A new book on an old approach to hip replacement

Kristaps J. Keggi, M.D. ’59, HS ’64, has played many roles at the School of Medicine, evolving through the ranks as a medical student, resident, and faculty member. So it’s not a surprise that he chose the Harvey Cushing/John Hay Whitney Medical Library as the venue on May 27 to launch his forthcoming book, The Direct Anterior Approach to Hip Reconstruction, to be published in June of 2016. Family, staff, and colleagues of Keggi gathered in the Medical Historical Library to hear about the book and celebrate Keggi’s legacy at Yale.

The first presentation of the approach was at the Annual Meeting of the American Academy of Orthopaedic Surgeons in 1977. A small group of orthopaedic surgeons have been performing it since then, but the approach has gained popularity over the past 15 years. Keggi is known as a pioneer of the procedure—which is quicker, less painful, and restores more normal function than other approaches—and is quick to give credit to the institution where he’s spent most of his lengthy career.

“It’s a Yale procedure. It goes back to my days as a first-year student at Yale, on the couches of this library, learning chemistry by osmosis with the books on my stomach,” he joked, referencing the couches that line the far walls of the Medical Historical Library. But he also acknowledged that the library served as a place of inspiration for him as a student, where he could be among the works of Hippocrates and Yale College graduate Harvey Cushing, M.D., a pioneering neurosurgeon.

To mark the occasion, library director John Gallagher and historical librarian Melissa Grafe, Ph.D., displayed several classic medical texts, including a copy of Andreas Vesalius’ De humani corporis fabrica (On the Fabric of the Human Body) once owned by Harvey Cushing. The pages of this text, printed in 1543, came to life with familiar images of the musculoskeletal system on pages illustrating hip anatomy.

Beyond the famous collections held in the Medical Historical Library, Keggi credits his success to the many mentors he had during his time at Yale, like Dorothy Horstmann, M.D., the first woman appointed as a full-time professor at the School of Medicine. Horstmann interviewed Keggi for admission and encouraged him throughout his career. They remained close friends until she died in 2001.

He mentioned the medical history seminars he attended by Thomas Forbes, M.D., the former associate dean of the School of Medicine. He also fondly recalled learning from the former chair of the Department of Orthopaedics and Rehabilitation, Wayne O. Southwick, M.D.

Lee E. Rubin, M.D., HS ’09, FW ’10, who completed his orthopaedic residency at the School of Medicine and completed an adult reconstruction fellowship with Keggi, also specializes in the direct anterior approach to hip reconstruction. He helped to write and edit the book with Keggi, along with B. Sonny Bal, M.D., J.D., M.B.A., a professor of orthopaedic surgery at the University of Missouri. Rubin says that despite inevitable changes to the procedure in the coming generations, this book will “always be the primary reference for the approach.”

Keggi’s colleagues acknowledge that this book is a well-earned symbol of Keggi’s success. Gary Friedlaender, M.D., a renowned orthopaedic surgeon and former chair of orthopaedics at the School of Medicine, was one of Keggi’s colleagues at the book launch. “I’m so glad his work was rediscovered and put in its proper perspective. It exemplifies inquiry and all that we stand for at the Yale School of Medicine,” said Friedlaender.

Keggi and Rubin hope the book serves as a guide for future surgeons interested in this minimally invasive approach to hip replacement. While Keggi celebrates the culmination of a career spent perfecting the procedure, he also looks ahead to the future of medicine. Surrounded by historical reminders of where the procedure is rooted, Keggi looked to Rubin and the younger members of the crowd and said, “Be the Cushing and Hippocrates of the next two generations.”