Direct anterior hip replacement

What is Direct Anterior Approach Hip Replacement Surgery?

Direct anterior hip replacement is a minimally invasive, muscle-sparing hip surgery to replace the hip joint without cutting through any muscles or tendons as against traditional hip replacement that involves cutting major muscles to access the hip joint.

Anterior Hip Replacement Procedure

Anterior hip replacement surgery is performed under general anesthesia or regional anesthesia. You will lie down on your back, on a special operating table that enables your surgeon to perform the surgery from the front of the hip. Your surgeon may use fluoroscopic imaging during the surgery to ensure the accuracy of component positioning and to minimize leg length inequality.

Your surgeon will make an incision, about 4 inches long on the front of the hip. The muscles are pushed aside to gain access to the joint and perform the replacement. Next, the femur is separated from the acetabular socket. The acetabular surface is prepared using a special instrument called a reamer. The acetabular component is cemented or fixed with screws into the socket. Then a liner made up of plastic, metal, or ceramic is placed inside the acetabular component.

The femoral head that is worn out is removed and the femur is prepared using special instruments so that the new metal component fits the bone properly. Then, the new femoral component is inserted into the femur either by a press fit or by using special bone cement. The femoral head component made of ceramic or metal is then placed on the femoral stem.

Once the artificial components are fixed in place, the instruments are withdrawn and incisions are closed with sutures and covered with a sterile dressing.

Post-operative Care for Anterior Hip Replacement

After direct anterior hip replacement, most patients can go home the day after surgery.

Select patients who are healthy and motivated and have family support may go to home the same day.

Patients will work with an in-home physical therapist for 1-2 weeks and then may do simple exercise at home on their own.

Traditional hip replacement techniques require postoperative precautions such as limited bending, avoiding leg crossing, and sleeping with a pillow.

With the direct anterior approach there are very few postoperative precautions. Due to the muscle sparing nature of the procedure, patients can usually return more quickly to a normal gate free of a walker or a cane, and return to regular activities.

The risk of dislocation is decreased compared with other techniques

Advantages of Anterior Hip Replacement

The advantages of anterior hip replacement include:

• Smaller incision
• Minimal blood loss
• Short hospital stay
• Less postoperative pain
• Minimal soft-tissue trauma
• Less scarring
• Quicker recovery
• Early mobilization
• Less postoperative restrictions
• Quicker return to normal activities
• Lower risk of dislocation

Risks and Complications of Anterior Hip Replacement

All surgeries carry an element of risk, whether it is related to the anesthesia or the procedure itself. Risks and complications with anterior hip replacement are rare, but can occur and may include:

• Infection at the incision site or joint space
• Fracture
• Numbness around the incision area
• Hemarthrosis - excess bleeding into the joint after the surgery
• Deep vein thrombosis (blood clot)
• Leg length inequality
• Dislocation