josh Mckenzie county healthcare orthopedic surgeon

Dr. Ravindra Joshi

The experiences of friends convinced Leonard “Sonny” Hoburka that a needed hip replacement wasn’t going to be any walk in the park. At least, not any time soon.

However, because of a muscle-sparing procedure that has been combined with a suite of precision surgical equipment offered by McKenzie County Healthcare surgeon Dr. Ravindra Joshi, Hoburka found himself able to go shopping in Minot a mere three days after his surgery.

In fact, Hoburka’s recovery was so pain free, that he showed up in the emergency room the next day, concerned because there just wasn’t any pain. This was certainly nothing like what he’d been led to believe would be normal by friends who’d been through hip replacements before.

“I just want to make sure you didn’t cut a nerve or something like that because I have no pain,” Joshi recalls the patient telling him.

But Hoburka’s experience was normal for this more precise procedure, Joshi said. And stories like that make him glad he’s practicing in the Oil Patch, where such advanced techniques and services have not always been commonly available.

“There are so many things that are done elsewhere that are not done regularly here,” Joshi said. “This is one of them.”

While anterior total hip replacements have been offered elsewhere in northwestern North Dakota for a few years now, Joshi has added precision equipment to the mix for more of what he calls a total package.

This suite of equipment includes the Joint Point Navigation System, the Kincise Surgical Automated System, and a newer table called the HANA table.

Joshi is originally from India. He trained to be a doctor first in Bombay, then did his residency in London. After that, he pursued a masters of surgery in Liverpool, then came to America, where he completed 20 months of specialty training in total joint replacement in New York, with a world-renowned surgeon.

In addition to the muscle-sparing hip replacement procedure he performed for Hoburka, Joshi is also skilled in reverse shoulder replacements and minimally invasive carpal tunnel treatment, as well as many other orthopedic surgeries.

Joshi is already working with McKenzie County Healthcare and other facilities to bring about a program that will bring this advanced package of surgical techniques from Watford City to Stanley, Tioga and Williston.

‘Advancing technology’

“All the technology is advancing,” Joshi told the Williston Herald about the suite of equipment he’s added to his anterior hip replacement procedures. “You have to go through quite a learning process.”

In addition to all the medical training for the anterior procedure, which is relatively new on the medical scene, Joshi also went through quite a bit of technological training as well.

In the old-style, traditional total hip replacement, surgeons had typically approached the joint either from behind (posterior) or from the side.

It’s easier to expose the joint and thigh bone or femur from those angles, but it’s also cutting through a lot of muscle. That’s why the traditional approach takes so much more time to heal and is so much more painful.

It also makes the hip joint much more prone to dislocation in the future, because the muscles around the joint have been substantially and forevermore weakened by the procedure.

Approaching the joint from the front or anterior position doesn’t involve cutting muscles. That’s why it is much less painful, and doesn’t take as much recovery time. It’s also less prone to dislocation in the future.

“The only thing there is, it’s difficult to expose the thigh bone,” Joshi explained. “There are special techniques to do that. It is a major learning curve, even for surgeons who have already been trained.”

Joshi went for multiple training programs that included practice on cadavers to learn the anterior system. He also had a mentor to help him.

Then, he added in precision equipment, like the HANA table, to position patients just so for the procedure, as well as the Joint Point Navigation System. That gives him eight possible precision options to choose from for positioning the joint, to ensure that the leg will be both the correct length, and correctly aligned.

The Kincise Automated Surgical System, meanwhile, assists the surgeon at key points during the surgery. And all of it works together to help ensure a precision outcome with as little pain as possible.

Joshi said his patients often don’t require as many narcotics — a plus given the opioid epidemic the nation is already facing.

Hoburka said he did not need to take any opioid painkillers after the surgery. At all.

“Before the surgery it was like I had a jackknife stuck in my hip,” he said. “The pain was horrendous every day, all day long. Any movement, and it would spike very badly. Now I feel like a 20-year-old. I never felt like this on that side at all. I’ve got my hips back, and I’m able to be way active again.”

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