Anterior Approach Total Hip Replacement
A Minimally Invasive Solution: Anterior Approach
Over 80% of our hip replacements are performed using the advanced minimally invasive anterior approach. An anterior hip replacement is muscle-sparing allowing for a potentially faster recovery rate and enhanced patient outcome after surgery
What is an “anterior” hip replacement?
“Anterior” refers to the surgeon’s approach to the hip (which side we will enter the hip joint).
There are 4 approaches to perform a hip replacement:
- Posterior (from the back of the hip)
- Lateral (from the side of the hip)
- Anterolateral (half way between the lateral and anterior)conventional hip replacement
- Anterior (from the front of the hip)
All approaches have been shown to allow excellent access to the hip joint to successfully implant the devices necessary for hip replacement. The majority of our hip replacements are performed through an Anterior Approach.
Anterior Hip Replacement Advantages:
- Less invasive and muscle sparing
- Decreased dislocation potential
- Live x-ray ensures accurate sizing and placement of components
Less Invasive and Muscle Sparing
The anterior approach is a single small incision, muscle sparing total hip replacement approach. Even the “mini-posterior” approach requires some splitting of the gluteus maximus muscle. With the anterior approach, your surgeon can work between your muscles and tissues without detaching them from the hip or thigh bones.
Decreased Dislocation Potential
Generally an anterior approach is inherently more stable than a posterior approach. A recent study in the Journal of Bone and Joint Surgery reported that the most common reason for revision (redo) of a hip replacement is for dislocation (where the ball pops out of the socket requiring a physician to put it back in place). In general, dislocations are almost always in a posterior direction. A posterior approach requires entering and cutting through the posterior lining of the hip potentially weakening this region and allowing for the hip to dislocate. Although experienced hip surgeons may have a very low dislocation rate with a posterior approach, an anterior approach avoids violating the posterior structures altogether. This potentially allows for a lower dislocation risk. In fact, our patients are not given any “hip precautions” (restrictions of certain positions) following an anterior approach allowing for more straightforward and potentially faster recovery.
Live Xray (Flouroscopy)
The anterior technique also calls for use of a live mobile x-ray (fluoroscope) during the procedure. This device enables your surgeon to not only visualize the components by direct vision, but also visualize the hip replacement with an x-ray to ensure that appropriate sizing and position of all components has been achieved.
The fluoroscope also allows your surgeon to compare one hip to another with increased ability to measure for correct limb lengths. One of the most common problems we encounter in hip replacement is limb length inequality. Although not foolproof, an intraoperative live xray comparison before the surgery is completed enhances the accuracy of this measurement.
Can both hips be done at once?
Yes. If it is determined that both hips would benefit from total hip replacement surgery, both can be done in the same setting. Patients may weight bear as tolerated immediately after the procedure on both legs. This is called Bilateral Total Hip Replacement.
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