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Total Hip Replacement: Anterior Approach

March 2, 2018  |  Staff

A total hip replacement procedure has the ability to relieve pain and restore normal function in cases where the hip joint has been destroyed by trauma or disease. Most surgeons use the posterior hip replacement approach, which is accessed from the back of the hip, for hip replacement surgery because it allows the surgeon excellent visibility of the joint and more precise placement of implants. With the anterior hip replacement approach, the hip joint is accessed from the front of the hip rather than from the side or back of the hip.

Recently, the anterior approach has emerged as a more desirable option for certain patients since the hip is approached and replaced through a natural interval between muscles without detachment of muscle from the pelvis or femur. As a result, the anterior approach requires less hospital time and rehabilitation is accelerated.

Anterior vs. Posterior Hip Replacement Surgeries

LOCATION OF INCISION

Anterior: The incision is made at the front of the hip starting at the top of the pelvic bone (iliac crest) and extending down toward the top of the thigh.

Posterior: The incision is curved on the side of the hip, just behind the greater trochanter (the knobby bit of bone that sticks out at the side from the top of the thigh bone).

MUSCLES AFFECTED

Anterior: The surgeon works between the muscles supplied by different nerves, so it's a natural separation that allows ready access to the hip joint. With this approach, there is minimal or no muscle cutting.

Posterior: The surgeon needs to cut muscles and other soft tissue at the back of the hip to access the hip joint. These muscles are repaired and reattached at the end of the surgery.

TECHNICAL EASE OF SURGERY

Anterior: The surgeon tends to have a limited view of the hip joint, making the surgery technically challenging, especially for less experienced surgeons.

Posterior: The surgeon tends to have a good view of the hip joint and comfortable access to the hip joint during posterior hip replacement.

Advantages and Disadvantages of Anterior Hip Replacement

Potential Advantages:

  • The anterior approach avoids cutting major muscles, meaning that there is less muscle damage. There are fewer muscles at the front of the hip, and the surgeon works between them, rather than cutting through muscle fibers or detaching muscles from bones.
  • Less post-operative pain since the surgery does not require cutting major muscles. Patients typically experience less post-op pain and require less pain medication.
  • Faster recovery than with traditional hip replacement. After surgery, an anterior surgery patient can bend at the hip and bear weight as soon as it is comfortable. Most anterior hip replacement patients can use crutches or a walker sooner than patients who have had a traditional surgery.
  • Decreased risk of hip dislocation since the surgery does not disturb the muscles and soft tissue structures that naturally prevent the hip from dislocating. This is a major post-surgical worry for most hip replacement patients since the new hip's ball and socket will sometimes dislocate.
  • Shorter hospital stay. A patient who undergoes anterior hip replacement can typically expect a shorter hospital stay than with a traditional approach. Of course, this depends on the patient and the frequency of physical therapy sessions provided in the hospital.

Potential Disadvantages:

  • Obese or very muscular people may not be good candidates because the additional soft tissue can make it difficult for the surgeon to access the hip joint.
  • It is a technically demanding surgery since the anterior incision provides a restricted view of the hip joint. Surgeons need years of training and practice to perfect this procedure.
  • There is potential for nerve damage with any type of hip replacement approach but particularly in anterior hip replacement. The lateral cutaneous femoral nerve runs down the front of the pelvis and past the hip to supply the thigh. There is more potential for damage to this nerve with the anterior approach.
  • There may be wound healing issues as the surgical incisions can get irritated, especially in very large patients or patients with large amount of abdominal fat, because that area can take longer to heal.

It is important to remember that a successful hip replacement surgery depends on many factors besides the surgical approach. Most importantly, the knowledge and skill of the surgeon, the type of hip prosthesis used, the patient's weight and build and the ability and willingness of the patient to participate in surgical preparation and post-surgical rehabilitation are important factors. The anterior approach can be challenging so you want to select a surgeon that has undergone special training before he or she performs anterior hip replacement.

To learn more about the procedure or to schedule an appointment with one of our anterior hip replacement specialists, call us at 800-698-1280.

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