My Thoughts on Anterior Hip Replacement
There has been, in the last 12 months or so, a wave of media hype about anterior hip replacement surgery. While this is a good approach it must be recognised that it has advantages and disadvantages, and it is not indicated for all patients.
The anterior approach utilises a tissue plane between muscles towards the front of the thigh as opposed to the posterior approach which passes through the buttock muscle. Associated with this muscle sparing approach is a potential for less post-operative pain and a better early recovery. The late results (after 3 months) have not been proven to be better than posterior surgery. It has been suggested that the anterior approach may be associated with a lower dislocation rate although this is yet to be proven. Because of the direction of the approach and the possibly improved stability with anterior surgery, the usual post-operative restrictions after a hip replacement are not usually necessary. These restrictions include things like being carful getting up from low chairs, the toilet and the car seat.
Potential disadvantages of the anterior approach include:
higher rate of fracturing the thigh bone during surgery – requiring plates or cables to fix the fracture
a scar that is towards the front and is more visible to the patient and generally does not heal as nicely
risk of damaging branches of a sensory nerve to the outer thigh resulting in outer thigh numbness (reported in up to 30% of patients)
The anterior approach must also be used with caution in obese patients, very muscular patients and patients with a short femoral neck (the part of the thigh bone that joins the ball to the main bone). It is also a less versatile approach for revision surgery.
I think anterior approach surgery is a good operation in the correctly selected patient but it must be appreciated that no particular operation is without risks specific to that approach and these must be decided on a case by case basis. The media commonly reports on the positive aspects of a new procedure but often fails to appreciate its specific draw backs and limitations and you need to discuss this with your surgeon.
If you would like to talk to me about anterior hip replacement surgery please contact my rooms on 5438 8900.
