Anterior Hip Replacement is a minimally invasive, muscle sparing surgery using an alternative approach to traditional hip replacement surgery, commonly referred to as the Direct Anterior Approach (DAA). Traditionally, the surgeon makes the hip incision laterally, on the side of the hip, or posteriorly, at the back of the hip. Both approaches involve cutting through major muscles to access the hip joint. With the anterior approach, the incision is made in front of the hip enabling the surgeon to access the hip joint without cutting any muscles. It is referred to as a muscle sparing surgery because no muscles are cut to access the hip joint enabling a quicker return to normal activity. This procedure also allows easy use of fluoroscopy (live x-ray) to ensure the new hip is being implanted in an optimal position.
Dr. Cooper is not new to the anterior hip surgery. Since beginning practice, he has performed all of his primary and many of his revision hip replacements through the Direct Anterior Approach, and it is his preferred surgical approach whenever possible.
Potential benefits of anterior hip replacement compared to the traditional hip replacement surgery, may include the following:
Anterior Hip Replacement is performed in a hospital operating room under a spinal or general anesthetic, depending on your preference. You will be placed supine (on your back) on an operating table that enables Dr. Cooper to perform your hip replacement anteriorly. Fluoroscopic imaging is used during the surgery to ensure accuracy of component positioning and to minimize leg length inequality.
Dr. Cooper makes one incision to the front of the hip, typically 3-5 inches long depending on the size of your hip. He then pushes the muscles aside to access the hip joint to begin the replacement. At no time during the surgery are any muscle fibers cut.
The femur (thigh bone) is separated from the acetabulum (socket) by removing the diseased femoral head (ball). The acetabulum is prepared using a special instrument called a reamer. The acetabular component is then inserted into the socket. This is occasionally reinforced with screws or rarely cemented. A liner, which is made of a specialized plastic called highly cross-linked polyethylene is then placed inside the acetabular component.
The femur (thigh bone) is then prepared using special instruments to exactly fit the new metal femoral component. The femoral component is then inserted into the femur. This may be “press-fit” relying on bone to grow into it, or cemented depending on a number of factors such as bone quality and morphology. The new femoral head component is then placed on the femoral stem. This can be made of metal or more commonly ceramic. The artificial components are fixed in place.
Dr. Cooper then injects a special “cocktail” injection to minimize postoperative pain and closes the incision with special stitches designed to absorb beneath the skin. The incision is then covered with a small sterile waterproof dressing.
After surgery Dr. Cooper will give you guidelines to follow. It is important that you follow these instructions for a safe and successful outcome. Normally, after a traditional hip replacement, you would be given extensive instructions on hip precautions to prevent dislocating the new joint. Hip precautions are very restrictive and usually include the following:
For Anterior Hip Replacement patients, however, hip precautions are generally unnecessary. Because the muscles are not cut, the risk of dislocation is greatly lessened enabling much more freedom of movement after surgery. Additionally, initial rehabilitation is faster for patients due to less muscle trauma during the surgery.
Common post-operative guidelines after Anterior Hip Replacement include the following:
Risks and Complications
As with any major surgery there are potential risks involved. The majority of patients suffer no complications following Anterior Hip Replacement; however, complications can occur following Hip surgery and include: