MINIMALLY-INVASIVE ANTERIOR HIP REPLACEMENT

anterior hip replacement

Patients who are candidates for a total hip replacement typically have hip pain, usually affecting the groin area, as well as limitations in motion. The pain can radiate down the front of the thigh, to the side of the hip, or to the lower back as well. Most patients are unable to perform their normal daily activities such as climbing stairs, putting on their shoes, or lifting their leg to get into the car. Patients have undergone conservative treatment such as activity modification, over-the-counter pain medication, physical therapy, or hip injections. When these are no longer effective, it may be time to have a hip replacement.

There are several different approaches to the hip in order to perform a hip replacement, with the two most common being the anterior and the posterior approach. The anterior approach means that the incision is over the front of the hip while the posterior approach means that the incision is over the backside. The posterior approach, which some refer to as the traditional approach, has stood the test of time. It allows surgeons to do more if needed and is appropriate for more severe cases or revision cases. Dr. Diamond prefers the anterior approach for routine total hip replacements. Typically, the incision is smaller and more discreet. During the immediate post-operative period, particularly in the first two to six weeks, patients who have an anterior approach total hip replacement progress with their post-operative mobility and reduce pain quicker than patients who have a posterior approach. One of the main reasons for this difference is the anterior approach is a muscle-sparing approach, where the muscles can be retracted out of the way instead of cutting through them or detaching them. This creates less irritation and inflammation in the muscles and less time spent waiting for them to heal.

Another benefit of the anterior approach is that it allows the use of imaging during surgery to help position the components of the hip replacement. This will aid in the stability of the hip and the longevity of the implants if they are properly positioned. It also lets the surgeon more precisely determine the leg lengths by comparing preoperative x-rays to those taken during surgery to ensure that they are similar.

Normally, after a traditional hip replacement, your surgeon would give you instructions on hip precautions to prevent dislocating the new joint. Hip precautions are very restrictive and remain in place for 3 months. While the posterior hip approach has multiple precautions after surgery, the anterior approach has no restrictions as hip precautions are unnecessary. Because the muscles are not cut, the risk of dislocation is greatly lessened, enabling the patient much more freedom of movement after surgery.

Surgery typically takes about an hour and most of Dr. Diamond’s patients go home the same day as surgery. During the first two weeks, the main goals are pain control and early mobilization—patients should be walking for 20 minutes 3 times a day. At the 2-week post-op visit, the patient will discuss their progress with Dr. Diamond to determine whether or not formal physical therapy is recommended. After 6 weeks when the incision is healed, most patients can start to get back to their everyday life, including things like swimming. Maximum improvement happens between 12 and 18 months after surgery, but after 3 months most patients are back to living their normal life without thinking or worrying about their hip.