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Anterior Hip Replacement

Oct 2008

Written by Dr. Edward P. Petrow, Jr.

Patients often have questions about the latest developments in arthritis-related surgery, and hip replacements have become an increasingly common way to relieve hip pain due to arthritis. The advent of minimally invasive techniques in orthopedic surgery has sparked renewed interest among surgeons in performing hip replacements through the front (anterior) of the hip, as opposed to the more traditional posterior approach (coming in from the back).

With the anterior hip replacement, the goal is to minimize muscle damage by separating muscles to gain access to the front of the hip, versus surgically releasing and then repairing muscles to gain access to the hip joint from behind, as is done using the posterior approach.

Both hip replacement methods have their strengths and weaknesses, so patients considering hip replacement surgery should explore both options with their surgeon. The following are answers to some frequently asked questions about the anterior hip replacement procedure:

Q: Is this a new technique?
No. The anterior hip ap-
proach was first described in 1917 by American orthopedic surgeon Marius Nygaard Smith-Petersen (1886-1953), and French surgeon Robert Judet performed the first hip replacement procedure anteriorly in 1947. In the 1960s, French surgeons were frequently using the anterior approach to replace damaged hip joints.

Q: If this technique has been around since the '60s, why is there new interest now?
Surgeons at that time found that while the anterior approach provided a clear view of the hip socket through the front of the hip, it was difficult to insert the long metal "hip stem" into the head of the femur. If complications occurred during surgery, it was difficult for the surgeon to modify the incision for a better view. Therefore, most surgeons opted to perform hip replacements through posterior (rear), or posterior and lateral (side) incisions. But thanks to specialized surgical instruments, improved hip implants, custom operating tables and real-time X-ray equipment, the anterior approach to hip replacement has regained popularity among surgeons. These technological advancements make the anterior approach easier and more reliable for surgeons to perform than ever before.

Q: What are the drawbacks?
During an anterior total hip replacement the patient must lie on a special operating table, to which the patient's legs are attached; the surgeon manipulates the table to align the leg in preparation for inserting the hip stem into the femur. Since it is difficult to judge how much force must be applied to the leg to insert the hip stem, leg bone fractures are a risk for any patient. The hip implant is placed using real time X-ray equipment, providing the surgeon with instantaneous feedback on how well he or she has positioned the implant. However, if the X-ray images are not exact, the surgeon risks improperly placing the implant, which, for the patient, can mean increased wear-and-tear on the new joint, as well as hip dislocation and a painful hip joint.

Q: Is it true that hip implants installed anteriorly will not dislocate?
No. All hip implants can become dislocated. However, the incidence of dislocation with an anterior approach has been historically less than with a posterior approach. The latest generation of replacement implants feature a larger artificial femoral head (the "ball" that rests in the hip joint) and thus have reduced the incidence of hip dislocation across the board.

Q: What approach do you recommend?
I recommend finding a surgeon who is versed in anterior, posterior and anterolateral (back and side) hip replacement. Every method has its pros and cons; therefore, the surgeon must match each patient's needs to the surgical approach that is most appropriate. The purpose of hip replacement, regardless of the method used, is to provide patients with a successful operation and a long-lasting replacement joint.

Dr. Edward P. Petrow, Jr., is an orthopedic surgeon and joint replacement specialist practicing with Orthopaedic and Spine Center of Newport News.