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Mr Arvind Jain MBBS MS FRACS FAOrthA

The Anterior Approach

Hip replacement surgery has been performed for many years and is a highly successful procedure. The surgery involves the diseased hip joint being replaced with an artificial prosthesis thus improving your quality of life and eradicating pain caused by the disease process. There are quite a few different surgical approaches that can be used when replacing the diseased hip joint. Mr Jain has recommended the anterior approach total hip replacement for you. The following information may benefit your understanding as to why this ‘approach’ has been recommended for you.
First of all, we will look at why you need a hip replacement.

Why Do I Need A Hip Replacement?

The vast majority of patients require a hip joint replacement due to arthritis. Arthritis is a group of conditions that cause damage to one or more joints. In your case the arthritis is in your hip joint. The most common type of arthritis is osteoarthritis, where there is gradual wear and tear of the joint. For some people this is a result of a previous problem or injury, but usually it happens without a known cause. Osteoarthritis eventually wears away the normal cartilage covering the surface of the joint and the bone underneath becomes damaged. This causes pain and stiffness in the joint, which can interfere with normal activities of day to day living. Hip joint replacement removes the diseased ball and socket components of your hip joint.

The Surgery

The manner in which exposure of the hip joint is achieved in order to remove the diseased hip joint and replace it with an artificial prosthesis is knows as the ‘approach’. For many years hip joint replacement has been performed via traditional methods with very good long-term results. These methods included the posterior approach (incision and exposure to the hip joint from the back of the hip) and antero-lateral approach (incision and exposure to the hip joint from the side of the hip).

Anterior Approach Replacement

Over recent years Mr Jain has elected to perform the majority of his hip replacements via the anterior approach (incision and exposure to the hip joint from the front of the hip). The anterior approach hip joint replacement has evolved in order to improve early outcomes, reduce the risk of dislocation and allow the patient to make a quicker recovery. The anterior approach involves a small incision being made at the front of the hip. No muscles or tendons are cut via this approach and therefore do not need to be repaired later. This allows faster patient recovery and the risks associated with traditional hip replacement are minimised, allowing the patient to rehabilitate quicker postoperatively. The advantages of anterior approach hip replacement surgery include:

  • Smaller incision than traditional hip replacement methods
  • No dissection or detachment of muscles and tendons reducing blood loss
  • Reduction in pain medication postoperatively
  • Patient is able to commence rehabilitation earlier
  • Less pain postoperatively
  • Patient stay in hospital is reduced
  • The chance of dislocation postoperatively is extremely low
  • Earlier return to work and activity
  • Minimisation of special precautions postoperatively
  • Patients can often drive 4 weeks post-surgery
  • Aids in the form of toilet seat raises or higher chairs are NOT generally required postoperatively
  • Progression from frame to crutches to no walking aids at all is generally quicker in the vast majority of patients

What Does The Operation Involve?

Various preoperative tests will be required to ensure that your health is optimal prior to surgery or to determine whether other medical professionals need to be involved in your surgical journey.
Various anaesthetic techniques are possible. Mr Jain will discuss preferred anaesthetic regimes with you. The anaesthetist will also discuss your anaesthetic and postoperative pain relief  edication with you preoperatively.

Antibiotics will be given to you during and after the procedure to minimise the risk of infection.

The operation itself takes approximately 60-70 minutes. At the end of the procedure the wound will be closed with stitches or clips.

Medication

You will be advised postoperatively of medications required for pain control and blood thinners to minimise the risk of blood clots.

What Can I Do To Help Make The Operation A Success?

Stopping smoking 6 weeks prior to surgery can minimise the risk of infection and improve your long-term health. Maintaining a healthy weight will lessen the risk of complication postoperatively. If you are able to undertake regular exercise prior to surgery this will aid recovery and improve your health.

To reduce the risk of infection in a surgical wound:

  • In the week prior to the surgery do not shave or wax the area where the cut is going to be made
  • Have a bath or shower either the day before or on the day of the surgery
  • Keep warm around the time of the surgery. Let Mr Jain, the anaesthetist or the nursing staff know if you are cold.

General Complications Of Any Operation

  • Pain. You will be given medication to control the pain and it is important that you take it as you are told so that you can move about as advised.
  • Bleeding during or after the operation. You may need a blood transfusion.
  • Infection of the surgical site (wound). It is usually safe to shower after 2 days but you should check with the healthcare team. Keep your wound dry and covered. Let Mr Jain or his rooms know if you have a high temperature, notice pus in your wound or if your wound becomes red, painful or sore. An infection usually settles with antibiotics, but you may need another operation.
  • Unsightly scarring of the skin, although hip replacement wounds generally heal to a neat scar.
  • Blood clot in your leg (deep vein thrombosis or DVT). This can cause pain, swelling, heat or redness in your leg, or the veins near the surface of your leg appear larger than normal. Often you are provided with stockings to wear postoperatively to reduce the risk of DVT. It is important to contact Mr Jain’s rooms if you experience any of the above symptoms or pain in your calf.
  • Blood clot in your lung (pulmonary embolus). Let the healthcare know straight away if you become short of breath, feel pain in your chest or upper back, or if you cough up blood contact Mr Jain’s rooms immediately or attend your local hospital emergency department.

Specific Complications Of This Operation

  • Infection in your hip, which can result in loosening and failure of your hip replacement (risk: 1 in 200). You will usually need one or more further operations to control the infection. If you get any kind of infection, including a dental infection, get it treated straight away as the infection could spread to your hip.
  • Dislocation of your hip replacement (<1% in the first 5 years). You may need another operation if this keeps on happening.
  • Leg length difference. Your surgeon will try to make your legs the same length again, but this is not always possible, especially if there is a large difference before the operation. You may need a shoe-raise.
  • Split in the femur when the stem of your hip replacement is inserted, if the bone is weak. Mr Jain may need to insert some wires around the femur, or use a different type of hip replacement.
  • Loosening without infection. You may need another operation to do your hip replacement again.
  • Damage to nerves around your hip, leading to weakness, numbness or pain in your leg or foot. Occasionally the patient can experience numbness over the lateral aspect of the thigh due to stretching of the lateral cutaneous nerve of the thigh. This usually gets better, but may be permanent.
  • Bone forming in muscles around your hip replacement (heterotopic ossification). This can cause loss of movement in your hip.

Recovery

You will spend 3 to 4 days in hospital. During this time your pain will be managed by the anaesthetist and nursing team. An xray of your hip will be done to determine the position of your new prosthesis is optimal. The physiotherapy team will visit you, usually the day following your procedure, to start mobilisation. You will see the physio daily until you go home. The physio will provide you with an exercise regime for you to do once you are home or suggest outpatient physiotherapy sessions if this is warranted. The nursing staff will arrange for your clips or stitches to be removed 12 to 14 days postoperatively by a nurse that will come to your home. You will see Mr Jain 6 weeks postoperatively in his rooms.

Most people make a good recovery, have less pain, and can move about better. It is important to follow the advice the physiotherapist gives you about exercises to strengthen your hip muscles. It is common for your leg to be swollen after a hip replacement, it can take up to 6-12 months for the swelling to go down. An artificial hip may never feel quite the same as a normal hip and it is important to look after it in the long term. A hip replacement can wear out with time. This depends on your body weight and how active you are. Eventually a worn hip replacement will need to be replaced. About 19 in 20 hip replacements will last 10 years. You should have an xray of your hip replacement at least every 5 years to check for any problems.

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