Benefits of the Anterior Approach THR Technique

By Alec E. Denes, M.D.

If you need a hip replacement, you're probably eager to get relief from constant hip pain so that you can resume a more active lifestyle. The good news is that surgical techniques have evolved to improve the recovery time, reduce both postoperative pain, and the risk of certain complications, and improve the outcome. Since 2007, I have been performing total hip replacements using the "anterior approach" technique, and you may be a candidate for this procedure. I perform several of these surgeries at ambulatory surgery centers and at local hospitals every week, usually as an outpatient procedure.

Traditional hip replacement techniques involve cutting through the gluteal muscles and the external rotators, two important muscle groups for the function and stability of the hip joint. There can be pain and weakness as a result, and these muscles must heal before full activity is resumed. Additionally, patients must be careful of avoiding certain movements with the hip, in order to prevent a dislocation of the new joint.

The anterior approach involves making an incision on the front of the hip, rather than through the buttocks or side of the hip. A natural interval between muscles can be used to access the hip joint, and they go right back together after the procedure. A special operating table, called the HANA table, was developed which allows me move the hip easily, so I can place the implants safely through a small incision. The table also allows me to use an x-ray machine during the procedure as necessary, to confirm proper implant position, and to ensure accurate leg lengths. I learned this technique in my fellowship, an additional year of training after residency, and subsequently attended multiple courses practicing on cadavers. I used the technique occasionally for my own patients in the first few years, to gradually hone my skills. Now, over 500 anterior total hip replacements later, I have had no patients dislocate, and only one infection (0.2% rate). I use titanium implants, which are not cemented, but instead a biological bond is formed when your bone grows onto the rough surface of the implant. The bearing surface is either metal-on-plastic or ceramic-on-plastic, depending on your age and activity level. I have never used the metal-on-metal hips that are in the news due to being recalled. Most patients go home the day after surgery, however, based on your individual case, you may go home on the same day as the surgery. My patients have gone back to surfing, mountain climbing, golfing, biking, water-skiing, tennis, racquetball, yoga, kite-surfing, even ballet.

This technique is gaining popularity, but still is only offered by a small percentage of surgeons nationwide. I do rarely see patients who are not candidates for the anterior approach technique, but those are typically only ones with severe congenital or post-traumatic deformities.

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