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Patient Education

Introduction

The anterior approach allows access to the joint without detaching any muscles around the hip. The muscles are carefully retracted along the internervous plane with the assistance of a specialized “hip table”. This allows the surgeon to minimize any soft tissue trauma to the hip allowing for a faster recovery.

  • What is hip arthritis?

    Hip arthritis is a common affliction that impacts millions of Americans.  It is a progressive wear of the protective cartilage of the hip joint.  As the protective cartilage wears, the bare bone is exposed leading to significant pain. Over 150,000 hip replacements are performed annually, and this number is expected to increase exponentially over the next decade.

  • What are common symptoms of hip arthritis?

    In addition to pain, many individuals experience a loss of motion, difficulty with weight bearing, and a limp.  As the arthritis progresses symptoms are typically exacerbated.

  • What are treatment options for hip arthritis?

    Weight loss, activity modification, physical therapy, anti-inflammatory medications, and cortisone injections.

    When non-operative modalities are no longer able to diminish the symptoms surgery becomes a viable option.

    A traditional minimally invasive approach (posterior-thru the back;  lateral-thru the side) detaches muscle around the hip joint prior to replacement.  These are subsequently repaired prior to skin closure.  After the operation, the patient typically has to follow specific precautions to prevent a dislocation (the replaced ball comes out of the socket).  These precautions may include a pillow in between your legs, no bending beyond 90 degrees of flexion, and no excessive turning of one’s feet.

    The direct anterior approach (through the front)  is a sophisticated procedure that allows the surgeon to replace the joint without detaching any of the hip muscles.  Unlike a traditional replacement, this allows one to freely move the hip in most instances.  Due to the muscle sparing, this leads to a decreased hospital stay and quicker rehabilitation.

  • How is this approach different from other minimally invasive approaches?

    Traditional hip surgery splits the gluteus maximus and short external rotator muscles of the hip joint. This requires patients to follow strict “hip precautions” after surgery to prevent dislocation. Hip precautions require patients to not flex the hip beyond 90 degrees. This can make activities such as getting into a car, sitting on a toilet seat, and climbing stairs more challenging. Since the direct anterior approach leaves the muscles undisturbed, typically hip precautions are not required.

  • Who is a candidate for surgery?

    Patients who have been suffering from arthritis or avascular necrosis may benefit from hip surgery.

  • Is there evidence to support superior outcomes of a direct anterior approach in total hip replacement?

    Yes. We’ve listed some reference annotations below:

    Bergin PF, et al.  J Bone Joint Surg Am, 2011 Aug 3;93(15):1392-8

     

    “A Clinical Comparative Study of the Direct Anterior with Mini-Posterior Approach”

    Nakata K, et al.  The Journal of Arthroplasty, 2009 Aug 24;5: 698-704

     

    “Enhanced Early Outcomes with the Anterior Supine Intermuscular Approach in Primary Total Hip Arthroplasty”

    Berend K, et al. J Bone Joint Surg Am, 2009 Nov 01;91: 1-7-120