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.
I recently had anterior hip replacement surgery by an HSS trained surgeon. Great out come, minimal post op pain, only a 4″ incision, I was walking without a cane in a week and over all quick recovery. Now, 8 months later, I don’t even think about my hip replacement. If you are a candidate, anterior is best approach.
Congratulations on a great road to recovery, Sam! We’d love for you to share your experiences at Hospital for Special Surgery (HSS) on Back in the Game: https://www.hss.edu/backinthegame.
Can this procedure be an option for hip replacement due to synovial osteochronomatosis? I had arthroscopy ten years ago to remove numerous loose bodies. hip replacement has been recommended. I am female, 55 years, have arthritis, and need knee surgery as well, unfortunately same side.
Hi Terri, thank you for reaching out. Dr. Michael Alexiades, Orthopedic Surgeon, says: “Yes, this procedure can be an option for hip replacement due to synovial osteochronomatosis. If pain persists, you should seek a consultation with an orthopedic surgeon.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.
What is the length of time under X-ray for this procedure?
Hi Patricia, thank you for reaching out. Dr. Michael Alexiades, Orthopedic Surgeon, says: “For the anterior hip method, x-ray time lasts about 10 seconds.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.
Does Dr. Alexiades use blood thinners to prevent a blood clot?
Hi Carolyn, thank you for reaching out! Dr. Michael Alexiades, Orthopedic Surgeon, says: “Yes, typically I advise patients to take aspirin if they are at a low risk and Coumadin if they are at a high risk. Before taking any measure, I advise all patients to consult with their physician first.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.
my hip was replaced 18 years ago i have been in pain in my lower back on the same side since the surgery. the pain starts when i stand or walk or put weight on the leg.i have been told that the rod was coming loose and i would need surgery again.would you be able to help me? i also had the other side 17 years ago that one is fine. i have been to many drs. but none have been able to help me thank you
Hi Rona, thank you for reaching out. Please email us at socialmediacontact@hss.edu so we can further assist you.
Is a general anesthetic used or spinal. Also I was told if you have any sort of belly/belly fat or are short the surgeon could not access the hip from the front. Is this true?
Hi Diane, thank you for reaching out. Dr. Michael Alexiades, Orthopedic Surgeon, says: “Usually, we use a spinal anesthetic. It is rare that it cannot be done for the conditions that you have listed, but it can prove to be more challenging for some surgeons.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.
Dr Alexiades was my Doc. #1
Hi Mary, thank you for your kind note! We will share with Dr. Alexiades.