ANTERIOR HIP REPLACEMENT- A New, Old Operation

Posted on: Aug 20, 2012 - 10:23 AM | General Information | Comments (0)

Despite all the recent interest, hip replacements through anterior incisions are actually not new. In fact, this particular surgical approach was first described in 1881, and French surgeon Robert Judet introduced the procedure using a form of replacement almost 60 years ago. What is new, however, is the minimally invasive instrumentation which, combined with the anterior approach and hip rehabilitation, is making an already great operation potentially better.

The success of hip replacement surgery is impressive. In two generations it has restored quality of life to millions of people who would otherwise have suffered with the debilitating pain of osteoarthritis. Not only is the improvement in the patients’ quality of life dramatic, so equally is the survival rates of the orthopaedic implants. We now consider a 90 % survival rate at 20 years to be a realistic expectation. Given that most of the replacements to date were done through posterior or lateral approaches, it is reasonable to ask why there is a need for something different.

The answer lies in improvements in how “user friendly” the procedure is for patients, and in particular relates to their ability to return to the basic activities of everyday life as quickly as possible. Not only do these benefits include increased comfort from being able to sleep on one’s side rather than having to sleep flat on one’s back for example, but they also include the earlier independence that being able to put on shoes and socks allows. Minimising post- operative restrictions is especially beneficial for patients who have difficulties in remembering an array of instructions and “do’s and don’ts”. Rightly or wrongly, patients have been limited in their return to activities of daily life following a posterior approach, primarily due to concerns of posterior dislocation. By contrast, this problem is extremely rare with the anterior approach.

There are advantages and disadvantages with the different approaches of hip replacement surgery. The anterior approach hip replacement is a muscle splitting approach; think of this as similar to when you separate drawn curtains on a curtain rail. In the body this means that you don’t cut across muscle or tendons, and is theoretically the reason for the faster recovery period. When considering the posterior approach, however, very little muscle is actually cut. While most people may be suitable for the anterior approach, some people will not be, such as those with some congenital or paediatric hip disorders causing secondary osteoarthritis. The aim in all cases remains to give patients a pain-free joint that will restore quality of life and last many years, in some cases more than twenty years.

Regardless of the approach used, hip replacement is one of the great operations of the latter half of the 20th century. Time will tell whether the minimally invasive anterior approach will be an advancement in the long run, however the results to this point are encouraging, giving confidence that the procedure can be offered to the right patients. I have been performing this procedure at Berkeley Vale Private Hospital for over a year now, and am happy to continue doing so.

 

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