By Matthew A. Dobzyniak, MD
In the world of orthopaedics and arthritis care, the total hip replacement has been a valuable and successful treatment option for decades for people suffering with arthritis, hip pain, hip stiffness and limited hip movement.
While a surgical approach to the hip from the posterior side has been, and continues to be, the most common method, other surgical approaches are becoming increasingly popular for their ability to be less invasive and have the potential to provide patients with a more comfortable post-operative recovery.
The anterior approach is one of these. This method has been performed in Europe since 1947 and has become increasingly popular in the United States since it was first used here in 1986.
Anterior vs. Posterior
The primary difference between the anterior and posterior approaches is that the anterior method accesses the hip from the front instead of the side or back. To gain access to the hip joint, muscles must be moved out of the way. The anterior approach allows for these muscles to be separated along their natural divisions without being cut and held by retractors, therefore muscle sparing. The posterior approach requires cutting through and splitting muscles, which may lead to instability in the hip joint and pain in the early postoperative period. The anterior approach results in less disruption of the structures that hold the joint together. The most important muscles for hip function, the gluteal muscles, are left undisturbed and therefore, do not require healing due to surgical trauma. This may result in a lower incidence of post-operative hip dislocations, which can be painful and difficult to treat. In addition, the lack of muscle cutting may lead to patients having a lower amount of post-operative pain.
During anterior hip surgery a special operating bed (Hana® Table) is utilized that helps place the leg in proper position for access to the different components of the hip joint. This bed combined with the use of intra-operative x-ray imaging allows for confirmation of implant placement and helps correct leg length differences. If you would like to see the website for the Hana® Table follow this link: http://www.mizuhosi.com/products/orthopedic-fracture-trauma/hana/
Both approaches utilize the same or similar implant components which, in normal patients, now last at least 20 years or longer.
In my practice I make a decision which approach is the best for the individual patient. Not all patients will be candidates for one approach every time. While I do the majority of my hip replacements using the anterior approach, I continue to take into consideration other factors that will have an impact on the success of the operation and patient recovery including: patient size, muscularity, level of activity prior to surgery and other preoperative medical conditions.