By Benjamin Frye, MD
Hip arthritis is a common cause of hip and leg pain. This pain can often be so severe that it may significantly limit a person’s function, mobility, and overall quality of life. Total hip replacement is a reliable solution to eliminate severe hip pain from arthritis. Hip replacement surgery involves removing the arthritic portions of the joint and replacing them with an artificial ball and socket prosthesis.
There are multiple surgical approaches for accessing the hip joint in order to perform hip replacement surgery. Each has its possible benefits that an orthopaedic surgeon at the Center for Joint Replacement can discuss with you.
Due to advances in surgical techniques, a procedure that has been receiving a lot of attention recently is the direct anterior approach for total hip replacement.
What is the direct anterior approach?
The direct anterior approach is a method for performing total hip replacement that involves an incision on the front of the hip, as opposed to the side. This allows the surgeon to access the hip joint by going in between muscles, instead of cutting, splitting, or detaching them from bone. This helps lessen damage to these muscles during surgery.
What are the benefits?
There are multiple advantages to the direct anterior approach. By avoiding muscle damage, the patient has the potential for less pain and more rapid recovery, compared to traditional methods. Patients are able to wean off of walkers and canes faster, and resume climbing stairs again sooner. They often feel better lying on their sides after surgery due to the incision being on the front of the hip.
Also, because the patient is positioned facing upward during the procedure, this allows the surgeon to use real-time x-ray while inserting the implants to help ensure accurate placement. Precise implant positioning decreases the risks of hip replacement issues, such as dislocation and premature failure. Dislocation risks are also reduced because important muscles and tissues in the back of the hip are not disturbed. Our surgeons can also use x-ray to ensure the patient’s leg lengths are equal after the surgery.
Are there any disadvantages?
The skin nerve that supplies sensation to touch on the outside of the hip can sometimes be stretched or damaged during direct anterior approach hip replacement surgery. This may lead to a patch of skin that feels numb. This numbness often decreases or resolves in many patients and has no impact on surgical recovery, function, or satisfaction.
How do I know if the direct anterior approach is right for me?
A WVU Medicine joint replacement surgeon will discuss with you whether or not you are a candidate for the direct anterior approach. This may depend on weight, bone quality, and any pre-existing conditions in the hip joint. Patients should seek out a WVU Medicine surgeon who performs the direct anterior approach because it is a technically demanding surgery and takes extra surgical training to master. Not all surgeons offer the direct anterior approach to their patients.
What is the recovery process like?
All patients undergoing this procedure are able to get out of bed and walk within hours after the surgery. The majority of patients are back at home within 24 hours. Patients use a walker for the first week, and most patients quickly move from a walker to a cane.
Many patients are walking well without any assistive devices within two weeks of surgery. Patients may gradually transition back to normal activities within a few weeks. Many patients will return to work within three and six weeks; however, heavy manual laborers may need up to three months. It’s very rewarding to see how quickly patients recover and get back to activities that they have long given up due to severe hip pain.
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