Direct Anterior Approach
The Direct Anterior Approach to Hip Replacement Surgery involves a small incision and placement of the hip implants from the front of the hip versus the more traditional posterior approach. Access to the joint is obtained from between muscles and nerves without cutting or releasing them. This allows patients the comfort and freedom from hip precaution restrictions enforced after a traditional posterior hip replacement. For these reasons, dislocation rates are lower after direct anterior hip replacement and recovery is faster and less painful. This surgery can be performed using a highly specialized operating table or through a more traditional table. The specialized table allows X-rays to be obtained during surgery to ensure precise placement of the implants, resulting in more functional hip mechanics and equal leg lengths.
The Benefits of the Direct Anterior, Tissue-Sparing Procedure are:
- Easier Access to the Hip Joint for the Surgeon
- Less Post-Operative Pain and a Speedier Recovery
- More Accurate Leg Lengths and Alignment with Intra-Operative X-Ray
- Preservation of the Hip Deltoid Musculature (the Tensor Fascia Latae and the Gluteus Maximus)
- Decreased Risk of Post-Op Dislocation (less than 0.6%)
- It is a Minimally Invasive Surgery (MIS) with a Cosmetic Scar
- Patients are Weight-Bearing as Tolerated and May Walk Same Day as Surgery
- Nearly ALL Patients are a Candidate for this Approach
Recovery after Direct Anterior Approach
Recovery success depends on several factors including surgeon training and experience, the surgical approach, the implant and the patient's health and commitment to post-operative physical therapy.
Since the operation is done through the front of the hip tissues, the posterior tissues are much less disturbed allowing the patient to sit up more easily and bend forward carefree. They are encouraged to get up and move freely. This is helpful in preventing pneumonia from developing. The patient is cautioned not to turn the knee and foot of the operated side outwards (external rotation) while over extending the hip joint (extension). These movements may cause the artificial components to dislocate.
The following day, the physical therapist will help the patient to get out of bed and stand. Depending on the physical condition of the patient, most patients go home two days after surgery. The patient will be able to walk with the help of a walker or crutches at home and in the neighborhood after being discharged from the hospital.
Recovery using this muscle sparing technique will be quicker but one must always remember it has to be a case by case situation. A person who requires a hip replacement may have other medical problems that may cause delays. However, when no muscles are cut, the pain after surgery is generally reduced during walking.
Direct Anterior Approach: Who is a Candidate?
The Direct Anterior Hip Replacement is one of the least invasive approaches to replacement surgery. This technique is proven in minimizing pain and recovery time. All patients with hip arthritis, even those who are overweight, may be a candidate for an anterior hip replacement. Moreover, patients suffering from arthritis in both hips may be considered for bilateral hip replacements in one surgery with this approach.
