The Anterior Approach
Best Possible Outcomes, Shortest Recovery Time
Dr. Shin performs hip replacements for patients who suffer from hip osteoarthritis, hip dysplasia, avascular necrosis and other congenital/acquired conditions that lead to pain and dysfunction. He utilizes a cutting edge surgical approach that allows the patient to have the best possible outcomes with the shortest recovery time, all the while minimizing the risk of complications during and after surgery. He proudly takes personal interest in the goals of each of his patients through a thorough evaluation and helps you decide if this is the best option for you.
Anterior Approach Advantages
The Anterior Approach describes an approach of the hip joint from the front, as opposed to a more traditional posterior approach to the hip. The hip is accessed in a naturally occurring interval between muscles as opposed to cutting or splitting through them. The technique uses the same implants as traditional hip replacement.
There are several unique advantages to using this technique for the patient.
Improved Dislocation Rate
Fast Control over Implant Positioner Recovery
Dr. Shin has performed hundreds of anterior hip replacements and believes the anterior approach is the “best option to restore normal anatomy, allow for the fastest recovery and provide the best chance for the patient to get back to activities they were unable to do as a result of their hip condition.
Traditionally, the gluteal muscles are incised or split with other approaches. The anterior technique allows us to preserve this muscle, allowing gait and strength to be restored sooner. Often patients are seen resuming normal daily and athletic activity weeks and even months earlier than an individual who has undergone a standard approach hip replacement. In addition, the preservation of these muscles allows for lower dislocation rates, as these muscles are very important for maintaining stability of the hip after surgery. A hip dislocation after surgery is a major complication and with the anterior hip replacement, we have been able to reduce dislocation rates to 1/1000, compared to 1/20 in some studies measuring dislocations after a traditional approach hip replacement.
“I am often asked how the low dislocation rates are achieved with an anterior approach.”
When performing an anterior approach total hip replacement, patients are positioned in a flat position for which we can utilize x-ray during the surgery to optimize implant position. This provides objective, measurable feedback to ensure a patient leaves the operating room with the implants placed in the best position to prevent dislocation. In addition, we are able to restore a patient’s normal anatomy with precision using the feedback from the measurements used with the x-ray images. Ultimately, this translates to faster recovery, better functional outcomes and lower complication rates.
Frequently Asked Questions
While the advantages of anterior hip replacement makes it a very attractive option, the main disadvantage is that there is a steep learning curve for the surgeon. The lowest risk to the patient is when you select a surgeon who has vast experience in the ANTERIOR approach to hip replacements.
Nerve injury is another possible complication that is present with any surgery. For anterior hip replacement, nearly 75% of patients describe some skin numbness around the thigh after surgery that typically improves over weeks to months. Nerve injury to a motor nerve (controlling motion of the knee and foot) is a much less frequent but more concerning complication that is very rare. The anterior approach does NOT have a higher rate of motor nerve complications compared to the standard posterior approach.
Finally, femoral fracture can occur during the procedure. This has been described as a more frequent complication for anterior hip replacements in the early literature for this procedure. However, with technological advances in instrumentation, the incidence has made this a rare complication as well. When it does occur, it is important that there is prompt recognition by the surgeon to address and fix the problem at the time of the hip replacement.
The surgery is performed at two types of facilities. One is a traditional hospital and the other is a same day outpatient surgery center. An evaluation will be completed prior to the surgery based on each patient’s medical history and home situation to decide which is most appropriate. Dr. Shin generally encourages patients to make preparation in their home to accommodate returning and staying at home for a few days after discharge from the surgical facility. Furthermore, in the appropriate situations, a home physical therapist and home health nurse can be utilized during the first few days after surgery.
Most patients will utilize a walking device (i.e. cane) for a few days to a few weeks after surgery. Return to driving is typically a few weeks. We recommend avoiding impact sports and activities where falling is possible for the first 3 months.
Pain medications are typically used for 1-3 weeks after surgery. The use of an ice machine is optional but can be utilized to help the patient wean off narcotics faster and allow for a more rapid form of swelling control.