The First Ever Anterior Approach Hip Resurfacing Surgery in Israel

An anterior approach hip resurfacing surgery was performed for the first time in Israel at the Shamir Medical Center (Assaf Harofeh) by Dr. Yaron Bar Ziv, head of the center's Joint Replacement Service. The procedure is an alternative to total hip replacement surgery (THR), replacing only the damaged hip tissue with a metal implant rather than removing the entire head of the thigh bone.

Dr. Bar Ziv, one of the leading practitioners in Israel of knee and hip replacement surgery, explains that “using the anterior approach to the hip joint means that no muscles or tendons are cut, and as a result recovery is less painful and considerably faster. This is also one of the reasons we recommend this procedure to athletes or to people whose work involves high-intensity physical activity.”

One famous patient to undergo hip resurfacing is British two-time Wimbledon champion Andy Murray. Murray, who had his hip resurfaced at age 30, announced that he would likely retire after the surgery. But several short months later, he made a professional comeback and as of March 2022 he is ranked 88 in the world. Floyd Landis, the American road cyclist who placed first in the Tour the France, also resumed his professional cycling career after hip resurfacing, as did several NBA basketball players.

Hip resurfacing is performed successfully in many countries, and is mainly recommended to younger patients who are physically active. In this procedure, more of the thigh bone is preserved, and better biomechanical reconstruction of the hip joint is possible. The procedure enables earlier surgical intervention, the rate of post-surgical infection is lower compared to total hip replacement, and recovery time is significantly shorter.

Back to Work in Six Weeks

The first patient to undergo anterior approach hip resurfacing in Israel is Igor Kochetkov, a maintenance worker at El Al Airlines. For Kochetkov, this was the second hip replacement procedure, the first having been performed in the traditional approach. At the age of 44 he was diagnosed with osteoarthritis, a degenerative joint disease that most commonly affects the hip joint, and was recommended hip replacement. “For six years I tried all sorts of other things—pain relievers, swimming, cycling. I was in complete denial, I didn't want to undergo surgery at such a young age,” he remembers.

When the COVID pandemic erupted, Kochetkov went on leave of absence and decided to have the surgery. “After the surgery, I couldn't understand why I had waited so long. The pain disappeared, and I could go to bed without taking pain medication. I was sure I had gotten rid of the problem,” he says, “but after a few months I went back to work, and the pain started in my other hip. This time, I wasn't going to suffer for another six years.”

When Igor arrived for a consult, Dr. Bar Ziv recommended having the second surgery in the new approach, considering Kochetkov relatively young age and the physical nature of his work. “Dr. Bar Ziv told me that my recovery would be much faster, so I decided to go for it,” he says, “and it was true: I was back on my feet in half the time it took me to recover from the first surgery. After six weeks I was already back at work, compared to three months the first time. Also, the day after the second surgery I was already back at home, and within a few days I didn't need crutches any more, compared to two weeks before. And I didn’t need as much pain medication.” Another major difference Kochetkov notes is the sensation and function of the replaced hip joint: “The hip that was replaced still hurts when I do certain movements. In the other leg there is no movement restriction at all.”

Dr. Bar Ziv points out that it is resurfacing in an anterior approach that makes speedy recovery possible. “In a resurfacing procedure, we cap the patient's joint rather than replace it, and so the outcome is as close to the original state as possible. The softer tissues adjust to the resurfaced joint more easily, and the chances of regaining normal sensation in the joint are greater,” he explains. “The anterior approach precludes damage to the muscles and enables us to make immediate adjustments during the procedure if necessary. Compared to a posterior approach surgery, this procedure is more complex and difficult for the surgeon, but easier for the patient.”

Kochetkov concludes: “I finally feel like myself again. Before the surgery I felt like I was 70 years old. There were a lot of activities I couldn't perform. These days I sleep without pain, I can lift things up, I can bend—I am no longer restricted. It's a different life entirely.”

Hip replacement surgery is one of the most common surgical procedures in the world, with comparatively high rates of success. Some 6,000 patients undergo hip replacement each year in Israel alone, resolving severe hip joint aches and movement limitation that impair everyday activities and decrease the quality of life.

Shamir Medical Center's Orthopedic division comprises two departments and is considered one of the leading of its kind in Israel. The division performs a wide variety of surgical procedures addressing numerous musculoskeletal conditions, with specialized units for pediatric orthopedics, hand surgery, joint replacement, foot and ankle surgery, orthopedic trauma, sports medicine, spine surgery, neurosurgery and more.

DR. Yaron bar-ziv