Anterior Approach to Hip Replacement Speeds Recovery, Minimizes Risk

(March, 2008) Nearly 300,000 Americans undergo hip replacement surgery each year, followed by an extensive, activity-limiting recovery process.

But thanks to the work of two orthopedic surgeons on staff at Ingalls, there’s a minimally invasive hip replacement surgery known as the “anterior approach” now available in the south suburbs. And while the procedure itself may be new to the area, the anterior approach has been performed with remarkable success in France and the United States for decades, helping to make recovery faster and easier for patients.

“The Anterior Approach to hip replacement was first performed in Europe in 1947,” explains David Smith, M.D., board-certified orthopedic surgeon on staff at Ingalls. Following extensive training, Dr. Smith and Joseph Thometz, M.D., board-certified orthopedic surgeon, have introduced the technique to Chicago’s South Suburbs. “Today, literally thousands of hip replacement patients have benefited from this minimally invasive approach in Europe and America.”

Drs. Smith and Thometz brought the anterior approach to Ingalls several months ago and have seen very positive results in their patients – like William Metz of Schererville, Ind., and Nancy Fallah of Olympia Fields. Fallah was the first patient at Ingalls to undergo the new procedure.

“I haven’t experienced any pain or problems since having the procedure done in late July,” Fallah explains. “I feel great.”

Since then, Fallah has set aside her walker to enjoy a life free of hip pain.

Metz, who suffers from arthritis of the hip, had the surgery to replace his right hip in November. Two years earlier, he had his left hip replaced using the traditional “posterior” approach.

“The anterior approach is a whole lot less invasive,” he adds. “And it’s a lot better in terms of recovery. I don’t have to worry about sleeping with a pillow between my legs. I don’t need a special, high toilet seat. And I can stand in the shower. These are all things that I couldn’t do the first time around. Other than a slight soreness, it’s been an easy recovery. I’d definitely recommend it to family and friends.”

Background on the Procedure:
The anterior approach to hip replacement surgery allows the surgeon to reach the hip joint from the front of the hip as opposed to the lateral (side) or the posterior (back) approach traditionally used in the United States. This approach allows surgeons to work between the muscles and tissues without detaching them from either the hip or thigh bones, sparing these tissues from trauma and a lengthy healing process. Keeping these muscles intact also helps prevent dislocation of the hip, a major benefit to patients.

Why, then, is this approach not more widely used in the United States? There are several reasons, including traditional medical school instruction, which espouses the posterior approach, and limited access to the necessary instrumentation and equipment, including a specially designed operating table now available at Ingalls.

“When I first began practicing in 1979, I worked with a doctor who used this technique, and I was always impressed with how well patients recovered after surgery,” Dr. Smith said. “At the time, however, orthopedic surgeons in the United States were trained to use the ‘posterior’ approach.”

How it Works:
The anterior approach is made possible with the use of a high-tech operating table that places the leg and pelvis in a stable position. The specially engineered table, which Ingalls recently invested nearly $100,000 in, includes leg supports that allow the surgeon to adjust the operative leg during surgery with a great degree of control and precision, helping to achieve excellent alignment and positioning of the implant.

“Rather than being positioned on their side or stomach as is the case in traditional hip replacement surgery, the patient is laid flat on his/her back, which minimizes tilting of the pelvis during the operation,” Dr. Thometz added. “The table also gives the surgeon excellent access to the femur, or thighbone, in order to position the stem of the implant effectively.”

X-rays taken during surgery with a fluoroscope ensure correct position, sizing and fit of the artificial hip components, as well as correct leg length.

“We perform these procedures together in the operating room,” Dr. Smith added. “Our patients benefit from our collaboration and from our more than 45 years of combined orthopedic surgery experience.”

How the Procedure Improves Recovery:
Conventional lateral or posterior hip replacement surgery typically requires strict precautions for the patient, including limited hip motion for six to eight weeks after surgery. Patients must also limit flexing of the hip to no more than 60 to 90 degrees which complicates normal activities like sitting in a chair or on a toilet seat, putting on shoes, or getting into a car. Climbing stairs is also more difficult during recovery.

Following anterior hip replacement, however, patients are allowed to immediately bend their hip freely and bear full weight when comfortable, resulting in a more rapid return to normal function. And, in supervised physical therapy, patients go up and down stairs before their hospital release.

“Rehabilitation following the anterior approach is simplified and accelerated, dislocation risk is reduced, leg length is more accurately controlled, and the surgical incision is relatively small,” Dr. Smith explained.

“Other surgical approaches involve detachment of muscle from the femur during surgery,” Dr. Thometz added. “In the anterior approach, by contrast, the hip is approached and replaced through a natural interval between muscles. The most important muscles for hip function, the gluteal muscles that attach to the posterior and lateral pelvis and femur, are left undisturbed, leading to immediate stability of the hip and a low risk of dislocation.”

Other benefits to patients include a shorter hospital stay (two to four days vs. three to 10 days with traditional hip replacement surgery); a smaller incision; less muscle trauma; reduced blood loss; less pain; and a more rapid return to normal activities.

For more information on the anterior approach to hip replacement surgery at Ingalls, please call Ingalls Care Connection at 1.800.221.2199.

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