Experience. Specialization. Expertise.
Coleman Fowble grew up in Columbia prior to attending Davidson College. He completed Medical School at the Medical University of South Carolina and Orthopaedic Residency at University of South Alabama Medical Center before continuing with Fellowship training at Boston City Hospital and Harborview Medical Center. He and his wife Lizzy returned to Columbia to raise their family. They are proud parents of 3 children who have successfully launched into adulthood. As an avid hunter, fly-fisherman and kite-boarder, Dr. Fowble enjoys an active lifestyle and strives to enable his patients to do the same.
Harborview is the Level-1 trauma center for one third of the United States geographically. The Western Medical Alliance (WAMI) includes Washington, Alaska, Montana, and Idaho. Harborview maintained 6 helicopters and two leer jet ambulances to transport injured patients from remote areas to Seattle. This specialized training equipped Dr. Fowble to treat extremely complex fractures that involve the joints.
Dr. Fowble’s experience reconstructing joints following traumatic injury led him to pursue specialization in total joint reconstruction secondary to osteoarthritis, which is more common in the aging population. He has extensive experience and interest in anterior hip replacement and hip resurfacing as alternatives to traditional hip replacement.
Multiple studies confirm that the more procedures surgeons perform, the better their patients’ outcomes. As in any activity one attempts to master, developing a skill takes time and repetition – even if you have some natural ability when you start. When it comes to complex surgery, the volume of a particular procedure as well as overall years of experience matter.
Experience builds on initial training to give surgeons a strong foundation from which they can discern multiple ways to achieve a goal; adjust techniques as needed to address unique patient needs; and innovate new treatment options.
Dr. Fowble operates at The Surgery Center at Midlands Orthopaedics & Neurosurgery and at Providence Health Northeast.
Total Joint Volume (as of 12/31/19): 2785
With almost 70 years of history, hip replacement surgery is a common and very safe procedure to replace a damaged hip joint. Hip replacement surgery is often recommended after a hip fracture or to resolve severe pain due to osteoarthritis, rheumatoid arthritis or arthritis that manifests following a traumatic injury. Osteoarthritis is particularly common in aging adults and results in loss of cartilage in the hip joint. As a result, movement is limited and pain is common. Eventually degenerative joint disease impedes normal activities that require bending at the hip. Conservative treatment measures include anti-inflammatory medicines, pain medicines, activity modification, assistive devices for walking and physical therapy. If these treatments are not helpful, hip replacement surgery may be the best option.
Hip resurfacing (conservative total hip) versus replacement may be an option for younger, highly active patients with significant hip disease. This innovative procedure replaces the hip without cutting the femoral head. A thin layer of bone from both sides of the hip joint is replaced with metal surfaces, which is biomechanically much more like the natural hip than a traditional hip replacement. This technique preserves 99% of the patient’s bone as well as all the angles and tendon and ligament attachments.
Resurfacing preserves more of the natural bone – an important consideration for the younger patient who may need additional surgery later in life. Resurfacing facilitates natural movement of the hip joint without fear of dislocation. As a result, these patients achieve a much higher activity level after surgery to include running and full athletic participation, which is not typically possible after a traditional hip replacement. Less bone loss, increased stability of the hip joint and avoidance of thigh pain are key benefits of hip resurfacing. Although the resurfacing implant is all metal, we have not experienced the complications of all metal total hips. The success of this all metal implant is multifactorial. We now x-ray every patient intraoperatively to make sure the acetabular/socket component is in the appropriate position. Also, we by maintaining the natural angle of the femoral neck, ligament, and tendon attachments, more natural motion of the hip is preserved which helps prevent metal debris. This technique is not universally successful in eliminating all metal problems. However, the incidence of reoperation is the same for a standard total hip and resurfacing on a percentage basis. In other words, hip resurfacing has no greater risk than total hip replacement that a repeat surgery may be necessary in the future.
For less active patients or those with low bone density, total hip replacement is likely the best option. This procedure is performed using either a posterior approach through the back of the hip capsule, or an anterior approach through the front of the hip capsule. The posterior approach has traditionally been utilized because it can be performed more quickly and easily by the surgeon. However, the extra time and effort required by the surgeon to perform an anterior total hip replacement offer advantages for the patient. The muscle undergoes much less injury through the anterior approach, which leads to faster mobilization, less pain, and a shorter hospital stay. Also, the stability of the hip is improved over the posterior approach.
During an anterior hip replacement, an incision is made at the front of the hip rather than through the buttocks or the side of the hip. This approach enables the surgeon to access the hip socket without cutting major muscle groups. Sparing the muscle allows greater range of motion for patients during recovery. Patients who have received a traditional, posterior total hip replacement must limit motions like reaching to the floor or crossing their legs. These restrictions are not necessary following an anterior hip replacement and the risk of dislocating the artificial joint is significantly reduced.
The damaged bone and cartilage of the hip joint is replaced with polyethlene (a plastic material) or ceramic and metal components. A hip prosthesis is composed of a femoral stem with a head and a socket cup. The femoral stem is made of metal. The head is made of ceramic or metal. If the cup is applied using cement, it usually consists of one component of polyethlene. If the cup is not cemented, it will usually consist of 2 pieces: a metallic acetabular shell and a liner.
The surgeons of Midlands Orthopaedics & Neurosurgery have performed over 2,000 total joint replacements in the Ambulatory Surgery Center (ASC) next door to the main office location in downtown Columbia. No other ASC in the region has this level of experience with outpatient joint replacement surgery.
A three-pronged approach including minimally-invasive surgical techniques, improved pain management and immediate rehabilitation promote rapid recovery from total joint replacement, making the outpatient surgery center setting a viable option for many patients. We experience pain as tissue injury during surgery leads to inflammation that triggers nerve stimulation through peripheral nerves to the spinal cord and on to the brain. Many opportunities exist to minimize pain throughout this process, but we have historically relied on narcotics alone to manage pain. More progressive techniques reduce the tissue injury at the outset thereby decreasing inflammation, which reduces nerve stimulation. Reducing tissue injury also reduces physical limitations, making rehabilitation easier and immediately possible. Additionally, adjustments to anesthesia and other medications reduce pain more effectively while also minimizing side effects like nausea that delay recovery. This comprehensive approach enables patients to experience only mild discomfort as they return home with a new joint the same day of surgery.
A large private insurance company in SC reports that the total cost of total joint replacements in Columbia hospitals ranges from $45,076 to $79,592.
Dr. Fowble is an in-network provider with the following insurance plans: Blue Cross Blue Shield, United Healthcare, Aetna, Cigna and traditional Medicare.
Total Hip Replacement or Hip Resurfacing: $26,640
Total Knee Replacement: $27,250
Uni-knee Replacement: $18,595
Patients local to Columbia, SC are welcome to schedule a surgical consult appointment with Dr. Fowble online or via phone: 803-256-4107.
Patients who are not local to Columbia, SC should complete the appropriate New Patient Packet below. The packet will be submitted electronically to Dr. Fowble’s team for his review. We will contact you to schedule a telephone consultation.
We request that you follow-up with us after surgery at the following intervals: 6 weeks (4 weeks for knees), 3 months (knees only), 1 year, 2 years and every 2 years thereafter.
Local patients may schedule these visits in the office. Patients who are not local may schedule a remote follow-up by completing the appropriate form below. Our team will contact you when the form is received to discuss next steps.