Outpatient Anterior Total Hip Replacement Overview

Total hip replacement surgery removes a painful, worn out ball and socket hip joint and replaces it with an artificial hip joint made from plastic, ceramic, and metal parts. The total replacement procedure is typically necessary when the joint wears down and produces irregularities in function that cause pain, a loss of range of motion, and impairment of regular activities like walking, sitting, or, in Bob’s case, riding a motorcycle. 

He says, “I wasn’t able to ride anymore, the pain was just unbearable.”

Results of total hip replacement surgery are dramatic, with substantial reduction in pain and a return to normal activities and increased mobility. Bob says, “After having these procedures done, I’m riding all the time and I feel great.”

However, not all hip replacement surgeries are the same. If you have hip pain and are considering surgery, what are your options?

Hip replacement can be performed in two primary ways: traditional (called open surgery) or a minimally invasive technique known as the anterior approach. The main difference between these procedures is the size and location of the incision. 

Traditional open hip replacement was the standard for decades. With the traditional approach, the surgeon makes one large eight to ten inch incision along the side of the hip. During the surgery, the doctor works through that larger incision to move the muscles to the side, exposing the joint. The ball portion of the joint is cut away and an artificial ball joint is cemented to the thigh bone. The surface of the hipbone is cleaned by removing damaged or worn-out cartilage and then the replacement artificial socket is connected to the hipbone. Finally, the ball is inserted into the new socket. A drain may be inserted to aid healing. Finally, the leg muscles are returned to their normal position and the incision is closed. 

Anterior hip replacement is a minimally invasive procedure that uses a small incision, spares muscle tissue and has patients back home to begin recovery within a few hours. 

Patients like Bob can literally have the surgery in the morning and be home recovering by lunchtime. Instead of making one large incision, surgeons make one to two small cuts from two to five inches long. Instead of working from the back of the hip (the posterior position), the surgeon works from the anterior (front) of the leg. The same procedure can be completed through these smaller openings. This reduces blood loss, speeds healing, reduces scarring, improves range of motion and gets the patient home much faster. The patient experiences less pain during recovery and anterior outpatient hip replacement can decrease downtime by several weeks.

After the anterior approach hip replacement, the patient is typically encouraged to get up and walk slowly as soon as they can within the safe confines of the outpatient surgery center. This movement enhances blood flow and reduces any risk of blood clots. Once home, there is a several week rehabilitation process that includes physical therapy to improve range of motion and strengthen the hip muscles. Most patients begin using a walker directly after the surgery, then switch to a cane, and finally resume walking on their own. Full recovery can happen within about a month to six weeks.

Bob’s experience with the first anterior outpatient total hip procedure was so positive he had the second just five months later. Today, he says, “I have zero pain in my hips now.”

Not all patients are candidates for the minimally invasive anterior total hip replacement procedure in an outpatient setting. The best candidates for this type of procedure include:

• Motivated patients who are committed to regaining their mobility
• Non-smokers
• Patients aged 70 or less
• Patients in good general health or that have well controlled medical issues
• Those that have a body mass index (BMI) of 35 or less

Typically, patients undergoing a total hip replacement are experiencing one, or more, of the following conditions:

• Osteoarthritis is a type of wear and tear arthritis that damages the cartilage at the ends of bones
• Osteonecrosis is a condition where there isn’t enough blood getting to the joint, which can happen during a traumatic injury
• Rheumatoid arthritis is a type of inflammation that erodes cartilage and sometimes bone, resulting in damage to the joint

Patients that inquire about hip replacement typically experience:

• Lack of mobility, stiffness, and problems walking or being active
• Pain that interferes with sleeping and normal activities
• Persistent hip, back, and leg pain that pain medication no longer helps
• Problems even getting dressed or even standing up from a sitting position
• Trouble going up and down stairs

After Bob went to Dr. Bonenberger, he said, “The experience was just amazing.”