Introduction

The direct superior approach to hip replacement is a minimally invasive procedure to replace a painful or dysfunctional hip. The hip joint is a ball and socket joint with the head of the thigh bone or femur forming the ball and a cavity in the pelvic bones forming the socket. Hip replacement surgery involves replacement of all or part of the diseased hip joint with artificial components. Muscles, tendons, and ligaments surround and support the hip joint and enable hip movements.

The direct superior approach to hip replacement avoids injury to the muscles such as the iliotibial or IT band and the external rotators of the hip which are needed for proper hip and leg movement. The IT band is a large muscle present on the outside of the leg extending from the pelvis to the knee. It is useful for activities such as walking and bending.

Indications

Hip replacement surgery is indicated for conditions such as:

• Arthritis
• Avascular necrosis
• Hip deformity
• Injuries to the hip joint, such as a fracture

Surgical Procedure

Direct superior hip replacement is performed under general anesthesia.

• You will lie on your side for the procedure.
• A small incision is made on the side of the hip above and behind your hip joint. This incision is smaller and higher when compared to the posterior incision used during traditional hip replacement surgery.
• The hip joint is accessed through the gluteal or buttock muscles without injuring the iliotibial band and external rotator muscles of the hip.
• Instruments are used to retract the muscles and soft tissues.
• The capsule of the hip joint is entered from above.
• Instruments are used to remove the damaged or arthritic bone and to prepare the femur and pelvic bones to receive the implants.
• The implants are placed and hip movement is assessed.
• The hip capsule, along with any other detached structures, are then anatomically repaired, thus increasing mechanical stability and proprioception of the hip.
• The incision is then closed with sutures.

Avoiding injury to the muscles and other soft tissues reduces postoperative pain, allows a faster recovery, and ensures good hip stability.

Post-operative Care

You will be advised on follow-up care and activity limitations to minimize complications due to the minimally invasive nature of the surgery. The majority of patients will not need any formal traditional hip precautions after surgery. However, please always follow the postoperative instructions of your surgeon. The life of your hip replacement can depend on factors such as your weight and activity level. You should avoid high impact activities such as running.

Risks and Complications

Risks and complications associated with direct superior hip replacement are like other hip replacement procedures, although reduced due to the minimally invasive nature of the procedure. Some risks include:

• Hip pain
• Fracture
• Change in leg length
• Joint stiffness
• Joint fusion
• Nerve and blood vessel injuries
• Blood clots in the legs
• Embolism
• Stroke
• Heart attack
• Failure of the implant

Summary

Direct superior hip replacement is an innovative procedure that results in a more stable hip joint that helps you get back to your activities sooner. Due to the nature of this approach, traditional hip precautions following hip replacement surgery are not necessary for most patients. Always follow your surgeon's instructions for the best outcome.