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Specialties: Anterior Hip Approach Procedure Overview

Reasons for the Procedure

Hip replacement surgery is a treatment for pain and disability in the hip. The most common condition that results in the need for hip replacement surgery is osteoarthritis.

Osteoarthritis is characterized by the breakdown of joint cartilage and adjacent bone in the hip. Damage to the cartilage and bones limits movement and may cause pain. Persons with severe degenerative joint disease may be unable to do normal activities that involve bending at the hip, such as walking or sitting, because they are painful.

Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a hip injury, can also lead to degeneration of the hip joint.

Also, hip replacement is one method of treating a hip fracture. A fracture is a traumatic event that may result from a fall. Pain from a fracture is severe and walking or even moving the leg is difficult.

If medical treatments are not satisfactory, hip replacement surgery may be an effective treatment. Some medical treatments for degenerative joint disease may include, but are not limited to, the following:

There may be other reasons for your physician to recommend a hip replacement surgery.

Risks of the Procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

The replacement hip joint may become loose, be dislodged, or may not work the way it was intended. The joint may have to be replaced again in the future.

Nerves or blood vessels in the area of surgery may be injured, resulting in weakness or numbness. The joint pain may not be relieved by surgery.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

In addition to a complete medical history, your primary physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

Notify your surgeon if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general). Notify your surgeon of all medications (prescribed and over-the-counter) and herbal supplements that you are taking. Notify your surgeon if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

Arrange for someone to help around the house for a week or two after you are discharged from the hospital.

Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

Hip replacement requires a stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Hip replacement surgery may be performed while you are asleep under general anesthesia, or while you are awake under spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Your physician will discuss this with you in advance.

Generally, hip replacement surgery follows this process:

After the Procedure

After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Hip replacement surgery usually requires an in-hospital stay of several days.

It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise program for you. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge.

You will be discharged home or to a rehabilitation center. In either case, your physician will arrange for continuation of physical therapy until you regain muscle strength and good range of motion.

Once you are home, it is important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.

Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Contact your physician to report any of the following:

You may resume your normal diet unless your physician advises you differently. You should not drive until your physician tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.

The Operating Table

Following anesthesia the patient is placed supine on the HANA or PROfx table. The unique capabilities of the table facilitate surgery through this smaller and less invasive approach. The carbon fiber spars that support the legs move appropriately and manipulate the operated leg during surgery. Additionally the table has a sterile robotic attachment that reaches inside the wound and lifts the femur to an accessible position. Not seen here are compression boots on the legs which prevent intra-operative blood clot formation.

The Approach
The hip is exposed by following a natural plane between muscles and without detachment of muscle or tendons from the bone. The femoral neck is cut and the arthritic femoral head and neck are removed.

Acetabular Preparation
The arthritic acetabulum undergoes a procedure called reaming. A hemispherical shaped reamer rotates on the end of a shaft. Reamers of gradually increasing diameter accurately shape the bone of the acetabulum to accept the acetabular prosthesis.

The Acetabular Prosthesis
An acetabular prosthesis slightly larger in diameter than the prepared acetabular cavity is inserted with a "press" fit that produces initial stability. During insertion active X-ray control with the fluoroscope is used to position the prosthesis accurately. One or more screws can also enhance initial stability. Later, stability relies on the biologic process of growth of the bone onto the prosthetic acetabular surface. Following insertion of this titanium acetabular "shell," the bearing surface (polyethylene, metal, or ceramic) is inserted.

Femoral Preparation
The table rotates the leg externally (foot pointed outward) and extends the hip, dropping the foot towards the floor to allow femoral access through this small approach. A broach is inserted into the femoral canal. Progressively larger broaches are then inserted. The broach size is limited by the hard outer cortical bone.

Sizing
Following insertion of the final broach, the driving handle is removed. The broach is temporarily left in as a "trial" femoral prosthesis and its upper end is capped with a trial femoral head. The table repositions the leg to its normal position and the trial head is "reduced" into the acetabulum. Active X-ray control is now used for sizing. Side by side television monitors compare the X-ray image of the patient's opposite hip to the operated hip. This comparison gives immediate information regarding equality of leg length and femoral offset (horizontal distance of the femur from the pelvis). The leg and hip are moved by the table to check for stability (resistance to dislocation). If the initial trial shows undesirable leg length, offset or stability adjustments are made.

The Femoral Prosthesis
A femoral prosthesis of specific size is accurately inserted to reproduce the sizing indicated by the trial phase.

The Final Result
The prosthetic hip is reduced by moving the leg into its normal position as the femoral head is placed into the acetabulum. The wound is washed with antibiotic solution and closed.

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Last Modified: June 24, 2014