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A new approach to hip replacement

Kinder, Gentler, Less Painful with a Quicker Recovery

Craig Mines, MD.

Over the past two decades the number of Americans having total hip replacement has doubled, to more than 300,000 a year. This trend is expected to continue as the baby boomer generation ages. Though most patients eventually walk again without pain or the use of a cane, traditional hip replacement recovery and rehabilitation can be rigorous, painful, and lengthy. Because of this many people with hip arthritis will delay surgery and choose to live in pain with disabilities. This fear and avoidance of hip replacement surgery often leads to a diminished quality of life.  

Now with a new approach to hip replacement, the Anterior hip replacement, patients with painful, activity limiting hip arthritis, are choosing to proceed with surgery and regain their mobility and independence from pain.  

Hip replacement surgery is extensive. As the name suggests, it involves removing the joint, the damaged bone and cartilage, and replacing the diseased ball and socket with artificial parts made of metal, plastic, and ceramics. Typically, hip replacement surgeons enter the joint from the rear, the posterior or lateral approach. This requires cutting through muscle, tendons, and ligaments. But with the anterior approach, the hip surgeon enters the joint from the front of the hip. This requires only spreading and stretching of the muscles and tendons. There is no cutting of normal tissues. By pushing the muscles aside rather than cutting them, postoperative pain can be minimized and time to recovery greatly decreased. According to well-respected research of the Anterior Hip Replacement, the benefits are substantial.

Dr. Mines, Board Certified Orthopedic Surgeon, has been performing hip replacement surgery for over 15-years and has been using the anterior techniques for the past few years. He is one of the few surgeons in Georgia trained to perform the Anterior Hip Approach and is pioneering this technique as the first and only Orthopedic surgeon currently performing this cutting edge surgery at Eastside Medical Center. “Patients used to be in severe pain after a hip replacement and would need substantial amounts of pain medicine. This came along with side effects such as nausea and vomiting which can lead delayed recovery and longer hospital stays,” says Dr. Mines. He also states “now patients can get up and walk the day of surgery. They can go home in only 1-2 days, rather than the traditional week it took after a posterior hip replacement”.  “My patients are much happier that they can more rapidly return to their normal active lifestyles.” 

When asked why all surgeons haven’t changed to this technique, Dr. Mines notes that “as with many medical advances, some surgeons are reluctant to change. The Anterior Approach hip replacement is not the way most American orthopedists were trained.  Learning a new technique takes effort and time to master. There is a learning curve that has kept many surgeons from transitioning to the Anterior Approach.”  

Dr. Mines feels that the benefits to his patients offered by the Anterior Hip Replacement have been worth learning this advanced surgical technique. Research has shown decreased pain medicine use and earlier discharge from the hospital. Anterior hip replacement also offers patients quicker return to full function and decreased complication rates when compared with traditional hip replacements. “I have seen my patients walking normally without a walker or cane in days to a few weeks rather than months with the typical posterior surgery”, says Dr. Mines. Complications can occur with any surgery.  

Hip replacement complications such as limping, leg length discrepancy, and hip dislocation have been shown by research to be minimized with the Anterior Approach when compared to patients undergoing traditional posterior hip surgery. Dr. Mines states, “Anterior Hip replacement allows the surgeon to more accurately place the prosthetic components during the surgery, this has been documented by research.

”During Anterior Hip Replacement the surgeon uses a live view x-ray machine called a Fluoroscope and you can watch live as the hip replacement pieces are placed in the patient. This cannot be easily done with any other hip replacement surgery. “We can fine tune and adjust the position and alignment of the hip to match the patient’s other side and accurate placement of the hip components leads to the long term success of the operation.” 

Which Patients are candidates for an Anterior Approach Hip Replacement?

“Most patients with osteoarthritis or rheumatoid arthritis are excellent candidates for this advanced surgery,” states Dr. Mines. There is a small group of patients with significant deformity of the hip or who are substantially overweight who can present increased challenges with the anterior approach. The procedure is available for all age groups and can be preformed in all types of patients safely. Dr. Mines notes, “only your surgeon can determine if you are a good candidate for an Anterior Hip.”

Potential benefits of Anterior Hip Replacement compared to traditional hip replacement surgery may include the following:

Smaller incision
Minimal soft tissue damage
Reduced post op pain
Faster healing time
Earlier mobilization
No post operative restrictions
Decreased hospital stay
Reduced complications such as dislocation, limp, unequal leg length

Normally, after traditional hip replacement, your surgeon would give you hip precautions and activity restrictions to prevent dislocation of your new joint. 

Hip precautions are very restrictive and can include the following:

You should sleep with a special 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
An elevated toilet seat should be used
Avoid squatting and stooping forever

For Anterior Hip Replacement patients, however, hip precautions are unnecessary. This is because the muscles, tendons, and ligaments are not cut and the risk of dislocation is greatly decreased.  This enables the anterior hip replacement patient much more freedom of movement after the surgery. Rehabilitation is much faster for these patients as well due to less muscle trauma during surgery.  Dr. Mines says, “Success of the hip replacement equals a happy patient with a quick return to a better quality of life.”