EVERY PATIENT AND EVERY OPERATION IS UNIQUE AND THEREFORE THIS ANTERIOR HIP REPLACEMENT GUIDE WILL NOT BE ABLE TO ANSWER ALL YOUR QUESTIONS. If you have any questions, simply book a consultation today.
Anterior Hip ReplacementKunal Shah2021-06-08T22:19:14+10:00
Figure 1: Anterior Approach to the hip joint
What is Anterior Hip Replacement Surgery?
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.
Figure 2: Chart to show the surgical approach used to replace the hip in Australia
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 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.
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.
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.
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
During your appointment, Dr Parminder Singh will take a history, examine you and review the relevant radiology. If any further scans are required Dr Singh will request those. Once the diagnosis has been confirmed Dr Singh will discuss the non-surgical option and surgical options of surgery. If no surgery is required Dr Singh may refer you to a physiotherapist for non-surgical management. If surgery is required Dr Singh will consent you for the surgery explained the risk and benefits of the procedure and the expected outcome.
Dr Parminder Singh will see you before the surgery in the waiting bay and ensure all your questions have been answered prior to surgery.
Dr Parminder Singh will examine your hip, thigh and leg making sure there are no open wounds or signs of skin infection.
If there are any signs of infection, you surgery will be cancelled and rescheduled for another day. Once this has been check Dr Parminder Singh will draw an arrow on the side of your thigh confirming with you the side of surgery. Dr Parminder Singh will check your consent form to again confirm the operation being performed and side of surgery.
Following your surgery, you will recover on the ward. Most individual stay three to four nights in the hospital and will be seen by the physiotherapist on the ward to facilitate mobilisation using crutches for the first 1-2 weeks.
Some individuals will use the crutches for longer depending on the type of injury and treatment required. Dr Parminder Singh will see you in his rooms approximately 10-14 days after the hip replacement surgery and inspect the hip wound.
The stitches will be removed during this appointment. Dr Parminder Singh will also explain the operative findings and recommended precautions and rehabilitation required. Another appointment will typically be organised for you around 6-8 week after this date to assess your progress. In the meantime, rehabilitation is usually recommended with a physiotherapist who has experience with hip replacement patients.
It is important to follow the hip precautions Dr Parminder Singh recommends to allow for the best possible outcome.
Further appointments will be made at approximately 6 and 12months post operatively and check x-rays will be requested. Dr Parminder Singh recommends to allow approximately 3 months for the soft tissue healing from the surgery and hip precautions during this period. The bone healing will continue for up to 12 months after surgery and Dr Singh will check this for you during the following up appointments. In terms of longer term, Dr Singh will review you in 5, 10, 15, 20 years after your hip replacement with regular x-rays.
Book a Consultation
Committed to improving the quality of patient advice, treatment and care in the field of orthopaedics, book a one-on-one consultation with Dr Parminder J Singh today.
21 Erin Street, Richmond VIC 3121 Book a consultation on: (03) 9428 4128
85 Wilson Street, Brighton VIC 3186 Book a consultation on: (03) 9428 4128
116-118 Thames St, Boxhill VIC 3128 Book a consultation on: (03) 9428 4128
Waverly Private Hospital, 343-357 Blackburn Rd, Mt. Waverley VIC 3149 Book a consultation on: (03) 9428 4128
389 Canterbury Road, Forest Hill VIC 3131 Book a consultation on: (03) 9428 4128
16 Brantome Street, Gisborne VIC 3437 Book a consultation on: (03) 9428 4128