Anterior Approach Total Hip Arthroplasty
Less Pain. Faster Recovery. Improved Mobility.

A Different "Approach" To Hip Replacement: Direct Anterior Approach Total Hip Arthroplasty

Osteoarthritis of the hip is the most common cause of chronic hip pain. According to an article by Hootman et al. in 2006, it is estimated that 1 in 5 people in the US have some form of hip arthritis and two-thirds of patients with arthritis are under the age of 65.

After conservative treatment has been exhausted, a total hip arthroplasty (replacement) may be recommended by your orthopaedic surgeon. Total hip arthroplasty (THA) has been deemed as one of the most cost-effective and beneficial procedures in all of medicine.

The hip is made up of a ball and socket joint. The surface that covers the femoral head (ball) and the acetabulum (socket) is a smooth, low friction tissue called articular cartilage. Arthritis is simply defined as a condition in which the articular cartilage is wearing or has worn away. It generally leads to stiffness, loss of motion and pain.

A THA is a procedure in which the diseased femoral head and acetabulum are removed and replaced with implants. The femoral components consist of a metal stem with a new ball consisting of either metal or ceramic material. The socket of the hip joint is replaced with a metal cup and consists of a specialized liner made of either metal, ceramic or polyethylene (medical-grade plastic).

Traditional hip replacement surgery consists of an incision on the side of the leg that extends toward the buttock, in order to access the hip joint. The anterior approach to the hip is an alternative means to perform a THA. By no means is this a new or experimental procedure. In fact, the anterior approach for hip replacement was first performed in 1947 by Robert Judet in Paris, France, and has decades of outstanding results. There has been a relatively new interest in the anterior approach in the United States due to a number of documented advantages.

The anterior approach THA is performed through a relatively small incision of around 4 inches, that is located on the front of the hip. This approach is deemed a “minimally invasive” approach based on the definition of the length of the skin incision. However, it is important to understand that a total hip replacement, regardless of approach, is invasive to some degree. What is important with the anterior approach is that it can be performed with less invasive soft tissue disturbance under the skin. During the approach, no muscle is split or detached from the bone of the pelvis or femur, which is required in other approaches. This has the theoretical advantage of preserving muscle function to allow for less pain, decreased hospital stay, faster recovery and a return to normal activities expeditiously.

It has a number of other advantages as well; Dislocation of the hip after a THA is still one of the most common
and feared complications. Despite the dislocation rate decreasing with traditional approaches as surgeon experience improves, the anterior approach has an extremely low dislocation rate due to a number of factors. The muscles and tissue around the hip posteriorly (in the back) are left undisturbed in the anterior approach. These muscles have been postulated to provide strength and stability to the hip joint. Another common reason to have problems with dislocation is implant position. An advantage of the anterior approach is the patient is placed in a supine position (on their back) allowing the ability to utilize x-ray in the operating room in order to ensure that the implants are positioned accurately and therefore decreasing the risk of dislocation.

While recovering from a THA with a traditional approach patients are often required to follow special precautions regarding the position of the leg in space in order to prevent an early dislocation. This usually results in a triangular pillow that is placed between your legs and often times strapped to your legs, which can be cumbersome. The anterior approach allows patients to avoid these hip precautions, with no pillows or devices strapped to the legs after surgery.

Ensuring equal leg lengths is very important in total hip arthroplasty, and again, with the use of the anterior approach and x-ray, this can be accomplished more accurately and predictably prior to leaving the OR.

As with any surgical procedure, decisions must be made. What kind of surgery? What components are used? When and where the surgery takes place and finally, what approach? Each patient and their situation are unique and the above considerations should be discussed with your orthopaedic surgeon.