Reconstructive Hip Surgery
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Anterior Total Hip Replacement

Anterior Hip Replacement is a minimally invasive, muscle sparing surgery using an alternative approach to traditional hip replacement surgery, commonly referred to as the Direct Anterior Approach (DAA). Traditionally, the surgeon makes the hip incision laterally, on the side of the hip, or posteriorly, at the back of the hip. Both approaches involve cutting through major muscles to access the hip joint. With the anterior approach, the incision is made in front of the hip enabling the surgeon to access the hip joint without cutting any muscles. It is referred to as a muscle sparing surgery because no muscles are cut to access the hip joint enabling a quicker return to normal activity. This procedure also allows easy use of fluoroscopy (live x-ray) to ensure the new hip is being implanted in an optimal position.

Dr. Cooper is not new to the anterior hip surgery.  Since beginning practice, he has performed all of his primary and many of his revision hip replacements through the Direct Anterior Approach, and it is his preferred surgical approach whenever possible.

Benefits

Potential benefits of anterior hip replacement compared to the traditional hip replacement surgery, may include the following:

  • Smaller incision
  • Minimal soft tissue trauma
  • Less postoperative pain
  • Shorter surgical time and less blood loss
  • Faster healing time
  • Quicker Recovery and return to normal activities
  • Less scarring
  • Earlier mobilization
  • Less post-operative restrictions
  • Reduced hip dislocations
  • Decreased hospital stay
  • More reproducible and optimized implant placement

Surgical Procedure

Anterior Hip Replacement is performed in a hospital operating room under a spinal or general anesthetic, depending on your preference. You will be placed supine (on your back) on an operating table that enables Dr. Cooper to perform your hip replacement anteriorly. Fluoroscopic imaging is used during the surgery to ensure accuracy of component positioning and to minimize leg length inequality.

Dr. Cooper makes one incision to the front of the hip, typically 3-5 inches long depending on the size of your hip. He then pushes the muscles aside to access the hip joint to begin the replacement. At no time during the surgery are any muscle fibers cut.

The femur (thigh bone) is separated from the acetabulum (socket) by removing the diseased femoral head (ball). The acetabulum is prepared using a special instrument called a reamer. The acetabular component is then inserted into the socket. This is occasionally reinforced with screws or rarely cemented.  A liner, which is made of a specialized plastic called highly cross-linked polyethylene is then placed inside the acetabular component.

The femur (thigh bone) is then prepared using special instruments to exactly fit the new metal femoral component. The femoral component is then inserted into the femur. This may be “press-fit” relying on bone to grow into it, or cemented depending on a number of factors such as bone quality and morphology. The new femoral head component is then placed on the femoral stem. This can be made of metal or more commonly ceramic. The artificial components are fixed in place.

Dr. Cooper then injects a special “cocktail” injection to minimize postoperative pain and closes the incision with special stitches designed to absorb beneath the skin. The incision is then covered with a small sterile waterproof dressing.

Post-Operative Care

After surgery Dr. Cooper will give you guidelines to follow. It is important that you follow these instructions for a safe and successful outcome. Normally, after a traditional hip replacement, you would be given extensive instructions on hip precautions to prevent dislocating the new joint. Hip precautions are very restrictive and usually include the following:

  • Avoid the combined movement of bending your hip and turning in your foot.
  • Sleep with a large foam cushion or pillow between your legs for 6 weeks.
  • Avoid crossing your legs and bending your hip past a right angle.
  • Avoid low chairs.
  • Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes.
  • An elevated toilet seat should be used.

For Anterior Hip Replacement patients, however, hip precautions are generally unnecessary. Because the muscles are not cut, the risk of dislocation is greatly lessened enabling much more freedom of movement after surgery. Additionally, initial rehabilitation is faster for patients due to less muscle trauma during the surgery.

Common post-operative guidelines after Anterior Hip Replacement include the following:

  • You may bend your hip immediately after surgery and bear full weight when comfortable, typically the same day as surgery.
  • You will be given pain medications to keep you comfortable at home.
  • The bandage is completely waterproof allowing a shower as soon as you feel comfortable. You may also shower once the dressing is removed (typically 5-7 days) unless otherwise directed.
  • You will be given specific instructions regarding activity and rehabilitation. You will not have to follow standard hip precautions.
  • Physical therapy will be ordered to restore normal hip function and strength.
  • If you have increasing redness or swelling in the wound or temperatures over 100.5˚ you should call Dr. Cooper’s office.
  • If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent infection in your new prosthesis. Consult your surgeon for details.
  • Your hip replacement may go off in a metal detector at the airport.
  • Eating a healthy diet and not smoking will promote healing.

Risks and Complications

As with any major surgery there are potential risks involved. The majority of patients suffer no complications following Anterior Hip Replacement; however, complications can occur following Hip surgery and include:

  • Infection: Infections can occur superficially at the incision site or in the joint space of the hip, a more serious infection.
  • Wound irritation: Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint
  • Fractures: This is rare but can occur during or after surgery. This may prolong your recovery or require further surgery.
  • Nerve damage: Trauma to nerves may be temporary or permanent and can cause numbness, tingling, pain, and weakness.  Irritation of branches of the lateral femoral cutaneous nerve, which supplies feeling to the front and side of the thigh, occurs in approximately 15-20% of patients undergoing Anterior Hip Replacement.
  • Hemarthrosis: A condition caused by excess bleeding into the joint after the surgery is completed. This may require additional surgery to irrigate the joint and evacuate the blood.
  • Blood clots (Deep Venous Thrombosis or DVT): A DVT can form in the calf muscles and can travel to the lung, a life threatening condition called pulmonary embolism (PE). If you get calf pain or shortness of breath at any stage, you should notify your Dr. Cooper.
  • Dislocation: A condition that occurs when the artificial ball and socket come apart after surgery.  This is very rare following Anterior Approach Hip Replacement, but when it occurs requires sedation in a hospital setting to put the joint back into place.
  • Leg length inequality: Traditionally, it can be difficult to make the leg exactly the same length as the other one. The Anterior approach for Hip Replacement can improve this outcome by allowing a direct comparison during surgery.  However; there are some occasions when it is not possible to match the leg lengths exactly. The vast majority of leg length inequalities can be treated by a simple shoe raise on the shorter side.
  • Wear: All joints eventually wear out. The more active you are the quicker this will occur. In general 80-90% of hip replacements should still be functioning well 20 years after surgery.
  • Failure to completely relieve pain: This is rare but may occur especially if some pain is coming from other areas such as the spine.
  • American Acadamey Of Orthopedic Surgeons
  • AAKHS
  • NewYork-Presbyterian Hospital
  • NYOH
  • Badges Ortho
  • Columbia Doctors