Anterior Hip Replacement
Mr Andrew Chia is an Instructional Consultant for the M.O.R.E. Institute Switzerland on anterior total hip replacements.
What is an anterior hip replacement?
A hip replacement is an operation performed to replace a worn-out hip joint. The diseased joint and bone is removed and a new ball and socket joint is inserted. There are many different types of artificial joints available, all made from different materials and offering different bearing surfaces. Your surgeon will often discuss the options available and what his or her preferences are.
When having a hip replacement, a very important consideration is the method used by your surgeon to insert the artificial joint. An anterior approach is a method of inserting the artificial joint through the front (i.e. anterior) without cutting any muscles or damaging nerves. All other common approaches (i.e. lateral and posterior) involve cutting muscles or tendons. This can result in limping and dislocations.
The anterior approach is performed through a small incision with no muscle damage. This is advantageous for the active patient as recovery tends to be quicker with less pain and no limp. There are no restrictions on activities after the operation with an anterior approach hip replacement.
What are the symptoms of joint damage requiring a hip replacement?
Most patients complain of pain in the groin, but pain may also radiate to your lower back or buttock, and also down to your knees. The pain is often made worse with walking. Daily activities such as putting on shoes and socks, going up and down stairs, getting up from chairs, driving, and walking around the block or shopping centre become more and more difficult. Some patients also have the sensation of ‘grating’ in the hip and develop pain at night.
How is osteoarthritis diagnosed?
A well-trained doctor or other paramedical professional will suspect osteoarthritis based on your symptoms and a thorough examination of your hip. A simple X-ray is often enough to confirm the diagnosis. Occasionally, a CT scan with 3D reconstruction or MRI may be required if the diagnosis is unclear with plain X-ray alone. Not all of these tests are required to confirm the diagnosis.
What are the causes of osteoarthritis?
Most commonly, osteoarthritis is due to ‘wear and tear’ of the joint as we age. It may also develop secondary to other conditions such as rheumatoid arthritis (or other inflammatory arthritis), hip dysplasia, Perthes disease, slipped upper femoral epiphysis, trauma and fractures.
More recently, femoral acetabular impingement (FAI) has been suggested as a cause of premature osteoarthritis. This may be the reason we see younger and younger patients developing arthritis.
Is it osteoarthritis dangerous?
Osteoarthritis is not life-threatening, but can severely impact your quality of life and function. The activities of daily living, which most take for granted, become increasingly difficult.
What is the treatment for osteoarthritis?
In the early stages of osteoarthritis, pain killers, physiotherapy and weight loss are effective. As the hip joint continues to wear out, these modalities becomes less and less so. When the symptoms begin to interfere with your function or lifestyle, the most effective treatment is a total hip replacement. A total hip replacement provides the most reliable and consistent results with respect to pain minimisation and return of function. The anterior minimally invasive surgical technique is an effective method of performing a total hip replacement.
When can I walk after an anterior total hip replacement?
Full weight-bearing and walking is allowed immediately after an anterior hip replacement. Initially, this will be aided by crutches. Most people will walk independently by 10-14 days postoperatively.
When can I drive after an anterior total hip replacement?
The Arthroplasty society acknowledges that driving is an important part of people’s lives and day-to-day activities. A patient should not return to driving after a hip or knee replacement until they can safely perform an “emergency stop” and they no longer require regular narcotic analgesia. The ability to perform an emergency stop varies between patients, but in most cases occurs between 4 and 6 weeks following a right leg hip or knee replacement. Licensing authorities do not specify specific driving restrictions after hip or knee replacement and require patients to seek advice directly from their treating surgeon as to when it is safe for them to drive.
When can I work after an anterior total hip replacement?
Your return to work will vary depending on the procedure performed and type of work you are engaged in. Most people can return to office work within 2 weeks. Labour intensive work however, may require you to take 4-6 weeks before returning to full duties.
When can I play after an anterior total hip replacement?
Low impact activities, such as cycling and swimming, can be commenced from week 6. High impact activities, such as running, or excessive twisting such as during tennis or golf, are best avoided for 12 weeks after surgery.
How long will I take to heal after an anterior total hip replacement?
The wounds take 7-10 days to heal. Most patients improve dramatically in the first 6 weeks. Occasionally, there are periods where the hip may become sore and then settle again. This is part of the normal healing process. It takes three months for your hip to fully recover from a hip replacement. Continued improvements may be gained up to 1 year post-surgery.
How much pain will I experience after an anterior total hip replacement?
Most patients are pleasantly surprised at how little pain they have after surgery. A local anaesthetic is injected around the wound during the procedure and a local anaesthetic catheter is placed in the wound after the procedure to minimise any pain you may experience. In combination with the muscle sparing anterior approach, this allows most patients to walk within a few hours after surgery.
How long will the prosthesis last after an anterior total hip replacement?
Older generation prostheses have a greater than 90% 15-year survival rate. The newer implants should have similar if not better results. A ceramic-on-ceramic bearing surface has minimal wear and should theoretically last a lifetime.
What are the risks of having an anterior total hip replacement?
Complications are not common, but can occur. Prior to making any decision to have surgery, it is important that you understand the potential risks so that you can make an informed decision on the advantages and disadvantages of surgery. The following list is by no means exhaustive, so it is important to discuss your concerns with your surgeon.
It is quite normal to experience some swelling and discomfort in the leg, thigh and buttock region after surgery. This is expected and will also resolve with time. Some patients occasionally report numbness or tingling in the outer thigh or around the wound. This usually resolves or reduces with time, but occasionally, it may be permanent. The altered sensation arises from a specific sensory skin nerve over the wound and does not compromise the THR, muscles or hip stability in any way. Surgical risks specific to hip replacements include fractures, dislocations, prosthesis loosening, nerve or vascular injury, ligament injury and stiffness.
Other general surgical risks include risk of infection, bleeding and clots in the leg (DVT) or lung postoperatively.
Apart from surgical risks, medical (including allergies) and anaesthetic complications can occur, and these can affect your general well being and health.