Total hip replacement surgery is regarded by orthopedic surgeons to be one of the greatest orthopedic inventions in history. This procedure predictably improves function and relieves pain in patients who suffer from debilitating hip pain due to osteoarthritis, rheumatoid arthritis, avascular necrosis (when the ball of the hip loses its blood supply), and various other hip diseases that cause joint destruction, including infections and childhood hip diseases.
Recent advances in surgical techniques and instrumentation have allowed surgeons to perform these procedures through minimally invasive approaches (smaller incisions). Traditionally, and most commonly, the posterior approach has been the preferred approach for most surgeons, and other surgeons have utilized an anterolateral approach to decrease the risks of dislocation. However, over the last 10-15 years, the direct anterior approach has been adopted by many surgeons, and it is estimated that 25% of all hip replacements per ormed now in the U.S. are done via the direct anterior approach.
So why all the buzz about the anterior approach?
First of all, by definition, a minimally invasive approach is technically defined as an approach that involves no cutting of, no cutting through, and no detachment of muscles during an approach to a joint. The anterior approach to the hip requires an incision 4 inches or less, followed by separation of two muscles, allowing the hip joint to then be accessed for the hip replacement procedure. All other approaches, despite the size of the incision, must cut through muscles to approach the hip joint, and this creates the potential for increased pain, increased risk of bleeding, and increased risk of limp due to trauma to the muscles, all leading to prolonged recovery times. Because the anterior approach is the only true minimally invasive approach by definition, there is less pain, less bleeding, and no detachment of muscles. This leads to faster recovery times and improved functional outcomes.
Secondly, the anterior approach is performed on a special table with the patient lying flat. This allows the surgeon to optimally position the operative leg to perform the surgery, and allows an X-ray machine to take intra-operative pictures of the hip. Using the X-ray machine offers the surgeon the ability to precisely position the hip replacement parts (called components). Improperly positioned components can lead to complications such as dislocation, leg length differences, and need for additional surgeries, potentially resulting in poor outcomes. The anterior approach can substantially reduce the risk of these complications. In fact, because the risk of the hip dislocating (popping out of place) is substantially reduced, patients do not need to wear any type of pillow or brace after surgery, and there are no motion precautions. Patients can thus cross their legs, get up from a seated position, and bend over and touch their toes without risking a painful dislocation.
Finally, due to the benefits of the anterior approach described above, patients have shorter hospital stays. Most patients go home from the hospital the day after surgery. Some patients are actually able to go home the SAME DAY!! Patients should be able to use a cane immediately for ambulation, although a walker is often use initially for patent comfort and support. Because recovery times are less, patients spend less time in physical therapy, and they are able to return to activities of daily living, driving, work, and allowable recreational activities much faster than with other approaches. Most activities that are not high impact are allowable following a hip replacement.
Deciding to replace your hip and determining if you are an appropriate candidate for a hip replacement should involve consultations with an orthopedic surgeon who performs this procedure on a regular basis, and your primary care physician and/or medical specialists who may be treating you for various medical issues (diabetes, high cholesterol, heart disease, high blood pressure, kidney disease). Optimization of medical problems lowers potential risks of medical and surgical complications after a hip replacement.
If you are suffering from debilitating hip pain, consider a consultation to determine what the underlying cause of this hip pain could be. Fortunately, non-operative management of hip pain may be a viable solution for many. However, if your hip condition warrants surgical intervention in the form of a hip replacement, please explore the idea of having it performed through an anterior approach, and ask questions regarding risks and benefits of this approach versus other approaches utilized. You will be better informed at that point to make an educated decision as to which method of treatment is appropriate for your individual situation.
Corey exhibits the traits and skills you would expect of someone who is fully invested in their patient’s health and personal care. He listens, he explains, he will talk as long as you need to talk and when you are ready, he will provide you with exemplary health care and follow up. He provided knee replacement surgery for my wife and torn rotator surgery for myself. His gifts have allowed my wife to join Cross Fit and me to continue my martial arts and Cross Fit journeys! Cheers Corey! You are the best.
Orthopedic Sports Medicine & Spine Care Institute
Corey G. Solman, Jr., M.D.
1001 S. Kirkwood Road, Ste. 120
St. Louis MO 63122