Anterior Approach to Total Hip Replacement

Additional Information by
Alec E. Denes, M.D.

The anterior approach is a surgical technique to replace the hip joint from the front of the hip joint as opposed to a lateral (side) approach to the hip or posterior (back) approach.
Rehabilitation is accelerated and hospital time decreased because the hip is replaced without detachment of muscle from the pelvis or femur. Using the anterior approach, the hip is replaced through a natural interval between muscles; the most important muscles for hip function, the gluteal muscles that attach to the posterior and lateral pelvis and femur, are left undisturbed.

Lack of disturbance of the lateral and posterior soft tissues also accounts for immediate stability of the hip and a low risk of dislocation. Following the anterior approach, patients are immediately allowed to bend their hip freely and avoid most restrictions. They are instructed to use their hip freely. Additionally, if patients are sexually active before surgery, there are no limitations on resumption of normal sexual activity after surgery.

A potential advantage of the anterior approach is that for patients who require bilateral hip replacement, this can be performed during a single operative session. With the patient in the supine position (as opposed to lateral with standard techniques) both hips are simultaneously prepared and then the hips replaced successively. The muscle preservation and absent post-operative restrictions also makes bilateral replacement more possible. However, this is only appropriate for younger, active, and healthy patients. I can discuss this with you personally, but typically I recommend doing the two surgeries separately, about six weeks apart.

The normal incision is about 4 inches but may vary (shorter or longer) according to a patient's body size. Though small incisions are often considered desirable by patients, it should be kept in mind that the degree and type of tissue disturbance beneath the skin is a more important factor. Incisions of adequate length allow the necessary side-to-side separation of the incision without undue force. Too small an incision can be more traumatic to the tissues, particularly to muscles that can be damaged by stretching too hard. With the anterior approach the patient lies supine (on their back) during surgery. X-rays taken during surgery with a fluoroscope ensure correct position, sizing and fit of the artificial hip components, as well as correct leg length.

The anterior approach does not limit the patient's and surgeon's options regarding type of hip prosthesis. Hip prostheses that are implanted with or without cement are applicable as well as all modern bearing surfaces including ultra-high density polyethylene, metal and ceramic. Surface replacement arthroplasty is also possible through the anterior approach.

Possible complications of anterior hip replacement surgery include infection, injury to nerves or blood vessels, fractures, hip dislocation and the need for revision surgery.

Evaluation and treatment by a physical therapist begins in the hospital a few hours after surgery and leads to walking and functional activities. Patients may go home after achieving an initial degree of independence in walking with crutches or a walker, as well as capabilities in basic day to day activities, including stairs.  Most patients with surgery scheduled in the morning are able to go home the same day.  Patients with significant health issues or with an afternoon surgery time are typically monitored in the hospital overnight, and are discharged the day after surgery.