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DIRECT ANTERIOR TOTAL HIP REPLACEMENT

What is Total Joint Replacement Surgery?

Total joint replacement surgery is one of the most advanced and successful procedures to treat severe hip and knee pain due to arthritis. Arthritis is a condition in which the articular cartilage that covers the joint surface is damaged or worn-out causing pain and inflammation.

The goal of the surgery is to relieve pain and restore the normal functioning of the joint and help you resume normal activities.

What is Direct Anterior Approach Hip Replacement Surgery?

Direct anterior total hip replacement is a minimally invasive and tissue-sparing hip surgery to replace the hip joint without cutting through any muscles or tendons. Traditional lateral or posterior total hip replacements involve cutting major muscles to access the hip joint.

Direct Anterior Total Hip Replacement Procedure

Direct anterior total hip replacement surgery is performed under general anesthesia or regional anesthesia. You will lie down on your back, on a special operating table that enables your surgeon to perform the surgery from the front of the hip. Your surgeon will use fluoroscopic x-ray imaging during the surgery to ensure the accuracy of component positioning and to minimize leg length inequality.

Your surgeon will make an incision, about 4 inches long, on the front of the hip. The muscles are pushed aside to gain access to the joint and perform the replacement. Next, the femur is separated from the acetabular socket. The acetabular surface is prepared using a special instrument called a reamer. The acetabular component is cemented or fixed with screws into the socket. Then a liner made up of plastic, metal, or ceramic is placed inside the acetabular component.

The femoral head that is worn out is cut off and the femur is prepared using special instruments so that the new metal component fits the bone properly. Then, the new femoral component is inserted into the femur either by press fit or by using special bone cement. The femoral head component made of ceramic or metal is then placed on the femoral stem.

Once the artificial components are fixed in place, the instruments are withdrawn, and the incision is closed with sutures and covered with a sterile dressing.

Risks and Complications of Direct Anterior Total Hip Replacement

All surgeries carry an element of risk, whether it is related to the anesthesia or the procedure itself. Risks and complications with direct anterior total hip replacement are rare, but can occur and may include:

  • Infection at the incision site or joint space
  • Fracture
  • Nerve damage
  • Hemarthrosis - excess bleeding into the joint after the surgery
  • Deep vein thrombosis (blood clot)
  • Leg length inequality

Post-operative Care for Direct Anterior Total Hip Replacement

After traditional posterior hip replacement surgery, you would be instructed to follow hip precautions to prevent your new hip from dislocating. These guidelines are very restrictive and include:

  • No bending or flexing of the hip past 90 degrees.
  • No crossing of legs.
  • Use a pillow between the legs when sleeping.
  • Use an elevated toilet seat.

However, after a direct anterior total hip replacement, you do not have to follow any hip precautions and have no postoperative activity restrictions. This is because the important tissues that help reduce the risk of dislocation are left intact during a direct anterior total hip replacement surgery but are cut during a traditional total hip replacement surgery. With the anterior approach, your doctor will give you specific instructions to be followed at home for a faster recovery. These include:

  • Take medications as prescribed to relieve pain and prevent infection.
  • Participate in physical therapy to restore hip function and strength.
  • Eat a healthy diet and do not smoke to facilitate healing and promote a faster recovery.
  • Contact your doctor if you observe increasing swelling or redness in the operated area.

Advantages of Direct Anterior Total Hip Replacement

The advantages of direct anterior total hip replacement include:

  • No postoperative hip precautions or activity restrictions
  • Lower risk of dislocation
  • Less postoperative pain
  • Quicker postoperative recovery
  • Smaller incisions
  • Minimal blood loss
  • Shorter hospital stay
  • Minimal soft-tissue trauma
  • Less scarring
  • Early mobilization
  • South bend Lions
  • University of Notre Dame
  • Saint Joseph Health System
  • Beacon Health System
  •  American Academy of Orthopaedic Surgeons
  • The American Osteopathic Academy of Orthopedics
  • American Association of Hip and Knee Surgeons
  • American Board of Medical Specialties
  • American Board of Medical Specialties
  • American Board of Foot and Ankle Surgery
  • American Orthopaedic Foot & Ankle Society
  • American Orthopaedic Society for Sports Medicine
  • North American Spine Society
  • American Society for Surgery of the Hand
  • American Academy of Physician Assistants
  • Zimmer Biomet
  • Stryker Corporation
  • Arthrex
  • Breg
  • Smith+Nephew
  • DePuy Synthes