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Holy Cross Hospital Orthopedic Surgeon William A. Leone Jr., MD, Invents Critical Device Used During Total Hip Replacement Surgery

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The PAL Pelvic Alignment Level(tm) could help minimize the risk of hip dislocation in patients

Doctor William A. Leone Jr., Orthopedic Surgeon at Holy Cross Hospital's Orthopedic Institute, has invented a new surgical instrument and technique called the PAL or Pelvic Alignment level, which can play a key role in the success of total hip replacement surgery. The PAL Pelvic Alignment Level(tm) has been designed to help reposition the patient pelvis into a precise anatomic alignment prior to prosthetic implantation. Precise pelvic positioning is critical for the surgeon to precisely position and implant the prosthetic acetabular cup in the hip joint. This new instrument also allows the surgeon to directly measure acetabular cup angles during implantation and measure leg length before and after the replacement surgery of see if leg length was changed and if these changes are optimal.

Total hip replacement has proved to be one of the most successful surgeries preformed in modern medicine. More than 400,000 total hip replacement surgeries are preformed in the United States each year and it is predicted that the demand will continue to increase. Unfortunately, two common complications continue to occur. Occasionally, prosthetic hip joints will dislocate and both of the patient's legs may not feel equal in length after surgery. Proper positioning of the cup and the femoral stem are crucial in preventing these complications from occurring. Optimizing hip biomechanics and longevity is also dependent on proper component positioning. The PAL gives surgeons a powerful, new tool in the operating room to improve accurate component positioning and leg length. Historical data suggests that prosthetic joints with optimal component positioning may function longer in the body.

The PAL and this technique now give surgeons a simple method of visualizing unintended pelvic motion which occurs during surgery and correct for this. There has been a huge need for this in hip replacement surgery," said Dr. Leone. With the recent trend toward making smaller incisions combined with an increase in obesity, the incidence of acetabular cups not optimally positioned has increased and the PAL directly addresses this.

In my experience, the PAL and this technique have made a huge difference for my patients," said Dr. Leone. "It has eliminated the 'guess factor' that surgeons must do regularly. It truly instills confidence during surgery, especially when patients are obese or have a congenital deformity or have had previous surgery."

Part of the beauty of the PAL is that it does not require hospitals to purchase expensive new equipment or for the physicians to significantly change techniques with which they are already comfortable. The PAL includes a sterile bubble level, similar to what one might see used at a construction site and which attaches to a small pin anchored in the pelvis. The surgeon can easily see movement of the pelvis by looking at the bubble in the level and make necessary corrections. The surgeon can also place the PAL on the instruments used to implant the cup and directly measure acetabular cup position. It also has an 'out rigger' to measure leg length.

Dr. Leone, a member of the Holy Cross Medical Group, specializes in the reconstruction of hips and knees. A member of numerous professional associations including the American Academy of Orthopaedic Surgeons, American Board of Orthopaedic Surgery, and American Association of Hip and Knee Surgeons, Dr. Leone has practiced orthopedic surgery at Holy Cross Hospital in Fort Lauderdale, Florida for 20 years.

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