Anterior Approach to Total Hip Replacement

Benefits of the Anterior Approach Hip Replacement Technique

Alec E. Denes, M.D.

So you need a hip replacement, and are ready to get relief from the pain and grinding of bone-on-bone arthritis in your hip. The great news is that you, like most patients, are probably a candidate for the new “anterior approach” technique, which in my experience, has resulted in dramatic improvements in the recovery after hip replacement surgery. After a few years of performing both this and other techniques, I have now switched to use the anterior approach as my preferred method for all hip replacements. I am now doing several anterior approach hip replacements every week at Providence St. Vincent Medical Center - Total Joint Program.

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.

If you have more questions, check out the links below, and call our office to make an appointment.

Medical Assistant: 503.214.5283

KPTV featured two separate anterior approach patients in their “Health Watch” series:

Michael, who had double hip replacement (both hips) on the same day

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Charles, who surfs regularly after his hip replacement

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More information from Dr. Joel Matta, the pioneer of this technique:

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