Anterior Approach Hip Replacement
What is the Direct Anterior approach?
The direct anterior approach (DAA) is a technique for performing hip replacement surgery using an incision on the front of the thigh. This allows access to the hip joint by going between the muscles at the front of the thigh, without the need to cut any muscles or tendons. The location of the scar and path between the muscles is shown on the images below.
What are the benefits of Anterior approach hip replacement?
As there is less damage to your muscles, early recovery from surgery is faster with anterior approach hip replacement. Most patients can go home after 1-2 nights in hospital, compared to 2-3 nights for conventional hip replacement. Balance and co-ordination also improve faster, and most patients will not require crutches or walking aids after 2 weeks. By 6 weeks post-surgery, there is little difference in mobility.
Anterior approach also has the lowest dislocation rate for any hip replacement technique. The dislocation rate is 0.2 – 0.5% compared to 1% for traditional hip replacement. Because of the location of the scar, patients will not need to follow any “hip precautions” after surgery. You will be allowed to sit in a normal chair, bend down to tie shoelaces as soon as comfortable and sleep in the position that is most comfortable for you.
Are there any risks with Anterior approach hip replacement?
Modern hip replacement surgery is generally a safe procedure with low risk of serious complications. Most complications that do occur are not related to the surgical approach. The main risks of surgery to be aware of include: bleeding, infection, blood clots (DVT or pulmonary embolus), dislocation, leg length difference, nerve injury, fracture and requirement for re-do (revision) surgery.
There are some risks that are specific to or more likely with the anterior approach. These include:
Lateral femoral cutaneous nerve injury. This is a small nerve that supplies feeling to the skin on the upper / outer part of your thigh. This nerve runs near or across the area of the surgical scar and can be stretched or cut during surgery. This can cause numbness in the outer thigh, which usually resolves or becomes less noticeable with time. Very rarely nerve pain (neuralgia) can develop, which may take several months to resolve.
The risk of thigh bone (femoral) fracture is also slightly higher with this approach. Fracture is still very unlikely with a risk of less than 0.5%. This problem mainly occurs in patients who have surgery performed on a traction table. Mr Gormack uses a technique in which a traction table is not required.
Is The Anterior approach suitable for all patients?
Currently the anterior approach is not available for all patients. The best candidates for this surgical approach are slim with an appropriate shape to their hip joint. As this is a minimally invasive approach, if you are very muscular or overweight, it may not be possible to place the implants for your new hip through the anterior approach. Also, some people with very severe arthritis, those with significant deformity of the hip joint are not able to have surgery via the anterior approach. Mr Gormack will make the final determination of whether he can safely perform your surgery via the anterior approach after meeting you and reviewing your x-rays.
Why don’t all surgeons offer anterior approach hip replacement?
The anterior approach is a newer technique for performing hip replacement surgery. Over the last 5-10 years it has become mainstream through large parts of Europe and America. It requires advanced training, and the use of specialty equipment. As a result the operation can sometimes take longer than traditional hip replacement surgery. Many surgeons in New Zealand have not had exposure to the anterior approach and have not undertaken the required training to be able to offer this as an option.
Does Anterior approach hip replacement lead to better long-term results?
There is no evidence to suggest that the anterior approach leads to better long-term results. Beyond six weeks post-surgery mobility and pain levels should be similar regardless of the surgical approach used by your surgeon.
Who will decide whether I should have an anterior approach?
The decision as to which surgical approach is most appropriate will be made after your consultation with Mr Gormack, and discussion about your individual case and requirements. If you are not able to have surgery using the anterior approach, Mr Gormack also offers an alternative minimally invasive option called the direct superior approach.