What is the direct anterior approach for a hip replacement?
Dr. Rupesh Tarwala is an orthopaedic surgeon practicing in Bronxville, NY. Dr. Tarwala specializes in the diagnosis, treatment, and rehabilitation of injuries, diseases and disorders of the body's musculoskeletal system. As an orthopaedic surgeon, Dr. Tarwala tends to bones, ligaments, muscles, joints, nerves, and tendons.... more
Hip Replacement: What is the direct anterior approach?
A 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 that 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 the back). The traditional approach for a hip replacement is going from the back or from the side needing to detach or cut one or a few muscles around the hip joint.
In the last few years, the anterior approach has gained a lot of popularity because of its tissue-sparing nature and accelerated recovery. This technique allows the surgeon to work between the muscles to gain entry to the hip joint without detaching or cutting them. This provides the potential for less pain after the operation and a faster recovery. The other potential benefit of the 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 the supine position (lying on back). An intraoperatively C-arm can be used to check the alignment of implants and leg length. Overall, whichever approach the surgeon uses for accessing the hip joint, the most important thing is correct implant positioning and alignment which is crucial for the long-term survival of the operation.
