Why Choose Anterior Hip Replacement Surgery? | El Camino Hospital


>>The anterior approach to hip replacement is really
the most sophisticated way to perform a total
hip replacement. The hip joint is a ball and
socket joint it’s normally in its un-diseased state covered
with smooth, articular cartilage and that allows the femur to
move in relationship to the hip. As you develop arthritis a
simplified way of looking at it is that the cartilage
wears off and becomes rough and you end up often with
two bones from the hip and the acetabulum grinding
together and this causes pain and stiffness and often a limp. Technology has allowed
significant improvements in the prosthesis over the
years and more recently with the anterior approach we’ve
improved the surgical technique which allows your hip to be
stronger, decreases your chance of a limp and dislocation. So with the anterior approach we
go through a true intramuscular, internervous interval, that means we don’t
disrupt the nerves which make the muscles work and
we also don’t damage the muscles so by going through this
plane it’s the one way to disrupt the anatomy the
least while doing a total hip replacement. With the posterior approach
we usually split the gluteus maximus, a large
muscle in your buttock and that can partially
denervate the gluteus maximus which would leave it
weaker after surgery which could contribute
to a limp. With the lateral approach you
also split the gluteus medius muscle and potentially
could injure the superior gluteal nerve. With the anterior approach after surgery all your
muscles have the potential to work the way they did before
surgery and this allows people to recover faster and actually
have a better functional result with less chance of dislocation. The anterior approach to the
hip is not a new approach, it’s been done for years and
may have been actually one of the first approaches to the
hip but the anterior approach for total hip arthroplasties
have been done for decades in Europe in the 1990’s
Dr. Mata [phonetic] down in Los Angeles he had
one patient who had his done in Europe and wanted
another one done so he explored this approach and
found it to have many advantages over the posterior approach. At El Camino Hospital we
started doing this approach about seven years ago and over
that period of time have done over 800 anterior
approaches to the hip which probably makes us the
leader in anterior approaches to the hip in California. The main difference is that
the dislocation rate is at least ten times lower. If you look at the
dislocation rate when you perform the
procedure through the back, through a posterior
approach it’s approximately 3 to 5 percent nationally and
if you do it through the front through an anterior approach it
runs between 0.3 to 0.8 percent so it’s about ten times lower. Once we get into the
joint and start putting in our components we
also have the advantage because the patient is laying
on its back as opposed to being on its side we can use
x-rays during the case, actually fluoroscopy, this
helps us with positioning of the components as
well as making sure that our leg lengths are equal,
we will actually break scrub at the end of the case and
measure the leg lengths just to ensure that the
leg lengths are equal. By doing the anterior
approach, we don’t have to do any precautions
after surgery, if you do a posterior approach
for three months you have to be very careful not
to sit in low chairs or on low toilet seats, not
to bend over past 90 degrees at the hip and not
to cross your legs. When we do an anterior approach
there are no hip precautions from day one. So the return to normal
activities is very different from person to person, some
people are able to return to work within two to three
weeks but it depends on the type of job that they do, if they
have a very physical job or a job where they have to
stand for a long period of time that can take up to
six to eight weeks. If they’re performing a desk
type job they can return usually within two and a
half to three weeks. As far as recreational
activities most of the golfers or tennis players can return
within six to eight weeks but there’s variation
from person to person. When patient’s come into my
office they often ask why do we do this and one of the main
things that I tell them is that I’ve had over 40 patients where I’ve performed a
posterior approach on one hip and then they came
back years later to have their second hip
done on the opposite side and we perform the procedure
through an anterior approach, those people all came back to
tell us that this was anywhere from four to five
times easier to recover from so it was a major force
and influence in determining that this was the right
thing to do for our patients.

4 thoughts on “Why Choose Anterior Hip Replacement Surgery? | El Camino Hospital

  1. My neighbor had anterior on one and then couple of years later, ended up with a new doctor who did the posterior approach, and she said the posterior was way harder to recover from and wished the new doctor she went to had done anterior. She recovered very quickly from the anterior approach, and has had no issues with the first hip replacement.

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