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.
Dr. Keggi in the United States has been performing anterior Total Hip Arthroplasty for many years, and he has been very successful with his approach. One of my mentors, Dr. Joel Matta, learned this technique, the anterior approach to Total Hip Arthroplasty from Dr. LeTournel and Dr. Judet in France. He brought the procedure to Los Angeles over 8 years ago and he has performed over 800 total hips with this approach. His complication rate is very low and there has been only 3 dislocations. My first fellowship was with Dr. Lawrence Dorr, and with him, I learned how to perform a Minimally Invasive total hip replacement through a posterior approach with an incision that is less than 10 centimeters in length. However, the following year, I learned the anterior approach and I became a convert. Deep down in my heart, I believe that this is the best procedure for patients. All of the merits of this procedure benefit only one person most, the patient.
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.
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