Anterior Hip Replacement

Here at Premier Orthopaedic and Trauma Specialists, anterior hip replacement is a very exciting topic; there are multiple advantages to the anterior hip replacement, which we will discuss now. Most physicians performing hip replacement surgery perform it through a standard posterior lateral or lateral approach. On the surface, this may not seem like much, but actually these techniques are completely different from the anterior approach. The posterior or lateral approach requires a fairly long incision with a lot of trauma to the muscles and the surrounding tissues. There is no natural plane to get to the hip joint via the posterior or lateral approach. As a result, very important muscles, like our gluteus muscles are cut in half, or sometimes completely detached, during the surgery. This causes significantly more pain, more bleeding, and a longer recovery, especially to get rid of a residual limp.

On the other hand, the anterior approach is truly minimally invasive surgery. We say that because not only is the incision small, which nowadays is often enough to be considered minimally invasive, but the actual invasiveness of the surgery inside to the soft tissue is minimal as well. The incision is usually no more than three inches and it utilizes a natural plane. In other words, we work between muscles and nerves, so none of these important structures are cut or damaged during this procedure. That leads to significantly less pain immediately after surgery, less risk of bleeding, and quicker recovery.

During the Procedure

During the anterior hip replacement, a special surgical table is used to help approach the hip and perform this minimally invasive surgery. Given the minimally invasive nature of this surgery, it gained significant popularity in the early 2000s. You may wonder why more surgeons do not perform this anterior hip replacement, and the reasons are fairly simple.

  1. It requires special equipment and special training and
  2. It is significantly more difficult for the surgeon and requires more experience

Fortunately, our surgeons at Premier Orthopaedic and Trauma Specialists have been performing this for many years and have thousands under our belts. All our patients take minimal narcotics after surgery and are usually discharged the same day or the following day. It’s reasonable to expect that you will go home within a day and be able to get to the bathroom on your own and perform normal functions with minimal assistance. This means a lot for most patients, because it allows them to regain independence more quickly and rely less on family and friends.

In addition, since patients are receiving this surgery lying flat on their back, on a comfortable operating table, the surgery is almost always done under spinal anesthesia with very light sedation, but no uncomfortable and painful breathing tube in the throat. Patients are in a much safer position for anesthesiologists as well. Avoiding general anesthesia also decreases blood loss, decreases nausea and vomiting after surgery, and minimizes issues with bowel or bladder function after surgery.

The other major benefit of an anterior hip replacement is that fluoroscopy is used during surgery, so the exact positions of the implants is known prior to leaving the operating room. This is one of the reasons why, in experienced hands, computer navigation is usually not necessary as imaging is being used during the surgery. The same is not true of lateral or posterior approaches as imaging, if used during the procedure, is not reliable.

The last and very important benefit of anterior hip replacement is that the dislocation rate is essentially zero. Given that a natural border is used, and the strong stabilizing muscles of the hip are not cut (as they are in the posterior approach) the hip is much more stable. The position of dislocation for an anterior hip replacement is not a natural, normal position we find ourselves in, so there are no restrictions after surgery. This is in contrast to the posterior or lateral approach, where simply bending over too far to get up from a low seat may dislocate your hip.

We encourage you to learn more about the anterior approach to hip replacement. To do so, please call our office and schedule a consultation with one of our experienced orthopedic surgeons.