Top Ten Questions about Anterior Hip Replacement

1. What is Anterior Approach Hip Replacement?

Total Hip Replacement Surgery can be successfully performed using a variety of techniques. Historically, the posterior approach (from the back) has been the most common method for hip replacement. Anterior Approach Hip replacement simply refers to performing the surgery 'from the front'.

This technique is also referred to a 'Direct Anterior Hip Replacement' and 'Anterior Supine Intermuscular (ASI) Hip Replacement.

2. What are the advantages of this technique?

With an Anterior Approach, the surgery can be performed without cutting any muscles. This allows for a more rapid, less painful recovery. The surgery is performed with the patient lying flat (supine) which allows for the use of fluoroscopy (live x-ray). The use of fluoroscopy throughout the procedure allows for more precise placement of the implants. Patients appreciate that with an Anterior Approach, we do not require routine hip precautions.

2. What are Hip Precautions?

Hip precautions are essentially a set of positions, which patients need to avoid in order to minimize the chance of a hip dislocation (hip popping out of joint). With traditional posterior approach hip replacement, most surgeons recommend hip precautions for 3 months after surgery. This includes sleeping with a special pillow between the legs and use of an elevated toilet seat. Patients also need to avoid crossing their legs, deep flexion of the hip, and internal rotation (pointing toes inward).

With Anterior Approach hip replacement, the surgery is performed without violating any of the hip's posterior structures. There is a low risk of dislocation and hip precautions are not required.

3. What are the restrictions following Surgery?

Patients can generally return to all activities, as they feel comfortable. The one activity to avoid is running. The repetitive impact of running could prematurely wear out the implant or cause them to loosen from the bone. Patients often comfortably return to walking, hiking, bicycling, swimming, tennis (doubles), yoga, and even snow skiing (groomed slopes). With their hip pain relieved, many patients return to activities they have not been able to experience for years.

4. Why don't all doctors do hip replacement this way?

Total Hip Replacement can be successfully performed through a variety of surgical approaches. Most surgeons are familiar and comfortable with either the posterior or direct lateral approach to hip replacement. These approaches have been very successful and absolutely can offer excellent outcomes for patients.

Anterior Approach can be technically challenging to learn to do well. There is a learning curve, and special training is helpful. Realizing the benefits of Anterior Approach, more and more surgeons are learning this technique.

5. Do you need a special table for this surgery?

There are a variety of tables designed to assist surgeons with Anterior Approach hip replacement. One of the more commonly marketed tables is the HANA table. These tables are surgical aids, and not necessary for a successful Anterior Approach.

Dr. Burke travelled to Belgium in 2005 to learn Anterior Approach on a standard operating room table. This is the technique he has been using since that time, and now regularly teaches to other orthopaedic surgeons interested in learning Anterior Approach Hip Replacement.

6. What are the complications with this surgery?

The risks of Anterior Approach hip replacement are generally the same as traditional hip replacement. Anesthesia, medical issues, infection, fracture, injury to nerves or blood vessels, and leg length inequality are some risks. Dislocation rate is low, but not zero with this technique. It is common for patients to have a small area of numbness over the thigh after Anterior Approach hip replacement. The numbness usually resolves within a couple of months. Occasionally, the numbness persists, but is generally not troublesome. 

7. How long is the recovery?

Recovery from surgery is quite variable. Many factors are involved including a patient's level of pre-operative function. Most patients are ready for discharge to home on post-operative day 1 or 2. Most patients utilize a walker initially after surgery, and many are already on a cane within 1 or 2 days.

Return to activity is permitted, as patients feel comfortable. Strenuous activity should be avoided for at least 4 weeks.  

8. How long does it take to perform the surgery?

The length of time for surgery averages about one hour, although may be longer or shorter depending upon an individual patient's anatomy.

Most patients are in the operating room close to 2 hours, with the extra time being necessary for anesthesia, positioning, and preparation.

9. How long will the implants last?

The durability of hip replacement components has improved greatly. With an Anterior Approach, we can use standard implants with proven track records. The greatest improvement has been in the quality of the materials. Today's generation of implants have not been utilized long enough to really know when they will wear out. We have the technology today to replace implants when they fail and this technology continues to improve.

10.  Are all Hip Replacement patients candidates for an Anterior Approach?

The majority of patients will be candidates for Anterior Approach Hip Replacement.  There are individual circumstances, for example unusual anatomy, which may make a patient better suited for a posterior or direct lateral approach.  Patients that have had prior hip surgery are also most commonly performed with a more traditional approach.