Anterior Hip Replacement

Figure 1: Anterior Approach to the hip joint

The anterior approach is a surgical technique used to approach the hip joint in an individual with arthritis. The anterior approach is commonly used to perform a total hip replacement and is considered a minimally invasive technique. This procedure also does not require the surgeon to cut any muscles and simply goes in between muscle planes (see figure 1)

Careful selection of the patients based on their anatomy, shape of their thigh and severity of arthritis can minimize complications via the anterior approach. Dr. Parminder J Singh, has received specialist fellowship training using the Anterior Approach under during his fellowship with Professor John O’Donnell in Melbourne in 2008. Dr. Singh has been performing anterior hip replacement for this Melbourne patients regularly since then.

Since 2008, the anterior hip replacement is being used more frequently in Australia. In the USA, 15-20% of the hip replacements are being undertaken via the anterior approach.  The Australian National Joint Registry started collecting the surgical approach data in 2015 and reported that 37% of joint replacement in Australia were being undertaken via the Anterior Approach (see figure 2)

The most common indication for an anterior hip replacement is osteoarthritis.  Individuals with advanced osteoarthritis typically will have pain in the groin, lateral hip (side of the hip), buttock and or thigh. This pain can be associated with stiffness in their hip movements.  Often the ability of the patient to undertake activities of daily living becomes increasingly more difficult.  Some patients walk with a limp and find it difficult to stand on one leg.  During your consultation with Dr. Parminder J Singh, he will assess your leg length and range of motion, among other things. Individuals with advanced osteoarthritis will have a restricted range of motion particular with internal rotation (IR) and external rotation (ER) (See figure 3)

Figure 2: Chart to show the surgical approach used to replace the hip in Australia

Figure 3: Clinical examination showing the internal and external rotation test

Radiological assessment of osteoarthritis often reveals some signs of loss of joint space, osteophytes (bone spurs), subchondral sclerosis and in some advanced cases sub chondral cyst formation (see figure 4)

Following a review with Dr. Parminder J Singh, which will include your medical history, clinical examination and radiological assessment, a decision will be made whether a hip replacement is indicated. Dr Parminder J Singh, will tailor his decision to determine the surgical approach and the type of hip replacement for you.

Dr. Singh in 2021 published his 5 years results in a prospective randomized control study comparing the anterior vs the posterior approach in hip replacement. The research demonstrated there was no difference in the functional, radiographic and survivorship outcomes between the direct anterior or posterior approach for hip replacements in Australia. These results are similar to other studies published around the world.

While in hospital post surgery, patients typical spend approximately 3 days in hospital prior to being discharged. Dr. Singh usually checks in on his patients approximately 10-14 days following surgery, to assess the healing of the wound and remove any stitches. Most of the patients come off their crutches in around 2-4 weeks post surgery. They would need to undergo some physiotherapy to support them during recovery. Dr. Parminder J Singh will monitor each patient’s recovery at regular, scheduled intervals and offer support with clinical and radiological assessment.

Most osteoarthritis patients will report a significant improvement in their pain, range of motion and quality of life following an anterior hip replacement. Melbourne patients prefer this approach for its faster recovery time and effectiveness.