Direct Anterior Hip Replacement Surgery, sometimes referred to as Anterior Approach Hip Replacement Surgery, Anterior Supine Intermuscular (ASI) Hip Replacement, or Direct Anterior Approach (DAA) is a minimally-invasive total hip replacement technique. Compared to traditional hip replacements, which are done by making an incision at the side or back of the hip, doctors performing this innovative operation do so by making a surgical incision on the anterior (front) side of hip. The anterior incision allows the physician to perform the surgery without detaching muscles or tendons from the hip or thighbone, which may help speed the recovery process and be less painful than traditional techniques.
During the operation, the orthopedic surgeon positions the patient on the operating table in such a way that allows him or her to easily access the front of the hip. A surgical incision is then made and the surgeon will work through the naturally occurring spaces between the muscles to access the hip bone and insert the hip implant. Throughout the surgery, the surgeon will take x-rays of the hip to ensure the hip implant is placed as accurately as possible. After the implant is in place, the surgical incision will be closed and a large dressing will be applied to the surgical area.
WHO NEEDS DIRECT ANTERIOR HIP REPLACEMENT SURGERY?:
Direct Anterior Hip Replacement can help to improve pain, stiffness and physical limitations due severe hip injuries and various types of hip arthritis, including osteoarthritis and rheumatoid arthritis. Typically surgery will only be considered after conservative treatments have been tried without favorable outcomes.
Most patients who are candidates for traditional hip replacements are viable candidates for Direct Anterior Hip Replacement Surgery. While it is not common, there are some patients, such as those who have had a previous hip surgery, who may be better suited for techniques that utilize a posterior (back) or lateral (side) incision. Your care provider will review your previous treatments and your current condition to determine if Direct Anterior Hip Replacement Surgery is the best procedure for you.
POTENTIAL BENEFITS:
Compared to traditional hip replacement techniques, there are many possible benefits of Direct Anterior Hip Replacement Surgery. While not all potential advantages have been thoroughly studied yet, many orthopedic doctors believe benefits of the approach may include:
- Smaller surgical incisions and reduced scarring
- Minimal damage to muscles, joints and tendons
- Reduced post-operative pain
- Improved prosthesis positioning
- Less restrictions after surgery
- Shorter post-operative hospital/outpatient stay
- Faster post-operative recovery and return to activities
- Improved post-operative mobility and function
PREPARING FOR SURGERY:
Before the day of your procedure, you may meet with your orthopedic surgeon for a pre-surgical consultation. During this appointment your doctor may do a physical examination to ensure you are healthy enough to have the operation. He or she may also take preoperative x-rays, ask you questions about your medical history, and create a comprehensive list of all your medications and allergies.
During this visit, it is likely your surgeon will also walk you through what will happen during the procedure. Depending on what type of anesthesia your orthopedic doctor is planning to give you, you may be told not to eat or drink anything after midnight the night before your surgery. Your doctor may also request that you stop taking certain medications prior to your procedure. Pre-operative instructions may vary from patient to patient. Your doctor will give you specific instructions prior to your surgery so you can prepare properly. Take the time to ask your care provider any questions you have as well. Knowing what to expect the day of your operation will help to keep you at ease.
On the day of your operation, your doctor will likely request that you arrive at the surgical center or outpatient facility one or two hours prior to your operation. After you fill out your paperwork and get admitted to the facility, you will be evaluated by an anesthesiologist and be sedated. You will sleep throughout the duration of your operation (which typically lasts about an hour or two) and you will not feel any pain.
POST-OPERATIVE CARE:
After your direct anterior hip replacement surgery is over, you will be taken to a recovery room for a period of observation. During this time, your vital signs, such as your heart rate and blood pressure, will be monitored. As will your overall pain level. After your condition has been stabilized, you will be brought to your room, where you will likely stay for two to three days.
After surgery you will find that a large dressing has been applied to the operated area. You may be hooked up to various medical devices including an IV filled with fluids, antibiotics and other medications. Most patients are able to move their hips and walk around with a cane or crutches the same day as their operation. Typically, walking aids can be discarded two weeks after surgery, however recovery rates can vary from patient to patient and greatly depend on the patient’s pre-operative function and health status.
POST-OPERATIVE LIMITATIONS:
Many patients will fully recover from Anterior Approach Hip Replacement Surgery within two weeks to two months. The majority of patients can return to their daily activities and fitness routine, as soon as they feel comfortable. In fact, with a “new and improved” hip, many patients are able to do exercises hadn’t been able to perform in years! Walking, hiking, bicycling, yoga and swimming are safe activities for most patients, however, running and high impact activities such as jumping should be avoided. Performing high impact exercise may prematurely wear out the hip implant or cause the implant to loosen from the bone.
If you have specific questions about what sports and activities are safe for you to participate in following your surgery, contact your surgeon for tailored instructions.
PHYSICAL REHABILITATION FOLLOWING SURGERY:
After Anterior Approach Hip Replacement Surgery an ongoing, formal physical therapy program is typically not needed. However, a physical therapist or care provider will show you simple exercises to do at home before you leave the hospital. Specific exercise programs will vary from patient to patient, however, exercises typically focus on strengthening the leg and hip muscles, improving flexibility and decreasing pain.
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