Total hip replacement surgery (also known as total hip arthroplasty) is considered among the most significant orthopedic developments in treating hip trauma and end stage arthritis of the hip. Despite providing this procedure in Blue Springs for nearly four years, I'm always puzzled to hear patients tell me they're surprised to learn it's being done locally.
Traditional hip replacement surgery involves surgeons essentially cutting their way to the hip joint. Muscles and tendons are severed and moved aside to allow the surgeon to remove and replace the "ball" in the joint's socket. These muscles and tissue must then be reattached after the new joint is in place. This technique is known as the "posterior" approach, from the patient's backside, or laterally through a side incision where the surgeon will take the muscles off the front of the hip, which can lead to a limp if they do not heal correctly.
Having performed standard hip replacements for years, I took up this technique four years ago. Since that time, I can only can say that the outcomes are impressive and the advantages are numerous.
The anterior approach involves a four-inch incision through the front of the leg, rather than the back making it possible to reach the hip joint by separating rather than cutting muscle which must be then reattached. Because the anterior approach goes in between – instead of through – the muscles, it provides many benefits, chief of which is less muscle and tissue damage.
Performing hundreds of anterior hip replacements, I've noticed almost 99 percent have resulted in a swifter recovery and shorter hospital stays for my patients, primarily due to decreased muscular damage.
There is also a significantly decreased risk of hip dislocation following surgery, which occurs more often with the posterior approach. Leg length and the position of the implant can be measured precisely with the anterior approach through x-rays, taken much more easily than the traditional technique.
Another frequently noted advantage is a big decrease in the amount of time needed for rehabilitation. Typical length of stay in the hospital is one to three days. Many, if not most, anterior hip replacement patients are able to walk with a cane by three weeks, and sometimes even sooner. By three months post-surgery both the anterior and traditional approaches are essentially identical in function.
I've had patients walk out of the hospital the day after surgery with just a cane, many needing very little if any pain medication. Most anterior patients can return to work about two weeks following surgery, versus six weeks for posterior. Often, within two weeks, many patients showed no signs of even having the surgery.
After returning home, patients work with a physical therapist or to increase strength and range of motion for about six weeks.
A number of studies of knee and hip replacements have shown that after 20 years, 90 percent or more implants continue to work, and after 30 years, seven out of 10 patients will still have a functioning hip implant.
The risks of infection, bleeding , blood clots and other systemic problems are similar risk levels in both approaches. Though risks of fracture of the hip are slightly higher in the anterior procedure, anterior hip replacements tend to be less risky in general and offer quicker recovery than the traditional surgery. Patients with implants from prior surgery, who are muscular, have a wide pelvis, or who are very obese may not be well-suited for this procedure. Talk with your doctor if you have concerns.
Dr. David Paul, D.O., is an orthopedic surgeon at St. Mary's Medical Center and can be reached at 816-220-8727.