Hip Replacements: What Is The Anterior Approach?
Hip replacement is a commonly performed procedure for painful bone-on-bone hip arthritis. Arthritis can be osteoarthritis (wear-and-tear type), rheumatoid arthritis (inflammatory), post-traumatic, avascular necrosis or others. Hip replacement is a surgical procedure in which the damaged socket (acetabulum) is reamed and the damaged head part (femoral head) is removed and replaced with an artificial joint. The artificial joint contains a ceramic ball on a prosthesis which moves inside a plastic liner (highly cross-linked polyethylene) which is fitted inside the titanium cup.
The procedure can be performed by approaching the hip joint either: anterior (front), lateral (side) or posterior (from back) (see figure). Traditional approach for the hip replacement is going from the back or from side, requiring the surgeon to detach or cut one or more muscles around the hip joint.
In the last few years, anterior approach has gained lot of popularity because of its tissue-sparing nature and accelerated recovery. The technique allows the surgeon to work between the muscles to gain entry to the hip joint without detaching or cutting them. This provides potential for less pain after the operation and faster recovery. The other potential benefit of anterior approach is less dislocation risk as the muscles are intact. Leg length can be easily checked and matched to equal as the patient is in supine position (lying on back). Intraoperatively, a C arm can be used to check alignment of implants and leg length.
Overall, whichever approach the surgeon uses for approaching the hip joint, the most important thing is correct implant positioning and alignment, which is most important for long-term survival of the operation.
Dr. Rupesh Tarwala, MD is a highly experienced orthopedist specializing in hip surgery. Dr. Leon Popovitz and Dr. Michael Mizhiritsky, along with their team of best-in-class orthopedic physicians, are known for their exemplary orthopedic surgical skill and best-rated physical medicine and rehabilitation program. This, along with their top in-office physical therapy and long-term sports rehabilitation processes, leads to athletes of all levels returning to their top physical potential. Contact us today to schedule a consult!
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