The Direct Anterior Approach to Minimally Invasive Hip Surgery - Patient Benefits
Hip Replacement Surgery
Hip replacement surgery was first performed in the early 1960's . Since then, it has become a common orthopedic procedure with more than 80,000 operations done each year in the UK alone - in fact it has become one of the most successful surgical interventions - in spite of recent media coverage about problems with a particular design of implant. In the past, physicians typically recommended hip replacement for older patients because they tend to be less active and put less stress on the artificial hip compared to younger people. But today, the procedure also may be an option for those who are younger and more active due to technologically improved implants that can withstand more stress, endure more strain, and last longer.
Developments in Hip Surgery
The procedure to replace hips has changed with the times too. Traditionally, the operation to remove the head of the thighbone and replace the ball-and-socket mechanism in the hip with artificial implants was done making a 10- to 12-inch incision on the side of the hip. The muscles would then be detached from the hip, which would be dislocated. In recent years, however, a technique called anterior hip replacement has been refined so it is now being done through smaller incisions using specialized instrumentation so it is less traumatic for patients.
“With anterior hip replacement we make a smaller incision on the front of the hip and can access the joint between muscles, rather than cutting and then reattaching the muscles,” says Jamie Wootton, consultant orthopaedic surgeon specialising in joint replacement and joint reconstruction at the Wrexham Maelor Hospital in North Wales. “This allows for less soft-tissue dissection so that patients have less pain, a faster recovery and rehabilitation, and a lower risk of hip dislocation.”
Hip replacement surgery, whether traditional or using the anterior technique, is performed to help decrease pain, increase mobility, and improve quality of life. It may be recommended if other treatment methods, such as exercise, walking aids, medication, or injections are not effective. High-impact activities, including tennis, basketball and jogging, should be avoided after surgery. Instead, patients can walk, swim or ride a bicycle to increase muscle strength and improve cardiovascular health without injuring their new hip.
Although Mr Wootton has over 3 years experience of this technique, with over 400 cases, the Direct Anterior Approach is a relatively new approach to hip replacement surgery in the UK but commonly used in France and other European countries for many years. The technique is also growing very fast in the USA and becoming to be seen as the 'gold standard' for hip replacement.
Just see what this American patient has to say about her experience - having had experience of both procedures:
Overall, minimally invasive anterior hip replacement allows faster recovery compared with more traditional methods with less complications in terms of dislocation, venous thrombosis (DVT) and infection. Trauma caused by tissue damage causes pain and swelling during part of the normal healing process - all of which is minimised in this approach. Since less invasive surgery requires no cutting of the muscle and much less dissection of normal tissues the end result is less pain during recovery.
Return to normal activities
As a result of the reduced surgical trauma and the minimal muscle damage patients are returned to their normal activities quicker but also are at significantly reduced risk of problems such as dislocation and require fewer precautions post-operatively that are required following more traditional surgery such as raised lavatory seats and chairs, sleeping on their back etc. All these can be ignored and walking aids can be discarded after a few days. Similarly patients are able to return to driving when they are comfortable.
The prosthesis or implants used are traditional implants and have not been modified to accommodate this type of surgery. More importantly the surgery is performed with the patient supine which makes orientation of the components easier and also makes the use of an x-ray to position the components accurately possible which is not possible with the posterior approach.
One of the complications of hip surgery is DVT or Deep Vein Thrombosis. This can be reduced by several methods most important of which is early mobilisation of the patient. Because the patients get up on the same day or the next day after anterior surgery the DVT rate is reduced. Also during surgery with the use of a special surgical table the mechanical methods to reduce DVT such as calf pump stimulation continues throughout surgery which is the period when DVT is most likely to develop, further reducing the clotting risk.
Summary of Patient Benefits:
- Rapid recovery with less pain
- Shorter hospital stay
- Small scar on the front of the thigh rather than a large scar on the bottom
- Lower dislocation risk
- Virtually no limping
- Quicker return to 'normal life'