Total hip arthroplasty was first popularized in the 1960s by John Charnley, MD. What was then breakthrough technology has now become one of the most frequently performed and most successful reconstructive procedures in orthopedic surgery. By 2030, it is estimated that 571,000 total hip arthroplasties (THA) will be performed each year in the U.S. In the past, THA was reserved for people 60 and older. Younger patients are receiving benefits from THA thanks to:
- Newer technologies
- Implant designs
- Surgical procedures
However, with younger patients comes an increased demand for higher functioning implants and quicker recovery.
Patients desire surgical approaches that injure less tissue and preserve function with quicker recovery. In spite of the successful history with total hip replacement surgery, complications do occur, such as:
- Leg-length discrepancy
- Residual muscle weakness
Dislocation of the THA remains the leading early complication in 0.4 to 11 percent of patients. Of those patients, about 25 percent require further surgery to correct the dislocation problem. Surgical approaches and implant position are the main recognized factors influencing total hip stability.
The most popular approach to the hip is the posterolateral approach, versus the anterolateral approach. This approach requires dividing the hip capsule on the back of the hip and cutting the external rotator muscles to have access to the hip joint. This approach has the highest dislocation rate. The anterolateral approach involves getting to the hip through the side. Though this approach reduces dislocation rates, it can leave the repaired muscle weaker and can cause a limp in as high as 20 percent of patients.
Is there a surgical approach that will reduce dislocation rates, promote faster healing, and preserve tissue and strength? Thankfully, the answer is yes – the anterior approach.
The anterior approach has been refined through the years to allow exposure of the hip through a single anterior (front) incision that does not require release of any muscles or tendons from the pelvis or femur. The back or posterior structures of the hip are left intact, decreasing the instability and dislocations associated with the release of these structures, which was required for the traditional posterior approach. The surgeon can simply work through the natural interval between muscles. The important muscles for hip function on the back of the hip are left undisturbed and, therefore, do not require healing. Muscle strength is preserved and postoperative limp is diminished as a result.
Conventional posterolateral or posterior approaches for hip replacement typically require strict precautions for the patient. They must limit hip flexion and extreme motions for six to eight weeks after surgery, making everyday activities difficult, such as:
- Sitting in a chair
- Putting on shoes
- Getting into a car
- Climbing stairs
The anterior approach allows patients to bend their hip freely immediately and bear full weight when comfortable, resulting in a more rapid return to normal function. They do not have cumbersome restrictions and are encouraged to use their hip normally. They do not have to wear a brace or sleep with a pillow between their legs. They can bend and sit in normal chairs. As a result, the patient experiences less anxiety about “dos and don’ts.”
Though not all physicians offer the anterior approach because additional education and surgical training are required, Tri-State Orthopaedics offers this exciting advancement in hip replacement surgery. Contact us to learn more about this advancement in total hip arthroplasty.