Introduction

When you need surgery to replace a damaged or diseased hip, some orthopedic surgeons have advanced training to perform anterior hip arthroplasty, also known as the direct anterior approach to hip replacement. This procedure is considered less invasive, as it spares the surrounding muscles that support the joint and minimizes scarring, pain, and down time. Patients can begin rehabilitation sooner and recover faster after having anterior hip replacement, compared to more traditional posterior hip replacement.

If you have suffered an injury due to a fall or have sudden onset of hip pain, seek medical attention immediately. If your pain is chronic, you should see a hip specialist for a complete evaluation of your symptoms.

Anatomy

Your hip is a ball-and-socket joint, where the pelvis and thigh bones meet on the left and right sides of the body. The hip joints are surrounded by supportive tissues including muscle, ligaments, and tendons to provide stability while allowing for movement. The bones are covered with cartilage, which forms a smooth surface for bones to glide across when we move.

Causes

There are several reasons for the need for hip replacement. Arthritis is one of the most common. Cartilage may deteriorate with age, leading to bone-on-bone rubbing. When this occurs in the hip, walking and other movements we take for granted can become extremely painful. Other forms of arthritis, such as rheumatoid arthritis and psoriatic arthritis, can lead to the need for hip replacement. Certain types of hip fracture are sometimes best treated with hip replacement.

Symptoms

Pain, stiffness, or limited mobility are common symptoms of hip arthritis. Most often, the pain is felt in the groin, thigh, or in your knee. You may notice a feeling like your leg might give out when you take a step.

Diagnosis

An evaluation of your hips begins with a comprehensive exam and X-rays. The X-ray will look for narrowing of the joints, bone spurs, and bone cysts that sometimes form in arthritic joints. In certain circumstances, your doctor may also order an MRI.

During the exam, the doctor will ask about your symptoms and how long your hip has been bothering you. You will need to demonstrate some movements, such as walking, bending, or standing up. This will help the doctor pinpoint the areas that need to be further examined.

Treatment

Unless you have an immediate need for surgery, the primary treatment will employ the most conservative, non-surgical options. Medication, rest, and exercises including physical therapy can be effective for treatment of hip arthritis and minor sprains and strains.

When conservative treatments fail to provide sufficient relief of your symptoms, you and your doctor may consider a surgical procedure to repair damage to the joint or replace the joint with an artificial implant (prosthetic hip). The extent of damage, your age, and activity level can help your surgeon decide if you are a candidate for surgery.

Many patients with severe hip damage caused by arthritis are candidates for anterior hip replacement surgery. Even large or obese patients can have a successful outcome with this muscle-sparing procedure. However, large size makes the operation more challenging.

Surgery

Anterior hip arthroplasty is an advanced orthopedic procedure used to replace a damaged hip by making an incision on the front (anterior) side of the hip.

Traditionally, hip replacement surgery begins with an incision to the side or back of the hip area. With the anterior approach, having the incision on the front of the hip prevents any discomfort in the incision area when sitting down or lying on your side.

This approach also allows the surgeon to leave your muscles and ligaments intact while replacing the hip joint. This can decrease the chance of the joint popping out of place (dislocating). Lastly, a smaller incision is needed than would be for a posterior or side approach.

Many orthopedic surgeons prefer the anterior approach to hip replacement because of these advantages.

Recovery

Compared to other approaches, the anterior hip arthroplasty is associated with shorter recovery times. This is because the surgical technique leaves the supportive tissues (muscles, ligaments, tendons) in place to support your hip immediately after the procedure.

Many people can begin post-operative rehabilitation right away and return to their normal activity level within weeks of surgery. Other approaches take longer because the muscles need additional time to heal.

Although the procedure is preferred over more traditional hip replacement, the anterior approach to hip surgery is not yet as widely performed. Advanced training in this technique is required for a successful outcome.