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Anterior Hip Replacement

The time required for post-operative recovery, and the amount and duration of pain during healing, remain factors that patients consider when deliberating whether to have a joint replacement of any kind.  Today though, a new approach in surgical access to the hip is helping to address these concerns in total hip replacement.

Anterior hip replacement could eventually make it possible to offer hip replacement as an outpatient procedure.

Performing this operation via an incision at the front (anterior) of the hip, rather than from the side or back of the hip, is helping patients stand and walk faster after surgery, with less post-operative pain and restrictions.   Orthopedic surgeons have performed anterior hip replacement to a limited extent since the 1980s, but new instrumentation that facilitates the procedure and also makes it easier to perform through smaller incisions has returned major attention to this strategy for both surgeons and patients.

Procedure Spares Musculature

For the vast majority of the hundreds of thousands of total hip replacements performed each year, the orthopedic surgeon makes an incision above or at the side of the buttocks. But posterior or lateral approaches require detaching muscles, including the deltoid of the hip, from the femur or pelvis.

With the anterior approach, the surgeon makes a four-inch incision through the top front of the thigh, and then divides the connective tissue and uses special retractors to move muscles to the side to get visual and physical access to the ball and socket aspects of the joint. The team rotates the hip and thigh as needed on a special operating table. The approach uses standard artificial-joint components and radiologic imaging during the operation.

Most importantly, because the surgeon works between the muscles, no muscle detachment is necessary.  For this reason, though, anterior hip replacement is also more difficult to perform and requires special training on the part of the orthopedic surgeon.

Hip replacement by frontal access

Hip replacement by frontal access does away with the need to cut muscles that attach to the pelvis or femur. The approach is gaining popularity across the country, primarily because it helps patients recover more quickly and uses fewer post-operative resources.

 

Frontal Approach Proving Itself to Patients and Surgeons

The anterior approach has the potential to shorten hospital stays for hip replacement. Younger patients are sometimes discharged after one or two days. With musculature in place and functioning, patients enjoy normal hip mechanics right away, immediate hip stability and fewer restrictions.

With little incidence of dislocation, anterior hip replacement means patients have no special postural precautions (related to bending, squatting, etc.) during recovery.  Some patients are able to walk and climb stairs the day of surgery, and have decreased time in post-operative rehabilitation and less need of pain medication. And, they avoid having to sit on the incision site.

The approach may reduce recovery time by several weeks. Studies are underway now to confirm these benefits.

The approach is especially appreciated by patients who are active and eager to return to work and their daily activities as quickly as possible.   The prospect of walking within hours has made anterior hip replacement popular among patients.

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