What is an Anterior Approach Total Hip Replacement Surgery?

3D illustration of total hip replacement – Orlando Orthopaedic Center

• What is the Posterior and Lateral Approach to Total Hip Replacement?
• What Happens During Total Hip Replacement?
• Who is a Candidate for Total Hip Replacement?
• What Are the Benefits and Risks of the Anterior Approach Total Hip Replacement?

Anterior Approach Total Hip Replacement Surgery are surgeries performed from in front of the hip. They are also called mini, modified, minimally invasive, or muscle-sparing surgeries.

Though all total hip replacements are performed in this basic manner, the surgical approach to the hip plays a major role in post-operative rehabilitation. Traditionally, several different types of approaches have been utilized. 

The two most common types are the posterior approach and the lateral approach. In both of these procedures, the patient is positioned on his or her side, with the side to be operated on up.

The anterior approach to the hip improves the speed of recovery following total hip replacement. The incision is made on the anterior surface of the upper thigh. The surgeon then separates hip muscles along natural tissue planes. Detachment of muscles or tendons is usually not required. Therefore, post-operative precautions are usually much more relaxed or not implemented at all. For this reason, this approach is also called “tissue sparing.” 

In many cases, smaller incisions (minimally invasive incisions) can be used. The patient is positioned supine on a special table. This table, called the Hana table, holds the patient’s feet and ankles in padded boots. Hinged bars attached to the boots can be angled and rotated to aid in surgical exposure. 

In some cases, the procedure is performed on a standard operating room table. Factors such as patient body habitus and surgeon training impact which table is used.

What is the Posterior and Lateral Approach to Total Hip Replacement?

In the posterior approach, an incision is made over the posterolateral aspect of the hip. Muscle and tendon units, called the short external rotators, are detached from the posterior aspect of the hip capsule. The capsule is entered and the procedure is performed. The capsule and overlying short external rotators are typically reattached to the proximal femur after joint implantation.

Eric G. Bonenberger, M.D. – Orlando Orthopaedic Center

The lateral approach requires detachment of part of the abductor muscles from the anterior aspect of the proximal femur. These must be reattached upon completion. In both cases, these soft tissue structures must heal to the proximal femur. This can take several weeks or months. During this time, post-operative body positioning can lead to stress at the repair site. If the repair fails, the prosthetic hip joint can become unstable or dislocate. To protect against this, a set of key rules are taught to the patient after surgery. These guidelines, called antidislocation precautions, prevent patients from stressing their soft tissue repair sites by teaching allowable hip and trunk positions. For example, hip flexion coupled with hip internal rotation can stress a posterior soft tissue repair. Therefore, posterior precautions recommend against deep hip flexion and hip internal rotation post-operatively.

What Happens During Total Hip Replacement?

The hip joint is a “ball and socket” joint. Both sides of the joint are replaced, hence the term “total hip replacement.” The surgery involves replacing the femoral head (ball) with an artificial ball, which is connected to a femoral stem. The femoral stem is potted within the upper part of the femur. The acetabulum is the “socket” side of the joint. The acetabulum is machined into a uniform hemispherical cup. A metal hemispherical shell is implanted into the prepared bone. The surgeon then couples the two parts of the joint together. After a layered closure, the surgery is complete.

Who is a Candidate for Total Hip Replacement?

Total hip arthroplasty provides excellent pain relief and improves mobility. People who suffer from several types of joint conditions are often excellent candidates for hip replacement surgery. Osteoarthritis, avascular necrosis, rheumatoid arthritis, post-traumatic arthritis, and hip dysplasia are commonly treated with total hip replacement surgery.

What Are the Benefits and Risks of the Anterior Approach Total Hip Replacement?

All of this typically leads to a quicker return to the patient’s desired activities, such as ambulation without assistive devices, driving, and certain sporting activities. The disadvantage of the anterior approach total hip replacement is the added technical difficulty and learning curve. For example, patients with a high body mass index or severe deformity may not be candidates for this procedure. Also, no hip replacement surgery is free of complications. As is true with traditional hip replacement surgery, dislocation, limb length inequality, periprosthetic fractures and other complications can occur.

In summary, traditional total hip replacement surgery yields excellent results for the treatment of painful hip conditions. Anterior approach total hip replacement may be beneficial because the post-operatively recovery is usually more rapid.

Originally Published in Orlando Medical News, May 2012.