Rubin_The Direct Anterior Approach to Hip Reconstruction, 2e

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SECTION I Introduction

who walked out of the hospital within a day or two of the operation, typically heavy drinkers or smokers need ing to get back to their habits. One of his patients, an old Yale friend, left the hospital 5 days after bilateral replacements and was back at work in New York less than 2 weeks after surgery. His patients recovered rap idly compared with patients who underwent surgery with the transtrochanteric or posterior approaches of that era and could often play golf less than a month after surgery. Advertising was out of the question at that time, so his practice grew rapidly by word of mouth. Later on, by 2009, with reductions in blood loss, use of multimodal oral pain control, and use of periarticu lar injections, some DAA patients were even discharged home the same day, well before the current era of ambu latory arthroplasty. “Where we came out ahead with the anterior approach is in the first hours, days, and months of recovery time.” —Kristaps J. Keggi (2019) Keggi’s academic accomplishments ultimately included 65 published articles (41 related to the DAA). His career was dedicated to the teaching of orthopedic surgery not only to Yale residents but also to clinical fellows. These included Dr. Michael Huo, his nephew Dr. John M. Keggi, Dr. Robert E. Kennon, and Dr. Lee E. Rubin. In addition, Keggi hosted over 250 interna tional fellows from the Baltics, Russia, Vietnam, and multiple former Soviet Republics through the Keggi Orthopaedic Foundation. This charitable organization evolved into the Keggi-Kimball Fund for International Orthopaedic Education at the Yale University School of Medicine. Dr. Lee E. Rubin now leads this program and continues Dr. Keggi’s tradition of hosting interna tional “visiting scholars” to learn modern total joint arthroplasty. Some of Keggi’s mentees have become accomplished political leaders. Dr. Valdis Zatlers became the seventh president of Latvia; Dr. John Barrasso, who coauthored publications with Keggi on anterior cervical spine dis ease 33 and reaming of deformed femoral shafts, 34 is now a US senator in Wyoming. Keggi was the recipient of mul tiple national and international awards and four honorary doctorates. He was also named a Sterling fellow for his charitable contributions to Yale. Henri Judet (1870-1943), Jean Judet (1905 1995), and Robert Judet (1909-1980) Henri Judet, born in 1870, was one of the first surgeons to practice orthopedic surgery in France. He completed his surgical internship training at the Paris hospitals. 35 Both of Henri Judet’s children, Jean and Robert Judet, went on to become renowned orthopedic surgeons. In 1950, the Judet brothers, who practiced in Paris, pub lished an article about an early form of hemiarthroplasty

Subsequently, the first modular single offset broach system was released in 1982 by Richards Corporation for the Mittelmeier Hip System; it was developed in part by Dr. Keggi ( Figure 2.4 ). Rasps were changed to broaches in order to compact bone at the edges of the femoral canal for the new press-fit femoral component, and broach sizing options were also expanded. Keggi also played a major role in curved retractor designs for the anterior approach; his many innovations in instrumentation have eased the insertion of THA implants while reducing soft tissue trauma. 32 The THA Keggi performed through his anterior approach allowed patients to recover rapidly. Early in his series of anterior hips, there were several patients FIGURE 2.3 Original image of the 1978 Howmedica Keggi Anterior Hip Rasp Set. (Reproduced with permission from Waterbury Hospital OR Archive.)

FIGURE 2.4 Earliest known modular single offset broach handles used for the DAA, developed by Dr. Keggi in conjunction with the Richards Corporation for the United States release of the Mittelmeier Hip System in 1982. (Reproduced with permission from Waterbury Hospital OR Archive.) Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024