“There are different approaches to hip replacement surgery that all work pretty well,” said Dr. Hohman. “What's nice about the anterior hip approach is that it allows the surgeon to get access to the front of the hip without detaching any muscles. As a result, patients tend to bounce back from the surgery pretty quickly and have a lot less discomfort, compared to traditional hip replacement surgery.”
By approaching the surgery from the anterior (front of the body) rather than from the back, the surgeon can reach the hip socket without cutting through major muscle groups. In addition, with the anterior approach, the capsule (bands of ligaments) in the back of the hip is not disrupted. That helps maintain the stability of the hip joint and avoid an unwanted side effect of hip replacement: hip dislocation.
“With the traditional approach, that capsular tissue is disrupted in the process of the surgery,” Dr. Hohman said. “As a result, the new hip joint has a tendency to dislocate, either immediately after surgery or even in the long term. Patients must follow precautions to help prevent dislocation for as long as they have the hip replacement. With the anterior hip surgery, there’s no capsular disruption, the hip remains stable, and patients don’t have to follow those precautions. For the most part, patients can treat their hips like normal. We've had a great success with that approach.”
The incision for anterior hip replacement is smaller – 3 to 6 inches, compared to the 10 to 12 inches required for the traditional approach. That means faster recovery and less post-operative pain. Other benefits include: less muscle trauma and damage; less limping; shorter hospital stays; less scarring; and better range of motion.
Is Anterior Hip Replacement Right for Me?
Hip replacement surgery is typically recommended for patients who have hip pain or stiffness that limits their everyday activities, such as walking or bending, and/or that continues while resting, either day or night. Typically, hip replacement surgery is not considered unless other, more conservative measures – such as medication, steroid injections and physical therapy – have been tried and failed to provide lasting relief.
Many patients are candidates for this minimally invasive approach to hip replacement. However, anterior hip replacement is not for everyone. Some patients may be best treated with other approaches based on their individual needs. For example, doctors may recommend traditional hip replacement surgery for patients with certain deformities in the hip area. Similarly, anterior hip replacement is often not recommended for patients who are obese, because the additional soft tissue poses a challenge for accessing the hip joint and performing the replacement.
Bottom line: the decision for the best surgical approach for an individual patient should be made by the operating surgeon in consultation with the patient.
Choosing an Experienced Surgeon for Anterior Hip Replacement
As with any surgical procedure, it is important to find a surgeon with solid experience in performing anterior hip replacement. Dr. Hohman is the medical director of the Joint Replacement Program at Texas Health Center for Diagnostics and Surgery and is a very experienced surgeon in the U.S. for anterior hip replacement; he performed Texas’ first ever custom anterior hip replacement surgery at Texas Health Center for Diagnostics & Surgery in 2018.
“Today, we do a lot of these procedures,” he said. “Most are done on an outpatient basis; patients are home within a few hours of the operation. There's not a prolonged downtime and no prolonged hospitalization with the operation because pain control is not really an issue. Generally, patients are really comfortable after the operation. We have people that go through it routinely and take only Tylenol for pain control.”
The anterior hip replacement surgery can lead to a speedier recovery with a reduced need for pain medication after surgery. Less pain means more than just less discomfort for patients. Without the need to aggressively manage post-operative pain, patients avoid a number of additional issues.
“When patients require heavy duty narcotics to get through the first couple of weeks after surgery, it creates a whole host of other issues, such as gastrointestinal problems or breathing problems,” said Dr. Hohman. “You can avoid these issues if the patient can avoid taking heavy duty narcotic medicines.”
After hip replacement surgery, some patients may require an assistive device such as a walker or crutches for a week or two after surgery. “I encourage patients to stop using these assistive devices as soon as they feel stable and are prepared to walk without assistance,” Dr. Hohman said.
Many patients considering hip replacement surgery ask Dr. Hohman: “When can I get back to my normal activities and to being mobile and be independent?”
Within a few days to a few weeks, patients are usually to walk unassisted. Anterior hip replacement patients return to normal activities within 10-12 weeks following surgery, including walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports. However, high-impact activities (such as running) are usually not recommended after hip replacement, to avoid damaging or quickly wearing out the new hip. With appropriate activity modification, hip replacements can last for many years.
Most patients follow a graduated walking program that enables them to slowly increase their mobility after the surgery. Exercise is a key component of post-operative care.
“Physical therapy is generally not extensive for hip replacement,” said Dr. Hohman. “Typically, it involves simply walking around and performing some routine movements. A physical therapist will instruct the patient on some exercises to restore strength and mobility to the hip, which will help the patient get back to their desired activities.”
If you are looking for solutions for your hip pain, reach out to us today to find out if you could be a candidate for minimally invasive hip replacement surgery.