“No pain, no gain” might me a truism when it comes to building muscle, but cutting through it is a completely different matter.

The vast majority of people we know with hip replacements could tell us unsavory stories of their pain, long rehabilitation and repeated problems with the same joint.

Those won’t be problems for people in Selma anymore if Dr. Lester Littell III has anything to do with it.

Littell, who practices orthopaedic medicine at Vaughan Regional Medical Center, is one of the few American physicians that utilizes the anterior approach to hip replacement surgery.

He has participated in training sessions in the anterior approach for more than 200 doctors in the past five years. In the past year, he has conducted training in Baltimore, Memphis, Tucson and Paris.

“The operation is the same implants, it’s just that we use a different surgical approach,” Littell said. “In the United States, most doctors use the posterior, or back approach. That requires splitting muscles and detaching tendons from the pelvis. All those things can have the effect of more pain, longer rehab and more likelihood of dislocation.”

In some cases, doctors use the lateral (side) approach, which also requires cutting into muscles.

The anterior (front) method allows the surgeon to work between the natural space between the muscles, preventing detachment from the pelvis or femur. Dr. Robert Judet of France developed the surgery in the late 1940s, but surgeons stopped using it until recently.

Littell, along with Dr. Gary Bradley and French doctors Philippe Paillard and Henri Judet — Dr. Robert Judet’s nephew — held a training session at Ecole de Chirurgie in Paris in late June to help reintroduce the surgery.

Dr. Joel M. Matta, Chair of Orthopedic Surgery at Good Samaritan Hospital in Los Angeles, brought anterior hip replacement to the United States in 1996. He has performed 600 surgeries in that time and has trained several more doctors.

Littell, a native of Tennessee, ran his own practice in Chattanooga from 1983 until 1999, and then moved to Alabama in 2000. He is a Fellow of the American Academy of Orthopedic Surgery and served as a Whitewater team physician for the 1996 Summer Olympic competitions held at Ocoee River in Cleveland, Tenn.

In addition to a smaller incision, shorter hospital stay and quicker recovery, patients suffer less blood loss and can resume normal activities almost immediately after the procedure.

With standard methods, postoperative patients were forbidden to flex their hip past 90 degrees, cross their legs, sit in low chairs, tie their shoes sleep on their side or twist their lower legs for the first six weeks of recovery.

The anterior method allows people to do all those things almost immediately.

The surgery requires an adapted table specially crafted to accommodate the procedure. Doctors use an X-ray machine while performing surgery to make sure the implant is properly aligned.

Not all doctors have jumped on board with the procedure, however.

“Most of the reason is the doctors are comfortable with the way they do it,” Littell said. “They feel good with the result, but they’re not with the patient at home after they go leave the hospital. They don’t realize how much pain (the patients) are in. After six months, it’s probably not a big difference if any.

“But that first six months is just a phenomenal difference in pain.”

Littell has performed the procedure on 250 patients, some from as far away as North Carolina.

As more doctors become more comfortable with anterior hip replacement, he predicts he will see less patients from out of state.

“Once doctors see the procedure, 95 percent of them want to learn it and do it,” Littell said. “But most are resistant until they see it.”