The Anterior Approach to Total Hip Replacement

What is the anterior approach?

“Anterior” is a medical term used to describe a location on the body more towards the front. The incision is in the area near your front pants pocket. A tradition posterior approach has an incision near your back pants pocket.

What are the advantages?

1. I am able to perform the entire hip replacement without cutting any muscles, something that is impossible from a more traditional posterior approach.
2. Quicker recovery and less pain postoperatively as a result of the less invasive, muscle preserving approach.
3. Higher accuracy with the positioning of the components due to better patient positioning and use of superior intraoperative X-ray visualization
4. A small incision can be used

 

 

 

What special equipment do you use?
The Hana Table is a specialized surgical table for the anterior approach. The table secures the patient during surgery, makes exposure of the hip easier, facilitates proper implant positioning, and allows real time X-ray verification of implants. You may notice the special boots being secured before you go to sleep.

 

How important is implant positioning?The hip joint is made up of two parts, a ball and a socket. Both are replaced in total hip surgery. Without going into excessive detail, the components can be tilted and spun in nearly any direction when implanted. The subtleties of implant mal-positioning can lead to many complications, and ensuring accurate placement is the most crucial part of any hip replacement. The anterior approach is famous for minimizing these complications to an absolute minimum.

 

Are the risks the same or different for an anterior approach?
A: The real answer is a little of both. Most of the biggest risks of surgery which are infection, complications from anesthesia, blood clots and medical complications exacerbated by surgery are present no matter how the surgery is done. These are the risks that every surgeon tries to minimize. However the anterior approach does have risks that are particular to it, as well as many benefits of reducing or nearly eliminating the risks of other approaches. The most important thing is having a surgeon who is comfortable with the approach that they use. I was trained on the anterior approach from my first day of residency until the end of my fellowship. My entire career has been highlighted by learning and perfecting this surgery from some of the top minds in the field across the country and adding to that some of my own experiences and innovations. All surgeons have a surgical approach that they perform best in their hands. For me, I believe that the anterior approach allows me to obtain the most reliable results while minimizing complications.

 

Should everyone get an anterior total hip?
Not everyone is a perfect candidate for this surgery. Some people have unique anatomy that makes a more traditional approach easier, safer and better. Because I perform hip surgery utilizing both approaches, we can have a thorough discussion about the best option for you.