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)

Data for Hip Replacement, PJS Orthopaedics Melbourne

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

Hip rotation test 1, PJS Orthopaedics Melbourne
Hip rotation test, PJS Orthopaedics Melbourne

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.

Hip structure figure, PJS Orthopaedics Melbourne

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.

Frequently Asked Questions About Hip Replacement?

Generally this varies between patients and whether they went to go home directly or to a rehabilitation centre after their hip replacement.  It is important to check your insurance covers your for rehabilitation prior to your surgery.  On average patient’s will be asked to walk the same day as their surgery or the following day under the supervision of the physiotherapist.  Patients are typically discharged from hospital on average 3-5 days after their surgery.  No patient will be discharged from hospital if they are not confident to manage at home.  Patients should be given information about telephone numbers or other methods of contacting the hospital or the orthopaedic service, should problems occur.

Mr Parminder Singh will usually see you in his rooms approximately 10-14 days after your surgery to inspect your wound and remove the skin stiches or staples.
The time will vary between patients and Mr Parminder Singh will advise you if it is safe to fully weight bear with your crutches or partially weight bear. This varies particularly if bone graft was used during your hip replacements. Generally, however, patients will use crutches for approximately 2-6 weeks after their surgery. Patients tend to progress from a walking frame to two crutches, one crutch and finally independent walking.
During your inpatient stay in hospital, the physiotherapist will go through any particular hip precautions which will vary depending on if you surgery in undertaken using the anterior muscle sparing approach or mini-posterior approach. Generally the extreme range of motion should be avoided initially, sitting on low seats and reaching for objects on the floor to reduce the risk of hip dislocation.

Most patient can drive approximately 6 weeks after your surgery. If you are not sure, please check with Dr Singh at your post operative appointment.

Put the passenger seat as far back as possible. Stand with your back to the car with knees touching the seat. Gently lower yourself down onto the seat with your bottom as far onto the seat as possible, sliding your operated leg out in from of you. Swing your legs round into the car. Getting out of the car is the same procedure in reverse.

Generally, you will require to medication for pain control and reducing the risk of developing clots in your leg. Generally pain control will diminish significantly over the first 2-3 months after your surgery.

Although deep vein thrombosis (DVT) can be demonstrated in 50-60% of patients after primary total hip replacement (THR), it is symptomatic in approximately 2%. The most severe consequence of DVT is fatal pulmonary embolism (PE). Thromboprophylaxis (taking blood thinners) reduces fatal PE by 70% and DVT by 50%.

Prophylactic (preventive) measures are pharmacological and mechanical. Mr Singh recommends a pharmacological agents that has anticoagulant properties to be administered once per day for six weeks. Mr Singh also recommends mechanical measures comprising foot pumps until discharge from hospital and graduated compression stockings for six week.

Yes you will benefit from ongoing physiotherapy following your hip replacement particular during the first 2-3 months after your surgery. Mr Parminder Singh can help you organise this should you need assistance with this. With the less invasive techniques, some patients will require even shorter duration of time with physiotherapy.

Approximately 1-2 % of patients sustain a hip dislocation after total hip replacement. Some sexual positions can increase the likelihood of hip dislocation.  In particular during extreme flexion and rotation of the hip. The following article provides some useful information to help guide the patient during sexual activity after their surgery : Sex after hip replacement surgery

The overall cost of a hip replacement surgery is inclusive of the surgeon’s fees, hospital fees, anaesthetist and surgical assistant’s fees.

  • Surgeon’s fees: Dr. Parminder J Singh follows the Australian Medical Association ( AMA ) fees guidelines for all of his surgeries.
  • Hospital fees: This cost is covered entirely by your private health insurance. If you are uninsured, our staff will assist you with providing an estimated quote for your surgery
  • Anaesthetist and Surgical Assistant Fees: Dr. Singh has his own team of assistants and anaesthetists who also follow the AMA guidelines.

Following your consultation with Dr. Singh, our staff will go through the exact cost of your surgery in detail.

What Is The Process Moving Forward?

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