As with any orthopedic surgeon worth his suture, Brian Lohrbach will state that he has never instructed a single patient struggling with pain to have joint replacement surgery. Ever. That’s not his role.
“Listening to my patients is key,” said Lohrbach, one of the physician-owners of the Appleton-based Orthopedic & Sports Institute. “Once we understand the issue, my job is to discuss the options available. There’s nothing prescriptive about it at all. The choice is 100% up to the patient and family, what makes the most sense to them.”
And for Lohrbach, the Appleton native who studied and trained in St. Louis and Chicago and then returned to his hometown to practice, patient care begins with trust.
Maybe it’s a Midwestern thing.
A physician whose routine runs the gamut from treating sprains and strains to performing total joint replacement of the knee, shoulder, and hip, Lohrbach has established himself as the area’s leading practitioner of anterior hip replacement. But you don’t necessarily have to lead with that.
“I love talking about the anterior approach, but I don’t just do hips,” said Lohrbach, who shared that a new patient looking for help with knee pain had been told from several sources that Lohrbach only did hips.
Perhaps that misconception exists because there are a lot of people walking around that have benefited from Lohrbach’s skill in delivering anterior hip replacement. Over the last seven years he has performed more than 850 of the procedures, experience that is unmatched in the area.
And as the subject of anterior hip replacement had been broached – and he clearly acknowledged it was something he enjoyed discussing – going down the path made sense.
Anterior hip replacement is a procedure whereby the surgeon accesses the patient’s hip joint from the front rather than from the rear (posterior). The latter is considered the more traditional approach and the one Lohrbach utilized exclusively for his hip patients during the first ten years of his practice.
A snowbird then changed the direction of his practice.
The gentleman, a hip replacement patient of Lohrbach’s, returned from Arizona with a story about friends there who had something called anterior hip replacement. All recommended it highly, noting speedy recovery times and fewer post-op restrictions. For the snowbird, this was music to his ears, especially as he was ready to have his other hip replaced by Lohrbach. So, he made a request.
“The gentleman asked me to do an anterior procedure on his other hip,” said Lohrbach.
The good doctor admitted he had never performed an anterior surgical procedure, nor had he been trained in it.
To this his patient replied, “Go learn. I’ll wait.”
What would become a surgical specialty for Lohrbach was a patient-driven journey. Upon completion of his anterior hip replacement coursework, Lohrbach told his hip patients he was going to utilize a new approach, and the rest is history.
For the last seven years, he’s done nearly all of his hip replacement surgeries using the anterior approach. Sometime in 2020, he’ll perform his 1,000th anterior hip procedure.
And whether you’re a hip patient undergoing an exam with Lohrbach or an attendee at one of his seminars, he’s up front about the anterior versus posterior debate.
“I tell patients this: if you are seeking the anterior approach because you are thinking it is better overall, I cannot tell you it is,” said Lohrbach. “If you look at a patient six months to a year out, the outcomes are the same.
“But if you want to recover a little faster, get back to work a little faster, maybe have a little bit easier recovery, this might be the way for you to go.”
Lohrbach states that in his experience his patients have a somewhat faster recovery in the short term. When making comparisons between the two approaches, he emphasizes his experience in delivering both.
“It’s not like I’m saying in the ten anterior hip procedures I have done, patients have reported faster recoveries,’” said Lohrbach. “I’ve done over 850.
“The reason I go with anterior is that I think the recovery tends to be a bit faster than the posterior approach,” said Lohrbach. “I think it allows for fewer restrictions, which is what people really want. They don’t want to worry about high chairs or pillows between their legs, not laying on their sides, things like that.”
He also feels there are technical advantages to the approach, such as using intraoperative x-ray, a tool which helps the surgeon to better size and properly position implants.
“We use fluoroscopy, a low energy, low radiation c-arm, which is real-time x-ray imaging,” said Lohrbach. “While I’m working, I’m confirming everything is lining up as I go.”
When he first started performing them in 2012, the procedure generally took him two and half to three hours to complete, whereas now he performs them in a little over an hour or so.
“It’s not because I’m rushing,” he said. “I’m just being efficient.”
When patients come in asking about the procedure, those who have done their research often ask about the special table – which comes with a $100,000 price tag – used by some practitioners of the approach. Lohrbach explains that not having the table was more a financial consideration than anything else.
“Knowing I was going to do these operations at different locations, and the table is not something you can just pop in the trunk of your car and bring with you, I assumed that I could not convince each location to purchase a table for me,” said Lohrbach. “I did need a special retractor – and got one at each – but that was considerably less expensive.”
Lohrbach returns to his statement that his job is to establish trust with patients, educate them on their options and let them know what they can expect. His patients, in turn, share their stories, and Lohrbach considers that very powerful.
“We serve smaller communities, so people often come in because you did somebody else’s hip replacement and they heard about it,” said Lohrbach.
He also notes the power of the seminars he presents to the public on anterior hip replacement, which he offers two or three times a year.
“People might come in for a seminar and I might not see them for a year, but seminars have been an effective way for me to get the word out about the approach,” said Lohrbach.
Scott Altmann is testimony to that.
Altmann, controller for Forest County Potawatomi Community in Crandon, had been dealing with hip issues for some time. Throughout his daily workouts, home projects, and skiing trips out West, the ever-active Altmann continued to power through increasing levels of pain and stiffness.
When his hip got bad enough, he signed up for a Lohrbach seminar in 2017 to learn about the technique.
“Dr. Lohrbach’s name was already familiar to me, and what he presented at the seminar was compelling,” said Altmann. “But I had another option I wanted to try before hip replacement surgery, so I went that route,” said Altmann.
A year later, when that method did not yield the desired results, Altmann decided to schedule his hip surgery with Lohrbach, in August of 2018.
“Just like in his seminar, he explained the procedure, how I would recover, what I could expect,” said Altmann. “And that’s how it worked.”
Altmann was back doing what he loved in weeks, and found himself in Utah in January of this year.
“I was absolutely shredding it,” he said. “My hip is doing great, better every day. And in March I skied more moguls in Colorado than ever before.”
Another patient, Oshkosh’s Kelly Handy, went with Lohrbach and the anterior hip after being told by other
orthopedic surgeons that she was too young and her hip wasn’t bad enough for surgery.
“Maybe if I was a couch potato I wouldn’t have needed surgery, but I was power walking every day three miles in the morning and two to four at night, lots of yard work, always running around doing something,” said Handy. “All I did was ache, all the time. That was my normal, and had been for a long time.”
Two and a half weeks after her procedure in March of 2019, Handy resumed her full-time work as controller for the Oshkosh Area School District. And nine weeks out from surgery, she’s returning to form.
“I’m back to two miles in morning and up to three miles at night now, minus the pain,” Handy said. “I feel really good.”
Altmann and Handy exemplify the active, motivated patients who often find their way to Lohrbach.
“Patients can’t be passive in the process,” said Lohrbach. “They have to be concerned about their own well-being, have appropriate goals, and be motivated towards those goals. Active patients that end up needing surgery for whatever reason, you can tell right away they are going to do well.”
That describes Ruth “Cookie” Berner to a tee. Lohrbach has replaced her right knee (2007), her left knee (2013), did her left thumb arthroplasty (2015), replaced her right shoulder (2017), and, most recently, replaced her left shoulder (2018).
Following her shoulder replacements, Berner tested herself with one of her many outdoor pursuits, kayaking. The 77-year-old had zero difficulty getting into the kayak. Getting out of it was going to be the test, which she passed.
“I didn’t want any help because if I’m going to kayak, I had to do this on my own,” said Berner. “No way I could have done this prior to my shoulder replacements.”
By the way, no anterior hip replacements for Cookie. Both her hips, she said, are good.
“I wrote him a thank you note for all the surgeries he’s done for me,” said Berner. “He’s kept me mobile. I’m as good as new now, and I have Dr. Lohrbach to thank for that.”
That’s what Lohrbach loves most about practicing orthopedics: that he can profoundly affect patients in an immediate fashion.
His patients are good with that too.