Joint replacement surgeons are increasingly using the anterior approach to hip replacement surgery in an attempt to improve outcomes and patient satisfaction.
The anterior approach to total hip replacement is becoming more popular because it can be less invasive, hospital stays can be shorter, and recovery and rehabilitation tend to be quicker for patients. Over the past 10 years, there have been several new and less invasive approaches to hip replacement surgery. The anterior approach is one of these “minimally invasive” procedures.
In the anterior approach, an orthopedic surgeon accesses the hip joint through the front of the body and between the hip muscles that help hold the hip joint in place. Smaller incisions are possible with this procedure versus traditional hip surgery. In addition, the minimal disturbance of the muscle also allows for a quicker recovery and rehabilitation. In traditional hip replacement surgery, an incision of eight to 10 inches is made beside or behind the hip joint. The surgeon must go through muscle and detach the muscles from the hip joint. With the anterior approach, the surgeon goes between the muscles, rather than through the muscles, so detachment is not required.
Another benefit of leaving the muscles intact is that the joint is more stable, thus reducing the chance of hip dislocation, one of the risks of hip replacement surgery. Most total hip replacement patients whose surgeries were done with an anterior approach are able to bear full weight soon after this surgery which means progression to return to normal activities occurs rapidly.
If you are considering joint replacement surgery, it is important to be in the best physical condition possible prior to surgery. It is imperative that patients considering joint replacement surgery consider weight loss prior to undergoing joint replacement. Obesity is a major complicating factor in recovery from joint replacement surgery. Obesity delays wound healing, increases risk of pulmonary complications and infection. Patients of normal weight will recover much quicker and faster and with fewer complications than the overweight patient.
Total hip replacements involve replacement of the joint’s cartilage and bone with implants. The ball (femoral head) is at the top of the long thigh bone called the femur. The ball fits inside the hip socket (acetabulum) which is on the pelvic bone side.
In healthy hip joints, cartilage covers the surfaces of the bones and enables the ball and socket to work smoothly. With arthritis, the cartilage surfaces degenerate, leading to pain and decreased mobility. In total hip replacement, the surgeon smoothes out the hip socket and removes damaged cartilage and any debris.
A cup-shaped implant is secured into the socket. The ball at the top of the leg bone is trimmed away and a metal stem is placed inside the leg bone and secured there. A ball (metal or ceramic) is placed at the top of the stem and then a smooth, sturdy plastic, metal or ceramic piece is placed inside the cup-shaped implant. This creates a new hip joint that moves smoothly.
Not all hip replacement patients are eligible for the anterior approach. A surgeon familiar with this approach will assess a patient’s suitability for this surgery. The type of hip replacement will depend on the patient’s history, a thorough examination of the patient, the quality of the bone and pre-existing deformities. With any type of joint replacement surgery, patients need to find a surgeon with experience who can help the patient make the best possible decision about surgery, treatment and rehabilitation.
Dr. Timothy Bopp is a board certified orthopedic surgeon with The Bone & Joint Center. Dr. Bopp specializes in reconstructive surgery of the hip and knee.