Anterior approach for hip replacement
When is this procedure indicated?
The decision is made on a case-by-case basis, but certain patients are not well-suited for this procedure, and if they do undergo it, it may require longer incisions. This includes people who have:
- implants or metal hardware in the hip from prior surgery;
- a very muscular or obese body type;
- a wide pelvis.
How is it performed?
Direct anterior hip replacement is a minimally invasive surgical technique. This approach involves a 3 to 4 inch incision on the front of the hip that allows the joint to be replaced by moving muscles aside along their natural tissue planes, without detaching any tendons. This approach often results in quicker recovery, less pain, and more normal function after hip replacement. Because the tendons aren’t detached from the hip during direct anterior hip replacement, hip precautions are typically not necessary.
A “bikini incision” anterior hip replacement uses an incision in the horizontal direction along your natural skin folds and follows Langer’s lines (sometimes called cleavage lines). By following Langer’s lines, the incision heals better, and the scar is less noticeable. This approach can be used on both men and women. Most patients are candidates for a bikini incision anterior hip replacement.
Once you are stable, someone can take you home if you’re having outpatient surgery. Otherwise you’ll be moved to your hospital room. You should be able to put weight on your new hip soon after surgery and may be able to walk using a walker or crutches the next day. You’ll need physical therapy to regain strength and mobility, and occupational therapy to work on daily activities like getting dressed and washing up. Some people have outpatient physical therapy, others receive physical therapy at home, and others go to a nursing home or rehabilitation facility. Most people can return to work after about a month, but it may take up to three months before you can return to work that requires a lot of standing, walking, or heavy lifting.
Research suggests that people who undergo anterior hip replacement may be more likely to have a problem with wound healing, particularly infection. For example, a study of 505 anterior hip replacements and 1288 posterior hip replacements found that 7 (1.4%) of the anterior hip patients had wound healing problems compared to 5 (0.2%) of the posterior patients.
There is a potential risk of nerve injury with any type of hip replacement approach. In anterior hip replacement, the surgical area is located near the lateral cutaneous femoral nerve, which runs down the front of the pelvis and past the hip to supply sensation to the outer thigh (it does not affect muscle control or strength).
Following anterior hip replacement surgery, there is potential for numbness in the thigh, and, in rare cases, a painful irritation of the skin supplied by that nerve, known as meralgia paresthetica. This condition is rare and happens in less than 1% of patients.