Tag Archive: anterior hip replacement

Anterior versus Posterior Total Hip Replacement

The surgical approach to total hip replacement (THR) may impact the surgical outcome. Total hip replacement is a common surgery, with more than 300,000 procedures performed in the United States each year. Traditionally, most total hip replacements have been done using the Hip painposterior approach, in which the surgeon accesses the hip joint through the buttocks or side. More recently, surgeons are using the anterior approach, which involves entering the hip joint through the front thigh region.

According to researchers, both direct anterior and posterior surgical approaches for THR yield excellent results as reported by patients. The surgical approach is not the singular variable that makes a difference in a 6-month post-operative outcome. Patients considering total hip replacement should ask the orthopedic surgeon about which approach is best for them. A decision will be made based on the risks and benefits of the surgical approach for the individual patient.

Clinical Studies

In a recent clinical study, involving 275 patients who had a total hip replacement between 2012 and 2014, the average age of patients was 65 years. Using certain outcomes for evaluation, researchers compared the two groups regarding pre- and post-surgical pain, function in recreation, function in daily living, and hip-related quality of life. According to results, there were no significant differences between the two groups.

In another study, researchers compared radiographic, clinical, and surgical outcomes among patients undergoing total hip arthroplasty performed via the posterior versus anterior approach. After evaluating 17 studies and 2,300 patients, researchers found that there was a significant difference in favor of the anterior approach regarding dislocations and length of stay after surgery.

canstockphoto38482995Researchers have found that the extent of muscle damage is different for each surgical approach as well. In a randomized clinical trial, researchers compared the two procedures. The main end point was the ability to walk unlimited distances and climb stairs at 6 weeks, 3 months, 6 months, and one year post-operative. At the 6-week follow-up, the direct anterior group had more patients walking limitlessly and climbing stairs compared to the direct posterior group. The differences were not as significant later on in the recovery process. However, the direct anterior approach was found to provide earlier restoration of function after total hip arthroplasty.

Another group of researchers evaluated 88 procedures (41 anterior and 47 posterior approaches for THA). The length of stay after surgery was shorter for the anterior group than the posterior group. The duration of surgery was longer, however, for the anterior approach group. Both groups performed similarly on questionnaires regarding pain and clinical outcome measures at the 6-month follow-up.

Before your surgery, the orthopedic surgeon will complete an extensive evaluation including a past medical history, physical examination, hip x-rays, and certain blood and diagnostic tests to establish fitness for surgery. Careful consideration will be given to how much pain the patient has and how often pain limits bending, walking, and resting. In addition, the surgeon will evaluate what measures have helped alleviate hip symptoms in the past.

How the Procedures Vary

During both anterior and posterior THR procedures, the head of the femur must be removed and replaced with a metal stem, as well as a ceramic or metal ball. The damaged cartilage and bone are removed from the hip socket and replaced with a metal prosthesis. Finally, a plastic spacer is placed between the new socket and ball to allow for a smooth gliding motion.

With the posterior approach, the hospital stay is usually 2-8 days, depending on the patient’s health condition, the severity of hip damage, and the surgeon’s recommendations. The incision will be 10-12 inches long, running from the outer buttock. Some muscles around the hip joint are cut and repaired, and recovery is 2-4 months. People who have this procedure have to follow specific precautions for 6-12 weeks, which include no internal rotation (turning leg inward), no crossing the leg, and no bending past 90 degrees.

With the anterior approach, the hospital stay is shorter (2-4 days), and the surgical incision is along the front aspect of the hip. The incision is shorter with this procedure (4-5 inches), and recover time is only 2-8 weeks. There are no specific precautions with the anterior approach, which makes it a more desirable procedure. With both procedures, patients must use an assistive device (walker or cane) while moving about, and physical therapy is required to improve strength, range of motion, and mobility.

Orthopedic and Sports Performance Institute in Gilbert AZ offers top hip replacement with surgeons performing both anterior and posterior procedures. Most insurance is accepted, with some of the procedures offered as an outpatient or a one day stay. Call us now!

Resources

Barrett WP, Turner S, Leopold J (2013). Prospective randomized study of direct anterior vs posterolateral approach for total hip arthroplasty. J Arthroplasty, 28:1634–8.

Higgins BT, Barlow DR, Heagerty NE, & Lin TJ (2015). Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty, 30(3), 419-434.

Martin CT, Pugely A, Gao Y, et al. (2013). A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty, 28:849–54.

 

How does Surgical Approach to Hip Replacement affect Recovery?

Anterior hip replacement is an approach to surgery used to improved patient outcomes. Thousands of hip replacement surgeries are performed each year, but only 20% of surgeries in the United States are done using the anterior approach. The other 80% of surgeries are performed using the posterior or lateral approach.

Advantages of the Anterior Hip Replacement

Supporters of the anterior hip replacement approach believe it offers the following canstockphoto10503438advantages:

  • Less damage to major muscles – The orthopedic surgeon avoids cutting and manipulating major muscles during the anterior hip replacement. The surgeon works between the front muscles rather than severing muscle fibers or detaching muscle from bone.

 

  • Less post-operative pain – Because anterior approach does not require manipulation and cutting of muscles, the patient has less post-surgical pain and requires less medication.

 

  • Faster recovery – After surgery, the patient can bend at the hip and bear weight sooner. Most anterior hip replacement patients use walker or crutches soon after surgery. In a recent study researchers found that anterior hip patients walked unaided 6 days earlier than those who had the posterior surgery.

 

  • Decreased risk for dislocation – With the anterior surgery, the hip is not at risk for dislocation because soft tissue structures are not moved.

 

  • Improved range of motion – Patients can bend over, sit with legs crossed, and perform other movements without risking hip dislocation.

 

  • Shorter hospital stay – A patient who undergoes anterior surgery will not stay in the hospital as long as with the traditional approach.

 

Advantages of the Posterior-Lateral Hip Replacement

In a recent study comparing posterior and anterior approaches to hip replacement, researchers found that both groups had improvements in pain and range of motion, with no observable differences in gait or dislocation. Advantages to the posterior approach can include:

 

  • Less technically demanding – The posterior approach to hip replacement is easier to canstockphoto24182699perform. Anterior approach requires considerable training, skill, and experience by the orthopedic surgeon.

 

  • Simpler and easier – Many Gilbert orthopedic surgeons believe the posterior approach is the simplest and easiest, therefore providing the greatest safety margin for patients.

 

  • Minimal risk of femoral fracture or implant problems – Due to ease of this surgery, there is less risk to the patient for femoral fracture or poor positioning of the prosthetic component.

 

  • No special surgical equipment required – This procedure does not require the use of high-tech, specialized surgical equipment.

 

Disadvantages of the Anterior Hip Replacement

There are a few limitations associated with anterior hip replacement. These include:

  • Not suitable for obese or large patients – Muscular, overweight, or obese people are not good candidates for the anterior procedure.

 

  • More technically demanding – The Arizona orthopedic surgeon must be very experienced in performing the anterior hip replacement. This surgery is known to be quite technically demanding.

 

  • Potential for nerve damage – The lateral cutaneous femoral nerve runs down the front of the pelvis and past the hip to supply the thigh. There is more potential for damage to this nerve with the anterior approach.

 

  • Delayed wound healing – Some studies show that wound healing is delayed using the anterior approach, with 1.4% of patients having a wound complication compared to 0.2% with the posterior approach.

 

Disadvantages of the Posterior-Lateral Hip Replacement

  • Higher post-operative dislocation rates – Some studies show higher rates of dislocation with the posterior approach. However, with improved technology, these rates have declined.
  • Longer recovery – The posterior approach to hip replacement is associated with longer hospital stays and recovery. However, with full participation in physical therapy and rehabilitation, the recovery time has shortened.

OSPI offers state of the art approaches for hip replacement which minimize hospital stay and complications, while improving outcomes. Most insurance is accepted by the Gilbert and Mesa orthopedic surgeons, call today!

Resources

Kennon RE, Keggi JM, et al. (2013). Total hip arthroplasty through a minimally invasive anterior surgical approach. Journal of Bone and Joint Surgery, 85-A:39-48.

Petis S, Howard JL, Lanting BL, & Vasarhelyi EM (2015). Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg, 58(2), 128-139.

Post, ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, & Ong A (2014). Direct anterior approach for total hip arthroplasty: indications, technique, and results. Journal of the American Academy of Orthopaedic Surgeons, 22:595-603.

Taunton MJ, Mason JB, Odum SM, & Springer BD (2014). Direct Anterior Total Hip Arthroplasty Yields More Rapid Voluntary Cessation of All Walking Aids: A Prospective, Randomized Clinical Trial. J Arthroplasty. pii: S0883-5403(14)00340-4. doi: 10.1016/j.arth.2014.03.051.

 

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Anterior Hip Replacement Surgery FAQs

How is anterior hip replacement surgery performed?

Anterior hip replacement is a relatively new surgical method that, unlike the posterior or posterior lateral approach, the patient lies on their back and not on their side. Access to the hip is made through a four-inch incision to the outside area of and just below the groin. After the incision is made, the surgeon locates two muscles, which are pushed to the side in order to allow access to the area. The hip is then replaced, including the ball and socket and other components. Unlike other surgical procedures, no muscles are detached or split. Thus, before closing the canstockphoto13092914incision no repair has to be done to any muscles. Upon completion of the replacement the incision is closed.

How is anterior hip replacement different from traditional hip replacement surgery?

Generally speaking, it is a less involved procedure. There is no cutting or splitting of muscles, access to the area is easier, and fewer muscles are involved. Traditional surgery includes making an incision from the buttocks that curves around to the outside of the hip. Then the buttock muscles are split and four other muscles are detached. All of these muscles must be repaired after the hip is replaced. With anterior hip replacement surgery, no muscles are split or detached, and only two are pushed to the side during surgery.

What are the benefits of anterior hip replacement surgery?

Any successful hip replacement surgery will improve a patient’s quality of life by allowing them to be more mobile, physically active, and involved in activities associated with work and leisure. However, there are benefits that are related specifically to the anterior hip replacement method.

Because muscles from the back of the hip are not cut, there is minimal muscle trauma, which allows for faster healing and reduced pain. Plus, due to the fact that muscles are not detached, there is less risk after surgery of the patient suffering a hip dislocation.

Post-surgery discomfort is also reduced due to the location of the incision, which is below and in the outer region of the groin area for the anterior method. Traditional technique involves the buttock muscles, which, weeks after the surgery is complete, affects sitting and sleeping. Finally, there is more comfort in terms of equal leg length, as the anterior method makes it easier for the surgeon to obtain optimum balance between the legs.

What precautions must be taken after anterior hip replacement surgery and are they different than those taken after traditional hip replacement surgery?

Prior to and following posterior hip replacement surgery, there are numerous precautions that surgeons must discuss with their patients. They must be taken after surgery is performed, and are numerous. These precautions do not apply to those who undergo the anterior hip replacement procedure.

The reason for taking the following safety measures is to guard against dislocating the new hip, which is a common complication. Precautions include:

  • For the first four to six weeks after surgery, a pillow must be placed between the legs when sitting or lying down.
  • For the first four weeks, patients who are recovering must sleep on their back with a pillow between their legs
  • Hips or knees must not be bent beyond 90 degrees during this time.
  • Leg crossing, inward turning of toes, and tying of shoes are also prohibited.
  • Low chairs or couches should not be sat on.
  • To preserve to 90-degree rule, patients are encouraged to use an elevated toilet.

With anterior hip replacement, the risk of dislocation is virtually eliminated. Thus, as noted, there is no need to follow the precautions outlined above.

In what ways is rehabilitation different for anterior hip replacement surgery than it is for posterior?

First of all, due to the fact that the above addressed precautions have been eliminated, rehabilitation for anterior hip replacement is much different than that for the posterior process. Muscle trauma is greatly reduced with the anterior method, which makes for a rehabilitation timeline that is much faster.

A patient having undergone anterior hip replacement surgery finds it’s much easier to use a walker, and, two to three weeks after the operation, they can progress to using a cane. Within four to five weeks, a patient is usually walking without the aid of a cane, and they can resume normal activity very shortly after that.

With posterior hip replacement surgery a patient utilizes a walker for the initial four to six weeks and then a cane for three to four more weeks. They will often be walking independently after approximately 10 weeks. A patient may resume their normal activities in about 12 weeks.

How invasive is anterior hip replacement surgery?

Although anterior hip replacement surgery is less invasive than the posterior method, it is still considered to be a major operation and invasive surgery. This is due to the fact that anterior hip replacement surgery involves a patient being put under an anesthetic, and their being exposed to blood loss and the cutting of bone. Plus, the joint area is opened up. All of these factors involve a certain amount of risk.

ospi_smallDo all orthopedic surgeons perform anterior hip replacement surgery?

No, not all orthopedic surgeons use this technique. Most surgeons have been trained in posterior hip replacement, which is a very effective method. It is still the most common technique used. In order to perform anterior hip replacement surgery, a doctor will have to be exposed to other surgeons knowledgeable about and experienced in the procedure. This costs money and takes time. Plus, a hospital would have to invest in special equipment, including an operating table designed for the procedure.

Is anterior hip replacement surgery more expensive and does my insurance cover it?

Anterior hip replacement surgery is more expensive, however, it does not cost a patient any more money to have this type of surgery performed. All insurances cover both types of procedures.

OSPI is the top orthopedic practice in the East Valley. Chandler and Gilbert orthopedic surgeons at the practice offer anterior hip replacement surgery along with cutting edge procedures such as stem cell therapy procedures. Most insurance is accepted, call 480-899-4333 for more information and scheduling with top orthopedic surgeons Gilbert, Chandler and Mesa trusts.

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