And with traditional hip replacements, there is a moderate amount of pain with activity that prevents you from doing too much. Researchers found that patients who underwent direct anterior approach (DAA) total hip arthroplasty had objectively faster recovery than patients who had mini-posterior approach. 2018 Feb;28(2):255-267. In the elective hip arthroplasty population, the direct anterior approach (DAA) has shown to be effective in helping patients to quickly obtain high postoperative function. In the last ten years, surgeons have started favoring the anterior approach for total hip replacement over the posterior approach, because it doesn't involve standard hip precautions. Hip replacement surgery is a common procedure that is performed to alleviate hip pain and repair damage caused by arthritis, a sports injury, or other hip conditions. This hip resurfacing preserves much more normal bone than a standard hip replacement. The top of your femur is shaped like a ball and covered with cartilage. This site is for educational purposes only; no information is intended or implied to be a substitute for professional medical advice. Hip replacements swap out damaged or diseased bone with a metal or plastic implant that’s designed to replicate a healthy hip joint. Anterior hip replacement surgery uses an incision at the front of the hip.  |  Limit passive extension and external rotation. Eur J Orthop Surg Traumatol. It works with the iliotibial band (IT band) to help stabilize the hip and knee. The speed of recovery is equal to the anterior approach. The large gluteus maximus muscle, which is attached to the fascia lata. Like the posterior approach, the direct lateral approach to hip replacement also requires the cutting of muscles. Technique allows excellent visual exposure of hip cup, but challenging exposure of femur requiring muscle and capsule release. Other studies have reported that the posterior approach is the safer, less painful option for healing after hip replacement surgery. October 22, 2019 by Herman Botero, MD. There are risks and benefits to each type of approach. It also helps stabilize the pelvis and keep the body erect. Low risk of dislocation when performed by a specialty-trained surgeon with a high volume of hip replacement. To compare the outcomes of the direct anterior approach (DAA) with the lateral approach (LA) for total hip arthroplasty (THA) patients. However, this needs very careful consideration, as many factors need to be taken into account when deciding upon surgical anterior or posterior hip replacement approach. Anterior vs. Posterior Hip Replacement. The incision used in this posterolateral approach, as it is called, is about six to nine inches long and is made along the side of the hip and the upper thigh. Very small (less than 1%) risk of sciatic nerve damage from excessive retraction during surgery. September 29, 2020. In addition, be prepared to ask your surgeon about their experience, complications, and overall outcomes. Typically discontinue use of walking device 1-3 weeks sooner than posterior approach. Once the surgical incision is made, the muscles must be pushed aside or cut to access the hip’s ball-and-socket. At 8 weeks, direct anterior patients had higher mean Harris hip scores (95 versus 89) but a lower return to work and driving with no difference in their use of gait aids, … The external rotators of the hip, which are small, short muscles that connect the top of the femur to the pelvis. This procedure is not entirely muscle sparing. Hospital stay is the same for both approaches. Light activity (walking, stationary bike, etc.) This is done by making an incision through the back of the hip while the patient lies on their side. However, the rate limiting step in recovery from hip replacement surgery, be it via an Anterior or Posterior Approach, is the 6-8 weeks it takes the bone to “heal” to the implant. 60015. prime The gluteus maximus allows a person to extend and rotate the thigh outward. Posted by happybug @happybug , Apr 2, 2019 What factors come into play on a doctor’s decision to do anterior vs posterior hip replacement? 1999-2021 Veritas Health, LLC. – 6 weeks, Light activity (walking, stationary bike, etc.) The patient is positioned on his or her back on a special surgical table so the surgeon can manipulate the leg during surgery. Any muscles that are cut during posterior or lateral surgeries are repaired and reattached at the end of the surgery. If you have osteoarthritis in your hip, you might be considering a total hip replacement. IL, Anterior vs. posterior hip replacement (THR): How do you decide? Indications and Eligibility for Total Hip Replacement Surgery, Total Hip Replacement Surgery Risks and Complications. That should give you an idea of the recovery time involved. The two most common surgical approaches in hip replacement are the posterior approach and anterior approach (sometimes called the "mini-anterior approach" or "muscle-sparing hip replacement"). These two approaches are the anterior approach (through the front of the hip) and the mini-posterior (just behind the top of the femur). The main incision goes through the gluteus maximus and will heal without repair. If you are considering a total hip replacement, this guide will help compare the two approaches and give you information to discuss with your surgeon. I think the biggest advantage to the anterior approach is there are no positional restrictions or “hip precautions” immediately after surgery. Your surgeon must go through muscle and detach some of the muscles from the “ball and socket” of the hip joint. A. Dislocations are usually anterior and can occur with external rotation of the leg during any activity. During this traditional approach, the orthopedic surgeon makes an 8-10 inch while you lie on your side. Whether these specialized tools and tables are necessary for better outcomes is a matter of ongoing research. Because of the technical difficulty associated with anterior hip replacement, adequate surgical training is essential. The anterior approach (through the front of the hip) has been utilized as long as the posterior approach but its popularity has grown in the US over the past 10-15 years. The information is produced and reviewed by over 200 medical professionals with the goal of providing trusted, uniquely informative information for people with painful health conditions. Encourage normal extension/stride with gait Hyperuricemia - High Uric Acid Levels and Gout, Dietary Supplements for Treating Arthritis. Both posterior and anterior hip replacement offer good outcomes for the right patient populations. The joint is held together by ligaments and muscles. This is a technically challenging procedure. Will Anterior Hip Replacements Cause An Epidemic Of Early Loosening? The most commonly utilized total hip replacement is the posterior approach (through the back of the hip), which has been performed successfully for decades. The anterior approach offers the fastest recovery time, but fewer surgeons perform it. These differences can have short-term and possibly long-term effects on patients. The medical equipment required for recovery for both approaches is the same. All rights reserved. Muscles that are used to externally rotate the hip are detached during the procedure and later reattached to bone and will heal without complication. During the hip resurfacing procedure, only a small amount of bone is removed from the ball-and-socket hip joint, and a metal cap is placed on top of the ball. In the posterior approach, an incision is made beside or behind your hip joint. Discuss with your surgeon, some do not have post-operative precautions with this procedure. The posterior surgical procedure has the longest recovery time, but … The surgical steps of an anterior approach hip replacement differ from the steps of the posterior approach. It is the most common approach and provides the greatest patient safety. Candidates for this approach are not significantly overweight, have no femur deformities, and normal pelvis anatomy. The anterior approach presents specific challenges, though. Posterior hip joint replacement in Jacksonville, FL, is considered to be the “traditional” approach to hip surgery. The big difference in anterior vs posterior hip replacement is primarily where the incision is made and how long it is. Many believe the mini-posterior approach to be the simplest and easiest approach, thereby providing the greatest safety margin for the patient. The majority of patients are a candidate for this type of surgery. Background: Traditional posterior approaches to the hip, posterolateral and mini-posterior, violate the iliotibial band and the short external rotators, specifically the quadratus femoris and obturator externus muscles 1-4.The direct anterior approach does not violate the iliotibial band or the quadratus femoris, resulting in earlier ambulation and lower dislocation rates 1, 5-9. Anterior hip replacement may provide some benefits in terms of speeding the early recovery timeline, although even this is a subjective debate. You may need a front-wheeled walker, cane, leg lifter, grab bars, and an elevated toilet seat. Higher risk of injury to lateral femoral cutaneous nerve, which may cause numbness in the outer thigh. Traditionally, orthopedic surgeons have approached the hip joint from the side and back when doing total replacement surgery. There are two main ways hip replacements are done. In the first few weeks after a joint replacement, all the tissue that was dissected to get to the joint has to heal back together. The location of the incision determines the where the postsurgical scar will be. Posterior approach: No hip flexion > 90 º no hip internal rotation or adduction beyond neutral. He elaborates, "the anterior approach involves a true internervous/ intermuscular plane. The indirect head of the rectus femoris is released to allow entry into hip. Functional milestones occurred about five days earlier for patients with DAA. While anterior hip replacement has some possible advantages, it is unlikely that the surgical approach is the most critical factor in determining the long-term success of a hip replacement surgery. This is done by replacing the damaged or diseased bone with a metal or plastic implant, which is designed to replicate a healthy hip joint. The most commonly utilized total hip replacement is the posterior approach (through the back of the hip), which has been performed successfully for decades. The anterior approach (through the front of the hip) has been utilized as long as the posterior approach but its popularity has grown in the US over the past 10-15 years. Patients should find a surgeon very experienced in this approach. The tensor fascia lata, which is a wide piece of fibrous soft tissue at the top of the outer thigh. Understanding the differences between these surgeries can help people decide what surgery, if any, is right for them. The decision to have anterior hip replacement surgery must be made on a case-by-case basis. The Latest Procedure: Anterior Approach Total Hip Replacement Surgery … Cartilage is a tissue that helps joints move. version.2020.07.019-2020.07.003, Advantages and Disadvantages of Anterior Hip Replacement, Deciding to Have an Anterior Hip Replacement, All About Gout - Symptoms, Diagnosis, Treatment, All About Pseudogout - Symptoms, Diagnosis, Treatment. The difference between the anterior approach to hip replacement surgery and the more traditional posterior approachis the access to your hip joint. Anterior vs. Posterior Hip Replacement. In a posterior hip replacement, the procedure is done on the side of the hip. Deerfield, The average hip replacement lasts 20-30 years or more. Veritas Health, LLC, When it comes to surgically replacing a hip joint, there are two standard methods – the anterior and posterior approach. If a patient pushes a recovery too vigorously in the early weeks post op, implant micromotion leading to loosening and further surgery can occur. Three English databases, PubMed, Embase, and the Cochrane Library, were searched for randomized controlled trials (RCTs) comparing the DAA with LA for THA. 520 Lake Cook Road, Suite 350, Comparison of direct anterior, lateral, posterior and posterior-2 approaches in total hip arthroplasty: network meta-analysis Eur J Orthop Surg Traumatol . Get Veritas Health eNewsletters delivered to your inbox. The patient and doctor must consider whether or not the patient is a good candidate for the surgery, the cost of surgery and recovery time, and the surgeon’s experience. © Anterior hip replacement surgery has lower rates of hip dislocation, but full posterior surgery has higher dislocation rates. For patients with osteoarthritis or that have experienced trauma to their hip, a total hip replacement can restore function and decrease pain. All hip replacements require the dislocating the hip and shaping the bones in order to implant prosthetic hip joint components. Posterior vs. anterior operative approaches to THA debated ... MD, advocates the posterior approach to total hip arthroplasty. – 4-6 weeks. The patient is positioned on his or her side during surgery. Anterior hip replacement (AHR) is surgery to replace a hip joint damaged by wear, injury, or disease. Because the hip joint capsule is opened anteriorly (in front) there is a lesser incidence of posterior (in the back) dislocation. External rotator muscles are cut and are not reattached during this approach. This incision typically starts at the top of the pelvic bone (iliac crest) and extends down toward the top of the thigh. The hip joint is where the top of your femur (thigh bone) sits in the socket of your pelvic bone. Higher risk of femur fracture due to more difficult exposure. Surgical tools and tables have been developed to accommodate anterior hip replacement surgery and make the procedure easier for surgeons. What Is Arthrocentesis (Joint Aspiration)? 2018 Feb;28(2):255-267. doi: 10.1007/s00590-017-2046-1. To begin the operation, the hip replacement surgeon will make incisions on either the back (posterior) or front (anterior) of the hip. In that surgical approach, the abductor muscles (gluteus medius and minimus) are affected. Intraoperative x-rays are often used to confirm placement of the implant due to less visual exposure. The surgeon makes a 4-6 inch incision just behind the hip, along the buttock area. Exposure of both the hip socket and the femur is straightforward. With the anterior approach, detaching muscles is not required … If you have had a relative who got a hip replacement several years ago, chances are it was a posterior surgery. But because the posterior approach cuts through the muscles, there’s a higher risk of dislocation following surgery, typically within the first year. In the short-term, anterior hip replacement is less painful and leads to a quicker recovery of mobility and strength compared to a posterior or lateral approach. Anterior vs. Posterior Hip Replacement Surgeries. This approach has also been shown to be effective in arthroplasty for displaced femoral neck fractures in a few studies. Very low risk of fracture due to easier exposure. A metal socket is placed in the pelvis, similar to the hip replacement procedure. Whether you are an orthopaedic patient or professional, or someone concerned about your health or the health of your community, the Canadian Orthopaedic Foundation exists for you - for your bone and joint health now and in the future. Putananon C, Tuchinda H, Arirachakaran A, Wongsak S, Narinsorasak T, Kongtharvonskul J. Putananon C, et al. See Total Hip Replacement Surgical Procedure. Information on the country, sample size, intervention, outcomes, and follow-up were extracted. As with the anterior approach, the mini-posterior approach is muscle splitting and not muscle cutting. There are 2 approaches to total hip replacement surgery – the anterior approach and the posterior approach. Dr. Salyapongse explains, "Although the basic concepts of hip replacement surgery remain the same with both the posterior and anterior approach surgery, there are some key differences." Due to risk of nerve damage, the incision enters the compartment of the tensor fascia latae muscle to expose the hip safely. Comparison of direct anterior, lateral, posterior and posterior-2 approaches in total hip arthroplasty: network meta-analysis. The surgeon makes a 4-6 inch incision on the upper thigh. Posterior hip replacement surgery uses a curved incision on the side and back of the hip. 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