expertise

Anterior Hip Replacement

The anterior approach procedure for hip replacement has been gaining popularity due to its numerous potential benefits. This is an approach to the front of the hip joint as opposed to a lateral (side) or posterior (back) approach. Rehabilitation is accelerated and hospital time decreased because the hip is replaced without detachment of muscle from the pelvis or femur.

Eric J. Thiel, M.D. is one of a small group of surgeons in the nation that performs this specialized procedure. Watch a video of Dr. Thiel.

Potential Benefits of the Anterior Approach

• Less pain and need for pain medications.

• Less risk of dislocation and no need for postoperative restrictions in motion.

• Faster return to recreational pastimes and return to work.

• The scar resulting from the surgery is much smaller than if done by the traditional method.

Another advantage of the anterior approach is that for patients who require bilateral hip replacement, this can be performed during a single operative session.

General Overview

While traditional hip replacement uses a single larger incision on the side of the hip and upper thigh, and requires muscle to be detached from the hip or thigh bones, the anterior approach uses one small incision on the front of the upper thigh. This way, the hip can be replaced without detachment of muscle from the pelvis or femur during surgery.

This technique allows the surgeon to work through the natural interval between the muscles. The most important muscles for hip function, the gluteal muscles that attach to the pelvis and femur, are left undisturbed and, therefore, do not require a healing process to recover from surgical trauma.

Traditional Incision                                           

 

A Closer Look at the Anterior Approach

The anterior approach requires a specialized operating table that places the leg and pelvis in a stable position, allowing the surgeon to adjust the operative leg during surgery with a great degree of control and precision. Rather than being positioned on their side or stomach, the patient is laid flat on his/her back, which minimizes tilting of the pelvis during the operation. The table also gives the surgeon excellent access to the femur, or thighbone, in order to position the stem of the implant effectively.

The incision length varies according to a patient’s size, weight and other factors. This approach lends itself to a relatively small incision because the hip joint is closest to the skin at the front of the hip. The muscle and fat layers are thinner than the muscle and fat tissue encountered when using other approaches on the side or rear of the thigh.

Anterior Approach Incision

Possibility for Improved Accuracy

With the anterior approach, the patient is positioned supine (lying on back) during the operation. This allows the surgeon to use active x-ray control in the operating room to ensure that your hip replacement is placed in as accurate a position as possible. Side-by-side television monitors compare the x-ray image of the patient's opposite hip to the operated hip. This comparison gives immediate information regarding equality of leg length. This is in contrast to conventional hip surgery when the first x-ray is often in the recovery room.

 

Potential Candidates

Your Bone & Joint orthopaedic surgeon will determine if you are a candidate for this surgery. Factors they consider include the patient's physical condition, age, level of activity, bone quality and weight, and whether or not they have osteoarthritis or rheumatoid arthritis.

As with any surgery, each of these techniques pose some risks. Recovery takes time and hard work and the life of a new joint depends on weight, activity level, age and other factors.