Learn more about anterior hip replacement

Total hip replacement is one of the most successful surgeries for relieving pain and increasing function if you suffer from osteoarthritis in your hip.  Traditionally, hip replacements were performed through two approaches – posterior or anterolateral. Now, the anterior method is gaining popularity as the “hip” hip replacement.

When you have osteoarthritis in your hip, we always begin with conservative treatments, including:

  • anti-inflammatory medications
  • maintaining a healthy weight
  • physical therapy
  • a cane in the opposite hand to off load the pressure on the joint
  • injections

But if your pain persists, it’s imperative to have a surgeon skilled in modern replacement strategies to get you back on your feet and active again.

Although originally described in 1881, the direct anterior approach to hip replacement was only sporadically used until recently.  Technology advances, coupled with patients’ increased desire for minimally invasive surgery and faster recovery, has the anterior hip replacement gaining in popularity.

Anterior hip replacement patients are routinely walking with physical therapy within hours following the surgery.

The anterior approach is a muscle-sparing procedure that exposes the hip joint with one small incision over the front of the hip. The muscles and tendons are spread apart temporarily, rather than detaching them from the hip or thigh bones, as done during the traditional hip replacement approaches. Anterior hip replacement leads to less trauma to the soft tissues and more stability following surgery.

During the surgery the patient is placed on a special table, called the Hana® table, that has independent leg spars allowing us to maneuver the patient’s legs to perform the surgery through the small anterior incision.

This table also allows us to use intra-operative x-rays to “fine tune” the alignment of the hip replacement components. This offers better wear properties and increased stability of the hip.  We use standing x-rays taken prior to surgery and reproduce this with our intraoperative x-rays to appropriately position the hip replacement components specifically for each patient, as well as make leg lengths equal.

One of the biggest differences between the anterior approach and traditional hip replacement is the freedom from “hip precautions” following the procedure. Anterior patients can position the hip anywhere they feel comfortable immediately after surgery. Muscles are not cut and the risk of dislocation is low, which enables patients to have more freedom of movement after surgery.  Anterior hip replacement patients are routinely walking with physical therapy within hours following the surgery.

Following a traditional hip replacement, the surgeon must give specific instructions on hip precautions to prevent dislocating the new joint.  These include avoiding bending the hip and turning the foot, sleeping with a pillow between the legs for six weeks, avoiding crossing the legs and not sitting in low chairs. But, for anterior hip replacement patients these precautions are unnecessary.

Many patients go home in less than 24 hours and complete outpatient physical therapy within four to six weeks.   The incision is closed with absorbable sutures and skin glue, which enables you to shower immediately and not have to have sutures or staples removed.

The direct anterior approach can be utilized for nearly all total hip replacements.  Whether patients have osteoarthritis, rheumatoid arthritis, femoral neck fracture or advanced avascular necrosis, the anterior approach is a reliable and reproducible surgical approach. Anterior hip replacement can help you get back to the life you want to be living.

By Justin Hoover, MD, orthopedic surgeon at AAMC Orthopedics. To reach his practice, call 410-268-8862.

Originally published March 31, 2015. Last updated May 31, 2018.

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