Why Choose Anterior Hip Replacement Surgery? | El Camino Health

Introduced in the U.S. in the 1990s, anterior hip replacement surgery is quickly becoming the favored technique of many top hip replacement experts. Patients love it because it is less invasive, resulting in a shorter hospital stay, a quicker recovery and a quicker return to normal activities. In this video, a group of orthopedic surgeons from El Camino Hospital in Mountain View, California (Drs. Bernardo Ferrari, Jeffrey Kliman, John Parker, James Page and Rodney Wong) cover the specific reasons why you should look into this approach to hip replacement surgery.

Transcript:

The anterior approach to hip replacement is really the most sophisticated way to perform a total hip replacement. The hip joint is a ball and socket joint. It's normally, in its undiseased state, covered with smooth articular cartilage, and that allows the femur to move in relationship to the hip. As you develop arthritis, a simplified way of looking at it is that the cartilage wears off and becomes rough, and you end up with often two bones from the hip and you have to have them grinding together. This causes pain and stiffness and often a limp.

Technology has allowed significant improvements in the prosthesis over the years, and more recently with the anterior approach, we've improved the surgical technique, which allows your hip to be stronger, decreases your chance of a limp and dislocation. So, with the anterior approach, we go through a true intramuscular, intranervous interval. That means we don't disrupt the nerves which makes the muscles work, and we also don't damage the muscles. So by going through this plane, it's the one way to disrupt the anatomy the least, while doing a total hip replacement.

With the posterior approach, we usually split the gluteus maximus, the large muscle in your buttock, and that can partially denervate the gluteus maximus, which would leave it weaker after surgery which could contribute to a limp. With the lateral approach, you also split the gluteus medius muscle and potentially could injure the superior gluteal nerve. But with the anterior approach, after surgery, all your muscles have the potential to work the way they did before surgery, and this allows people to recover faster and actually have a better functional result with less chance of dislocation.

The anterior approach in the hip is not a new approach. It's been done for years. It may have been actually one of the first approaches to the hip. But the anterior approach for total hip arthroplasty has been done for decades in Europe. In the 1990s, a Dr. Matta down in Los Angeles, he had one patient who had his done in Europe and wanted another one done. So he explored this approach and found it to have many advantages over the posterior approach. At El Camino Hospital, we started doing this approach about seven years ago, and over that period of time have done over 800 anterior approaches to the hip, which probably makes us the leader in anterior approaches to the hip in northern California.

The main difference is that the dislocation rate is at least ten times lower. If you look at the dislocation rate when you perform the procedure through the back, through a posterior approach, it's approximately 3% to 5% nationally. And if you do it through the front, through an anterior approach, it runs between 0.3% to 0.8%. So it's about ten times lower.

Once we get into the joint and start putting in our components, we also have the advantage, because the patient is laying on his back as opposed to being on his side, we can use x-rays during the case, actually fluoroscopy. This helps us with positioning of the components as well as making sure that our leg lengths are equal. We will actually break scrub at the end of the case and measure the leg lengths just to ensure that the leg lengths are equal.

By doing the anterior approach, we don't have to do any precautions after surgery. If you do a posterior approach, for three months you have to be very careful not to sit in low chairs or on low toilet seats, not to bend over past 90% at the hip, and not to cross your legs. When we do an anterior approach, there are no hip precautions from day one.

Contact El Camino Health today to learn more about the anterior approach to hip replacement.