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Anterior Hip Replacement
If your hip is worn with arthritis, or damaged from injury or other conditions, it may be hard for you to perform simple activities such as walking. Getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.
Hip replacement surgery is a safe and effective procedure that can relieve pain and help you resume normal activities. It is one of the most successful procedures in all of medicine. (You can follow this link for more general information about hip replacement.)
There Are Different Options For Hip Replacement
When it comes to hip replacement surgery, it is important to know that not all hip replacements are the same. There are significant differences that can influence both your initial experience as well as the long term outcome. As a patient, it is important to know these factors up front so you can make a well informed decision when choosing to have surgery.
In all total hip replacement procedures, the damaged bone and cartilage are removed and replaced with prosthetic components. However there are different ways, or “approaches” to reach the joint. Hips have traditionally been replaced through an incision on the side or back of the hip, called the “posterior approach.” When a hip replacement is done this way muscles are split then detached from the back of the femur (thigh bone) to gain access to the hip joint.
The anterior hip replacement uses an incision in the front of the hip. Unlike the posterior approach, the muscles are not split or detached to do the hip replacement. We take advantage of a natural divide between the muscles in the front of the hip. We can come right down on the hip joint without dissecting any muscle.
Goals of Total Hip Replacement
The goals of a total hip replacement by any approach are:
- A painless joint that functions well for the long term.
- Minimize potential complications
Choosing a well trained, experienced surgeon is the most important step in achieving these goals and having a successful outcome regardless of the approach used. Not every anterior hip replacement surgeon does it the same way, nor does every posterior hip surgeon. It is a surgeon who has mastery of their technique that will give the best chance of achieving the goals above.
With this in mind, there are additional considerations when deciding on hip replacement that can influence your experience and outcomes
- Amount of post-operative pain to expect
- Time for recovery
- Closure and size of the incision
- Long term restrictions
- Complications associated with the approach
These too vary surgeon to surgeon, but there are, however, certain advantages and disadvantages to consider associated with the different approaches.
Anterior Hip Replacement
- The surgery can be performed through a smaller incision about 3-4 inches long, with less damage to the muscles and soft tissues.
- This typically means less pain and a quicker recovery.
- Since there is less damage to muscles there is also a much lower risk of dislocation.
- No cumbersome restrictions, you can bend forward, tie your shoes. No special toilet seat or a triangular pillow between the legs while sleeping.
- Easy to use live Imaging / X-ray during the procedure
- The surgical technique allows the surgeon to more accurately place the prosthetic components,
- The normal anatomy and leg lengths can be controlled precisely
- Low risk of sciatic nerve injury that can lead to foot and leg weakness
Though there are multiple advantages, the nerve which supplies sensation to the front and side of the thigh crosses the front of the hip. Because of this it is common to have some numbness on the outside aspect of the incision. Although this is usually minor and improves with time, there is a risk of of having a burning or tingling sensation that can persist. The anterior hip replacement is a harder technique to learn. Studies show there is a higher complication rate when a surgeon is learning the technique. According to once recent study, it takes a surgeon about 100 cases to learn how to do the procedure well, and more than that to master it. (Most surgeons who perform hip replacements do fewer than 25 a year.) Experience and training are very important when choosing your surgeon.
Why I use the Anterior Approach
As a surgeon I want my patients to have the best clinical results with a hip that will last 20+ years, with the lowest risks of complications. My patients would like to have less pain, a quicker recovery, smaller incision, and not have to worry about the hip coming out of the socket. The anterior hip approach allows me to do both! Having used the Anterior hip technique over the past nine years I have found that it gives me the best precision in placing the hip replacement implants in the correct position. Complications are extremely rare, narcotic usage has decreased, blood loss has decreased and most importantly my patients are much happier with their experience.
For me, the Anterior hip approach
- Allows for better technical precision
- Gives excellent pain relief
- Can restore function and activity
- With less post-op pain and disability
When it comes to hip replacement surgery, and Anterior hip replacement in particular, surgeon experience matters. As a fellowship trained joint replacement specialist I have spent an extra year focusing on hip and knee replacement. I have gained experience in multiple approaches and techniques in joint replacement, and participated in hundreds of anterior hip procedures during fellowship training. I have been using this approach for my hip replacement procedures for the past nine years and over a thousand cases. I am a member of the American Association of Hip and Knee Surgeons (AAHKS), and keep up to date on current techniques and patient care protocols. I believe that this experience has contributed to the success I have had with this procedure.
For additional details on hip replacement surgery please see the Total Hip Replacement page.