Anterior Hip Replacement

Anterior hip replacement is a minimally invasive hip surgery performed to replace the hip joint without cutting major muscles. It is also known as a muscle-sparing surgery because no major muscles are cut, allowing for a faster return to normal activity. Traditionally, with total hip replacement, the surgeon makes the incision either laterally, on the side of the hip, or posteriorly, at the back of the hip. Both of these approaches involve cutting major muscles to access the hip joint. With the anterior approach, the incision is made on the front of the hip, which allows the surgeon to access the joint without cutting any major muscles.

Indications

Hip replacement is indicated for patients with arthritis of the hip joint. Arthritis is a condition in which the articular cartilage covering the joint surface is damaged or worn out, causing pain and inflammation. Some of the causes of arthritis include:

• Advanced age
• Congenital or developmental hip diseases
• Obesity
• History of hip injury or fracture
• Increased stress on the hip due to overuse

Symptoms

Patients with arthritis may have a thinner articular cartilage lining, a narrowed joint space, the presence of bone spurs, or excessive bone growth around the edges of the hip joint. Due to all these factors, patients with arthritis may experience:

• Pain
• Stiffness
• Restricted movements

Diagnosis

Your doctor will evaluate arthritis based on your characteristic symptoms and diagnostic tests. Your orthopedic surgeon will perform a physical exam, order X-rays and other imaging tests, and also some blood tests to rule out any other conditions that may cause similar symptoms.

Procedure

Anterior hip replacement surgery involves the following steps:

• The procedure is performed under general or regional anesthesia.
• You will lie on your back on a special operating table that allows the surgeon to perform the surgery from the front of the hip.
• Your surgeon may use fluoroscopic imaging during the surgery to ensure accurate component positioning and to minimize leg length inequality.
• Your surgeon will make an incision about 10 cm long on the front of the hip.
• The major muscles are moved aside to access the joint and perform the replacement.
• The femur bone is then separated from the acetabulum. The acetabular surface is prepared with a special instrument called a reamer.
• The acetabular component is cemented or fixed with screws into the socket.
• A plastic, metal, or ceramic liner is then placed inside the acetabular component.
• The worn femoral head is cut off, and the femur bone is prepared with special instruments so that the new metal component fits properly into the bone.
• The new femoral component is then inserted into the femur bone, either by press-fit or using special bone cement.
• The femoral head component, made of ceramic or metal, is then placed on the femoral stem.
• Once the artificial components are fixed, the instruments are removed, and the incisions are closed with sutures and covered with a sterile dressing.

Risks and Complications

All surgeries carry an element of risk, whether related to the anesthesia or the procedure itself. Risks and complications are rare but can occur. Below is a list of complications that may occur after any hip replacement procedure:

• Infection at the incision site or in the joint space
• Fracture
• Nerve damage
• Hemarthrosis (excessive bleeding into the joint after surgery)
• Deep vein thrombosis (blood clot)
• Leg length inequality