“Hip Arthroplasty” or “Hip Replacement”refers to the surgical reconstruction or of the hip with a ceramic on plastic or metal on plastic artificial joint.
Direct anterior total hip arthroplasty or replacement is a minimally invasive hip replacement performed to replace the total hip joint without cutting through any muscles. It is also referred to as muscle sparing surgery because no muscles are cut enabling a quicker return to normal activity and preserving the overall stability of the hip joint.
Traditionally with total hip replacement, the surgeon makes the hip incision laterally, on the side of the hip, or posteriorly, at the back of the hip. Both approaches involve cutting major muscles to access the hip joint. With the direct anterior approach, the incision is made in front of the hip enabling the surgeon to access the joint without cutting though any muscles.
Hip replacement is indicated in patients with arthritis of the hip joint.
Arthritis is a condition in which the articular cartilage that covers the joint surface is damaged or worn out causing pain and inflammation. Some of the causes of arthritis include:
Patients with arthritis may have a thinner articular cartilage lining, a narrowed joint space, presence of bone spurs or excessive bone growth around the edges of the hip joint. Because of all these factors arthritis patients can experience pain, stiffness, and restricted movements. This impacts their ability to walk and climb stairs. As the joint gets stiffer many patients are unable to put on their shoes and sock. Often the pain is referred to the knee and it is not uncommon to have more knee than hip pain. In the final stages of the disease patients will often wake up at night from the pain or will develop back pain because the stiff hip puts additional strain on the back.
After discussing your symptoms Dr. Boettner and his team will carefully exam your hip to identify any limitations of its movement from the arthritis. While an x-ray is very helpful in evaluating the overall extend of arthritis the clinical symptoms and the degree of stiffness are often more important for the decision to move on with a hip replacement.
We use special implants for anterior surgery. Usually they are shorted and curved which makes it easier to insert them into the femur from the front. Some modifications are required to insert straight stems or use cemented fixation.
Direct anterior total hip replacement surgery involves the following steps:
Using an image intensifier allows Dr. Boettner to accurately position the cup. An excellent cup position is important to optimize range of motion, decrease the risk of dislocation and minimize plastic wear.
Using the C-arm x-ray Dr. Boettner is also able to judge how much anteversion the cup has, which is crucial for the overall stability of the new hip.
X-ray is also used to verify the stem position in the femur. This makes sure the appropriate size of the femur is choosen.
The x-ray also allows Dr. Boettner to accurately check your leg lengths. This minimizes the risk of lengthening your leg during the procedure.
With all implants in place a final check is performed to make sure everything is perfect.
The final image shows a well positioned total hip. The use of intraoperative imaging makes it easier for the surgeon to position your hip and make sure your leg length is restored. This does directly affect your postoperative function and overall satisfaction with the procedure. The incision is closed with intracutaneous stitches and you can shower when you get home.
After traditional hip replacement surgery, you would be instructed to follow hip precautions to prevent your new hip from dislocating. These guidelines are very restrictive and include no bending or flexing the hip past 90 degrees, no crossing of legs, use a pillow between the legs when sleeping, and use an elevated toilet seat.
With the anterior approach you will not have to follow standard hip precautions.
Dr. Boettner will however give you instructions to be followed at home for a faster recovery. These include:
Contact your doctor if you observe drainage from the incision or a fever. You can drive and return once you are comfortable. Usually patients are able to drive by 2 weeks and return to work depending on the job between 7 and 28 days after surgery.
Out of state patients:
You can fly home after you are discharge from the hospital. Most patients that are operated on Friday will fly back Tuesday. Please discuss this with Dr. Boettner. He will give you stronger blood clot prophylaxis on the day you fly and give you special instructions for getting through the airport. Some patients decide to stay in New York for 2 weeks to do their rehab and have the final check up with Dr. Boettner before they leave.
Risks and complications
All surgeries carry an element of risk whether it is related to the anesthesia or the procedure itself. Risks and complications are rare but can occur. Below is a list of complications that can occur following anterior hip replacement procedure: