Patient Stories

Mark C. Hartley, MD

Always athletic and competitive, Brian Grzelak initially shrugged off the pain he felt in his left hip during his daily run.  “I thought I could work through it,” says the 49-year-old Reston resident and home building company executive who has spent his life training for, and competing in, athletic events. “I never even considered that arthritis could be the cause. I was only in my early 40s – definitely too young for a hip replacement.” 

But as the pain intensified over the next few years, and a switch from high-impact running to biking only temporarily alleviated it, Grzelak gradually came to grips with the fact he would need surgery.  He consulted Mark Hartley, MD, an orthopaedic surgeon at OrthoVirginia, who recommended a replacement, but not a traditional one. Young, healthy and active, Grzelak was a perfect candidate for minimally invasive surgery – an advanced option featuring a smaller incision, quicker recovery and faster return to work and activities, including the competitive athletics he loved. 

“Surgery was good and I had a great comfort level with Dr. Hartley,” Grzelak recalls of his minimally invasive hip replacement at Reston Hospital in 2005.  “There wasn’t much pain and I went home in two days. Within two weeks I was driving, working and riding a stationary bike.”

For Grzelak, and hundreds of others like him, the physical benefits of minimally invasive surgery are only part of OrthoVirginia comprehensive approach, which surgery are only part of OrthoVirginia approach, which begins long before the patient enters the operating room.

“Our minimally invasive philosophy is a comprehensive one,” says Dr. Hartley.  “We’ve developed a minimally invasive total joint program that encompasses all aspects of the surgical process – everything beginning with pre-operative education, advances in  pain management techniques, implant modifications, post-operative care and obviously smaller incisions with less tissue trauma. Our patients feel more relaxed and positive heading into surgery and all these techniques contribute to a more rapid recovery and better early outcomes.”

Minimally invasive total joint replacement surgery has been gaining ground in the United States over the past decade and OrthoVirginia surgeons were among the first to perform these state-of-the-art procedures in the Washington area.  Today, most hip and knee replacement surgeries are minimally invasive, with numerous benefits to the patient, including:

  • smaller incisions – three to five inches versus eight to 10 in traditional open surgery
  • less post-operative pain, bleeding and tissue trauma since fewer muscles are cut
  • shorter hospital stays –one to two days compared to three to five for traditional surgery
  • faster recovery - weeks rather than months

Total joint patients at OrthoVirginia get comprehensive pre-operative education in collaboration with area hospitals, such as Virginia Hospital Center’s monthly class for patients and  classes such as Total Joint Camp – an hour-long session run by trained nurses in Reston Hospital’s joint replacement program which helps patients prepare physically and mentally for their procedure.  Topics include what to expect before, during and after surgery, practical matters about their hospital stay, physical and occupational therapy goals and home assistance following discharge.  “Pre-op classes such as Total Joint Camp go a long way toward setting patient expectations and easing fears,” Dr. Hartley says. “When patients are educated they are less afraid and more focused on doing things to help themselves get better. They can begin their recovery on the day of their surgery.”

Pain management is another important aspect of minimally invasive total joint replacement, and OrthoVirginia surgeons work in partnership with anesthesiologists to head off pain before it begins. “We hit pain pathways with a variety of medicines before, during and after surgery,” Dr. Hartley explains. “By launching this pre-emptive strike, we greatly reduce post-operative pain and minimize the side effects of anesthesia. Patients are up and active much more quickly.”

Staying ahead of the pain has also significantly reduced the need for long-term IV narcotics following surgery, with most patients taking only oral medications. “Pain management protocols are definitely the biggest advancement in minimally invasive surgery right now,” says David Romness, MD.  “Multi-modal pain control not only makes surgery more comfortable, it also speeds recovery. A patient’s biggest worry is pain and when we can control pain we improve outcomes both psychologically and physiologically.”

The minimally invasive approach hastens rehabilitation, too.  “Because we are making smaller incisions in the tissue and cut through fewer tendons and muscles, there’s less blood loss and function returns much more quickly after surgery than it did in the past,” Dr. Hartley explains. “Most patients can do good leg lifts immediately and walk farther faster. They’re able to get back to their daily activities and return to the workplace sooner.”

Dr. Romness agrees. “Minimally invasive surgery coupled with newer, stronger prosthetics means patients can put their full weight on their new hips and knees from day one, with far fewer restrictions on activity. I tell my patients to go as fast as they feel comfortable.”

Good candidates for minimally invasive total joint replacement surgery have strong bone quality, normal anatomy and weight, and have had no prior replacement surgeries. Others may achieve better results with conventional surgery, so it’s important to manage expectations, as Dr. Hartley cautions. “Although the data suggests there is no long-term difference between minimally invasive and standard surgery, we never want to compromise the end result for short-term gain.  That’s why each patient should be carefully screened to determine the type of procedure that is most appropriate.” 

Happily for Brian Grzelak, minimally invasive hip replacement was the best option, allowing him to quickly return to the athletic lifestyle he loves.  Just six months after his surgery, he competed in one of his favorite events: the annual Bike Hill Climb at Wintergreen Resort in Virginia, riding up the mountain in 46 minutes – four minutes shy of his previous best time.  A year later, he erased those four minutes.  And now, he’s competing in 100-mile bike races and has some encouraging words for his fellow baby-boomer athletes: “It’s important they know I’ve been able to return to a high level of competitive activity,” he says. “You never completely forget it’s not your original hip, but surgery does make it dramatically better.”