Growing in popularity, the anterior approach is a modern technique for hip replacement surgery that is offered by surgeons at Center for Specialty Surgery. This involves an approach to the front of the hip joint as opposed to a lateral (side) approach to the hip or posterior (back) approach.
Rehabilitation is accelerated because the hip is replaced without detachment of muscle from the pelvis or femur. Other surgical approaches necessitate detachment of muscle from the femur during surgery. In the anterior approach, by contrast, the hip is approached and replaced through a natural interval between muscles. The most important muscles for hip function, the gluteal muscles that attach to the posterior and lateral pelvis and femur, are left undisturbed.
Lack of disturbance of the lateral and posterior soft tissues also accounts for immediate stability of the hip and a low risk of dislocation. It is normal for patients undergoing lateral or posterior incisions to follow strict precautions that limit hip motion for the first few months after surgery. Most importantly, they are instructed to limit hip flexion to no more than 90 degrees. These limitations complicate a patient’s simple daily activities such as sitting in a chair or on the toilet or getting in a car. Following the anterior approach, however, patients are immediately allowed to bend their hip freely and avoid these restrictions. They are instructed to use their hip. Additionally, if patients are sexually active before surgery, there are no limitations on resumption of normal sexual activity after surgery.
The normal incision is about 4 inches but may vary (shorter or longer) according to a patient’s body size. Though small incisions are often considered desirable by patients, it should be kept in mind that the degree and type of tissue disturbance beneath the skin is a more important factor. Incisions of adequate length allow the necessary side-to-side separation of the incision without undue force. Too small an incision can be more traumatic to the tissues, particularly to muscles that can be damaged by stretching too hard. With the anterior approach the patient lies supine (on their back) during surgery. X-rays taken during surgery with a fluoroscope ensure correct position, sizing and fit of the artificial hip components, as well as correct leg length.
The anterior approach does not limit the patient’s and surgeon’s options regarding type of hip prosthesis. Hip prostheses that are implanted with or without cement are applicable as well as all modern bearing surfaces including cross-linked polyethylene, metal and ceramic.
Possible complications of anterior hip replacement surgery include infection, injury to nerves or blood vessels, fractures, hip dislocation and the need for revision surgery.
A spinal anesthetic is preferred for this procedure, along with intravenous sedation. Patients are typically alert and ready to eat an hour or two after surgery. Evaluation and treatment by a physical therapist begins following surgery and leads to walking and functional activities. Patients may go home after achieving an initial degree of independence in walking with crutches or a walker, which is typically accomplished a few hours after surgery.
