In this week’s installment of Ask the Expert, Dr. Michael Alexiades, Orthopedic Surgeon, discusses the anterior approach to hip replacement surgery.
Anterior hip replacement surgery, where the surgeon accesses the hip from the front, is an alternative to other hip replacement surgery. The anterior procedure is sometimes called a mini hip replacement or mini anterior hip replacement because it uses an incision in front of the hip that can be as small as 3-4 inches rather than the traditional 8-12 inch incision used in traditional approaches. It’s also known as a muscle or tissue-sparing hip replacement because it doesn’t require detaching or cutting muscles or tendons.
The location in which the hip joint is accessed is what makes the anterior approach unique; as with other hip replacements, worn hip components are replaced with a metal socket lined by a metal, plastic, or ceramic insert, and a metal thighbone prosthesis connected to a metal or ceramic ball that rotates within that socket. You will be encouraged to bear weight on your hip almost immediately after surgery. There are few dislocations after anterior hip replacements, so unlike other procedures that usually require movement restrictions to prevent accidentally dislocating the hip while healing, you will be able to bend at the hip, cross your legs, and sleep without a pillow between your knees.
Most patients return home within two days of the procedure, but some leave the day after or even the same day as the procedure. Drain tubes, which I personally do not use, will be removed the day after surgery and the external stables or sutures are usually removed in 10 days to two weeks. My preference is for a plastic surgical closure with dissolving sutures that allows for showering within a few days after surgery. Your scar will fade considerably over time.
Because muscles are not cut or detached, there is often minimal pain during recovery and patients generally don’t need extensive physical therapy. Most patients use crutches for a day or two then a cane for about a week and are able to walk unaided and return to light physical activity in about two weeks. Your surgeon will recommend when you can return to specific sporting activities and driving.
The anterior approach can be used in most patients needing hip replacement. Exceptions are patients with extensive metal hardware due to prior surgery that may require removal and certain hip deformities. The anterior hip replacement procedure minimizes the impacts of recovery, provides complete or nearly complete pain relief for a wide variety of patients, and has a high degree of patient satisfaction.
Dr. Michael Alexiades, Orthopedic Surgeon, concentrates on orthopedic surgery of the hip, knee, shoulder, and elbow, including arthroscopic surgery for each of these joints, joint-sparing surgery and joint replacement. He is an early adopter of the Mini Anterior technique in hip replacement surgery and has been active in the development of hip and knee implant design and instrumentation, including the Biomet Vision Hip system and Biomet knee systems.