Knees and Hips
Anterior Approach to Hip Replacement Surgery FAQ
What is the anterior (or frontal access) approach for hip replacement surgery?
In the anterior approach, an orthopaedic surgeon accesses the hip joint by entering through the front of the body and going between the hip muscles that help hold the hip joint in place. Smaller incisions are possible with this procedure versus traditional hip surgery.
The anterior approach to total hip replacement is becoming more popular because it is less invasive, hospital stays are shorter, and recovery and rehabilitation are quicker for patients. This less invasive surgery is especially appropriate for patients who are active and eager to return to work and their daily activities as quickly as possible.
Are the surgeries the same in both types of total hip replacement?
In traditional hip replacement surgery, an incision of 8 to 10 inches is made beside or behind the hip joint. The surgeon must go through muscle and detach the muscles from the “ball and socket” of the hip joint.
With the anterior approach, because the surgeon goes between the muscles, detachment is not required.
In total hip replacements, no matter the approach, both surgeries include the replacement of the joint’s cartilage and bone with implants. The ball (femoral head) is at the top of the long thigh bone called the femur. The ball fits inside the hip socket (acetabulum) which is on the side of the pelvic bone.
Cartilage and other tissues cover the surfaces of the bones, hold the joint together, and enable the ball and socket to work smoothly. With arthritis, the cartilage surfaces degenerate, leading to pain and decreased mobility.
Are the implants different?
Basically the implants are similar for hip replacement, regardless of the approach. In any total hip replacement, the surgeon smoothes out the hip socket and removes cartilage and any debris such as damage to the bone from osteoarthritis.
A cup-shaped implant is secured into the socket. The ball at the top of the leg bone is trimmed away and a metal stem is placed inside the leg bone and secured there.
A ball (metal or ceramic) is placed at the top of the stem and then a smooth, sturdy plastic, metal or ceramic piece is placed inside the cup-shaped implant. This creates a new hip joint that moves smoothly.
Why is this approach easier on the patient?
This approach is what you would call a less invasive surgery than a traditional total hip replacement. With smaller incisions and by going between the muscles rather than cutting them, the surgery is less painful. In addition, the minimal disturbance of the muscle also allows for a quicker recovery and rehabilitation.
One other benefit of leaving the muscles intact is that the joint has more stability. This reduces the chance of hip dislocation, one of the risks of hip replacement surgery. Most total hip replacement patients whose surgeries were done with an anterior approach are able to bear full weight soon after this surgery which means they can move forward faster on their return to activities.
Are all total hip replacements being done this way?
Although the first anterior approach to hip replacement surgery was done more than 50 years ago, its popularity with surgeons and patients is relatively recent as training, techniques, and equipment have improved and facilitated performing total hip replacement through this approach.
Are all patients eligible for the anterior approach to hip replacement surgery?
Not all hip replacement patients are eligible for this type of surgery. A surgeon familiar with this approach will be able to assess a patient’s suitability for this surgery. The type of hip replacement will depend on the patient’s history, a thorough examination of the patient, and studies such as X-rays or magnetic resonance imagings (MRIs). With any type of joint replacement surgery, patients need to find a surgeon with experience who can help the patient make the best possible decision about surgery, treatment and rehabilitation.
Dr. Jason Lang is a specialist in the anterior approach to hip replacement surgery.