Methodist Sports Medicine is proud of its record of bringing pioneering new procedures and surgical outcomes to Central Indiana. Dr. R. Presley Swann has recently begun performing four new types of surgeries that can bring about much faster and pain-free recoveries, with smaller scars or minimally invasive techniques that spare muscles.
The outcomes he’s getting are very dramatic, and we’re excited to tell you about them!
Knee replacement with kinetic balancing and pain management
The knee is one of the most frequently impacted joints. Recovery and pain management remain some of the biggest challenges of total knee replacement. It’s not unusual for patients to still be struggling to walk normally three months after surgery. And the number one reason for readmission post-op is nausea and disorientation resulting from powerful pain meds.
Using a blend of kinetic balancing and a new approach to pain protocols, Swann is realizing some truly staggering results with knee replacement:
- Outpatient procedure with zero time in a hospital.
- Patients go home the same day.
- Most patients have full range of motion two weeks post-op.
- Most are pain free in two weeks.
How is this achieved? The first has to do with kinetically balancing the knee when cutting through the bones to mimic the patient’s natural shape. Historically, surgeons made a flat cut in the bone to accommodate the plastic and metal of the artificial joint. By altering their anatomy, doctors made patients re-learn how to walk. In making his bone cuts, Swann focuses on replacing the areas with wear and tear and keeping everything else natural.
The other tactic is pain control management during and after the surgery itself. Swann installs a long-acting pump in the thigh to release medication that keeps their knee completely numb for three days. He also gives medication with no narcotic pathway. After a few days the pump is removed by a nurse, and the patient switches to regular over-the-counter painkillers.
By keeping the replacement knee as close as possible to the knee you had before the arthritic condition started, and keeping narcotics to a minimum, Dr. Swann is setting a new standard for post-surgery recovery. He is currently the only doctor in Indianapolis performing offering this experience to knee arthroplasty.
Bikini incision hip replacement
Direct anterior hip replacements aren’t particularly new – but performing them using the “bikini incision” is something only about five surgeons in the entire country perform, including Dr. Swann. What’s more, it is now being performed as a same day outpatient procedure.
This surgery involves going in through the bikini crease – the line formed between your thigh and stomach when you sit. This results in a hip replacement with a scar about 3½ inches long that fits easily under a normal bikini bottom or underwear. This cosmetic benefit makes the surgery more palatable to younger women who play sports or place an emphasis on staying in shape.
Hip pain and wear is a growing concern for female patients, with some needing replacement surgery as young as age 20. The bikini incision allows them regain full mobility with only an easily concealed scar.
Periacetabular Osteotomy (PAO)
Great strides have been made in screening newborns for hip dysplasia so treatment can be rendered at a young age. However, mild or “shallow” dysplasia of the hip socket, or acetabular dysplasia, often goes undetected until the person is in their teens or even 20s. They experience severe hip pain due to an improperly seated femoral head (ball) because the socket is not completely formed.
Periacetabular osteotomy involves making small surgical incisions around the socket and hip joint to reorient the patient’s pelvis to reduce wear and tear. This minimally invasive form of hip preservation can usually prevent them from needing a hip replacement for 20 years.
Older procedures involved releasing all the muscles around the hip, resulting in a more invasive surgery with longer recovery. Based on Harvard results, the operation took four hours, the patient lost 2000 mL of blood and stayed in the hospital for five days.
With this muscle-sparing approach, Swann’s averages are 1½ hours in surgery, 400ccs of blood loss and just two days post-op in the hospital.
The field of hip preservation has exploded nationwide and Dr. Swann has helped develop this field through his research and authoring multiple papers for the medical literature. He offers a new approach to hip arthroscopy of which he is one of just two surgeons in the country offering the technique.
The surgical difference is that the hip is accessed from outside of the outer layer under direct visualization with the scope. This has the effect of reducing damage to the hip caused by the surgeons when using the more traditional technique. Dr. Swann feels this is a safer procedure and is excited that his video of the surgery was accepted for presentation at the American Academy of Orthopaedic Surgeons this spring in Orlando.