Anterior approach hip replacement

The anterior approach is one of several ways a surgeon can reach the hip joint during a total hip replacement. The incision is made on the front of the hip, and the surgeon works in the space between muscles rather than detaching them from the bone. The implants are the same as with other approaches; what differs is the path to the joint.

The reasons for hip replacement are the same whichever approach is used. It may be worth discussing when:

• Hip or groin pain limits walking, bending, or daily tasks
• Pain continues at rest or disturbs sleep
• Stiffness makes it hard to put on shoes and socks or get in and out of a car
• Non-surgical treatment no longer gives enough relief

Hip replacement by any approach is most often done for osteoarthritis. Other reasons include inflammatory arthritis, osteonecrosis, and arthritis after an injury.

Some features can make the anterior approach a less typical choice, such as higher body weight, a very muscular build, earlier hip surgery, significant deformity of the hip, or conditions that slow wound healing. Your surgeon weighs these alongside their own training and experience when recommending an approach.

The evaluation is the same as for any hip replacement: a review of your health and symptoms, an examination of the hip, and X-rays. The surgeon uses this information to plan the implants and to recommend the approach that suits your anatomy.

Hip replacement is generally considered after non-surgical care — exercise and physical therapy, activity changes, weight management when appropriate, medications, a walking aid, and sometimes injections — no longer controls symptoms.

A total hip replacement can be performed from the back of the hip (posterior approach), the side (lateral or anterolateral approach), or the front (anterior approach). For the anterior approach you lie on your back, and the surgeon often uses a specialized operating table and live X-ray imaging during the operation to help position the implants.

Each approach has potential advantages and trade-offs. The anterior approach involves less cutting of muscle, and some studies have found that patients reach early recovery milestones a little sooner. Other studies have found similar function and complication rates across approaches, and no approach has been shown to give better long-term results. The surgeon's experience with a given approach also matters.

Risks include those of any hip replacement — infection, blood clots, dislocation, a difference in leg length, and wear or loosening of the implant over time. Problems more associated with the anterior approach include numbness on the front of the thigh from irritation of a small skin nerve, which often improves, wound-healing problems in the groin crease, and fracture of the thighbone during surgery. Ask your surgeon which approach they recommend for you and why.

Recovery follows the same general path as hip replacement through other approaches. Walking with a walker or crutches begins on the day of surgery or the next day, followed by a home exercise program and a gradual return to daily activities over the following weeks. Many people go home the same day or after a short stay.

Movement precautions after surgery depend on the approach and on your surgeon's preference; some surgeons give fewer position restrictions after an anterior approach. Follow the specific instructions you are given.