Anterior Approach Hip Replacement

Overview

Hip replacement surgery, or arthroplasty, is when a hip that is damaged by arthritis is replaced with an artificial joint called a prosthesis and was called the surgery of the century given how successful it is.. There are typically 4 components to a hip replacement – a metal shell and a liner typically make up the acetabular (or cup side), and the stem and ball make up the femur side.

The anterior approach to hip replacement is done through front of the hip joint as opposed to the posterior (back) approach or lateral (side) approach. The anterior approach is quickly becoming the standard for hip replacements given the benefits of the approach. It is a muscle sparing approach as the surgery is performed through a naturally occurring interval between muscles. Unlike other approaches, which often require cutting muscle and repairing it at the end of the surgery.

Some of the benefits of the anterior approach are:

• Decreased hospital stay – majority are even outpatient surgery where the patient goes home the same day.

• Quicker recovery – some patients back to hiking within a month.

• Lower dislocation risk – approximately 1 in 1,000.

• Increased accuracy of prosthesis placement – patient is on their back throughout surgery and each step is verified using x-ray.

• Bikini incision – may be used in some patients and is more cosmetic and has less wound problems.

Dr. Shelton uses several innovations learned from his time learning from Dr. Joel Matta (the surgeon responsible for the anterior approach in the United States) during the surgery to improve patient outcomes.

Some of those are:

• DePuy Synthes Actis® collared stem – has the lowest 7-year revision rate of any implant on the market and the collared stem has been shown to decrease postoperative subsidence and fracture.

• DePuy Synthes Velys^TM Hip Navigation – interacts with x-ray images taken during surgery to improve implant positioning and leg lengths.

• The Hana® Table – a table specially designed to help control the leg during surgery ensure better exposure resulting in more accuracy.

• Kincise^TM – an impact hammer that uses a controlled amount of force to place implants which decreases the risk of intraoperative fracture

Using these innovations and the anterior approach, patients are able to return to a very high function – including skiing, triathalons, ultramarathons, weightlifting, etc. In most cases, physical therapy is not needed following surgery. And for the first 3 months, patients are asked not to participate in activities in which they might sustain a high energy impact to allow the bone-implant interface to mature.

Potential Implications

Blood loss, infection, damage to nerves or blood vessel including numbness over the lateral (side) of the thigh, intraoperative fracture, leg length differences, hip dislocation, deep vein thrombosis (DVT), and need for additional surgery.