Anterior Approach Total Hip Replacement

Hip osteoarthritis can be a disabling condition that can significantly affect an individual’s quality of life. Total hip arthroplasty (THA) through an anterior approach is a great surgical procedure that can quickly restore an individual to a pain free lifestyle. The anterior approach for total hip replacement is a dramatic improvement over the more traditionally used surgical approaches. The anterior approach, although not a new procedure, has only recently gained popularity with physicians due to improvements in training and development of operating room tables that aid in the surgical approach. Patients have benefited from this approach by quicker recovery, less dislocation risk, smaller, less invasive incisions and leg length is more accurately controlled.

The anterior approach is the only true inter-muscular approach that does not require cutting any muscles to gain access to the hip joint. Since no large muscles are cut, patients feel less pain and have a quicker recovery. The lack of disturbance of the muscles also accounts for immediate stability of the hip and lower risk of dislocation. Other approaches require strict precautions of limiting hip flexion to 90 degrees up to 3 months. This movement is important for functional activities such as putting socks and shoes on, getting up and down from a chair or toilet and resumption of normal sexual activity.

The normal incision is about 4 to 5 inches but may vary according to a patient’s body size. The anterior approach does not limit the type of hip prosthesis implanted. Hip prostheses that are implanted with or without cement can be used as well as all modern bearing surfaces. Many surgeons who do not use anterior approach are using large metal and metal bearings as a way to decrease their patient’s risk of dislocation. However, metal on metal bearings have recently come under FDA warning due to development of early failure rates and development of pseudo tumors due to the elevated metal ions. Most individuals who are in need of a hip replacement are candidates to have their procedure performed through an anterior approach.

If you would like to discuss hip replacement, please make an appointment with
Dr. Rhoads or Dr. Keller call (502) 364-0902.

Top Questions about Total Hip Replacement

Hip replacement is a combination of a stem with a ball attached that is placed into the upper part of a thigh bone and cup that has a inner liner that is placed into the socket of the pelvis. This removes both sides of the arthritic joint.

The surgeon needs to know if you have any history of metal allergies, difficulty wearing jewelry, problems with other surrounding joints, history of infections, complications from previous surgeries, history of excessive bleeding, or history of blood clots.

A.    Anterior (front) approach

B.    Posterior (back) approach

C.     Harding (side) approach

A. Metal on plastic. Most hip replacements in U.S. are this type. Overall very good option, has lots of options for liner to help with stability. Should last 20 + years.

B. Ceramic on ceramic. Has the best wear of any option. Could last 30 + years or lifetime of patient. Very small risk of component fracture or squeaking. I will use this for very active patients or younger patients.

C. Metal on metal-Good for stability, bad for metal ions and pseudotumors. Under review by FDA for early failures. In my opinion, should not be used. Many have been removed prematurely.

Any person who has developed end stage hip arthritis (complete loss of cartilage) or has developed avascular necrosis (AVN). AVN is a loss of blood supply that can cause flattening of the femoral head.

A. General endotracheal
B. Spinal anesthetic

Typically one is in the operating room for about 1 ½ to 2 hours. This includes the time to position the patient, the anesthesiologist to administer the anesthetic or place the spinal.

Usually 2 or 3 days.

Most are able to go home with home health physical therapy, some individuals will go to an inpatient rehabilitation. These individuals typically do not have any family who will be able to watch out for them, or they have a significant barrier (i.e. live on 2nd story) that inhibits from them going home.

A. Home health usually for 2 weeks or
B. Inpatient Rehabilitation usually for 2 weeks
C. Outpatient therapy dependent on how patient is progressing

Motion restrictions depend on approach of surgery performed. Activity restrictions include not performing impact exercise activities. (i.e. running, jumping, quick twisting)

Dependent on which leg was replaced, and when patient is weaning off of narcotics. Can be as fast as 3 weeks postoperative.

Dependent on goals and from what functional level the individual is starting. Can be as short as 2 weeks, or as long as 3 months.

Typically 6 weeks for a sitting job and 3 months for factory work.

Pain quickly settles in a few days where it is controlled easily with oral pain medications. Typically one takes medication either before therapy or sleep.

Early Loosening, Late Loosening, Infection, Implant failure, fracture of surrounding bone.

A. Deep venous thrombosis (DVT)
B. Pulmonary Embolism
C. Infection
D. Fracture of surrounding bone
E. Implants not growing into bone
F. Leg Length Discrepancy
G. Nerve Injury
H. Vascular Injury
I. Death

A. Baptist Health Louisville Hospital
B. Jewish St. Mary’s Elizabeth Hospital
C. Nortons Brownsboro Hospital

A. If you have medical illness that requires frequent medical intervention, (i.e. heart disease, history of heart attack, diabetes, history of cardiac surgery) you will need to obtain cardiac or medical clearace
B. Strengthing muscles around hip
C. Cleaning hip with hibicleans soap starting 3 days before surgery
D. Using bactroban ointment in nose.

Fall into 2 main categories based on how implants are fixed to bone. Pressfit where the bone grows into implants, or cemented.

Several companies have had several problems with excessive metal debris forming in hip joint leading to tumor like lesions, early loosening of implants, and pain.

It is a metal on metal device that allows for higher physical activity, but carries a significant elevated risk of metal ions, hip fracture and increased level of having chronic pain.

Usually 3 months.

It is possible in the ideal candidate to get both his replaced at the same time. Usually individual is very healthy of working age who cant afford missing significant amount of work.