Anterior Approach to Hip Replacement
The anterior approach is the most significant advancement to hip replacement in the past 10 years. The use of minimal invasive approaches in joint replacement has dramatically changed the recovery from Hip Arthroplasty. These techniques using smaller incisions with less muscle and tendon damage have allowed for quicker mobilization after surgery and fewer pain medications needed after surgery.
The anterior approach to hip replacement requires special instrumentation and training. It allows for repairing the hip joint without cutting Muscles tendons or nerves. The rehabilitation after surgery is faster, on average resulting in one fewer days in the hospital. Limping is eliminated on average 16 days after anterior hip approach vs. 24 days after a posterior approach. Pain relief is faster, 98% of patients are off narcotics 2 weeks after an anterior approach, vs. 70% off narcotics after a posterior approach.
The risk of dislocation after anterior approach is lower due to not having to cut muscle or tendons and a much stronger repair of the anterior capsule. There are no restrictions on hip flexion after an anterior approach.
There are however a number of reasons not to consider an anterior approach to hip replacement. These are related to the limitations of working through a very small incision. On average the operative time is 20-30 minutes longer and the blood loss may be greater. There is a small superficial nerve, the lateral femoral cutaneous nerve, which can be stretched during the procedure. This can result in hypersensitive skin or numbness on the front of the thigh for 6-12 months after surgery in up to 17% of patients. I do not recommend this approach in specific patients:
- Prior surgery through the posterior approach.
- Significant deformity, that wound necessitate lengthening or shortening, of the leg length.
- Marked Obesity.
- Cardiac disease that would not tolerate the stress of a longer procedure with possibly more blood loss.
Hip replacement through an anterior approach has sped up the initial recovery after surgery. It has eliminated the need for hip flexion restrictions after surgery. In the correct situation this approach allows for rapid rehabilitation an even same day out patient hip replacement. This is the latest improvement to hip replacement, one the most successful Orthopedic procedures.