People in Your Neighborhood: Local doctor brings new hip replacement approach to La Jolla

Dr. Anna Kulidjian uses a new approach to hip replacement surgery in La Jolla.

Dr. Anna Kulidjian is using her years of training in orthopedic surgery to bring a new approach to hip replacement locally, performing 40 surgeries since June with new techniques that she says result in minimal pain and recovery time.

With more than 15 years’ experience as an orthopedic surgeon, Kulidjian, who currently works at Scripps Green Hospital in La Jolla, said being “able to bring [the new approach] to San Diego is phenomenal.”

Kulidjian, who lives in La Jolla’s Soledad South neighborhood with her three children, answered questions from the Light about the medical milestone:

Q. Can you explain the current methods for hip replacement and the new approach you use in La Jolla?

A. “Hip replacement is considered to be the most successful surgery across all disciplines, because over 98.5 percent of patients are completely satisfied. The race has become to make the procedure more predictable to minimize the outcome differences.

“You can go from the back, the side and the front. The difference from the anterior approach is the procedure is faster. It typically takes six weeks to recover from other approaches, but there’s faster recovery from the front. People in the U.S. are trained to use this special table [for the anterior approach] because it allows people to be placed in a specific position where people can get to the hip.

“Not everybody fits the table and the leg is put in contorted positions. Only a small proportion of patients could have a safe anterior approach.

“[This new approach] moves away from the special table. A surgeon invented these self-suspending retractors that make the procedure very easy and predictable. You can learn the technique very quickly; the risks are extremely minimal.”

Q. What are the major benefits to this method?

A. “The retractors move with the patient’s soft tissue; they’re on a string, so it’s self-guiding in a way. You don’t need a special table … you can operate on an OR table, on any size. There’s not a surgical limitation anymore. You don’t need additional people to move the table or hold the retractors. There’s less chance of someone moving the wrong way, tearing the tissues.

“Surgery time goes down, from 45 minutes or an hour to 30, 35 minutes. And with no soft tissue damage, the infection rate goes down.”

Q. How and when did you learn of the technique?

A. “I went to a conference where innovators meet to work on new techniques in Florida in November 2019. I saw a [Belgian] surgeon [Dr. Kristoff Corten] working on a new technique he invented, on this approach. It sounded amazing. I said, ‘I’m going to Belgium [to learn].’ I went and visited him there for a week in January.

“He scrubbed me in the moment I arrived. Because the retractors are self-held, I was able to operate with him and didn’t need to hold anything. It was firsthand experience. At the end of each day, we would practice on a cadaver and I would do the procedure. It was a condensed fellowship, only possible in an environment like that.

“After that, I came here, very excited to start. I arranged for the retractors to be brought in; they were [Food and Drug Administration]-approved. Scripps was very proactive in getting everything organized.

“And then COVID happened.”

Q. The COVID-19 pandemic stopped elective surgeries for a few weeks in the spring. How did that affect initiating the new hip replacement approach in La Jolla?

A. “We were a little bit discouraged but turned it into an opportunity. We booked cadaveric specimens and we brought in all the equipment. The orthopedic chairman [and] a junior partner came in; the three of us worked on the technique and did a whole bunch of hip replacements in the cadaveric lab.”

Q. What struck you about being able to use this approach?

A. “We had an unfortunate [emergency surgery] patient who’d had a hip fracture who was very interested [in the new technique]. She was bedridden, she couldn’t move. That was our first one we did.

“The surgeon in Belgium had said, ‘Make sure you don’t do hip fractures; they’re the toughest ones.’ But ... we had this great technique. We felt, why not offer it?

“The woman within a week was walking. The pain was immediately better after surgery; we’d never seen anything like that before. She walked into my office 10 days later in skinny jeans, without any walking aid. I’ve been a surgeon for over 15 years — I’ve never seen this!”

Q. Has anything else surprised you in the development and introduction of the technique?

A. “What’s incredible about this hip replacement is the scar; it actually hides in the crease lines along the groin, so you can’t even see it. That’s been a perk I didn’t really expect.”

Q. What does it mean to you to be able to introduce this approach here?

A. “It’s absolutely phenomenal to feel that even with hip replacement techniques that are so successful, you can be part of something that allows further improvement — not just incremental, but significant improvement in patients’ outcomes.

“It’s a big honor to join this group [Scripps Green orthopedics], but to be able to bring something new to the team ... adds great pleasure. This is the future, and I’m very excited to be part of it.”

Q. How did you get started in medicine and how did you come to specialize in orthopedic surgery?

A. “My dad is an orthopedic surgeon in Armenia. An earthquake happened; I was 14 at the time, planning a career in arts. There were not enough doctors or nurses. I was asked, with a group of high schoolers, to join and work in local hospitals to help the patients.

“Through that experience, I realized simple fractures can result in life-altering change when there’s not enough good medical care. Because there weren’t orthopedic surgeons, a lot of patients with fractures ended up with amputations.

“American orthopedic surgeons came. Those who were fortunate enough to have surgeries didn’t have their legs cut off; they walked. That changed everything for [me]. I promised myself one day I would become the best orthopedic surgeon. It’s been a dream come true, a life commitment.”

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