Anterior Hip Replacement

Minimally Invasive Anterior Approach for Hip Replacement Surgery

Anterior hip replacement surgery is part of the recent trend to use smaller, less-invasive surgical approaches. The idea of this method of surgery is to perform the same procedure with less disruption to the surrounding muscles and soft-tissues. By performing surgery through smaller incisions, with less soft-tissue dissection, it is hoped that patients will have less pain and a faster recovery.

hip replacement
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Understanding Anterior Hip Replacement

Anterior hip replacement is not a new surgery. Many surgeons have performed hip replacements through an anterior incision for decades. In fact, the most widely referenced report of this technique was published in 1980. What is new about anterior hip replacement is that the surgery is being done through smaller incisions with more specialized instrumentation to help make this surgery less traumatic to the patient.

The hip joint is deep within the body at the junction of the pelvis and the top of the thigh bone. All hip replacements, regardless of incision type, require your surgeon to replace the top of the thigh bone and the socket of the pelvis. There are a number of ways for your surgeon to perform this task, as your surgeon can approach your hip from the back of the joint (posterior approach), the side of the joint (lateral or anterolateral approach), the front of the joint (anterior approach), or through a combination of approaches (two-incision approach).

It is important to understand that all of these approaches accomplish the same goal of replacing the ball and socket of the hip joint. Some specific implants may be better suited to insertion through a particular approach versus another, but in general, any implant can theoretically be used through any approach. Some of the more less invasive approaches are less conducive to using larger implants which are sometimes necessary when a more complex reconstruction is being performed, but most typical hip replacements can be inserted through a number of different surgical incisions.

Unique Aspects of Anterior Approach Hip Replacement

The anterior approach hip replacement is a muscle-splitting approach, meaning that the surgeon gets to the hip between two muscles, rather than by removing and then reattaching a muscle. The advantage is thought to be that rehabilitation can proceed more quickly by not having to allow the reattached muscle to heal.

As with other minimally invasive approaches, the incision size is kept as short as possible in an effort to help limit post-operative discomfort. Anterior hip replacements are thought by some surgeons to have a lower rate of dislocation, although with newer implants other surgeons feel that this is no longer a distinct advantage of the anterior approach hip replacement.

Most complications associated with anterior approach hip replacement are similar to standard hip replacement complications. One specific complication is an injury to a large skin nerve just adjacent to the incision of the anterior approach hip replacement. Injury to this nerve, the lateral femoral cutaneous nerve, during surgery can lead to chronic pain and abnormal sensations along the front and side of the thigh.

Is Anterior Hip Replacement Better?

As with many changes in joint replacement surgery, it is simply not known if anterior hip replacement is an improvement over other approaches for a hip replacement surgery. There are advantages and disadvantages of the different approaches for hip replacement surgery. While some argue that rehab may be faster or pain may be less, there is conflicting data to support this argument. Some studies have found no difference in recovery when an anterior approach hip replacement is compared to other techniques.

The desire to minimize pain and speed recovery is understandable. However, the most important aspect of hip replacement surgery is to give you a joint that is pain-free and will last you a long time. These goals cannot be compromised when changes are made to hip replacement techniques.

While anterior approach hip replacements may provide some benefits when compared to other types of hip replacements, it is not known if this truly represents an improvement in hip replacement surgery. You can discuss these issues with your doctor when you are ready to consider hip replacement.

A Word From Verywell

Advances and joint replacement surgery are exciting, and everyone wants the most successful outcome possible. While anterior hip replacement has some possible advantages, it is unlikely that the surgical approach is the most critical factor in determining the long-term success of a hip replacement surgery. Anterior hip replacement may provide some benefits in terms of speeding the early recovery timeline, although even this is a subjective debate. Certainly anyone considering anterior hip replacement should find a surgeon who performs this procedure regularly as this is a technique that like many other surgical techniques requires experience in order to be done consistently well.

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