Anterior Hip Replacement Surgery
Total Hip Replacement, also known as Total Hip Arthroplasty, replaces damaged bone and cartilage with an artificial joint (or ‘prostheses’). Joint replacement surgery is recommended for those who have failed conservative treatments (for example, physiotherapy and injections) or who have pain or loss of function in the hip.
Direct Anterior Approach and Its Benefits
The Direct Anterior Approach (DAA) is a minimally invasive approach through the front of the hip (anterior). Mr. Blackmore prefers the anterior approach, and has performed hip replacements with this approach extensively, both in Australia and overseas.
Compared to traditional approaches through the back of the hip (posterior), the anterior approach does not involve the removal or cutting of muscles in order to gain access to the hip, thereby preserving the posterior muscles and joint capsule.
By preserving the joint in this way, the anterior approach results in a faster recovery time, decreased risk of dislocation, minimizing the risk of leg length discrepancy and increased hip stability.
The anterior approach also allows for real-time imaging of the hip using x-rays, allowing Mr. Blackmore immediate results and positioning of the prosthesis, rather than the traditional approach that requires post-operative imaging. This results in increased precision whilst positioning the new joint.
Other benefits of the anterior approach include a smaller incision and less scarring, shorter stay in hospital, faster healing time and reduced post-operative pain.
Which Patients Are Candidates for the Anterior Approach?
The majority of patients with osteoarthritis of the hip are ideal candidates for this kind of approach, and it is extremely rare for Mr. Blackmore to perform anything but the anterior approach for total hip replacements.
The procedure can be performed in all age groups, however not all patients are candidates. Many factors including the anatomy of your hips, previous fractures, body type, deformities of the hip and previous hip surgeries all play a part when deciding the approach that is most suitable for you.
For those patients who are not suitable for anterior hip replacement, the traditional approach will be discussed, and whilst the anterior approach may have additional benefits, the long-term outcome goals remain the same.
During your appointment with Mr. Blackmore, you will have a discussion regarding how appropriate anterior hip replacement is for you, the risks and benefits, type of implant and your expectations of surgery.
The Decision to Have Treatment
The decision to have surgery should be made after your consultation with Mr. Blackmore, once you are satisfied with the information provided to you. The decision is yours and should not be taken lightly. During your consultation we will discuss the results you want, the surgery to be done, the reasons as to why a particular approach is more suitable than others, and the long-term goals and outcome to be expected.
Once you have decided to go ahead with surgery, the below gives an example of what may happen before your procedure:
- You will be provided with an instruction pack with hospital forms and a list of all of your pre-operative appointments
- You may require routine blood tests and other investigations prior to your surgery, to ensure you are fit and able to have a general anaesthetic
- You may require a pre-operative check with a physician to assess your general health and medications
- You will be asked to stop smoking as long as possible pre-surgery, to improve your surgical outcome and rehabilitation.
Day of Your Surgery
On the day of your surgery you will be admitted to the hospital. Your anaesthetist will meet with you and discuss the anaesthetic options with you, as well as post-operative pain management, including the pain medication you will take home with you from hospital.
Immediately prior to being transferred to the operating room, your operation site will be shaved and cleaned, and you will be asked to change into a gown. From there you will be transferred to the operating room, and put under a general anaesthetic.
Immediately After Your Operation
You will wake up in the recovery room with intravenous drips in your arm, and your vital signs will be monitored. Staff will assess how stable you are, and once ready, you will be transferred to the ward.
There are a number of risks post-surgery, and these risks will be discussed with Mr. Blackmore during your appointment, and pre-surgery. A common risk is blood clotting in your legs (Deep Vein Thrombosis), therefore you may wake up from surgery with leg coverings or stockings to help minimize this risk.
Once on the ward, we encourage patients to get up and start walking as soon as possible, with assistance. Your rehabilitation in hospital will be under the guidance of occupational therapists and physiotherapists.
Usually, you will remain in hospital for 3-5 days. Depending on your needs, you will either return home or move to a rehabilitation facility.
At Home Following Surgery
After you have returned home from hospital or from a rehabilitation facility, you are encouraged to resume your normal daily activity, as the usual precautions associated with posterior hip replacements are unnecessary with an anterior approach.
You will discuss your individual rehabilitation with Mr. Blackmore as well as therapists in hospital depending on your individual situation, however we recommend patients try and fully weight-bear as soon as possible, ambulating without the use of crutches and canes as soon as you are comfortable.
Activities such as walking and stationery bike are recommended as soon as you are able, whilst high impact activities such as tennis and running are restricted for a few months to allow bone to properly heal around the prosthesis. You may need to modify your sleeping arrangements at home, especially if they are up a lot of stairs, as some patients find it difficult to climb stairs initially. You should be walking reasonably comfortably by 2 weeks.
Once the wound is healed, you may shower. You can drive at about 6 weeks, once you have regained control of your leg.
Mr. Blackmore will see you approximately 2-3 weeks post operatively for an initial check-up, and you will have regular reviews for approximately 18 months.
If you ever have any unexplained pain, swelling or redness or if you feel generally poor, you should contact Mr. Blackmore’s room as soon as possible.
Risks and Complications
As with any major surgery, there are potential risks involved, which can be general and specific to hip replacements.
These include general health and anaesthetic risks including allergic reaction to medications or general anaesthetic, complications with nerve blocks and nerve damage. General medical risks include heart attack and stroke, kidney failure, blood loss, prolonged hospitalization and rarely death.
Other complications directly relating to hip replacement can include:
Blood Clots (Deep Vein Thrombosis)
Fracture and Dislocation
Leg Length Discrepancy
Wound Irritation or Breakdown
The general and specific risks of surgery will be discussed with you prior to your surgery, and we will ensure you are fully informed prior to your decision to go ahead with surgery. Although the majority of our patients are complication-free, it does not mean that everyone will have the same outcome, and you must be aware of these risks prior to making a decision.
We welcome any enquiries regarding anterior hip replacement surgery, please call (03) 9928-6188, or via our online web form or email.