Direct Anterior Hip Replacement: A New Approach with Great Results

Fort Sanders Regional Medical Center is among only 15 percent of U.S. hospitals with the staff and facilities available to perform the latest approach in hip replacement surgery, called “Direct Anterior Hip Replacement.”

In this procedure, the surgeon goes through the front (anterior) portion of the hip instead of the side or back. This allows the surgery to separate important muscles and tendons instead of cutting through them to position a new hip joint implant.

“When I first started doing hip replacement surgery this way, I thought it was just another option to access the joint, but people have done amazingly well with this approach,” said Dr. Paul Yau, an orthopedic surgeon with Fort Sanders Regional Medical Center.

“With traditional hip replacements, we have to cut muscles or tendons, which prolongs the recovery process and may require limitations on hip motion,” said Yau. “It is common to hear patients being told not to bend at the hip more than 90 degrees, squat, reach to the floor or cross your legs after hip replacement because it would risk a dislocation.

“With the anterior approach, none of these typical ligaments are cut, which means all of these common activities are safe immediately after surgery,” Yau explained.

The anterior approach does require a specialized surgical table and intraoperative X-rays.

“The specialized table allows for safe leg placement not possible with a traditional surgical table,” said Yau. “This unique table improves access to the hip joint and permits the use of intraoperative X-rays to ensure accurate implant position.

“Traditionally, leg length discrepancies are a well-known complication after total hip replacement. The use of live, real-time imaging during surgery allows the surgeon to make both legs balanced and symmetric in length,” he said. “This means the implant will last longer. I no longer say you have to be a certain age to get a hip replacement.”

With the anterior approach, the patient should expect usually one or two nights in the hospital.

“Some people even go home the same day,” said Yau. “People recover so much faster it’s unbelievable.”

Yau said he began doing the anterior surgery routinely about a year ago and uses it today for about 95 percent of his hip replacement and repair surgeries.

“It does require special facilities and a trained staff, which we have at Fort Sanders. There are a lot of moving parts to the surgery and they all need to be coordinated or you’ll have problems,” he said.

Studies have backed up Yau’s opinion of anterior hip replacement.

“You know how progress tends to happen in increments?” he asked. “I want to say this is a giant leap instead of an incremental one in orthopedic surgery. I haven’t seen anything this dramatically improve people’s outcome from surgery, ever.”



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