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

Frequently Asked Questions

Open all Close all
  • What experience does Dr. Fowler have with the anterior approach?
    Dr. Fowler trained for an entire year at Stanford University Medical Center performing the direct anterior approach under nationally recognized surgeons. Because of this training, you as a patient are in experienced hands. Dr. Fowler performs around 250 total hip replacements per year utilizing the Anterior approach.

    This is a good question and should be asked regardless of your surgeon. The answer involves a number of factors. Most orthopedic surgeons were not specifically trained to perform this procedure through an anterior approach. The anterior approach is a technically challenging procedure for most surgeons and it is very unfamiliar. Unfortunately, it is very costly and time consuming for orthopedic surgeons to go to national meetings to learn and work on cadavers to feel comfortable enough to attempt to perform this procedure on their patients.
  • How long will I be in the hospital?
    Total hip patients who have the Direct Anterior approach can often time be discharged the same day as surgery. Whether the surgery takes place at a surgery center or hospital will be decided between you and your physician based on each individual patient needs. 98% of patients go home the same day or on the first day after surgery. Rarely do patients need to go to an inpatient rehabilitation facility upon discharge from the hospital.
  • What training has Dr. Fowler had with the anterior approach?
    Dr. Fowler trained for an entire year at Stanford University Medical Center performing the direct anterior approach under nationally recognized surgeons. Because of this training, you as a patient are in experienced hands. Dr. Fowler performs around 250 total hip replacements per year utilizing the Anterior approach.

    This is a good question and should be asked regardless of your surgeon. The answer involves a number of factors. Most orthopedic surgeons were not specifically trained to perform this procedure through an anterior approach. The anterior approach is a technically challenging procedure for most surgeons and it is very unfamiliar. Unfortunately, it is very costly and time consuming for orthopedic surgeons to go to national meetings to learn and work on cadavers to feel comfortable enough to attempt to perform this procedure on their patients.
  • How soon after surgery do I follow up with Dr. Fowler in the office?
    3 weeks following your surgery. There may be occasions we'll ask that you return to the office sooner.
  • How soon after surgery before I can drive?
    Your return to driving largely depends on which hip was affected. If you had surgery on your left hip, you may be able to drive a car with an automatic transmission sooner than if the surgery was on your right hip with a manual transmission. Regardless of your progress, you should not consider driving if you are still taking prescription pain medication.

    You must feel strong, and alert to drive. For most people, this will be two to four weeks after surgery. You must be able and comfortable of quickly applying the brakes in an instant, being unable to do so will put you and others at risk of injury. Practicing in an empty parking lot will help you gauge your ability and comfort level of driving.
  • How soon can I return to work?
    The physical demands required for your job, as well as your own progress, will determine when you can return to work. Your surgeon will tell you when you can return to work and if there are limitations.
  • What is arthritis and how does it affect my hip?
    Arthritis is a disease of the articular cartilage, the smooth cushion that pads and protects joints. In a healthy hip, there is a layer of smooth cartilage on the ball of the upper end of the thighbone (femur) and another layer within your hip socket. This cartilage serves as a cushion and allows for smooth motion of the hip. Arthritis is a wearing away of this cartilage. Eventually, it wears down to the bone. Bone on bone causes discomfort, swelling, and stiffness.
  • What is total hip replacement?
    A total hip replacement is an operation that removes the arthritic ball of the upper thighbone (femur) as well as damaged cartilage from the hip socket. The ball is replaced with a metal or ceramic ball that is fixed solidly inside the femur. The socket is replaced with a plastic or ceramic liner that is usually fixed inside a metal shell. By replacing the diseased and painful surface, the bone-on-bone articular pain is eliminated and allows you to return to an active, healthy lifestyle.
  • What is the Hana operative table?
    Stacks Image 52
    This is a specialized orthopedic table made by MIZUHO OSI, that allows an anterior approach total hip replacement be performed. Dr. Fowler performs this procedure utilizing the Hana® table in order to effectively and efficiently perform this procedure.
  • How much pain should I expect after hip replacement surgery?
    Everybody is very different when it comes to a pain response after total hip replacement. The pain that you experienced preoperatively is usually immediately relieved by the procedure itself. You will often times have discomfort following the surgery and this is related to the surgery itself.  Many patients report to me that the discomfort post-operatively is much easier to tolerate than the pain from arthritis. You will be given pain medication after your procedure if needed. These medications do nothing to your hip but trigger your brain to ignore the pain. These medications are addictive, but for some people, necessary to a certain extent. Only take the medications as needed to help control the pain. If you run out, call the office during office hours and you can likely get a refill. Refills will not be made by the doctor on call after hours, plan ahead. 24 Hour notice is requested when requesting a refill.
  • What risks are involved?
    All surgeries carry a certain amount of risk. Infection, blood clots, and hip dislocation are two major complications. However, because of our proactive approach in treating possible complications, the likelihood of these complications is significantly diminished.

    We take special care to safeguard you from infection following surgery. You will be given antibiotics both before and after the surgery. To further minimize the risk of infection, we have streamlined the surgical procedure to take less time. The less time your wound is open, the less chance of infection.

    Following surgery, blood clots, commonly known as deep vein thrombosis or DVT, can be a problem. You will usually be given medication to reduce the risk of blood clots forming. Examples of such blood thinners or anticoagulants are Aspirin or Lovenox. Getting out of bed and walking soon after surgery is the best way to reduce the risk of DVT. Blood clots occasionally lead to a dangerous condition called pulmonary emboli. This can still occur despite the use of blood thinners. Chest pain and difficulty breathing following surgery should be reported immediately to your surgeon.

    Hip dislocation is the act of when the ball slips out of the socket after total hip arthroplasty. This complication has been decreased to below 1% with the Direct Anterior Approach.  The combination of utilizing X-ray in real time while placing implants and avoidance of cutting any muscle seems to provide the stability needed to decrease the risk of dislocation with this approach. 
  • Will I have swelling after surgery?
    Some swelling is common after joint replacement. Common swelling is recognized in the thigh and hip region only and is fairly normal and expected. To help reduce initial swelling, elevate your feet above your heart throughout the day. You may need more or less time elevating your legs depending on the severity of your swelling.  Excessive swelling throughout the lower leg, foot and ankle can be a sign of a blood clot and is a very serious complication. You should call the office if you experience swelling in the lower leg, foot or ankle. 
  • Will I be confined to a bed after surgery?
    On the day of surgery, you will be expected to get up, stand, walk, and potentially even climb some stairs under the supervision of a physical therapist. This streamlined approach to therapy and mobilization will improve your recovery and get you back to normal activities as soon as possible. Usually, most patients use a walker to mobilize until they feel comfortable without assistive devices. 
  • How do I care for my incision?
    Dressings are to be kept clean and dry. A small amount of clear drainage or bleeding may occur. If this happens, the dressing needs to be changed daily to help avoid infection.

    I utilize a plastic dressing that will remain on your incision until your first post operative appointment back in my office. This will allow you to shower without worry of water making way into your dressing.

    If purulent material (thick white/greenish in color) is coming from the wound, or the wound is red around the edges of the incision, or you have a temperature of 101.5 or higher, you should call the office immediately.

    You can resume your showering regiment three days after surgery if the incision is dry and dressings are clean. The incision should be patted dry with a clean towel. No soaking the incision until your first follow-up appointment. This includes bathtubs and hot tubs.