Total hip replacements, also known as total hip arthroplasties (THA), are one of today’s most successful orthopedic procedures. Over 300,000 total hips are replaced annually in the U.S.
The most common approach to hip replacement has been the “posterior approach.” More recently, an “anterior approach” has become popular. Let’s look at the differences between the procedures, and pros and cons of the newer anterior approach.
During a posterior approach, a curved incision is made on the side of hip, just behind the greater trochanter. This approach requires surgeons to cut muscles and soft tissue at the back of the hip to access the hip joint. These muscles are repaired and reattached at the end of the surgery.
During the anterior approach, the incision is made at the front of the hip, with the incision starting at the pelvic bone and ending toward the top of the thigh. The surgeon works between the muscles with minimal or no muscle cutting. The surgeon has a limited view of the hip joint which makes this surgery more technically challenging. The anterior approach has been referred to as a “minimally invasive” approach. This is because there is less muscle cutting which for most patients speeds the recovery.
Advantages of the anterior approach:
• Less damage to major muscles;
• Less post-operative pain;
• Faster recovery – in general, anterior approach patients walk unaided sooner than posterior approach patients;
• Decreased risk of hip dislocation, since muscles and soft tissues surrounding the hip are kept intact;
• Better range of movement – patients can cross legs and bend over after surgery (posteriorapproach patients usually must wait 6-8 weeks);
• Shorter hospital stays, depending on the patient and access to on-site physical therapy.
Disadvantages of the anterior approach:
• Obese or very muscular patients may not be good candidates;
• Very technically demanding surgery; steep learning curve for surgeon; • Potential for nerve damage – surgical area is close to the lateral cutaneous femoral nerve which supplies sensation to the outer thigh; potential for numbness in the thigh;
• Wound-healing issues — surgical incision can become irritated especially in very overweight patients.
Success of a total hip replacement depends on many factors beyond surgical approach. The most crucial factor is the knowledge and skill of the surgeon. In addition, the type of hip prosthesis, the patient’s weight and build, and his or her willingness and ability to participate in post-surgical rehabilitation are all important considerations.
SUSAN LOCKE is Healthnetwork Foundation’s medical director.
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