Seebacher
insistedI undergoa precautionaryprocedure beforehe would operate.At Phelpsa
week beforemy scheduledhip operationa
vascularsurgeon,Dr. PravinShah,inserted
a filter in the inferiorvenacava,the large
vein leadingfrom the legsto the heart.
The device resemblesa tiny closed
umbrellawithout any cloth. The surgeon
carefully snakedit upwardsthrough the
veins from a tiny puncturein my groin.
Whenit reachedtheproperpointbelowmy
heart,he poppedit open.Tiny hooksat the
endsof the umbrella'sribs anchoredit permanentlyin the vein. Called a Greenfield
[ilter for its inventor.it servesas a sl.rainer
to block waywardclots from makingtheir
way to my heartand lungs.
A brief history of hip replacement
surgery
joint. To
The hip is a ball-and-socket
getan ideaof how suchajoint works,make
a fist with one handand twist it into the
cuppedpalm of your otherhand.
When healthy,the ball of the joint is
glassysmooth.It sits at the end of the thin
"neck" of the femur, or thigh bone-the
largestbone in the human body. It is this
part of the bone that so often breaksin a
fall and is termeda "hip fracture."
The ball fits neatlyinto a socket,a cavi t y i n t h e p e l v i s c a l l e dt h e a c e t a b u l u m
(Latin for "vinegarcup," a Roman vessel
ancientanatomists
thoughtit resembled).
A leatherycapsulesurrounds
thejointand
holds it together.
As operationsgo, total hip replacement
is a comparatively recent procedure. Starting in the 1930s,surgeonsimplanted metal
or plastic artificial hips in patients,but early
prostheses offered only brief and incomplete relief from pain.
A breakthrough came in England in
1961.An orthopedicsurgeon,John Charnley,
had spent the war years in the Middle East
restoring the shatteredbones of British soldiers. He concluded that the developmentof
a successfulhip prosthesislay in the application of engineeringprinciples.
Convinced that friction was the
villain in earlier attempts, Charnley
decided it could be reduced by using
d i s s i m i l a rm a t e r i a l sa n d a s m a l l e rb a l l t b r
the femoral head.
Charnley made his ball of stainless
steel and formed the socket from Teflon.
the same slippery substance used to coat
cooking utensils. To anchor the femoral
stem in the hollowed marrow canal of the
femur, he used a newly developed acrylic
dental cement. The May 21 , 1961, issue of
the respected British medical journal, The
Lancet, carried an account ofhis procedure.
Chamley soon discoveredthat the Teflon
was causing problems and replacedit with a
new plasticlike polyethylene used in
nonlubricated machine bearings.Although
producing five times more friction than
Teflon, it is a thousandtimes tougher.Introduced in 1963,Charnley's new combination
of materials was an immediate success.
Queen Elizabeth rewarded him with a knighr
hood. SirJohn Charnleydied in 1982.
For nearly ten years, Charnley's procedure ior total hip replacement was unavailable in the United States. Its use here
depended on approval by the Food and
DrugAdministration,which was concerned
about the safety of the cement. Trials began in 1969 in severalteachingcenters.
The materials received F.D.A.
approval in late 1970.Sincethen, surgeons
have performed well over a million hip
replacements in this country. Over half of
these have been fbr osteoarthritis;about
20%ctwere because of fractures of the
femoral neck.
Recipients of artificial hips invanably
describe the operatronas "a miracle." Total
hip replacementis one of the most successful surgical procedures performed today.
More than three decades later. it is a
tribute to Charnley's genius that hip replacementsare still basedon the principles
of his low-tiiction design.
A full-service community hospital
My choice of Dr. Seebachermade rt
possible for the surgery to be performed at
Phelps Memorial Hospital Center in Sleepy
Hollow. Opened in 1956and named forthe
family who donated the land, it replaced
existing hospitals in Ossining and
Tarrytown. With 235 beds, it is the only fullservicecommunrty hospitalin Westchester
County.
The hospital recently remodeled a part
of one wing and dedicated it to the care of
orthopedic and rehabiIitation patients.Even
the rooms were made larger to fit the special needs of such patients. The staff, including doctors Anthony Infantino, M'D',
and Joseph Annichiarico, D.O., rehabilitation nurses directed by Ellen Yaeger, R.N.
and the physical and occupational therapists, are all specialists.The money for remodeling this wing was generouslydonated
by Dr. Seebacher's mother.
A local hospital like Phelps offers patients many advantages.Not the least is proximity to home, enabling relativesand friends
to visit. And Dr. Saleem M. Mir, the Croton
internist lamiliar with my medical history
over many years. could attend me.
Familiar f'aces greeted me at Phelps.
When I needed tests. amon-qthe selfless
volunteerswho so tirelesslypushedme on
a gurney or wheelchair turned out to be
fiiends liom Croton-John and Bob Grant
and Bob Reibel. Volunteer MargaretAlbert,
a tennis partner of my wif'e, brought the
hospital's book cart to my room regularly,
keeping me supplied with readingmatter.
The anatomy of a hip replacement
Paradoxically, preparation for a total
hip replacement takes longer than the operation itself. Recording my medical hrstory in detail rs the first step.lbllowed by a
thorough medical examination.Next come
sophisticatedcomputer-analyzedX-rays of
my severely worn hip socket, and routine
heart. 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 e
hospital's blood bank. I give two ptnts
o f b l o o d t o r e p l e n i s h l o s s e sd u r i n g t h e
operau on.
On the appointed day, I rePort to the
hospital at 6 a.m. fbr the operation scheduled to start at u a.m. This will be Dr.
Seebacher'sl.026th joint replacement.It will
be my first. Another orthopedlc surgeon.hrs
partner,Dr. George Burak, will assrst.
The operation itselftakes about an hour
and a half. Lookin-eas if they steppedout
of a spacecrafi, surgeons and nurses have
becomeblue scrub-suitedfiguresrn bubble
h e l m e t s .T h e o p e r a t i n g r o o m l s s c r u p u lously clean, its temperature surprisingly
cool. Precautions are taken to assure that
everything near the incision is completely
sterile. I lie on my left side on the operating table, my knees bent almost in a fetal
position.
First, an anesthesiologist fusses over
me, placing a blood-oxygen sensor on an
index finger, an IV line into an arm, EKG
leadson my shoulderand back, and a needle
catheterbetween two vertebrae.A sedative
and an anestheticare administered. During
the operation, I will be in a dreamlike state,
awake but unaware of any of the details of
the operation.
Using a felt tip marker, the surgeon
draws a foorlong line along the upper part
of my right thigh. Cutting through skin and
fat, he reachesunderlying muscles.He does
not cut these. Instead. they are separated
and pulled aside. He must divide the three
ligaments wrapped around the head of the
femur, however. They will be rejoined later.
A total hip replacement has been described as an internal amputation. By rotating my leg, the surgical team forcibly
separates the femoral head from the acetabulum. With the upper portion of my
femur now completely exposed, the surgeon uses a power saw to remove the diseased femoral headjust below the neck.
Next. using a drill and a series of
spherical cutters, the acetabulum is ground
down to reach healthy bone. The surgeon
pounds a titanium cup into the recess and
screwsit in place. He placesthe tough polyethylene liner inside it.
Turning his attention again to my femur, he hollows it out to receive the metal
stem. It resembles nothing more than an
old-fashioned tent peg. Attaching the shiny
b a l l t o t h e s t e m .h e p u s h e si t i n t o i t s c u p .
Finally, the motion of my leg is
tested. If movement is satisfactory, the
task of stitching ligamentsand stapling
t h e w o u n d b e g i n s .W h e n t h e s h i n y m i n iature staples are later removed from the
n o w a l m o s t - i n v i s i b l es c a r o n m y s i d e , I
count them. There are 36.
With my leg cradled in a sling, I am
moved to the recovery room. Here nurses
carefully monitor my vital signs and reflexes for about an hour. I feel euphoric.
Hip, hip, hooray
Rehabilitationbegins almost immediately with simple exercises performed in
bed. A few days after the operation, I transfer from my postoperative hospital room
to a room in the nearby rehab section. Here
therapistsgive me daily instruction in techniques for household activities, such as
dressingand negotiating stairs.Initially, hip
patients must observe certain precautions:
bending over, rotating the pelvis and crossing the legs are all taboo.
Having the operation performed at
Phelps may have been a lifesaving decision
on my part. A Doppler study of the circulation of my legs made in the hospital a week
after the operation revealed a large clot in
a deep vein near the site ofthe replacedhip.
With the Greenfield filter in place just
below my heart, however, the clot was not
regarded as a serious threat. Had I chosen a
surgeonwho might not have insistedon the
protection of the filter or a short-stayhospital without rehabilitative care,I would already
have returned home unaware of the clot.
Once discharged from the hospital, I
continuedrehabilitationthreetimes a week
as an outpatient in the recently opened facility of the PhelpsPhysicalMedicine and
Rehabilitation Department. Completely
equippedwith every conceivablephysical
training device and staffed by skilled and
compassionateprofessionals,rehabilitation
there becomes something to look forward
to. Phelps is the only community hosprtal
i n W e s t c h e s t e ro f f e r i n g s u c h a f u l l y
equippedrehabilitationcenter.
Progressing fiom a walker to a pair of
crutches, then a single crutch and later a
cane.I now walk unaidedand have resumed
my former activities. From the moment of
the operation,I have experiencedabsolutely
no paln.
The miracle of hip replacement has
become almost commonplace-but it is a
miracle nonethelessto those who benefit
from it.
Behold now one on whom such a
miracle has been worked.
Copyright O 1998 Robert Scott
About the Writer
Robert Scott has been writing a
r 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 weekl y p a i d - c i r c u l a t i o nc o m m u n i t y
newspaper with editorial offices in
Croton-on-Hudson. His column
appears in two editions, Ossining/
Briarcliff Manor and Croton-onthe Hudson/ Cortlandt. "The
Thigh Bone's Connected to ... My
Artificial Hip"appeared in the
May 28, 1998 issueo{ Tbe Gazette.
"Three
'Women
Named Mollie,"
one of Mr. Scott's 1997 Gazette
columns about three Revolutionary
War heroines, was awarded
first place in the Feature Story
category in the New York Press
Association's annual Better
Newspaper competition.
His 1984 book Office at Home,
among the first to explore the home
office phenomenon, was named one
of the ten best businessbooks of the
year by Library Journal.