Recent advances are enabling hip replacement to take place with much less disturbance of the muscle and soft tissues around the hip. Along with improvements in anaesthesia, and the implants and instruments used, this is leading to easier and more rapid recovery after hip replacement surgery.
The anterior approach to the hip is not new to orthopedic surgery. This approach has been performed for decades in orthopedics, but it has only recently been applied to hip replacement surgery in North America. This interest has occurred due to advancements in instruments and implants as well as the normal progression that occurs with surgery.
The anterior approach for hip replacement has been adopted by surgeons for a number of reasons. These reasons include:
- less chance of posterior dislocation due to decreased trauma to the capsule, ligaments and muscles at the back of the hip
- less pain after surgery due to decreased soft tissue disruption
- easier rehab after surgery
- improved precision of implant placement with the use of x-ray during the procedure
The anterior hip replacement procedure is usually performed with a spinal anaesthesia. Reasons for recommending a spinal anaesthetic include:
- relaxes the muscles about the hip
- reduce risk of blood clot
- reduced blood loss during surgery
- easier transition after surgery where patient remains more aware and in control
The procedure is usually performed with the patient lying flat on the operating table. A skin incision is made over the front/outside at the top of the thigh bone. The size of the incision is kept to a minimum, but made large enough to see what needs to be seen. Pain after surgery is less dependent on incision size, and more on the trauma to soft tissue structures under the skin.
After incising the skin, muscles are spread to gain access to the hip joint. No muscles are removed or detached, allowing faster recovery. The capsule is incised to expose the underlying bones of the hip. The bone is then prepared much the same as a traditional hip replacement. The implants are placed in the bone, using x-ray to decrease the variability in implant positioning. The soft tissues are closed and covered and patient brought to the recovery room.
After surgery, the patient is encouraged to walk and move. There are no restrictions on weight bearing or movement during the recovery time. Pain is the main dictator of activity. Patients are encouraged to place ice over the hip, and elevate the leg above the heart in a lying position to avoid swelling. Discharge home occurs once the patient can go the bathroom and do stairs. Usually the stay in hospital is 1 to 2 nights depending on other medical conditions.