Anterior Hip Replacement

Total hip replacement is a common orthopaedic procedure. As the population ages, it is expected to become even more common. Hip replacement surgery involves removing the head of the thighbone (femur) and replacing the ball-and-socket mechanism of the hip with artificial implants. This relieves pain and improves mobility.

Muscle sparing, anterior hip replacement allows Dr. Alex to perform the hip replacement through a small incision near the groin. A “natural interval” between muscles is utilized to reach the ball-and-socket joint without cutting muscles or tendons. Patients usually have less pain compared with traditional hip replacement surgery, and rehabilitation is faster. Studies have shown fewer signs of muscle damage, patients will often have less pain that routine, or posterior, hip replacement surgery; and they will recover faster.

Osteoarthritis and Hip Replacement

Osteoarthritis of the hip is the most common reason for hip replacement. Osteoarthritis is caused by the wear and tear of aging. It causes the cartilage covering the joint surfaces to wear out, resulting in bone spurs, pain, stiffness, and loss of motion.

Other conditions that can cause destruction of the hip joint include loss of the blood supply to the head of the thighbone (osteonecrosis), rheumatoid arthritis, injury, infection, and developmental abnormalities of the hip. Patients with arthritis may also have brittle bones (osteoporosis), but there is no direct relationship between bone density and the development of arthritis of the hip.

Symptoms

Hip arthritis typically causes pain that is dull and aching. The pain may be constant or it may come and go. Pain may be felt in the groin, thigh, and buttock, or there may be referred pain to the knee. Walking, especially for longer distances, may cause a limp.

Some patients may need a cane, crutch, or walker to help them get around. Pain usually starts slowly and worsens with time and higher activity levels.

Patients with hip arthritis may have difficulty climbing stairs. Dressing, tying shoes, and clipping toenails can be difficult or impossible. Pain may also interfere with sleep.

See your doctor to diagnose hip arthritis. The doctor will inquire about your symptoms and perform a physical examination. X-rays may show loss of the cartilage space in the hip socket and a “bone-on-bone” appearance. Bone spurs and bone cysts are common.

Sometimes, the doctor may recommend additional tests to confirm the diagnosis. Additional testing such as magnetic resonance imaging (MRI) or computed tomography (CT) scans are rarely required to make the diagnosis of osteoarthritis. However, in some cases advanced imaging studies are important.

Treatment for Osteoarthritis

Nonsurgical Treatment

For hip arthritis, the first treatment a doctor may recommend is an over-the-counter, anti-inflammatory medication, such as ibuprofen, or naproxen. Some nutritional supplements, including glucosamine, may also provide relief. Exercises and physical therapy may help improve function, increase strength, and reduce stiffness.

For patients with more advanced arthritis, the use of a cane opposite the affected hip can help transfer weight away from the painful hip, and improve walking ability. A walker can also be used. Arthritis, however, is progressive. Even with treatment, it will worsen over time. Weight loss can help decrease stress on all of the joints.

Surgical Treatment

Pain and mobility may worsen with hip osteoarthritis, even when all of the recommended nonsurgical treatments have been tried. If this happens, the doctor may recommend surgery. Surgical options include:

  • Arthroscopy
    Arthroscopy of the hip is a minimally invasive, outpatient procedure that is relatively uncommon. The doctor may recommend it if the hip joint shows evidence of torn cartilage or loose fragments of bone or cartilage.
  • Osteotomy
    Candidates for osteotomy include younger patients with early arthritis, particularly those with an abnormally shallow hip socket (dysplasia). The procedure involves cutting and realigning the bones of the hip socket and/or thighbone to decrease pressure within the joint. In some people, this may delay the need for replacement surgery for 10 to 20 years.

Types of Hip Replacement:

Anterior Hip Replacement Using a Muscle Sparing Minimally Invasive Approach
Minimally invasive hip replacement surgery allows the surgeon to perform the hip replacement through a single small incision 4-6 inches in length in the front of the hip, near the groin.

Anterior muscle sparing total hip replacement surgery is available to most hip replacement candidates. Prior surgery or deformities in the hip are important to share with your doctor to help make an informed decision.

Before you decide to have an anterior minimally invasive hip replacement, get a thorough evaluation from your Surgeon. Discuss with him or her the risks and benefits. Anterior muscle sparing, minimally invasive hip replacement procedures are technically demanding. They require that the surgeon and operating team have considerable experience. Dr. Alex and his team at Steamboat Orthopaedic & Spine Institute, and the Yampa Valley Medical Center have the most experience in Northwest Colorado for anterior hip replacement surgery.

Technique

The surgical procedure is similar, but because of the natural interval in the front of the hip, no muscles have to be cut. There is less soft-tissue disruption and trauma caused by the surgery. A single minimally invasive hip incision may measure only 4 to 6 inches. It depends on the size of the patient and the difficulty of the procedure.

The implants used for minimally invasive, anterior muscle-sparing hip replacement surgery are the same as those used in traditional hip replacement surgery. Specially designed instruments are needed to prepare the socket and femur and to place the implants properly

Once the joint has been opened up and the joint surfaces exposed, the surgeon removes the ball at the top of the thighbone, or femur. The hip socket is prepared by removing any remaining cartilage and some of the surrounding bone. A cup-shaped implant is then pressed into the bone of the hip socket. It may be secured with screws. A smooth plastic bearing surface is then inserted into the implant so the joint can move freely.

Next, the femur is prepared. A metal stem is placed into the femur to a depth of about 6 inches. The stem implant is either fixed with bone cement or is implanted without cement. Cementless implants have a rough, porous surface. It allows the bone to adhere to the implant to hold it in place. A metallic ball is then placed on the top of the stem. The ball-and-socket joint is recreated.

To perform the anterior minimally invasive hip replacement procedure, the Surgeon requires guidance from X-rays. It may take longer to perform this surgery than it does to perform traditional hip replacement surgery.

Traditional Hip Replacement

Traditional hip replacement surgery involves making a 10- to 12-inch incision on the side of the hip. The muscles are cut and detached from the hip, allowing the hip to be dislocated. A larger incision and more muscle damage may require patients to use more pain medicine, resume walking independently more slowly and require more time for a full recovery. Nonetheless, traditional hip replacement patients gain the same advantages as anterior hip replacement patients in terms of pain relief and curing the underlying osteoarthritis. Some patients may better qualify for a traditional rather than an anterior hip replacement. Speak with your Surgeon for more details.

The incision is usually placed over the outside of the hip. The muscles and tendons are split or detached, but to a lesser extent than in the traditional hip replacement operation. They are routinely repaired after the surgeon places the implants. This encourages healing and helps prevent the dislocation of the hip.

Benefits

Reported benefits of anterior muscle-sparing, minimally invasive hip replacement include:

  • Less pain
  • More cosmetic incisions
  • Less muscle damage
  • Rehabilitation is faster
  • Hospital stays are shorter

Many patients need extensive rehabilitation afterward. With less-invasive procedures, the hospital stay may be as short as 1 or 2 days. Some patients can go home the day of surgery. Traditional hip replacement patients used to require hospital stays averaging 4 to 5 days.

Studies suggest that minimally invasive hip replacement surgery streamlines the recovery process, but the risks and long-term benefits of less-invasive techniques have not yet been documented.