Direct Anterior Hip Replacement
Total hip replacement surgery has been traditionally performed by making an incision on the side or back of the hip. This allows the surgeon access to the arthritic hip. The downside to this approach is that muscle and soft tissue are cut and disrupted. This can lead to a prolonged recovery in some cases.
The direct anterior approach to total hip replacement technique was developed as a less invasive alternative. This approach is considered tissue sparring and may provide for a faster recovery with less post-operative pain. With a traditional hip replacement, disruption of the posterior hip capsule can lead to complications of dislocation. The direct anterior approach has been shown to have a lower risk of dislocation in the literature, as the strong and powerful muscles of the back of the hip are not being disrupted.
The procedure involves making a relatively small incision over the front of the hip. Instead of cutting through muscles, the surgeon utilizes a space that exists in between muscle planes. The arthritic femoral head is removed and the acetabulum (part of the pelvis) is resurfaced. A hip prosthesis can then be placed. The stem of the prosthesis is placed into the femur while the “cup” is placed in the acetabulum. A ball this then placed on the stem. Once the correct size implants have been selected the final implants are placed. The hip is relocated back into the socket and the surgical incision is then closed. Fluoroscopy (live x-ray) is used during surgery to help confirm correct placement and size of the implants.
Recovery from this procedure is shorter than a standard approach total hip replacement. Typically, a patient will spend 1-3 days in the hospital following surgery. Full weight bearing is encouraged immediately after surgery. Patients can typically get back to normal daily activities, as they feel comfortable. Low impact activity is recommended, as there is a risk of wearing out the hip replacement with higher, repetitive activities.
As aforementioned, there are many potential advantages to this approach over traditional hip replacement techniques. Outcomes from this surgery are dependent upon a number of factors including age of the patient, bodyweight, activity level, and lifestyle.
This procedure is performed by a trained joint replacement surgeon. Not all patients are candidates for this type of approach. It may be technically challenging for some based on body habitus and those with unusual anatomy.
Complications from this type of surgery are similar to a standard total hip replacement. Risks include infection, fracture to the bone(s), nerve and blood vessel injuries, blood clots and risks associated with anesthesia. Temporary numbness over the front of the hip may occur.