Anterior Hip Replacements

The Anterior hip Replacement is a form of hip replacement performed from the front of the hip as opposed to the traditional hip replacement done from the back (Posterior hip replacement) or side of the hip (Anterolateral hip replacement) 

The Anterior hip replacement is a minimally invasive technique preserving the muscle and soft tissue. In other words, there are no muscles or tendons cut in this form of hip replacement done through the anterior method. 

The Anterior hip replacement procedure involves making a small incision in front of the hip joint, as opposed to an incision on the side or back of the hip which are done traditionally.

The incision for the anterior hip replacement can be vertical (standard anterior hip replacement) or bikini incision anterior hip replacement where the scar is in the groin crease hidden and cosmetically pleasing.

The direct anterior hip replacement is also called muscle sparing surgery or soft tissue preserving or minimally invasive hip replacement, because no muscles are cut to access the hip joint, enabling a much quicker return to normal daily activity. 

What does anterior hip replacement surgery involve and Where is the anterior hip replacement Cut ? 

The anterior hip replacement cut is placed on the front of the hip, slightly angled towards the outer aspect of the thigh like the image shown below.

ASIS (Anterior superior iliac spine – part of the pelvic bone)

ASIS (Anterior superior iliac spine

Patients who wish to see the full video of anterior hip replacement See Video Below

Surgical steps of anterior hip replacement

Once the skin incision is made, the plane between the muscles is identified.

It is an intermusclular and internervous plane.

The space between the 2 muscles sartorius and tensor fascia lata is opened without cutting any muscles or tendons.

The hip joint in anterior hip replacement is reached without actually cutting any muscles – figures below.

  • Surgical steps of anterior hip replacement
  • Surgical steps of anterior hip replacement
  • Surgical steps of anterior hip replacement

The next step in anterior hip replacement surgery involves deep minimally invasive tissue dissection to expose the joint capsule

The hip joint capsule is then identified and opened to explose the hip joint. – See below.

ASIS (Anterior superior iliac spine

Once the hip joint capsule  is opened and reflected,

The neck of the femur (thigh bone) with the arthritic head in the hip joint is then resected without hip joint dislocation with a special resection saw and removed – see diagram below.

The Images below show photos of how the head and neck is resected in anterior hip replacement and how it looks. The head and resected part of the neck is

  • head-and-resected
  • head-and-resected

The femur is then prepared to put the femoral implant with specialized tools in anterior hip replacement  - See Below

ASIS (Anterior superior iliac spine

The special broaches is used to prepare the femur to achieve the right sized implant – See Below 

 

Special pneumatic tools used by Dr. Nizam in femoral preparation in Anterior hip Replacement – See Video Below

The Socket is then prepared in anterior hip replacement with a special reamer of increasing sizes until the desired size is achieved as planned on Xray or computer. See below image – showing the reamed

ASIS (Anterior superior iliac spine

Once the acetabulum (Socket) is prepared the cup is then inserted and placed into the appropriate position and in some cases surgeons use screws – See below.

ASIS (Anterior superior iliac spine

The Femoral component is then inserted through the small incision of the anterior hip approach technique and impacted to the accurate depth. See image below

ASIS (Anterior superior iliac spine

The femoral Head (Ball) is then inserted and the hip reduced into place and the surgical wound is closed. – See below.

ASIS (Anterior superior iliac spine

Once the patient is back on the ward, Xrays are performed – see below

ASIS (Anterior superior iliac spine

The Advantages of Anteiror hip replacement include:

  • Less Post surgical pain as muscles are not cut, Less Blood Loss, Less muscle weakness
  • Early mobilisation (as early as 3-4 hours after surgery), Rapid recovery
  • Less risk of dislocations, Early discharge home
  • Drive within days to weeks after surgery

Anterior Hip Replacement recovery questions:

How soon can I walk after Anterior hip replacement?

Patients are usually walking within hours after anterior hip replacement usually with the aid of a frame or crutches a few hours after surgery depending on the patient. Patients then come off the crutches from days to upto a week or 2.  Some patients get rid of their crutches within a few days after anterior hip replacements – this usually depends on comfort and confidence and the surgeon always recommends caution.We recommend patients resume regular daily activities as soon as comfort and confidence returns after anterior total hip replacement.

What pain medication do I take when I go home after Anterior Hip Replacement ?
There is usually less pain in this procedure as no muscles or tendons are cut and less soft tissue disturbance takes place. Pain medications usually consist of regular panadol with or without some anti-inflammatory (unless allergic or medical issues) Other pain medications will be discussed as it can vary from patient to patient.

Can I sleep on the side after anterior hip replacement?

Yes patients usually can sleep on their sides soon after anterior hip replacement if patients are comfortable to do this within 24 to 48 hours.

Can I cross my leg after anterior hip replacement?

Yes, one can cross ones leg after anterior hip surgery since the muscles envelope is still intact and the hip should be stable. But patients should avoid extremes and this can be discussed with the surgeon.

Can I lean forward to pick up things after anterior hip replacement?

Yes there are usually no restrictions on picking things from the floor after direct anterior hip surgery but patients should do this very carefully over the first few weeks.

Can I use a normal toilet after anterior hip replacement?

Yes there is no need for a raised toilet seat such as after posterior hip replacement as the posterior soft tissue structures are still intact and a patient can use a normal toilet seat after anterior hip hip replacement

How Soon can I use stairs after anterior hip replacement?

Stair climbing is usually assessed on the same day after surgery or the next day and patients should comfortable do stairs depending on confidence from the day after their anterior hip replacement surgery

Do I need rehab after anterior hip replacement surgery?

Usually rehab is not necessary as no muscles or tendons are cut in this procedure and patients can go home directly and walking is the best exercise. Some individual patients may need some stretching and strengthening exercises in time and this can be discussed with the surgeon.

Are there any precautions after anterior hip replacement?

The only major precaution is to avoid combined extension and external rotation of the leg for upto 6 weeks after surgery. In other words, avoid moving the whole leg backwards and at the same time turning the foot outwards as this could increase the chances of dislocations over the first 4-6 weeks. But after 6 weeks it should be fine to do this – please check with the surgeon.

When Can I drive after anterior hip replacement?   - Refer to the driving blog