Direct Anterior Approach
Less Damage to Major Muscles
With the posterior and anterolateral approaches to the hip, the surgeon is required to cut through muscle fibers, split muscle fibers or detach muscles from bones. These actions often force the surgeon to make reattachment repairs at the end of these surgeries and make it necessary to protect the muscles during healing in the post-operative period. The anterior approach avoids cutting any muscles. Since there are fewer muscles at the front of the hip, the surgeon works between them. This leaves the large muscles utilized in walking intact thereby enhancing recovery.
Less Post-Operative Pain
Because the surgery does not require cutting or splitting any muscles, patients typically experience significantly less pain after surgery. Since the single most significant source of pain after the direct anterior approach is muscle spasms, patients are immediately walked in the recovery room after surgery to rid them of pain. Our patients often recover only requiring Extra-Strength Tylenol in the post-operative period.
After posterior and anterior-lateral approach hip replacement surgery, patients are given a list of precautions, certain movements, and activities that should be avoided in order to prevent the new hip from dislocation. They are also protected with a walker, crutches, or cane for a period of time to allow for the split or detached muscles to heal. Precautions are typically followed for the first 6 weeks after these surgeries. Research suggests people who have anterior hip replacements stop using walkers, canes, and other assistive devices sooner than posterior or anterolateral hip surgery patients. They do not need dislocation precautions due to the muscle sparing and preserving nature of the approach.
Less Potential Nerve Damage
While research is limited, many studies seem to suggest that the risk of damage to the major nerves near the hip, in particular the sciatic nerve, which controls most of the muscles in the lower extremity, is lower with the anterior approach than with the posterior approaches. This is because the sciatic nerve runs behind the hip joint, so it is not exposed when using the anterior approach.
At UNOVA Hip & Knee Center our patients recover more rapidly for a number of reasons. The first is the surgical approach which allows us to preserve muscle function and gait and limit the use of dislocation precautions. The second is the Opioid Free/Non-narcotic anesthesia and recovery program which means that the vast majority of our patients are alert and oriented from the time they awaken in recovery, which allows us to perform most of these surgeries as an outpatient.
Many surgeons do not utilize the Direct Anterior Approach to the hip because they face a steep learning curve for this procedure making it a technically demanding procedure. The surgeons at UNOVA Hip & Knee Center have spent many years perfecting their skills with this approach. It is important to remember that a successful hip replacement surgery depends on many factors besides the surgical approach. For example, the knowledge and skill of the surgeon, the type of hip prosthesis used, the patient’s weight and build, and the ability and willingness of the patient to participate in surgical preparation and post-surgical rehabilitation are important factors.
A patient considering anterior hip replacement surgery should speak with his or her surgeon about potential advantages and disadvantages in the context of the individual’s specific circumstances, such as the patient’s hip arthritis, anatomy, overall health, and lifestyle.
If you are considering a Total Hip Replacement, we invite you to learn more about the unique Direct Anterior Approach and experience the UNOVA Hip & Knee Center difference for yourself.