Anterior Hip Replacement Surgery

Does hip pain keep you from wanting to get out of bed and slow you down throughout the day? You’re not alone … and the options for relief have never been better.

Millions of Americans are suffering from hip pain as a result of rheumatoid arthritis, osteonecrosis, or injury. According to a 2014 study, 2 of every 100 Americans have joint replacements. That number is likely much higher now as the procedures continue to rapidly increase in popularity.

HIP REPLACEMENT OVERVIEW

A total hip replacement surgery replaces the damaged bone and cartilage of the joint with a plastic material and metal or ceramic components. The main reasons a patient will decide to go through with surgery is to reduce pain, recover lost mobility from the painful and damaged hip cartilage, and improve their quality of life.

There are several methods of replacements, though. Not all of them are the same and each one has its own set of advantages. Use this guide to find the right fit for you.

Types of Hip Replacement Methods Include:

  • Anterior (through the front)
  • Posterior (through the back)
  • Anterolateral

 

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ANTERIOR APPROACH

The word “anterior” means front, so the Anterior Approach is a procedure where the surgeon accesses the hip joint from the front. Other surgical approaches access the hip joint from the back or side.

Some techniques claim to be “minimally invasive” but the Anterior Approach is the only technique which follows intermuscular and internervous planes to reduce the risk of injury to muscles, tendons, vessels, and nerves.(1) Other hip approaches involve cutting muscles to access the hip which can carry longer recovery times.
History of the Anterior Approach

The Anterior Approach was first described by Dr. Hueter in 1881. The first total hip performed through this approach was first performed in the 1940’s by Dr. Robert Judet. He was able to perform the surgeries successfully but the approach fell out of favor due to the difficulty in patient positioning aids available and the implants being large and straight. Today with the help of specialized table extensions, modified instrumentation and the success of smaller and more curved implants surgeons are able to perform this technique with much greater ease and success.

Advantages of the Anterior Approach

  • Less Pain: No muscles are cut which can cause less pain than other approaches.(2,3)
  • Shorter Rehabilitation: Usually patients are up walking the same day as their surgery and starting rehab based on your post-operative condition. (3,4)
  • Shorter Hospital Stay: Patients are usually sent home the same or next day.(5,6)
  • Smaller Skin Scar: The skin incision is usually smaller than what is necessary for other approaches.(3)
  • Faster Return to Daily Activities: Return to your normal daily activities in a shorter time frame.(5,7,8)
  • Less Blood Loss: Preservation of muscles and vessels potentially reduces blood loss.(3,6)
  • Reduced Risk of Dislocation: the risk of dislocation is reduced because the anterior approach is performed from the front of your body and dislocation is mainly related to posterior hip structure damage.(4,9,18)
  • Less Limping: Minimizing muscle and nerve damage reduces the chance of limping.(10,11,12,13)
  • Reduced Mortality Rate: Patients who need their hip joint replaced after breaking their hip (also known as a femoral neck fracture) have a reduced mortality rate with the Anterior Approach compared to the Posterior Approach.(17)

Disadvantage of the Anterior Approach

  • Not all surgeons can perform this surgery. It requires intense training to be able to perform the Anterior Approach and not all surgeons have been through the necessary training.
  • There is a potential for nerve damage and vascular injury.

 

Find Out If Anterior Approach Is Right For You

Schedule an appointment with one of our physicians to see if you are a candidate for the Anterior Approach today!

Call Now 419-721-6889

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POSTERIOR APPROACH

The word “posterior” means back or rear, so the Posterior Approach is a surgical procedure where the surgeon accesses the hip joint from the rear.

Many of today’s surgeons learned the Posterior Approach as the way to perform a Total Hip Replacement in their training. During their training, it was considered the gold standard because of the ease of performing the procedure and patient success. The Mini-Posterior Approach is similar but splits muscles and does not cut them like in the Posterior Approach.

History of the Posterior Approach

The Posterior Approach was popularized in the 1950’s by Moore because it provides adequate visualization of both the acetabulum and femur during both reconstruction procedures. The good visualization for the surgeon helps with using the larger and straighter instrumentation to accurately prepare the bones for the implants.

Advantages of the Posterior Approach

  • High visibility of the joint for the surgeon
  • Many surgeons can perform without struggle
  • Best for complex cases

Disadvantages of the Posterior Approach

  • Longer rehabilitation time than Anterior Approach(20,21,22)
  • More pain than Anterior Approach(23)
  • Higher readmission rates than Anterior Approach(23)
  • Mini-Posterior Approach has more soft tissue damage than Posterior Approach(19)
  • Studies show that there is no advantage of the Mini-Posterior over the traditional Posterior approach.(14,15)

 

Find Out If Posterior Approach Is Right For You

Schedule an appointment with one of our physicians to see if you are a candidate for the Posterior Approach today!

Call Now 419-721-6889

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Anterolateral Approach

The Anterolateral Approach is performed through a different route than the Posterior or Direct Anterior. It goes through the side of the hip while being a bit more Anterior than Posterior. This approach requires dealing with some of your important muscle structures differently than the other two approaches. The Watson Jones Anterolateral Approach requires dealing with the gluteus medius and minimus muscles and must be damaged or cut to gain exposure.

History of the Anterolateral Approach

The Anterolateral Approach was first described by Sir Watson Jones in 1936. The Rottinger minimally invasive modification was conceived by Henry Rottinger, M.D. in 2003 which uses a small incision.

Advantages of the Anterolateral Approach

  • Reduced risk of hip dislocation(16)
  • “Minimally invasive” compared to Posterior Approach

Disadvantages of the Anterolateral Approach

  • There is potential for nerve damage(25, 26)
  • In nearly 50% of patients, tendon defects and fatty atrophy of the gluteus minimus muscle was seen.(27)
  • Lower patient satisfaction than with Anterior Approach(28)
  • Worse gait analysis than with Anterior Approach(28)
  • Improved function and pain scores at six weeks and six-month post-op were also better in the Anterior Approach patients over the Anterolateral.(28,29)

 

Find Out If Anterolateral Approach Is Right For You

Schedule an appointment with one of our physicians to see if you are a candidate for the Anterolateral Approach today!

Call Now 419-721-6889

Conclusion

You no longer have to live with hip pain. Medical advances have made it possible to find a customized solution to improve your quality of life.

There are a number of solutions both surgical and non-surgical to treat hip pain. Depending on your condition, your doctor may suggest that you undergo a total hip replacement.

 

Find The Perfect Solution To Your Hip Pain Today

If your doctor recommends surgery, there are options for your surgery. Our surgeons specialize in the Anterior Approach which can get you back faster and with less pain to a better quality of life. Consult one of our surgeons to see which is the best fit for you.

Give our office a call to find out more information on the Anterior Approach Total Hip Arthroplasty. You can also meet with one of our surgeons to see if you are a candidate for this procedure. Enjoy a better quality of life and get your life back today!

Call Now 419-721-6889

References

  1. Single-Incision Direct Anterior Approach for Total Hip Arthroplasty Using a Standard Operating Table; TP Lowell; The Journal of Arthroplasty Vol. 23 No. 7 Suppl. 1 2008
  2. Arthroplastie totale de hanche par voie antérieure et son évolution mini-invasive; F. Laude et al.; EMC; 2004, 44-667-B
  3. Minimally Invasive total hip arthroplasty: anterior approach; F. Rachbauer; Orthopäde, 2006 Jul;35(7):723-4, 726-9
  4. Mini-incision anterior approach does not increase dislocation rate: a study of 1037 total hip Replacement; T Siguier et al; Clin Orthop Relat Res, 2004 Sep, (426): 164-73
  5. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table; JM Matta et al; Clin Orthop Relat Res, 2005 Dec, (441): 115-24
  6. Der anteriore Zugang für die minimal-invasive HTEP. C Dora; Leading Opinions Sept 2006, 1/2006
  7. Abductor Tendons and Muscles Assessed at MR Imaging after Total Hip Arthroplasty in Asymptomatic and Symptomatic Patients. C. Pfirmann et al., Radiology 2005, 235: 969-976.
  8. MR imaging of the abductor tendons and muscles after total hip replacement in asymptomatic and symptomatic patients. PD Dr. Dora, EFORT 2007
  9. What‘s new in hip arthroplasty; MH Huo et al; JBJS Am; 2005 Sep, 87(9):2133-46
  10. Rapid Rehabilitation and recovery with minimally invasive total hip arthroplasty; RA Berger et al; Clin Orthop Relat Res, 2004, (429): 239-247
  11. The minimally invasive anterior approach to hip arthroplasty; RE Kennon et al; Orthopäde, 2006 Jul, 35 (7): 731-7
  12. Dislocation after hip hemiarthroplasty: anterior versus posterior capsular approach.; JB Bush et al; Orthopedics. 2007 Feb;30(2):138-44
  13. Muscular damage after total hip arthroplasty: conventional versus minimally invasive anterior approach.; Dr Dora, Dr Kalberer; AOA 2008, Australia, Hobart
  14. A minimal-Incision technique in total hip arthroplasty does not improve early postoperative outcomes; L Ogonda et al; JBJS April 2005, (Vol 87A, n°4): 701-710
  15. Comparison of primary total hip replacements performed with a standard incision or a mini-incision; ST Woolson et al; JBJS Am 2004 Jul, 86-A(7):1353-8
  16. Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach; KC Bertin, H Roettinger; Clin Orthop Relat Res, 2004 Dec; (429): 248-55
  17. Outcomes after displaced fractures of the femoral neck. A meta analysis of one hundred and six published reports; GL Lu-Yao et al; JBJS Am 76 (1): 15-25, 1994
  18. Sariali E, Leonard P, Mamoudy P. Dislocation after total hip arthroplasty using Hueter anterior approach. J Arthroplasty. 2008 Feb;23(2):266-72.
  19. Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H. A clinical comparative study of the direct anterior with mini-posterior approach. J Arthroplasty;24(5):698-704,2009.
  20. Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013 Oct;28(9):1634-8.
  21. Martin CT, Pugely AJ, Gao Y, Clark CR. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. Arthroplasty. 2013 May;28(5):849-54.
  22. Zawadsky MW, Paulus MC, Murray PJ, Johansen MA. Early Outcome Comparison Between the Direct Anterior Approach and the Mini-Incision Posterior Approach for Primary Total Hip Arthroplasty: 150 Consecutive Cases. J Arthroplasty. 2013 Dec 1.
  23. Schweppe ML, Seyler TM, Plate JF, Swenson RD, Lang JE. Does surgical approach in total hip arthroplasty affect rehabilitation, discharge disposition, and readmission rate? Surg Technol Int. 2013 Sep;23:219-27.
  24. T Stähelin. Abductor repair failure and nerve damage during hip replacement via the transgluteal approach: Why less invasive methods of joint replacement are needed, and some approaches to solving the problems. Orthopade, 5(12):1215-24, 2006.
  25. Ince A, Kemper M, Waschke J, Hendrich C. Minimally invasive anterolateral approach to the hip. Risk to the superior gluteal nerve. Acta Orthopaedica 2007; 78 (1):86-89.
  26. Unis DM, Benitez C, Friedmann P. MRI Assessment of Tensor Fascia Lata after modified Anterolateral Total Hip Arthroplasthy.; AAOS 2010 Proceedings, 9th-13th March, New Orleans.
  27. Müller M, Tohtz S, Winkler T, Dewey M, Springer I, Perka C. MRI findings of gluteus minimus muscle damage in primary total hip arthroplasty and the influence on clinical outcome. Arch Orthop Trauma Surg. 2010 Jul;130(7):927-35.
  28. Clayson P. AMIS vs Röttinger approach. Podium presentation at the 6th M.O.R.E. International Symposium on total hip and knee replacement, Stresa, Italy, May 13-14, 2011.
  29. Renken F, Renken S, Paech A, Wenzl M, Unger A, Schulz AP. Early functional results after hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach. BMC Musculoskelet Disord. 2012 Aug 8;13:141