Anterior Approach Total Hip Replacement

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Overview

Direct anterior approach hip replacement is a surgical procedure that has gained worldwide acceptance as an alternative technique to standard posterior hip replacement. At present, a conservative estimate is that 30% of surgeons are now utilizing this technique for hip replacement.

The anterior approach implies an approach from the front, as opposed to a more traditional approach to the hip through the side or buttock. The hip is accessed in a naturally occurring interval between muscles without cutting or splitting them, which is done in more conventional approaches. The technique uses the same implants as traditional hip replacement or resurfacing procedures.

The anterior approach for hip replacement offers some unique advantages over traditional techniques. Advantages of the anterior approach include:

• Quick recovery
• Low dislocation rate
• Improved surgeon control of implant position

Most traditional hip replacements are generally done with the patient lying on his/her side. The approach and incision are made from the side or lateral aspect of the patient. Nearly all of the conventional techniques require that the gluteal muscles to be cut or split. These muscles are some of the most powerful in the body and are required to walk with a limp-free gait.

Approaches to the hip that injure these muscles put the patient at risk for a longer recovery or a permanent limp. The anterior approach preserves the gluteal muscles which in turn allows for a quicker recovery. Many patients can leave the hospital after a short overnight stay, or even the same day. Many begin walking immediately. Normal stair climbing and more athletic pursuits commonly resume in a matter of days as opposed to weeks or months with standard techniques.

A common problem of traditional hip replacement surgery is dislocation. This is a problem where the ball “jumps” out of the socket. The patient has agonizing pain and generally is unable to get up off of the floor to walk. Often, this occurs when the patient goes to sit in a low chair or on a toilet, or when the patient bends over or rotates their leg. The patient must have the hip replacement put back in place by a trained medical provider in the emergency room.