Direct Anterior Approach Total Hip Replacement
By Dr. Eric Buxbaum, Orthopedic Surgeon
Hip replacement surgery has become one of the most common and successful orthopedic procedures performed in the United States. There are multiple ways for surgeons to perform hip replacements, with the classic and still most common technique through the posterior approach, where the surgeon makes the incision on the back or side of the leg. A newer technique, which has shown to have many benefits, is through the anterior approach.
What is direct anterior hip replacement surgery?
The direct anterior approach for hip replacement is a minimally invasive procedure performed through an incision made on the front of the leg. This is considered a “muscle sparing” approach, as the surgeon uses a natural interval between the muscles around the hip to reach the hip joint.
What are the benefits of direct anterior hip replacement surgery?
Because the incision is only 3 or 4-inches long, compared to up to 12 inches with the traditional posterior approach, there is less damage to nearby tissue. Additionally, when going through the front of the hip, the surgeon doesn’t have to cut into muscles and tendons (that later need to be repaired) to reach the damaged hip, something that must be done with posterior hip replacement. Instead, the surgeon carefully moves the muscles aside while inserting the implant, and then moves them back into place after. This helps reduce pain, expedite recovery, and provide greater stability to the hip when compared to the classic posterior approach.
Thanks to these minimally invasive techniques, the anterior approach offers several benefits:
- Less pain, because less soft tissue, ligaments and muscles need to be cut
- Less need for pain medications
- Quicker healing and recovery
- Less rehabilitation and physical therapy, which means a quicker return to normal activities
- No need for “hip precautions” – movements and positions posterior approach patients are told not to do
- Quicker independent mobility
- Shorter hospital stay.
Additionally, patients should be able to start moving around within hours after surgery. Sometimes patients may go home the same day.
What to expect with direct anterior hip replacement
A hip replacement surgery usually takes several hours. It requires either general or regional anesthesia; you and your doctor will decide which option is best for you. Doctors administer regional anesthesia with either a spinal or epidural that numbs the lower extremities.
Your doctor will prescribe pain relievers, such as opioids and non-steroidal anti-inflammatory drugs, to help alleviate pain after surgery.
For physical therapy, patients begin walking immediately after surgery. After leaving the hospital, patients may begin performing light activities at home and increase their walking distance to help increase mobility. No formal outpatient physical therapy is typically required. Recovery can take between three and six months, but many patients will return to normal daily activities even sooner.
What are the risks of direct anterior hip replacement?
Whether it’s anterior or posterior approach, hip replacement is one of the safest, most effective operations you can have. Most people who have hip replacement surgery don’t experience major complications, but all surgical procedures carry some risks. Doctors will consider the risk for each individual patient. Age, weight and medical conditions such as diabetes can affect a patient’s risk for complications following hip replacement.
Hip dislocation or loosening is one of the major risks of hip surgery, especially in the weeks after the surgery. However, it’s less likely with the anterior approach because the technique preserves the muscles and soft tissues that prevent dislocation. Another risk of both posterior and anterior hip replacement is leg length discrepancy, but again, this is less likely with the anterior approach as the patient’s position during surgery allows for easier and more reliable assessment. Additional risks with the anterior approach include numbness of the skin in the front of the thigh, because the skin nerves get stretched. This usually goes away after a few months. One complication specific to anterior approach, is an injury to a large skin nerve near the incision. If injured during surgery, it can lead to chronic pain and abnormal sensations along the front and side of the thigh.
Who is a candidate for direct anterior hip replacement surgery?
People experiencing hip pain and disability that disrupts their regular activities are candidates for hip replacement. For people suffering from osteoarthritis, hip injuries, rheumatoid arthritis or bone tumors, hip replacement may be the only solution to relieve pain. Weight and age are not restrictions, although they may be risk factors that should be considered. Total hip replacements have been performed successfully on people of all ages, but most patients are usually between the ages of 50 to 80.
Is Hip Replacement Surgery for You?
When making the decision to have hip replacement surgery, it’s important to consider the benefits and risks specific you. If alternative and first-line treatments such as physical therapy and pain medication don’t provide relief, a hip replacement procedure may be the right solution for you. The good news is that the techniques and instruments used for hip replacement keep improving, which means more positive outcomes and better quality of life for patients.
