direct anterior approach hip replacementOne of the most aggressive and disabling forms of pain is hip pain. As the largest joint in the body, the hip plays an integral role in almost every bodily action from sitting to standing, walking to running, and even sleeping. Those that suffer from chronic hip pain generally experience diminished quality of life as mobility becomes restricted. Hip pain is normally an indicator of a separate issue.

The most common causes of hip pain include arthritis, wearing of the hip joint, bursitis, inflammation of the bursa sac in the hip joint, stress fractures, injuries to the bone due to overuse, groin pulls or tears, an injury to the hip muscle, or referred pain, “pain perceived at a location other than the site of the painful stimulus/ origin.”

While this list may seem plentiful, there are avenues to either treat the underlying issue or eliminate pain via full hip replacement surgery. With the growing number of patients opting for full hip replacement as a form of treatment, surgeons have started implementing a less invasive form of hip replacement surgery called the direct anterior approach.

What is the Direct Anterior Approach?

Basic hip replacement involves “a traditional hip arthroplasty in which the surgeon uses a stemmed device and prosthetic head to replace the upper part of the femur (the head and neck of the bone) and a hemispherical shaped cup to replace the acetabulum, the socket of the pelvis in which the femoral head fits.”

Traditionally, surgeons have approached hip replacement surgery from either the lateral (side) or posterior (back) of the hip. The invasive nature of the traditional approach usually requires an incision up to 12 inches long and may disturb joint and connecting tissues. Both are aspects that affect the length, pain level, and success of healing post surgery.

The direct anterior approach to hip replacement surgery minimizes the invasive impact on the patient. The surgeon approaches from the anterior, or front, of the thigh. Instead of incising a large area, the surgeon generally requires only 4 to 6 inches (dependent on size of patient and patient history). This access point allows the surgeon to circumvent muscle.

In technical terms, the “orthopedic surgeon is able to repair your painful hip through a natural space between the muscles of the anterior (front) portion of the hip, rather than making the incision on the posterior (back) side, which has the potential of damaging the muscles that make up the primary support system for the joint.”

Advantages of the Direct Anterior Approach

Small Incision

While this is not always the case, in a majority of direct anterior hip replacement approaches the size of the initial incision is dramatically decreased. As mentioned earlier, lateral and posterior incisions can be as long as 12 inches. The anterior approach most often sees incision sizes of 4 to 6 inches. A smaller incision generally means a smaller, less noticeable scar. It also requires a shorter healing time and is often easier to care for post surgery.

Minimize Disturbance of Tissues

When surgeons enter the hip from the lateral or posterior access points, they must split the gluteus maximus muscle as well as detach and reattach two of the external rotator muscles, the piriformis and superior gemellus. In general, these muscles take anywhere from 4 to 6 weeks to heal.

Although the anterior approach may disturb the connective tissues of the hip, this approach allows for minimized impact.

Depending on the specific approach of the surgeon, it is possible to completely avoid disturbance of the gluteus maximus muscle, as well as three of the four rotator muscles. With an anterior approach, only one of the rotator muscles, the piriformis muscle, is disconnected in order to make way for the femoral implant.

Faster Healing Time

Healing time is dependent on many factors including the initial health and age of the patient, as well as the success of the surgery barring any complications.

While medical professionals cannot provide an exact time frame of recovery, hip surgery via the direct anterior approach generally requires between 1 and 3 months of recovery, while a posterior or lateral approach requires 3 or more months. This includes the initial stage when the patient can return to sedentary work – the anterior approach requiring 1 to 2 weeks and the lateral and posterior requiring at least 2 weeks – as well as a return to vigorous activity such as sports or fitness routines – the anterior approach requiring 1 to 3 months, while the lateral or posterior approach requires a minimum of 1 and 1/2 months up to 3 months.

The Patient-Based Approach to Surgery

When it comes to hip replacement, there are many factors that should be considered before deciding on a surgical approach. While the direct anterior approach offers many positive benefits and side effects, there are also disadvantages based upon the origin of the patient’s ailment. Therefore, it’s important to confer with an orthopedic surgeon, conduct personal research, and gain a comprehensive knowledge base to make an appropriate decision.

With a highly trained staff, Hampton Roads Orthopaedics & Sports Medicine is privileged to be able to provide the latest in innovative hip replacement procedures. We strive to ensure our patients receive the best healthcare possible. For more information on hip replacement surgery request an appointment online or call (757)873-1554.