Hip Replacement - Total Hip Arthroplasty

Anterior Total Hip Arthroplasty

Total hip arthroplasty, also referred to as hip replacement, is one of the most successful procedures in medicine.  It has a predictable outcome which may give long lasting pain relief.  At the same time, the complication rate from the surgery is low.

Why anterior total hip arthroplasty?

Traditional surgery, which is performed through a posterior approach, means that in order to get into the hip, muscle and tendon are detached, split, and or cut from the bone.  Also, because these muscles and ligaments are removed from the backside of the hip joint, it destabilizes the joint, meaning that there is no support on the back of the joint until the tissue heals, which may be up to 6 or 8 weeks.  With traditional hip replacement surgery, after surgery, the patient must follow and adhere to specific restrictions.  We call them hip precautions.  The reason why the patient must follow these restrictions is to prevent the new hip replacement from popping out the back.  We call this dreaded event a hip dislocation.  The hip replacement precautions include the following restrictions:
1.  Cannot sleep on your side or stomach for first 6 weeks.
2.  Cannot cross your legs over.
3.  Cannot sit in low chairs.
4.  Cannot flex your hip more than 90 degrees.
5.  You must use an elevated commode adaptor.
6.  You must use specialized equipment, which are to assist you with putting socks and shoes on since you are not allowed to reach towards your feet.
With the anterior total hip arthroplasty, the surgery is performed through the front of the hip joint where there is a natural plane where surgeons can get into the hip joint without detaching, splitting, or cutting muscle.  The incision is usually 7 to 10 centimeters in length.  The whole surgery can be performed with one single incision and the use of a specialized operating room table called the ProFX.

After surgery, there are no restrictions or precautions to follow.  All you have to do is walk.  Most patients will be in the hospital for 3 days, but some people may be in from 2 days up to 5 days, depending on their muscle strength, level of activity, and motivational level going into the surgery.

With the posterior approach, the following muscles are split or detached from:  Iliotibial band, gluteus maximus, piriformis, superior and inferior gemellus, obturator internus, and quadratus femoris.  Sometimes the gluteus maximus tendon is also released from the femur.  Also, the posterior hip capsule, which is part of the ischiofemoral ligament, is cut out or split open.  The ischiofemoral ligament is the main ligamentous posterior restraint of the hip joint.  It affords stability to the back side (posterior) of the hip joint.

When muscles in the back of the hip are cut as well as tendons and ligaments, after surgery, the hip is weak and has less stability.  For these reasons, the patient has to to adhere to the hip precautions taught to them by the physical therapists.  Also, the recovery time is longer and the pain level is higher.  Patients are also at a higher risk of hip dislocation, meaning that the hip socket can pop out of place.


Benefits:
1.  No hip precautions to follow after surgery.
2.  Less pain after surgery.
3.  The surgery is performed with fluoroscopic image guidance, which helps to maximize component positioning, and further decrease the risk of dislocation and to maximize equality of leg lengths.
4.  Immediately after surgery, the patient can move their hip as they wish, they can flex as much as they want, they can reach towards their feet, they can sleep in any position they want, they can sit in a chair, on a regular toilet, they can put full weight on their leg.