Total Hip Replacement – Direct Anterior Approach

• A minimally invasive surgery to replace a damaged hip while avoiding nearby muscles and tendons

• For eligible patients who want less pain and a quicker recovery from surgery

• Not all hip surgeons perform the anterior approach, which is more technically demanding

If you need a hip replacement, you are not alone. Total hip replacement is the second most common joint replacement surgery, falling just behind total knee replacements. In fact, it is projected that over half a million hip replacements will be performed in the US annually by 2030.

Thanks to new advancements and techniques, hip replacements are one of the most successful operations you can have. One of these advancements, called the direct anterior hip approach, has been gaining popularity over the last 20 years due to its many benefits. This muscle-sparing technique allows surgeons to avoid cutting important muscles and soft tissue, allowing patients to walk out of the hospital the same day as their surgery!

Randall Peyton, MD, orthopaedic surgeon and president of Arthritis & Sports, is a leading expert in the direct anterior approach. He is regularly featured as a guest speaker at surgeon education courses throughout the county, helping his fellow surgeons learn the direct anterior hip approach. In this article, he helps explain how the direct anterior hip approach benefits his patients.

What is a total hip replacement?

A total hip replacement is exactly what it sounds like – a surgery that removes the worn-out and damaged parts of the hip joint and replaces it with artificial components.

The hip is a ball-and-socket joint, with the rounded head of the femur (thigh bone) sitting inside the acetabulum of the pelvis (hip bone). During a total hip replacement, the damaged femoral head is removed and replaced with a metal ball and stem (which fits inside the hollow center of the femur), while a metal socket replaces the damaged surface of the acetabulum.

There are several surgical approaches, which we will discuss in a minute, but they all generally follow the same path. After your surgeon makes a single, large incision near your hip joint, they carefully remove the damaged parts of the joint (bones and cartilage). To gain full access to the hip joint, the surgeon might need to cut through or detach some of the muscles and tendons. While these are repaired, patients may be at risk for dislocation until these supportive structures are healed.

What is the direct anterior hip approach, and how is it different from other approaches?

As we stated above, your orthopaedic surgeon can access the hip from different angles. The surgical approach your doctor will recommend depends on several factors, including how the surgeon will gain access to the hip, the type and style of the implant and how it will be attached, and your age and activity level, and the shape and health of the hip bones.

The three most common ways to access the hip joint are from the back (posterior approach), the side (lateral approach), and the front (anterior approach). The posterior approach is by far the most common surgical approach for total hip replacement, both in the US and throughout the world. While this technique is very versatile, it requires the surgeon to cut away important muscles and tendons during the surgery to access the hip joint. This leaves the joint vulnerable to dislocation, which can lead to longer recovery times.

The direct anterior approach, on the other hand, preserves these important structures during surgery. By accessing the hip from the front of the thigh, the surgeon is able to work around the muscles and tendons to access the damaged bone and tendons. Instead of needing to cut them away, the surgeon gently pushes the group of muscles and ligaments aside, inserts the implants, and then moves them back to their proper position.

What are the benefits of anterior total hip replacement?

Proponents of this “muscle-sparing” technique believe it offers several advantages, including:

• Smaller incision (3 to 4 inches, compared to up to 12 inches with the traditional approach)

• Lower risk of dislocation (thanks to the supportive structures)

• Faster postoperative recovery (patients walk on their own―no walkers or canes―as much as six days earlier compared to traditional surgery)

• Shorter hospitalizations (many leave the same day!)

• Less postoperative pain

Why should you go to Arthritis & Sports for direct anterior hip replacement?

Arthritis & Sports is Northern Virginia’s leader in orthopedic care. Our board-certified, fellowship-trained surgeons are skilled in providing nonsurgical alternatives and minimally invasive approaches that prevent our patients from experiencing lengthy recoveries. Our practice is also home to one of the largest outpatient rehabilitation facilities, helping our patients to fully recover after their surgery. Our therapists are equally concerned with providing outstanding care for our patients, contributing the final piece to help you fully heal and return to your active life.

Dr. Randall Peyton, Arthritis & Sports’ president and lead total joint surgeon, has special expertise in anterior hip replacement surgery. In addition to the thousands of successful joint replacements he has performed, Dr. Peyton is regularly featured as a guest speaker at surgeon education courses throughout the county, helping his fellow surgeons learn the direct anterior hip approach. Thanks to his surgical technique and outcomes, as well as his “Patients First” attitude, Dr. Peyton is frequently recognized by his patients and peers, appearing in “Top Doctor” editions of the Washingtonian Magazine, Northern Virginia Magazine, and Virginia Living.

Posterior hip replacement and anterior hip replacement are the most common approaches, and each has its own benefits and risks. At Arthritis & Sports Orthopaedics, we offer the full breadth of treatment—from nonoperative to operative—for hip arthritis. While a hip replacement is one of the safest, most effective operations you can have, all surgical procedures carry some risks. As with any surgery, it’s important to talk to your surgeon about any risk factors you may have, including your age, your weight, any medications you may be taking, and your general health.

To see if you are a good candidate for anterior total hip replacement, we invite you to call us at 703.444.5000 to schedule an appointment with Dr. Peyton here at Arthritis & Sports or click here to request an appointment. To stay up-to-date on the latest news and tips from us, be sure to follow us on Facebook and Instagram, and sign up for our monthly newsletter for even more information sent straight to your inbox!