As a university surgeon, I am often asked what the latest advances in arthritis surgery are. With the advent of minimally invasive techniques in orthopedic surgery, there is a renewed interest in anterior hip replacement with the front of the hip instead of the more traditional backside or posterior approach.
The reason for replacing the front hip is to try to minimize muscle damage by moving the muscles away from the front of the hip, rather than relaxing and adjusting the muscles to access the hip join from behind in summary, there is no ideal way to provide hip joint implants. Therefore, we will all perform this procedure only for hip replacement surgery. After receiving this information, here are my frequently asked questions in my office:
Is anterior hip replacement a new technique?
Smith-Petersen first described the anterior approach to the hip in 1917. French surgeon Robert Judet used it in 1947 to perform a separate replacement of the femoral head. Subsequently, other French surgeons became those who, after previous exposure in 1960, underwent hip arthroplasty.
If this technology has been around since the 1960s, why are you interested in it now?
Early surgeons found that the acetabulum at the front of the hip was excellent. However, it is very difficult to insert a long straight metal rod into the femur anteriorly. If complications occur during surgery, it is very difficult to change or expand the previous approach to overcome difficult operations and provide better visualization.
Therefore, most surgeons choose a hip replacement for posterior or posterior and lateral exposure. Aftercare has become the standard of care. In special instruments, the new generation of hip replacement, a custom operating table, and a real-time intraoperative X-ray machine, the old hip replacement is again presented. These additions make the above approach easier and more reliable than ever.
What are the drawbacks to anterior hip replacement?
To perform a complete front hip replacement, you must stand on a special operating table and adjust your legs directly on the table. When manipulating the table, the leg is positioned to insert the hip. Since the force exerted on the leg is difficult to assess, bone fractures occur on the operating table. The implants are placed in real time using an X-ray machine. If this machine is moved, the implants can rest, which can lead to increased wear or dislocation and a painful joint.
Is it true that the hips made with an anterior approach are immobile?
No. All hip replacements are transferable. Historically, the incidence of dislocations was less an anterior approach than a posterior approach. However, with a new generation of hip replacement, the use of larger femoral head implants has reduced the frequency of hip dislocations in all techniques.
What hip approach do you recommend?
I recommend finding a surgeon with experience in anterior, posterior, and anterolateral hip replacement. Since each hip exposure has specific advantages and disadvantages, the surgeon’s job is to meet the needs of each patient for a specific procedure. Patients and surgeons want to reduce pain and speed recovery. However, the main goal of hip replacement is to allow patients to perform surgery with the correct location of the substance and to expect it to last for the next 20-30 years.
Anterior Hip Replacement – What is it all about?
Anterior hip replacement is fast becoming the preferred method of hip surgery, preferring the traditional approach and providing a faster recovery with less pain. If you have been told that you need a hip replacement or that you have chronic hip pain, you may be the ideal candidate for this procedure.
What is the difference between approaches?
In the traditional approach, a large 7 to 8-inch incision is made in the posterior (posterior) or lateral (lateral) part of the hip. In both techniques, the buttocks (glutes) must be cut. Most of the pain after hip surgery is due to the loosening, repair, and healing of damaged muscles. For the anterior approach, a smaller 3-inch incision was made in the front of the hip. There is no need to change muscles. Instead, surgeons work through the natural opening between the muscles: recovery is quicker, and there is less pain than conventional procedures.
Who is the right candidate for the above strategy?
Almost all people eligible for anterior hip replacement are suitable candidates for anterior hip repair. The most common candidates are people over 50 with chronic hip pain from osteoarthritis or rheumatoid arthritis, with cartilage between the head of the femur (ball) and acetabulum (the concave surface of the pelvis) or the cavity if it causes pain in the bones.
With the advancement of prosthetic materials, the length of artificial joints has increased significantly, making the operation attractive to people in their forties.
Poor patients with relevant hip arthroplasty or severe hip dysplasia or excessive enlargement of the hip (heterotopic bone formation) may not be good candidates for the superior approach.
What are the advantages of the previous strategy?
The above approach has many advantages, including:
- Minimal engraving
- Less pain and scarring
- Reduced risk of hip replacement after surgery because the muscles that support the hip are not affected.
- More precise positioning of the implanted components, leading to a longer prostate.
- Reduces the length of the legs
- Less attention to the hip after surgery: patients can resume activities such as walking and bending the hips almost immediately.
- Shorter hospital stays and faster healing: patients are usually home the next day, and recovery takes around 2 to 8 weeks, instead of 2 to 4 months for the traditional approach.
What makes the procedure described above possible? The above approach is probably mainly due to the use of a specially designed table that allows specific positioning during operation. The Hana table allows rotation and hyperextension of the leg and hip so that the surgeon can adjust the prostate with greater precision and precision. The table is made of carbon fiber so that the surgeon can see scanned images of the surgical site during surgery, allowing for greater precision in leg length. The combination of the special table and the imaging system allows access to the front.