DIRECT ANTERIOR HIP REPLACEMENT
The anterior approach allows access to the joint without detaching any muscles around the hip. The muscles are carefully retracted along the internervous plane with the assistance of a specialized “hip table”. This allows the surgeon to minimize any soft tissue trauma to the hip, allowing for a faster recovery.
What is hip arthritis?
Hip arthritis is a common affliction that impacts millions of Americans. It is a progressive wear of the protective cartilage of the hip joint. As the protective cartilage wears, the bare bone is exposed, leading to significant pain. Over 150,000 hip replacements are performed annually, and this number is expected to increase exponentially over the next decade.
What are common symptoms of hip arthritis?
In addition to pain, many individuals experience a loss of motion, difficulty with weight bearing, and a limp. As the arthritis progresses, symptoms are typically exacerbated.
What are treatment options for hip arthritis?
Weight loss, activity modification, physical therapy, anti-inflammatory medications, and cortisone injections.
When non-operative modalities are no longer able to diminish the symptoms, surgery becomes a viable option.
A traditional minimally-invasive approach (posterior-thru the back; lateral-thru the side) detaches muscle around the hip joint prior to replacement. These are subsequently repaired prior to skin closure. After the operation, the patient typically has to follow specific precautions to prevent a dislocation (the replaced ball comes out of the socket). These precautions may include a pillow in between your legs, no bending beyond 90 degrees of flexion, and no excessive turning of one’s feet.
The direct anterior approach (through the front) is a sophisticated procedure that allows the surgeon to replace the joint without detaching any of the hip muscles. Unlike a traditional replacement, this allows one to freely move the hip in most instances. Due to the muscle sparing, this leads to a decreased hospital stay and quicker rehabilitation.
How is this approach different from other minimally invasive approaches?
Traditional hip surgery splits the gluteus maximus and short external rotator muscles of the hip joint. This requires patients to follow strict “hip precautions” after surgery to prevent dislocation. Hip precautions require patients to not flex the hip beyond 90 degrees. This can make activities such as getting into a car, sitting on a toilet seat, and climbing stairs more challenging. Since the direct anterior approach leaves the muscles undisturbed, typically hip precautions are not required.
Who is a candidate for surgery?
Patients who have been suffering from arthritis or avascular necrosis may benefit from hip surgery.
Is there evidence to support superior outcomes of a direct anterior approach in total hip replacement?
Yes. We’ve listed some reference annotations below:
FREQUENTLY ASKED QUESTIONS
How long does the operation take?
Although this can be variable, in most cases the surgery is performed in 1-2 hours.
Where is the incision made?
The incision is located off-center in front of the thigh.
How long is the incision?
Body habitus can influence length, but in most cases it is between 4-6 inches.
How many days do I stay in the hospital?
Pre-op level of function can play a critical role; however, most patients are discharged home within 24 hours.
What are common symptoms to expect after the surgery?
Swelling is common after most surgeries and the anterior hip is no exception. We find anterior hip patients are more active in the immediate postop interval. The activity can exacerbate the swelling. We ask patients to ice 10-15 minutes/hour, 4-6 hours a day. In addition, we have found utilizing compressive shorts to mitigate swelling has been extremely effective.
Will I need to participate in outpatient physical therapy?
We feel mobility and muscular control are issues most candidates have prior to surgical treatment. In particular, extension mobility and gluteal strength are usually compromised. Out-patient physical therapy can address these deficiencies, making a good hip into a great hip.