Six hours after surgeons replaced his right hip joint through two small incisions, Jay Dudek was up and walking.

Krista Schinagl, Post-Gazette Hours after surgery May 3, Jay Dudek is up and walking. Click photo for larger image. More on hip replacement Nerve blocking techniques are real boost to recovery Graphic: The minimally invasive method

Slight nausea and lightheadedness prevented him from going too far on that maiden voyage. But he was steady on his feet by the time he went home to Wheeling, W.Va., the next day.

Dudek's speedy progress after an operation that typically has patients recovering for weeks is due to advances in minimally invasive surgery and pain control.

Surgeons at UPMC Shadyside replaced his damaged hip joint through two small incisions, instead of a thigh-long one. And anesthesiologists used nerve blocks to treat the operative pain before it really even began.

The combination had Dudek, 53, marvelling. "After one week I still have not experienced any pain!" he said in an e-mail. "This is absolutely amazing to me."

The doctors who made it possible are just as delighted.

"Seeing these patients is just unbelievable," said Dr. Jacques Chelly, director of the Posner Inpatient Pain Center at UPMC Shadyside.

First performed in 1960, hip replacements now are done in more than 168,000 people a year, according to the American Academy of Orthopaedic Surgeons. The need for this surgery is expected to surge as the population continues to age and also get heavier.

	Lake Font, Post-Gazette Dudek strides out of surgeon Dr. Dana Mears' office after a follow-up visit May 25. Click photo for larger image.

Dudek's hip problem began when he was in eighth grade. He was tackled while playing football and his thigh pad drove into his hip when he hit the ground. He didn't think anything of it at the time, although it hurt off and on for about a year.

But in all likelihood, that injury damaged the growing end of the ball of his femur, or thigh bone, and the cartilage, explained Dr. Dana Mears, of Greater Pittsburgh Orthopedic Associates. The ball, or head, moves within the socket of the pelvis to form the hip joint.

Osteoarthritis can develop if the problem, formally known as a slipped capital femoral epiphysis, is left untreated, as in Dudek's case.

An injury's consequences

Seven years ago, Dudek's hip problems returned and gradually got worse. He felt weak and he limped, almost dragging his right leg. He'd see his reflection in storefront windows and think, "It looks bad."

In Dudek's words, dull pain prevented him from taking normal steps. About six months ago, stairs became a challenge.

"The more active he was, the worse it was," said his wife, Patty, a cardiac nurse. "He would restrict himself. He didn't want to go here or there because he knew there would be walking involved."

After talking with doctors, Dudek knew he'd eventually need hip replacement surgery. But he'd never had an operation before, and he wanted to put it off as long as possible.

Then in early spring, he heard about a new procedure from two colleagues who had hip replacements who were "ecstatic" about the results, Dudek said. One helped his wife hang drapes within a week of surgery.

"They told me it was a cakewalk," he said. "The difference was like night and day."

So Dudek sought out their doctor, Mears, and had the operation on May 3.

The surgeon's first incision was a little more than two inches long and made on the front of Dudek's thigh, just below the groin. Through that small window, Mears cut through the thigh bone in two places near its ball-like head, and screwed out the chunk as if taking a cork out of a bottle.

Next, he removed the head, which had a bony protrusion in one area and other surfaces that were cueball shiny because the protective cartilage had worn away.

"There's nothing normal about that," Mears noted. The surgeon then hammered a metal cup and plastic liner into the hip socket in which the prosthetic head could swivel.

Mears repositioned Dudek's legs (see diagram) and made a second incision higher and farther back on his hip. Through the opening, he could see the cut edge of the femur, where the piece of bone had been removed.

He carved a canal into the femur for the insertion of the shaft of the prosthetic. Finally, the head was attached to the shaft and popped into place in the hip socket through the first incision.

After an X-ray was taken to confirm everything was where it should be, the incisions were sewn shut. With time, Dudek's own bone will grow into the manmade joint to add even more stability.

The operation took a little more than an hour. Dudek woke up in the recovery room 30 minutes later and was soon wiggling his toes.

Four surgeons' inventiveness

Minimally invasive hip replacement surgery was devel-oped by three orthopedic surgeons and by Mears, then working in New York at the Albany Medical College.

About a decade ago, Mears figured out that using two small thigh incisions and changing the position of the patient's leg might allow him to slip between the thigh and hip muscles to remove the damaged joint and to insert prosthetics.

The process is "akin to the assembly of a ship in a bottle," as Mears wrote in an article for a UPMC Shadyside publication last fall.

Zimmer Inc., made specially designed, smaller tools for the surgery and, in 2000, a multicenter trial of 250 patients was launched. The first operation was done in Chicago about three years ago by pioneer Dr. Richard Berger, a mechanical engineer turned surgeon.

Lake Fong, Post-Gazette Jay Dudek talks about his hip surgery at Dr. Dana Mears' office. Click photo for larger image.

A quarter of the participants went home on the day of surgery and another third went home the following day, Mears said. With a conventional operation, the average hospital stay is 3 1/2 days followed by another week to 10 days in a rehabilitation hospital.

According to a Zimmer spokesman, there are orthopedic surgeons in most large cities now performing minimally invasive hip replacements. In addition to UPMC Shadyside, the procedure is offered at Allegheny General Hospital and Mercy Hospital of Pittsburgh. Four hours after his surgery, under the watchful eyes of physical therapists, Dudek gripped a walker and stood. He felt a bit woozy, though, so he had to lie down again. He got up two hours later and, with a walker, did a round trip of about 20 feet from the bed to the door.

Chelly said a mild blood pressure drop due to dehydration was making Dudek a bit lightheaded.

"By tomorrow you will feel like a different person," Chelly promised.

He was right. Dudek walked at least 30 feet and went up and down stairs, so he was sent home with a cane. The day after that, his wife removed the nerve block catheter in his back that pumped in anesthetic to control his pain (read article).

Three weeks after the operation, Dudek walked without assistance at his follow-up visit with Mears. He was allowed to drive himself home and to cross his legs, activities that were forbidden immediately after the surgery.

"I haven't crossed my legs in five years because it hurt too much," said a cheerful Dudek. "Now [I have] to forget that I have this thing in me."

Mears told him to join a health club after getting physical therapy to strengthen muscles that had grown weak from favoring the sore hip. Walking, swimming, biking and even easy tennis should be fine, he said.

Dudek was already satisfied with the results as he walked, unlimping, through Mears' office.

"It worked out perfect for me," he said. "Amazing, isn't it?"