Total Hip Replacement, Anterior Approach

Introduction:  The hip is made up of a ball and socket joint.  Joint damage, which can occur due to several reasons, may cause pain and discomfort. A total hip arthroplasty involves replacing the ball and resurfacing the socket to help alleviate these symptoms.  Traditionally, Orthopaedic surgeons have used a posterior approach (through the back of the hip) to perform a total hip replacement surgery.  Recently, there has been a growing trend in anterior hip replacement.  In an anterior hip replacement, the surgeon approaches the surgery through the front of the hip.  The surgery is performed using a minimally invasive technique allowing for the muscles to be moved apart, rather than cutting through them as in the posterior approach. Furthermore, the anterior approach allows the use of X-ray during the surgery.  This allows the surgeon to ensure the components are the correct size and in the correct position to help equalize your leg lengths. In addition, unlike the posterior approach, there are no hip movement precautions for patients undergoing the anterior approach. 

Purpose: A total hip arthroplasty helps alleviate hip joint pain, increases mobility, overall function, and ultimately, allows you to live the lifestyle you desire.  

Diagnosis: Your surgeon will have a detailed conversation with you to see how your condition is affecting your everyday activities.  In addition, they will perform a physical examination to analyze your hip mobility, the way you walk, and assess blood flow.  X-rays are routinely taken during this evaluation to help understand the anatomy of your hip and the extent of wear and tear (i.e. osteoarthritis).  Further imaging studies such as a CT scan or an MRI are not routinely required but can be ordered on a case by case basis. 

Indications: The most common indication for hip replacement is due to osteoarthritis, or wear and tear of the cartilage in the hip joint.  It may also be performed for diagnoses such as rheumatoid arthritis, avascular necrosis (the blood supply to the femoral head is disrupted), developmental dysplasia of the hip (the hip did not form properly from birth) or post-traumatic arthritis (arthritis that may develop following a fracture of the hip joint).  Your surgeon will have a conversation with you regarding your activity limitations, impact on lifestyle and diagnosis.  From there, you can determine if a total hip replacement is the best option for you.  

Surgery:  An anterior hip replacement surgery usually takes about 1.5-2 hours and you will spend at least one night in the hospital.  You will get up and start walking with an ambulatory assistance device (walker, crutches or cane) on the day of surgery.  You will work with physical therapy in the hospital and do home health physical therapy upon discharge from the hospital.  You will follow up with your surgeon at routine intervals immediately after surgery and, then, on a yearly basis for close monitoring.  

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