The Anterior Approach: A quick operation, fast recovery, minimal pain, a neat scar.
Anterior (frontal) approach to Total Hip Replacement
The Anterior Approach hip replacement has become more popular in recent years and Professor Walter has seen this approach deliver excellent results for patients. The patient is placed on their back during the operation. An incision is made at the front of the body over the hip joint. The tensor facia lata muscle is pushed aside (it is sometimes released a little if necessary) and the joint is accessed by dividing the hip joint capsule, part of the short external rotator muscle insertion may also be released. If exposure is difficult the tensor fascia lata muscle may be partially released from the iliac crest and later repaired. A new acetabular cup is put into the pelvis. The top of the femur is removed and a new femoral stem is inserted into the femur bone. This articulates with the new cup implant, to create a new hip joint.
Incision used for anterior approach
With anterior surgical approach, the incision may be longitudinal (down the front of the thigh) which leaves a visible scar. Some patients are appropriate for a “bikini” incision, which is an oblique incision that is hidden in the groin crease. This is often important for women. The anterior hip scar is less visible and can be easily covered with underwear. Incisions at the front of the thigh often cause numbness (numbness is less common with a lateral incision used for a posterior approach). An area of decreased sensation is commonly occurs on the side of the thigh beside the incision. In one out of 8 patients this numbness extends more than half way to the knee. Less commonly the front of the thigh may be affected. Rarely muscle weakness may result but this can occur with any approach to the hip.
Anterior approach and computer navigation for the most precise placement of implant
Most hip surgeons do not use navigation guidance technology to get accurate placement of the implants. Navigation has been shown to make a difference in helping the surgeon to more accurately achieve the target position of the implants. Professor Walter does use navigation technology with the anterior approach. lends itself to computer navigation better than any other approach, with the result that the components can be placed more precisely in the bone through an anterior approach than through a posterior approach.
Advantages of the anterior approach and recovery time
The advantages of the anterior approach over the posterior approach is that post-operative pain is minimised, surgical blood loss is minimal and the operation itself is usually a bit quicker, taking about 60 – 75 minutes. Compared to other approaches, there is often a slightly faster recovery. Patients are up and walking the next day and tend to be ready to leave hospital 3 – 6 days after surgery.
Which surgical approach is best for me?
Patients often request that Professor Walter use a particular approach for their surgery. Many patients are hearing that the anterior approach hip replacement is the best option for them and in many cases this is true. Talking to a friend or doing a quick Google search can yield a great deal of information and you may form an opinion about which approach you may prefer. Very often, the approach you ask for is the best one for you. However, you should be aware that there are many factors which are considered when deciding which of these surgical approaches is most appropriate and these may not be obvious to you when you compare notes with friends or search the internet. Patient size and weight, an individual’s skeletal anatomy, type of hip implant to be used, past hip surgeries, medical history, physiological and anaesthetic considerations need to be carefully considered in order to decide what best for you. Of course, please ask as many questions as you like when you come to see us.