Patients suffering osteoarthritis or have experienced any trauma to the hip joint can damage the parts of the hip. In such cases, a total hip replacement can help to restore the lost functions of the hip. Hip replacement is a surgical intervention where the damaged bony parts in your hip joint are replaced with metal or plastic implants(artificial parts) also called prosthetics through total hip arthroplasty.
There are two main types of approaches in hip replacement surgeries; one is the traditional posterior approach; in this approach, the incision is made behind your hip. The other one is the anterior approach, or anterior hip replacement become more common from the 1980s, in this approach, the incision in the front of your hip. This procedure also called as minimally invasive or muscle-sparing hip arthroplasty.
The surgical method of an anterior approach varies from the posterior approach during hip replacement surgery. These differences can have short-term or long-term impacts on patients. The main difference between anterior and posterior approaches is the location of the incisions.
Anterior hip replacement surgery: In this approach, the incision made at the front of the hip. Typically, the incision starts from the top of the pelvic bone and is extended down towards the top of the thigh bone. It is rare, but sometimes the incision is made horizontally.
Posterior hip replacement surgery: In this approach, the curved incision is made on the side and back of your hip. The incision curves just behind the greater trochanter, tubercle(a knobby bit of bone) that sticks out at the top of the femur-thigh bone, near its joint with the hip bone.
During the surgery in these approaches, some muscles need to be pushed aside or cut to get access to the ball-and-socket in the hip joint.
In this procedure, the incision is made on the front side of your hip joint. The hip surgeon pushes the muscles aside to reach the damaged part of the hip joint—this natural separation which allows access to the hip joint with less or no muscle cutting. Later the surgeon removed the damaged part of your thigh bone, i.e. the ball and the socket of your hip bone and replaced with prosthetic joints. In the anterior approach, the hip surgeon needs to works over the muscles supplied by different nerves.
Patients choosing this approach should not be overweight, no femur deformities, and the pelvis anatomy normal. It requires a very experienced hip surgeon because it is quite a challenging procedure technically and takes 90-100min of surgical time.
Posterior Hip Replacement
In this posterior hip replacement approach, the surgeons need to cut muscles and other soft tissue around the back of your hip, which include:
- The tensor fascia lata, it is a long fibrous soft tissue attached to the outer thigh. It helps to stabilize the hip joint.
- The fascia lata is attached to the large gluteus maximus muscle, which allows the thigh to extend and rotate outward. It also helps stabilize the pelvis and maintains the body straight.
- The external small, short rotator muscles of the hip connected to the pelvis. These muscles are responsible for hip stability and prevent dislocating the femur out of the hip socket.
Like the posterior approach, there is another process for hip replacement known as the direct lateral approach, in which the cutting of muscles is necessary. In this surgical approach, the gluteus medius and minimus known as abductor muscles, are also affected. The muscles which have cut during these surgeries are fixed and reattached at the end of the surgery.
A posterior approach is the most common type of surgery suitable for many patients. It is the most significant patient safety approach and nearly takes 60-70min operating time.
The medical field is constantly evolving and trying to develop better surgical outcomes in people getting hip replacements. Patients and doctors should make better choices choosing the procedure based on the current information available and clinical outcomes.
Advantages of Anterior Hip Replacement
The potential benefits of the anterior hip replacement include:
- The damage of muscle is very less because there is no involvement of cutting major muscles or detaching muscles from the bones. The surgeon operates by adjusting the muscles.
- The postoperative pain is very less because there is no requirement of cutting major muscles, and also it is a minimally invasive surgery.
- Recovery is faster; researchers say that people who have undergone anterior hip replacements able to walk within 5 to 7 without any assistive devices
- Less post-surgical complications
- Less risk of hip dislocation
- Very few restrictions on the activities after surgery
- Less chance of different leg lengths
- It can also be done as an outpatient procedure
Advantages of Anterior Hip Replacement
- The success rate of anterior hip replacement is high
- The placement of implants is more precise
- The visibility of the joint is excellent compared to the posterior approach
- Low risk of dislocation
Hospital stay is almost the same for both procedures. But in some cases, the posterior approach can also be performed as an outpatient (discharge on the same day of surgery) process. Postoperative complications risk of infection, pain, structures problems, blood clots and anaesthesia risks might also be the same for both approaches. Up to two weeks, you need to take complete bed rest, and later after six months you can light activities like walking etc. after posterior approach and with 4-6 weeks you can go to normal activities in cases of anterior hip replacement surgery.
However, both approaches have their benefits and risk. Which procedure to choose from both depends on various factors and will be discussed with the patient after a complete evaluation of the condition. For more information like the cost of hip replacement surgery or any other concerns, contact Dr. Vasudeva Juvvadi, Hip Replacement Surgeon in Hyderabad.