Direct Anterior Approach Total Hip Replacement
The anterior approach is a minimally invasive surgical technique used for Total Hip Replacement where Associate Professor Harvie can obtain access to the joint using intervals between muscle groups without the requirement for significant muscle detachment or splitting. For anterior approach procedures the incision is placed on the front and side of the upper thigh and the surgeon follows natural anatomic gaps between adjacent muscles to access the hip joint.
What are the advantages of the Direct Anterior Approach?
There are two main advantages. Firstly, as muscle attachments and function are less compromised, people consistently rehabilitate quicker with a substantial reduction in pain and swelling, enabling an earlier return to functional activity. Secondly, from a longer term perspective, anterior approach techniques also provide a much more stable hip replacement with a substantial reduction in the risk of dislocation.
What is a typical recovery process?
Most people will be capable of walking on the same day of their surgery. You are permitted to place all your weight upon the operated hip when walking, however crutches are recommended for 2 weeks to assist in confidence and stability. Typically people will stay in hospital 2-4 nights after their procedure, however as people recover differently there are no ‘set number of days’ allocated for your hospital stay – you can go earlier or stay longer depending on your progress.
Am I suitable for Direct Anterior Approach Surgery
Most people with hip arthritis requiring replacement are suitable for anterior approach techniques, there are some people with hip joints that are better suited to other surgical approaches. This may depend on a number of factors including bone shape, pattern of arthritis, implant design selected or the presence of significant obesity. Your suitability for anterior approach hip replacement will be determined by examination and evaluation of your hip prior to surgery.
What are the alternatives to the Direct Anterior Approach?
Total Hip Replacement procedures can be conducted using many different types of surgical approach, each of which has particular merits. For patients less suitable for direct anterior approach procedures I usually recommend a posterior approach. Regardless of the approach used, the outcomes after hip replacement surgery using modern surgical techniques and anaesthesia are excellent and rehabilitation consistently progresses in a safe and rapid manner. It is important to understand that posterior approach hip replacement is not necessarily ‘better’ or ‘worse’, each surgical method has advantages and disadvantages depending on the circumstances and not every person has the same requirements.
What are the disadvantages of the Direct Anterior Approach?
A patch of skin numbness below the skin incision on the outer aspect of the thigh below the incision is common, but is usually temporary. Significant complications have been encountered by surgeons inexperienced with Direct Anterior Approach Surgery when early in their ‘learning curve’. I have published research in International Journals on this subject and have undergone advance training in this field within Australia (in Brisbane, Sydney, Melbourne & Hobart) as well as Internationally in the USA and South Africa.
What are the Risks and Complications?
As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or local complications specific to the Knee. Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.
Complications include:
- Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission
- Heart attacks, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
Ideally, your knee should bend beyond 115 degrees but on occasion, may not bend as well as expected. Sometimes manipulations are required. This means going to the operating room where the knee is bent for you while under anesthetic.
The plastic liner eventually wears out over time, usually over 10 to 15 years, and may need to be changed. Alternatively the remainder of your own knee may wear out requiring revision to a Total Knee Replacement.
Fractures or breaks can occur during surgery or afterwards if you fall. To repair these, you may require surgery.
The operation will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this. Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.
The knee may look different than it was because it is put into the correct alignment to allow proper function.
Your leg will be restored to it’s original length as the deformity caused by wearing of the knee has been corrected.
There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem. This problem is minimised with Robotic Assistance.
Rarely these can be damaged at the time of surgery. If recognized they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.
Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.
Summary
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain. Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and GP. Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.