For many people, having a hip replacement is a dreaded ordeal. The conventional method means spending weeks of painful recovery in rehab facilities, then returning home to a life with limited mobility. Now, a growing number of patients are enjoying a new lease on life thanks to a more sophisticated, newer hip surgery technique.
Anterior hip replacement was first performed in the 1980s on a limited number of patients, but over the last few years it has gained greater popularity as more orthopedic surgeons have been trained in the intricate method. Now, it’s a viable option for most of the 400,000 Americans who undergo the surgery every year.
“It’s an anatomic operation,” says Roy Davidovitch, M.D., assistant professor at the New York University School of Medicine and director of the New York Hip Center at the NYU Hospital for Joint Diseases. “You remove the joint and put in an artificial joint without altering the anatomy.”
Conventional posterior hip replacement, the more common method of treating arthritic or diseased hips, involves entering the area through the side or near the buttocks and removing the damaged hip joint by cutting the gluteus maximus muscle off the bone. But anterior hip replacement is performed from the front (the area where the front pants pocket is located), separating the layers of muscles without damaging them.
“It avoids the need to detach muscle from bone or go through the belly of the muscle to get to the joint,” says Dr. Davidovitch. The approach also makes it easier to position the artificial joint properly with the help of a special X-ray technique, and it utilizes a smaller incision than the posterior approach.
“Patients bounce back about twice as fast, and their rehab is accelerated,” says Dr. Davidovitch.
After one to two days of recuperation in the hospital, patients are discharged back home to work with a nurse and physical therapist for a week or two. Best of all, the surgery leaves the hip’s range of motion intact, with less risk of hip dislocation than the posterior procedure. Patients can safely bend over, cross their legs, and resume their normal activities almost immediately.
Anterior hip replacement does have its critics. Some surgeons say that the operation results in more blood loss and a greater risk of fractures. Patients may also suffer nerve damage resulting in numbness or tingling along the thigh. And posterior surgery may be a wiser option for certain patients, such as the very obese or individuals who have already had metal implants or hardware placed in the hip. (Hip surgery patients who received one of the metal-on-metal implants recalled by the Food and Drug Administration should be monitored closely by their doctor, but may not necessarily need to have the implant replaced right away.)
But doctors who support the anterior procedure counter that the benefits outweigh the disadvantages.
“If you’re expert at [the anterior surgery] and have been trained on it, the risk profile is the same as with posterior surgery,” says Dr. Davidovitch. “With someone who’s more of a novice, the complication rates would be higher.”
No long-term research has yet been conducted to compare the effectiveness of the two surgeries. If you’re a candidate for hip replacement, your best strategy is to learn about both options and speak to surgeons before making a decision. Word of mouth is often a good way of finding a surgeon experienced in anterior hip replacement; hospitals specializing in joint diseases or sports medicine are also good sources. Dr. Davidovitch warns against choosing a doctor who offers both surgeries.
“You either believe in anterior replacement or you don’t,” he says.
When selecting a doctor, ask how many anterior replacements he or she has performed; an average of 50 or more per year is preferable. You should also inquire about the doctor’s infection rate – it should be less than 1 percent – and how many of his or her patients have suffered dislocations.
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