Anterior Hip Replacement
Anterior Hip Replacement is a minimally invasive hip surgery to replace the hip joint without cutting through any muscles. The surgical procedure involves a small incision in front of the hip, anterior, as opposed to an incision on the side or back of the hip. It is referred to as a muscle sparing surgery because no muscles are cut to access the hip joint enabling a quicker return to normal activity.
In order to understand anterior hip replacement and its benefits over traditional hip surgery, it is important to understand the normal anatomy of the hip.
- Normal Hip Anatomy
- Arthritic Hip
- Surgical Procedure
The thigh bone, femur, and the pelvis, acetabulum, join to form the hip joint. The hip joint is a “ball and socket” joint. The “ball” is the head of the femur, or thigh bone, and the “socket” is the cup shaped acetabulum.
The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.
The cartilage cushions the joint and allows the bones to move on each other with smooth movements. This cartilage does not show up on X-ray, therefore you can see a “joint space” between the femoral head and acetabular socket.
The pelvis is a large, flattened, irregularly shaped bone, constricted in the center and expanded above and below. It consists of three parts: the ilium, ischium, and pubis.
The socket, acetabulum, is situated on the outer surface of the bone and joins to the head of the femur to form the hip joint.
The femur is the longest bone in the skeleton. It joins to the pelvis, acetabulum, to form the hip joint.
The upper part is composed of the femoral head, femoral neck, and greater and lesser trochanters.
What is arthritis?
Arthritis is a general term covering numerous conditions where the joint surface (cartilage) wears out.
The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for a number of reasons; often the definite cause is not known.
When the articular cartilage wears out, the bone ends rub on one another and cause pain.
There are numerous conditions that can cause arthritis and often the exact cause is never known. In general, but not always, it affects people as they get older and is called Osteoarthritis.
Other causes include:
- Childhood disorders such as a dislocated hip, Perthe’s disease, or slipped epiphysis
- Growth abnormalities of the hip, such as a shallow socket, may lead to premature arthritis
- Trauma (fracture)
- Increased stress from overuse
- Avascular necrosis (loss of blood supply)
- Connective tissue disorders
- Obesity- the additional weight puts extra force through your joints which can lead to arthritis over a period of time
- Inflammation such as in Rheumatoid arthritis
In an arthritic hip:
- The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis.
- The capsule of the arthritic hip is swollen
- The joint space is narrowed and irregular in outline; this can be seen in an X-ray image.
- Bone spurs or excessive bone can also build up around the edges of the joint.
The combinations of these factors make the arthritic hip stiff and limit activities due to pain or fatigue.
Hip conditions should be evaluated by an Orthopaedic surgeon for proper diagnosis and treatment.
Your surgeon will perform the following:
- Medical History
- Physical Examination
Diagnostic Studies may include:
- X-rays: a form of electromagnetic radiation that is used to take pictures of bones.
There is no blood test to diagnose osteoarthritis.
Anterior Hip Replacement is a minimally invasive, muscle sparing surgery using an alternative approach to traditional hip replacement surgery. Traditionally, the surgeon makes the hip incision laterally, on the side of the hip, or posteriorly, at the back of the hip. Both approaches involve cutting major muscles to access the hip joint. With the anterior approach, the incision is made in front of the hip enabling the surgeon to access the hip joint without cutting any muscles. A special operating table is used that facilitates various anatomical positions enabling the surgeon to replace the hip joint anteriorly.
Potential benefits of anterior hip replacement compared to the traditional hip replacement surgery, may include the following:
- Smaller incision
- Minimal soft tissue trauma
- Reduced post op pain
- Less blood loss
- Shorter surgical time
- Faster healing time
- Less scarring
- Earlier mobilization
- Less post operative restrictions
- Reduced hip dislocations
- Decreased hospital stay
Anterior Hip Replacement is performed in a hospital operating room under general or regional anesthetic depending on you and your surgeon’s preference. You will be placed supine, on your back, on a special operating table that enables the surgeon to perform your hip replacement anteriorly. Fluoroscopic imaging is used during the surgery to ensure accuracy of component positioning and to minimize leg length inequality.
The surgeon makes one incision to the front of the hip, about 4 inches long. The surgeon then pushes the muscles aside to access the hip joint to begin the replacement. At no time during the surgery are any muscles cut.
The femur (thigh bone) is separated from the acetabulum (hipbone socket).The acetabulum (socket) is prepared using a special instrument called a reamer. The acetabular component is then inserted into the socket. This is sometimes reinforced with screws or occasionally cemented.
A liner, which can be made of plastic, metal or ceramic material, is then placed inside the acetabular component. The femur (thigh bone) is then prepared. The femoral head which is arthritic is cut off and the bone prepared using special instruments to exactly fit the new metal femoral component.
The femoral component is then inserted into the femur. This may be press fit relying on bone to grow into it or cemented depending on a number of factors such as bone quality and surgeon’s preference. The real femoral head component is then placed on the femoral stem. This can be made of metal or ceramic. The artificial components are fixed in place.
The surgeon withdraws the instruments and sutures the incision closed. The incision is then covered with a sterile dressing.
Post Operative Care
After surgery your surgeon will give you guidelines to follow. It is important that you follow your surgeons’ instructions for a safe and successful outcome.
Normally, after a traditional hip replacement, your surgeon would give you instructions on hip precautions to prevent dislocating the new joint. Hip precautions are very restrictive and usually include the following:
- Avoid the combined movement of bending your hip and turning in your foot.
- You should sleep with a pillow between your legs for 6 weeks.
- Avoid crossing your legs and bending your hip past a right angle.
- Avoid low chairs.
- Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes.
- An elevated toilet seat should be used.
For Anterior Hip Replacement patients, however, hip precautions are unnecessary. Because the muscles are not cut, the risk of dislocation is greatly lessened enabling the patient much more freedom of movement after surgery. Rehabilitation is much faster for patients as well due to less muscle trauma during the surgery.
Common post-operative guidelines after Anterior Hip Replacement include the following:
- You may bend your hip immediately after surgery and bear full weight when comfortable.
- Your surgeon will prescribe pain medications to keep you comfortable at home.
- Keep the incision clean and dry. You may shower once the dressings are removed unless otherwise directed by your surgeon.
- You will be given specific instructions regarding activity and rehabilitation. You will not have to follow standard hip precautions.
- Physical therapy will be ordered to restore normal hip function and strength.
- If you have increasing redness or swelling in the wound or temperatures over 100.5˚ you should call your doctor.
- If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent infection in your new prosthesis. Consult your surgeon for details.
- Your hip replacement may go off in a metal detector at the airport.
- Eating a healthy diet and not smoking will promote healing.
Risks and Complications
As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.
It is important that you are informed of these risks before the surgery takes place.
Complications can be medical (general) or specific to hip replacement surgery.
Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:
- Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission
- Heart attacks, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.
The majority of patients suffer no complications following Anterior Hip Replacement, however, complications can occur following Hip surgery and include:
- Infection: Infections can occur superficially at the incision site or in the joint space of the hip, a more serious infection.
- Fractures: This is rare but can occur during or after surgery. This may prolong your recovery or require further surgery.
- Nerve damage: Trauma to nerves may be temporary or permanent and can cause numbness, tingling, pain, and weakness.
- Hemarthrosis: A condition caused by excess bleeding into the joint after the surgery is completed. This may require additional surgery to irrigate the joint and evacuate the blood.
- Blood clots (Deep Venous Thrombosis or DVT): A DVT can form in the calf muscles and can travel to the lung, a life threatening condition called pulmonary embolism. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
- Leg length inequality: It is very difficult to make the leg exactly the same length as the other one. The Anterior approach for Hip Replacement can improve this outcome however, there are some occasions when it is simply not possible to match the leg lengths. All leg length inequalities can be treated by a simple shoe raise on the shorter side.
- Wound irritation: Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint
- Wear: All joints eventually wear out. The more active you are the quicker this will occur. In general 80-90% of hip replacements survive 15years.
- Failure to relieve pain:This is rare but may occur especially if some pain is coming from other areas such as the spine.
Risk factors that can negatively affect adequate healing after hip replacement include:
- Poor nutrition
- Age (over 60)
- Chronic Illness
- Steroid Use
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Houston Hip Specialists
Advanced Orthopedics and sports medicine has numerous Board Certified/Eligible physicians who are thoroughly educated in the latest treatment techniques both surgical and conservative. They are well versed in advances in hip treatments including arthroscopic labral repairs, minimally invasive anterior hip replacement, total and partial hip replacements.
Drs Elbaz and Brooks now perform Platelet-Rich Plasma (PRP) injections for the treatment piriformis syndrome, greater trochanter bursitis, ischial bursitis, sacroiliac joint pain and hamstring tendonitis/tears. PRP stimulates a more rapid healing of tendon, ligament, muscle and bone.
Contact us today to Schedule an Appointment or call us at 281-955-2650 to learn more about our Shoulder Treatment Services.
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I had been in so much pain with my back for years. It got so bad that I knew I had to do something. I went to Dr Mohr for help. I was so afraid to have spine surgery as I had heard so many horror stories. He and his staff were very informative. I was amazed at the new technology in spinal surgery. December 8, 2016 I had rods and pins put in my back. I am so happy I did now. I am healing really fast and the pain is going away as my body heals. Thank you Dr Mohr for you expertise and sensitive nature. You were understanding about my fear and helped assure me so I could receive the help I needed. You are an excellent Doctor.
I have been a patient of Dr. Cubbage for several years. Each time of go there, he always presents a thorough plan of care. From ordering the most appropriate diagnostic tests to making sure you understand each step of his plan of care. He consistently instills confidence that you are the road to recovery.
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I would highly recommend Dr. Cubbage if you are having any type of spinal issues. I have seen Dr. Cubbage several times over the last 3 years for lumbar pain and numbness in my left leg. Dr. Cubbage explained my diagnostic results in such a way that it was easy for me to understand. He patiently answered all my questions and explained my options. Fortunately, Dr. Cubbage has been able to manage my pain with conservative treatment but know surgery is inevitable. When that time comes, I would choose no other than Dr. Cubbage! And it’s a plus that he has such a kind and caring staff.
For the first time in many years and many knee operations on one leg I am without any knee pain. This is a result of a procedure performed by Dr. Patel.
I made an appointment to see Dr. Patel on the recommendation of Dr. Tanous following knee replacement and several months of continued pain. Dr. Patel explained the procedure to me and explained how we would proceed. The first procedure was to determine if I would be a good candidate for the second procedure. After the first procedure my pain was anywhere from 0 and 5. Dr. Patel explained to me at follow-up that I was not a good candidate for the second procedure due to my pain level being above the 0 to 3 level. After talking for a while I said “any relief would be better than the pain I had been having.” With this it was agreed that I would have the second procedure. It has now been 6 days since the procedure and I am without any pain.
I realize this is only a few days of not being able to sleep, with a pillow between my knee or under my leg at night. I know the pain may come back at anytime but until then it has been well worthwhile. I hope it will last 6 months, if not, I will have the procedure again after 6 months.
Thank you Drs. Patel and Tanous.
Outstanding Physicians. I’ve had two surgeries here, one on my foot with Dr. Bacon, and an extensive back surgery with Dr. Cubbage. I’m new to the area and my wife found me these surgeons. I have to say that each surgery I’ve had with these physicians have had excellent results. I was very pleased with my foot surgery and decided to see Dr. Cubbage for my back. Other surgeons I’ve seen regarding my back only gave me a 50/50 success rate. I have to say, the low back surgery with Dr. Cubbage was like a miracle. Right away, I noticed a difference and I’ve continued to improve rapidly. I’m almost eight weeks out and I haven’t felt this good in years. I’d like to thank Dr. Stacy Bacon for my foot surgery and Dr. Matthew Cubbage for my low back surgery. Without these drastic results, I’d not be walking today. Thank you all very much and I highly recommend your services. God bless you all.
Dr. David R. Mack replaced my right hip in June 2009, and my left in October 2010. I am already able to go places and do things on my own again. His excellent staff are very caring and helpful throughout the entire process, including recovery. The out-patient therapy is the best. I am walking very well now and am very pleased to have my life back. Thank you so much Dr. Mack and your great staff! Sincerely,
Dr. Bacon, I can never thank you enough for what you have done for me and for my daughter, Melia. In 2011, on the first anniversary of my surgery, my wife and I walked for two hours on Copacabana beach in Rio. I also completed a four hour nature walk over rough terrain in The Falklands and hiked to del Fin del Terre at the tip of South America. You are truly a great doctor, and I thank God every day for you and for Dr. Fogarty who recommended you for Melia’s surgery.
When I started, I couldn’t put any weight on my right leg and now I can do virtually anything. While I hope to not need future therapy, this is without a doubt the place I will return to in the future.
It has been eight weeks since my partial knee replacement and now I realized just how much I was missing. Having it done has made such a difference to my life. For a start my leg is now straight and my knees actually touch! I have started walking and even plan to ride my bike. The most thrilling part is that I am playing and dancing with my grandchildren again.