Through The Front Door

Published In Senior Beacon

As a specialist in hip surgery, I meet patients every day who have hip arthritis. When we discuss surgery, almost every patient has asked me if I do hip replacement “that new way.” What is the new way of doing a hip replacement? Some surgeons, myself included, have started doing hip replacements through a direct anterior approach. Before a surgeon can replace a hip, first she has to get to it. The hip joint is surrounded by several muscles. Just like going into your house, there are several doors which can give access to the hip. The front (anterior) the side (lateral) and the back (posterior) doors each allow the surgeon to get into the hip so that the worn cartilage can be replaced with a metal and plastic ball and socket. Each method of getting into the hip has advantages and disadvantages.

The anterior approach to the hip is the most direct way to do the surgery, just like going through the front door of your house. And like many front doors, the anterior approach has been little used, at least until recently. Hip replacement surgery has become an extremely successful treatment to decrease pain and improve mobility in patients with arthritis. However, it can take 2 to 3 months after surgery to get back to full activity after surgery. Both patients and surgeons are interested in minimally invasive procedures to limit damage to muscles during surgery and speed recovery.

The advantage of the anterior approach is that the muscles are pushed aside during surgery instead of being cut. This decreases pain and speeds recovery. The incision is not smaller, but there is less damage to the muscle underneath the skin. Also, there is less chance that the hip will dislocate or “pop out” of it’s socket after surgery. Since x-ray is used during the surgery, leg length can be restored more accurately in this approach.

If it is so much better, why do so few surgeons use the anterior approach? Most patients do extremely well after hip replacement, no matter what approach is used to get into the hip joint. The anterior approach can be slightly more difficult to perform. There is more blood loss and a greater risk of requiring a blood transfusion. Postoperatively, a small percentage of patients will have some numbness in the thigh because of the proximity of a superficial skin nerve to the area of surgery, this numbness usually (but not always) goes away in a few months. Some legs are too large to safely do the surgery this way. Sometimes the hip is so destroyed by the arthritis that one of the other approaches provides better visualization of the joint. No matter which approach is used for a hip replacement, the bone has to grow into the new hip and that takes 6-12 weeks.

Hip replacement surgery can be life altering for those who have been limited by the pain of hip arthritis. Most people remark that they wish they had gone ahead with surgery years before. The anterior approach helps to speed recovery after this surgery by limiting damage to muscles around the hip. If you think you have hip arthritis, talk to an orthopaedic surgeon about options for treatment.