Updated December 15, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
A recent trend in hip replacement surgery has been to perform the surgical procedure through smaller, less-invasive approaches. The idea of this method of surgery is to perform the same procedure with less disruption to the surrounding muscles and soft-tissues. By performing surgery through smaller incisions, with less soft-tissue dissection, it is hoped that patients will have less pain and a faster recovery.
Anterior Hip Replacement
Anterior hip replacement is not a new surgery. Many surgeons have performed hip replacements through an anterior incision for decades. In fact, the most widely referenced report of this technique was published in 1980. What is new about anterior hip replacement is that the surgery is being done through smaller incisions with more specialized instrumentation to help make this surgery less traumatic to the patient.
The hip joint is deep within the body at the junction of the pelvis and the top of the thigh bone. All hip replacements, regardless of incision type, require your surgeon to replace the top of the thigh bone and the socket of the pelvis. There are a number of ways for your surgeon to achieve this, as your surgeon can approach your hip from the back of the joint (posterior approach), the side of the joint (lateral or anterolateral approach), the front of the joint (anterior approach), or through a combination of approaches (two-incision approach).
It is important to understand that all of these approaches accomplish the same goal of replacing the ball and socket of the hip joint.
Unique Aspects of Anterior Approach Hip Replacement
The anterior approach hip replacement is a muscle-splitting approach, meaning that the surgeon gets to the hip between two muscles, rather than by removing and then reattaching a muscle. The advantage is thought to be that rehabilitation can proceed more quickly by not having to allow the reattached muscle to heal.
As with other minimally invasive approaches, the incision size is kept as short as possible in an effort to help limit post-operative discomfort.
Anterior hip replacements are thought by some surgeons to have a lower rate of dislocation, although with newer implants some surgeons feel that this is no longer a distinct advantage of the anterior approach hip replacement.
Most complications associated with anterior approach hip replacement are similar to standard hip replacement complications. One specific complication is injury to a large skin nerve just adjacent to the incision of the anterior approach hip replacement. Injury to this nerve, the lateral femoral cutaneous nerve, during surgery can lead to chronic pain and abnormal sensations along the front and side of the thigh.
Is Anterior Hip Replacement Better?
As with many other changes in joint replacement surgery, it is simply not known if anterior hip replacement is an improvement over other approaches for a hip replacement surgery. There are advantages and disadvantages of the different approaches for hip replacement surgery. While some argue that rehab may be faster or pain may be less, there is conflicting data to support this argument. Some studies have found no difference in recovery when an anterior approach hip replacement is compared to other techniques.
The desire to minimize pain and speed recovery is understandable. However, the most important aspect of hip replacement surgery is to give you a joint that is pain-free and will last you a long time. These goals cannot be compromised when changes are made to hip replacement techniques.
While anterior approach hip replacements may provide some benefits when compared to other types of hip replacements, it is not known if this truly represents an improvement in hip replacement surgery. You can discuss these issues with your doctor when you are ready to consider hip replacement.
Sources:
Klausmeier V, et al. "Is there faster recovery with an anterior or anterolateral THA? A pilot study." Clin Orthop Relat Res. 2010 Feb;468(2):533-41.
Light TR, Keggi KJ: Anterior approach to hip arthroplasty. Clin Orthop Relat Res 1980; 152: 255-260.
Vail TP, Callaghan JJ. "Minimal Incision Total Hip Arthroplasty" J. Am. Acad. Ortho. Surg., December 2007; 15: 707 - 715.
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