Hip Replacement Using a “Direct Anterior Approach”

By Dr. Joseph Tauro. Follow on Twitter @OCSM_

Hip replacement surgery is a very common operation, with over 300,000 patients undergoing hip replacement in the U.S. last year alone! Here at Ocean County Sports Medicine, it’s been very satisfying for my patients and myself, with a return to almost all activities and generally a 95 percent reduction in pain after surgery. Of course, this type of surgery is not for everyone. A patient’s hip problem has to be very painful and debilitating to justify a hip replacement.

The pictures below show the appearance a normal hip in comparison to an arthritic hip:

 

hip 1hip 2
Over the years that I have been in practice, the operation itself has become less invasive and less painful. The implants have gotten better and better (for the most part, with the much publicized exception of metal on metal implants which caused many problems…we never used them!)

Over the last two years, we have gradually switched over to a “new” way to do the replacement: the direct anterior approach. Why did we make the switch?

Most hip surgeries are done through a “posterior” approach. The requires splitting the buttocks muscle, the gluteus maximus, and then detaching the external rotation muscles from the back of the hip in order to gain access to the joint.

In the long term, this operation is proven and works very well. The problem is that in the early period after the hip replacement (the first 3-6 months), there is an increased chance of dislocation of the ball from the socket and often persistent weakness which causes a limp.

What patients really don’t like are the precautions necessary immediately after the surgery to prevent a dislocation: the pillow between the legs; raised toilet seats and avoiding low seating in general; and a delayed return to driving and other normal activities.

The illustrations below show how the hip is approached from the posterior:

hip 3
hip 4hip 5

With the direct anterior approach, the chance of a dislocation is greatly reduced because it does not require spitting or detaching any muscles. There are minimal precautions necessary after the surgery and return to normal activities is much faster.

My patients who have undergone a replacement using the posterior approach and then more recently had a replacement using the anterior approach have universally preferred the newer technique.

The illustrations below show how a hip is approached using the anterior approach:

hip 6 hip 7

There is much more information on hip replacement on our web site and on the web in general and anyone needing a hip replacement should check it out! OK everyone, summer is here so it’s time to hit the beach! Maybe I’ll see you on the beach with a kite in South Seaside Park. Don’t forget your sunblock!

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