Aug. 10, 2011
Alternative Hip Replacement Procedure Gaining Popularity
Anterior Approach Gives Patients Another Option
ATLANTA – Orthopaedic surgeons at Emory are offering a hip replacement procedure that allows the surgeon to enter through the front of the hip and work between the muscles, reducing the pain and recovery time after total hip replacement. The technique is called “Anterior Approach Hip Replacement.”
Thomas Bradbury, MD, orthopaedic surgeon at Emory Orthopaedics & Spine Center, and colleagues are part of a small group of orthopaedic surgeons in the country who are trained to perform this procedure.
With traditional surgical approaches, the muscles surrounding the hip must be cut to allow access to the joint. These muscles are then repaired after the hip components are implanted.
Most surgeons feel that motion of the joint should be restricted until these muscles have healed back to the bone. This restriction of motion is called “hip precautions” and is often enforced for two or three months after surgery. Restrictions include the avoidance of crossing the legs, sitting in a low chair, tying shoes or any other activity that requires the combination of bending and internal rotation of the hip.
“Certainly, the pain and time to full recovery after total hip replacement is multifactorial,” explains Bradbury, who is an assistant professor of Orthopaedics at Emory University School of Medicine.
“Because the anterior approach minimizes disturbance of the muscles surrounding the hip, the joint remains stable. Hip precautions are not considered necessary and the patient is able - and encouraged - to move the leg in any position during the healing process without concern that the hip will become dislocated.
“Since patients are allowed to move the hip as their comfort allows, there is much less fear and anxiety about movement. The result is confidence for the patient during the recovery period. This confidence encourages patients to resume activities more quickly after surgery. We have yet to see a dislocation, despite elimination of hip precautions after this procedure.”
Another benefit of the procedure is a potential reduction in two complications associated with total hip replacement: improper positioning of the components and leg length difference.
“Because the surgery is done with the patient facing up, we can use fluoroscopy or ‘live x-ray’ during the procedure. This allows us to see the components and make appropriate adjustments to both the placement of the components and the length of the leg. This information is difficult to obtain during traditional approaches to the hip because the patient is lying sideways.”
The surgical team performs the procedure on an orthopaedic table that can be turned and rotated in any direction, improving access to the anterior entry of the hip. The surgery requires a small three to four inch incision instead of the conventional five to eight inch one, preserving soft tissue.
Bradbury, who has done more than 350 of these surgeries, has seen a decrease in hospital time. Most patients are able to leave the hospital on the first or second day after surgery.
“I’m not sure if the reduction is because of a less traumatic approach or better patient confidence,” says Bradbury. “Regardless, an earlier discharge from the hospital is nice.“