June 13, 2018
Total hip replacement, also called hip arthroplasty, has become a widespread procedure in recent years due to its proven, long-term effectiveness in treating hip pain. In fact, the overall prevalence of the procedure, alongside methodological and technological innovations, has made hip replacement one of the most versatile surgeries that exist.
Today, there are several effective approaches to total hip replacement but the anterior approach is quickly becoming one of the most popular, especially among elite athletes and those who rely on their hip for their occupation. The anterior (from the front) approach provides a faster recovery, less post-operative pain, and much less limitation of motion (lower risk of dislocation).
This article will answer frequently asked questions about anterior approach hip replacement, particularly the differences between an anterior approach and traditional hip surgery.
What is the Anterior Approach for Hip Replacement Surgery?
Anterior hip replacement, also referred to as a direct anterior hip replacement and anterior supine intermuscular (ASI) hip replacement, involves an orthopaedic surgeon accessing the hip joint by entering through the front of the body and going through the hip muscles that stabilize the hip joint.
First, the surgeon will make a small incision approximately 3 to 5 inches long on the front of the upper thigh. Next, the surgeon will spread the muscles (not cut through them) surrounding the hip joint and then insert specially designed instruments, including a tiny camera called an arthroscope, into the natural space between them. By working between muscles, the anterior surgical approach can be performed without cutting tissue. After the surgeon gains access to the hip joint, they will resurface, remove, and replace the damaged bone. Finally, the surgeon will close the incision.
The surgery typically requires 1 to 2 hours as well as an additional 1 to 2 hours for preparations and recovery in the operating room.
What are the Advantages of an Anterior Approach?
An anterior approach provides the same long-term benefits as a traditional approach; however, it also provides a number of short-term benefits that are ideal for athletes and professionals who need to resume their activities quickly.
Less Damage to Muscles
Because there are fewer muscles on the front side of the hip, the surgeon does not need to cut or remove tissue in order to access the joint.
Compare this to a traditional hip replacement where the incision is made either at the back or the side of the hip. A traditional replacement requires muscles and tendons to be detached from the hip, leading to increased post-operative pain, delayed recovery, and higher risk of dislocation.
Less Postoperative Pain
Since the incision is relatively small and muscles are sparred during an anterior approach, patients experience less postoperative pain and often require less pain medication as well.
Naturally, patients are able to achieve a full recovery sooner because there’s less tissue that needs to heal in the first place. Total recovery time for an anterior approach is approximately four weeks which is about half of the time it takes with a traditional approach.
Shorter Hospital Stay
After traditional hip surgery, a patient will typically stay in a hospital for 3 to 5 days. At Beacon Orthopaedics and Sports Medicine, hip replacement surgery is performed in an outpatient setting. Outpatient hip replacement, also called a same-day hip replacement, allows the patient to receive surgery and return home in about 24 hours. Many patients prefer this for three reasons:
- The patient is able to recover in the comfort of their own home.
- The patient is able to avoid the cost of a hospital stay.
Lower Risk of Hip Dislocations
Since anterior hip replacement surgery does not disturb the muscles that hold the joint in place so there is a significantly lower risk of dislocations. This also means that there are fewer postoperative restrictions on what activities a patient can engage in.
What are the Risks of an Anterior Approach?
An anterior approach is not ideal for everyone. As with all forms of surgery, there are serious risks to consider, including:
- Blood Clots
- Nerve Damage
- Change in Leg Length
Note that these complications can also occur during traditional hip replacement.
While the general risk of a complication increases with age and a history of smoking, it is also highly dependent on factors that must be evaluated on a case-by-case basis. To determine if an anterior approach is appropriate for you, schedule an appointment with Dr. Chaudhary.
Who is a Candidate for an Anterior Approach
In general, candidates for hip replacement surgery have pain and immobility that impair or prohibit everyday activities. Candidates for an anterior approach, in particular, tend to be younger and in otherwise good health apart from their hip problems. Moreover, candidates must be willing to participate in postoperative physical therapy. A physical therapist will not only help the patient regain hip strength and mobility but also teach them how to preserve their new joint.
An anterior approach may not be ideal for individuals who are obese or extremely muscular. This is because additional soft tissue can make it difficult for the surgeon to access the hip joint. It also may not be ideal for patients who have previously received a traditional hip replacement.
- Anterior hip replacement is performed at the front of the hip. This differs from a posterior hip replacement which is performed from the back.
- Anterior hip replacement is minimally invasive. Since the incision is small and muscles are not cut, healing and recovery occur sooner.
- Anterior hip replacement provides additional short-term benefits. While the long-term results are typically the same as a traditional hip replacement, these short-term benefits are often ideal for professionals and athletes who must resume their activities quickly.
- The skill of your surgeon as well as postoperative physical therapy will significantly impact your outcomes.
- Anterior hip replacement is not suitable for all patients. Your physician will determine if you are a candidate for minimally invasive surgery.
Talk to an Orthopaedic Specialist
As with any surgery, the most important factor is not the approach used but the skill and the experience of the surgeon. Moreover, your participation in postoperative physical therapy will also have a significant impact on your recovery and help you preserve your new hip joint.
At Beacon Orthopaedics and Sports Medicine, we provide you the best in each of these areas ensuring you an optimal recovery. Dr. Haleem Chaudhary is a board-certified orthopaedic surgeon who specializes in joint reconstructions, replacements, and revisions. In fact, Dr. Chaudhary worked to pioneer anterior approach hip replacements in the Greater Cincinnati region. Dr. Chaudhary will work with you as well as a premiere team of physical therapists to put you on the fast track to recovery. Schedule an appointment with Dr. Chaudhary today.