Total hip replacement surgery is regarded among the most valued developments in the history of orthopedics in treating hip trauma and end stage arthritis of the hip.

Total hip replacement surgery is regarded among the most valued developments in the history of orthopedics in treating hip trauma and end stage arthritis of the hip.

Over the years, there have been many improvements in techniques and technology. And today it is one of the safest and most effective treatments in medicine. Yet, a different approach to hip replacement is showing even better results for patients.  

In traditional hip replacement surgery, surgeons essentially cut 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 referred to as a “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.

Today, some surgeons are using an “anterior” approach. Having performed standard hip replacements for years, I took up this technique two years ago. While it is technically more challenging for the surgeon, the benefits and outcomes for patients are impressive. After hundreds of anterior hip replacements, I’ve noticed almost 99 percent have resulted in a swifter recovery and shorter hospital stay for my patients, due to less muscular damage.

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. First and foremost, possibly the best benefit of this technique is there is less muscle and tissue damage.

There is a significantly decreased risk of hip dislocation following surgery, which occurs more often with the posterior approach. Leg length and implant position are able to 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 requiring very little if any pain medication. Within two weeks, many patients showed no signs of even having the surgery.

Implants used for both the anterior and conventional approaches are identical. The only difference is the actual approach the surgeon takes to get to the hip. Patients of both techniques can expect their hip replacements to last the same amount of time.

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 have similar risk levels to traditional hip replacement surgery. The risks of fracture of the hip are slightly higher, but most 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.