Anterior Hip Replacement Fact Sheet

The Anterior Hip Replacement is an increasingly popular method of replacing a hip joint as it doesn’t involving cutting muscles or tendons leading to rapid recovery.

These benefits include:

  • Preservation of Muscle: The anterior approach of the hip goes in between the muscles in the front of the hip, without the need to cut any muscles or tendons. Thereby preserving the muscles. The 2 most common traditional methods, called the Posterior and Lateral Hardinge approach, require the releasing of muscles and tendons off the femoral bone.
  • Prevention of limping: By preserving the muscle, patients are less likely to develop long term problems such as a limp, which can occur after the the gluteal tendons are detached from the top of the femoral bone, such as in the lateral hardinge approach.
  • Post-operative pain: In conjunction with modern anaesthetic techniques, patients experience much less pain with hip replacement surgery.
  • Reduced risk of hip dislocation (separation of the hip ball and socket): By preserving the muscles around the hip, the stability of the hip is greatly improved. The risk of dislocation is minimal. Also, the post-operative limitation of movements, usually necessary with the posterior and lateral techniques, is no longer necessary. The risk of dislocation is reduced because the Anterior Hip Replacement technique is performed from the front of your body and dislocation is mainly related to damage the structures around the back of the hip.
  • Rehabilitation and Recovery: Rehabilitation starts the day of the operation. Standing up and walking with arm-crutches or a walker can begin immediately.
  • Return to daily activities: We measure our patients functional performance before and after surgery, and the majority of our patients have regained their preoperative function by 10 days.
  • Small skin scar: The Anterior approach of the hip is performed through a small incision in the front of the hip.
  • Hospital stay. Most patients go home after 3 days after the operation with minimal pain and walking comfortably.
  • Less blood loss: Preservation of muscles and vessels reduces blood loss. Transfusions and blood clots in the legs (deep venous thrombosis) are uncommon.

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Xray of both hips.
The right hip has a Total Hip Replacement and the left hip is normal.

The Goal of the Anterior Hip Replacement

The primary goal of Anterior Hip Replacement is to minimize harm to muscles, blood vessels and nerves surrounding the joint. The Anterior Hip Replacement technique is designed to specifically to achieve these goals.

The Anterior Hip Replacement technique approach is a true muscle-sparing surgical technique. With the Anterior Hip Replacement surgical approach, your muscles are not cut, which aids in rapid recovery.

What to Expect From Anterior Hip Replacement Surgery

It is important to understand what a anterior hip replacement can and cannot do before deciding to undergone the operation.

Most people who have anterior hip replacement surgery, experience a dramatic reduction of hip pain and a significant improvement in movement allowing them to better perform common activities of daily living.

With almost 70 years of history, hip replacement surgery is a very common and safe procedure for the treatment of severe osteoarthritis.

The main benefits of a successful total hip replacement are:

  • Reduction in hip pain: the pain will be rapidly and dramatically reduced and usually eliminated.
  • Recovery of mobility: your hip will function with less effort, almost regaining your original mobility.
  • Improvement in quality of life: your everyday activities and your social life will no longer be limited by pain and reduced mobility.

However, there are certain things that you cannot do with an anterior hip replacement. Such as

  • jogging
  • any high impact sports such as football.

You will also be restricted from certain movements that may lead to dislocation of your hip.

Who is this operation for?

The Anterior Total Hip Replacement is for patients who have severe pain and stiffness in the hip.

Reasons to replace a hip

The most common reason to replace a hip is arthritis. There are many causes of arthritis, but the most common ones include:

  • Osteoarthritis. Usually affects people above 50 years old, but can affect people who are younger. It is essentially a ‘Wear and Tear’ process affecting the cartilage of your hip. Cartilage covers the bones of your hip joint, the femoral head (ball) and acetabulum (socket). As you age, your cartilage wears down, causing hip pain and stiffness.
  • Rheumatoid arthritis. Is an autoimmune disease in which a special membrane in you hip joint, called the synovial membrane becomes inflamed. This inflammation damages the joint cartilage.
  • Osteonecrosis. You hip joint can be affected by a condition called osteonecrosis or ‘bone death’. There are many possible reasons for osteonecrosis which include prolonged steroid use, alcohol abuse or genetics.

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Xray of the Pelvis.
The Right Hip has been affected by Osteoarthritis

Is the Anterior Hip Replacement Surgery for You?

Whether to have hip replacement surgery should be a joint decision made by:

  • yourself
  • your family
  • your family doctor (GP)
  • Dr Phong Tran.

You should consider

  • the pros and cons of the operation,
  • the possible complications
  • alternative treatments other than surgery
  • the surgical options

You may benefit from hip replacement surgery, if:

  • Your hip pain is severe
  • It limits your movements and activities such as walking and climbing stairs
  • It impairs your ability to look after yourself such as showering, putting on shoes.
  • The pain is present at night and at rest.
  • You have tried non-surgical alternatives without success

Medacta Anterior Hip Replacement Leaflet

What are the nonsurgical options for hip osteoarthritis?

  • Hip replacement surgery should only be considered after trying other options that don’t involve surgery.
  • These include
    • pain relieving medications
    • physiotherapy
    • weight loss
    • walking aids such as walking sticks.

What happens during the operation?

Admission

Most people are admitted to hospital on the day of surgery.

Anaesthesia

The anaesthetic team will see you and decide the type of anaesthetic that’s best for you.

The different types of anaesthesia include:

  • General Anaesthetic. This type of anaesthetic puts you asleep during the whole procedure and a machine controls your breathing.
  • Spinal Anaesthetic. An injection is placed into your back to numb your hip and legs. You will be awake during the procedure, however a sedative can be given to you to help you doze off.
  • Nerve Blocks. This special injection is used to help with your pain after the operation and often used  in conjunction with a general anaesthetic.

The Hip Replacement Operation

The operation usually takes between 1 to 2 hours.

The damaged cartilage and bone and replace it with a new hip replacement.

Your wound is usually between 10-15 cms long, depending on your shape and your hip anatomy, and is located directly in front of your hip.

Your muscles are then carefully separated until your hip joint is found.

The arthritic femoral head (ball) is removed. This allows access to your acetabulum (socket) which is prepared for the new implant.

The acetabular implant is then secured into your hip joint socket.

Your thigh bone (femur) is then prepared and your new femoral stem and ball is inserted.

Your hip joint is then tested for stability, flexibility and size.

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Anterior hip replacement

Anterior Hip Replacement

Prosthesis choices in the Anterior Hip Replacement

What is the Anterior Hip Replacement made of?

Hip replacements are made of surgical grade metal (often chromium cobalt, stainless steel or titanium), highly wear resistant plastic or ceramic.

A hip joint is basically a ball and socket joint, and a hip replacement is designed to replace this normal anatomy.

A hip replacement is composed of a:

  • Socket: Medically called the Acetabular Component. It can be made of highly wear resistant plastic, metal or ceramic.
  • Liner: The liner fits snugly into the socket to provide an ultra-smooth surface for the hip joint. It can be also be made of plastic, ceramic or metal.
  • Ball: The artificial ball component is smaller than your normal hip ball. It is incredibly polished and perfectly round and smooth. It is usually made of metal or ceramic.
  • Stem: The stem fits snugly into your thigh bone (femur) to provide a stable structure for the ball. It is made of metal.

There are types of hip replacements available, and Dr Tran will decide which one is best for you.

Recovery Room

After the operation, you will be resting in the recovery room, where specially trained nurses will closely monitor to. This usually takes 1 to 2 hours. After which, you will be taken to your hospital room.

How long will I stay in hospital after an anterior hip replacement?

The time you spend in hospital depends on your individual circumstances and general health. Most patients will spend their time in hospital on either the 1st Floor or 2nd Floor of St Vincent’s Private East Melbourne.

The average stay in hospital is 2-4 days, but if your general health is poor, then you may need to spend more time on the ward recovering or in rehabilitation. For your convenience, rehabilitation can be organised for the 3rd Floor of St Vincent’s Private East Melbourne.

The golden rule is … you only go home after you are walking safely and your pain is well controlled. How long that takes is different for everyone.

The wonderful nurses and physiotherapists at the St Vincent’s Hospital East Melbourne will take the best care of you and tailor your stay to your needs.

What can I expect during my stay in hospital?

Pain

A special local anaesthetic pump is inserted during the operation to slowly infuse local anaesthetic into your hip joint for 24 – 48 hours. Most people find this wonderful pain relief, but there are also backup medications we can give you incase you need more medications to help with your recovery.

Walking

Most people are able to start gently walking on the day of surgery. Over your stay in hospital, you will increase the distance you want and the time you spend on your feet.

Bruising and Swelling

It is not uncommon for your thigh to become quite bruised and swollen. It can sometimes look very severe and also include your knee and calf. This is due to the effect of gravity and usually quite normal.

Preparing for Surgery

Tip

Carry a list of your medications with you including the name, dosage and how often you take it.

Before your operation, your fitness for the operation will be assessed by our perioperative physician ( Dr Belinda Smith) and all the necessary tests performed in preparation for the operation.

Tests

Tests that may be ordered for you include:

  • blood tests
  • Urine Test
  • ECG

Preparing Your Skin

Your skin should not have any infections or irritations before surgery. If either is present, contact Dr Phong Tran for a program to improve your skin before surgery.

Medications

Dr Belinda Smith will advise you which medications you should stop or can continue taking before surgery.

Go see your dentist

Consider getting treatment for significant dental diseases (including tooth extractions and periodontal work) before your hip replacement surgery. Routine cleaning of your teeth should be delayed for several weeks after surgery.

Get some help from your friends and family

Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry. If you live alone, our office can help you make advance arrangements to have someone assist you at your home or a ongoing stay at Rehab can be arranged.

Home Planning

The following is a list of home modifications that will make your return home easier during your recovery:

  • Securely fastened safety bars or handrails in your shower or bath
  • Secure handrails along all stairways
  • A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
  • A stable shower bench or chair for bathing
  • A long-handled sponge and shower hose
  • A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
  • A reacher that will allow you to grab objects without excessive bending of your hips
  • Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
  • Removal of all loose carpets and electrical cords from the areas where you walk in your home

Recovery and Rehabilitation after Anterior Hip Replacement Surgery

How do I look after my wound?

It is important to keep your wound as dry as possible.

Most patients are discharged home with a waterproof dressing, which can be left on for showering.

During the first 24 hours, it is normal to have some minor bleeding. After being discharged home, there should be no discharge, redness or bleeding around the wound.

If there is redness, discharge or a foul odour, please seek medical attention as soon as possible.

When will my stitches be removed?

There are a number of ways your wounds may be closed.

You may have either have

  • nonabsolvable stitches
  • absolvable stitches
  • surgical staples.

The stitches or staples are usually removed 10-14 days after surgery.

Usually, the wound is closed with a dissolvable stitch and surgical glue is used to seal the wound. Therefore, normally there are no sutures or surgical clips that need to be removed.

What should I eat and drink?

There are usually no specific diet or extra vitamins / nutrients needed to recover from a total hip operation.

It is important to have a normal healthy balanced diet and plenty of nonalcoholic fluids.

If your Body Weight Index is over 40, then you should endeavour to loose weight before the surgery. Patients with a BMI over 40, have an increased risk of surgical infection and complications.

Calculate your BMI

What exercises should I do at home?

Physiotherapy and the exercises that you perform at home are extremely important to achieve the best results after a hip replacement.

After returning home, you should gradually be able to do more and more. It is important to look after your new hip and follow Dr Tran ‘s and physiotherapy instructions.

Your program may include exerises that work on your:

  • walking
  • sitting
  • stair climbing
  • muscle strength

Avoiding Falls

A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery.

Be careful on Stairs. Stairs are a particular hazard until your hip is strong and mobile, and you’ve regained your balance. You should use a walking aid such as cane, crutches, a walker. Use the handrails on your stairs or ask for someone to help you., or handrails or have someone help you.

Special Precautions

One of possible complications of hip replacement surgery is dislocation. Dislocation is most common during the first year after surgery, but can also occur at any time. There are certain positions and precautions that must be avoided.

  • Do not cross your legs.
  • Do not bend your hips more than a right angle (90°).
  • Do not turn your feet excessively inward or outward.

Taking care of your new hip

Long term care of your total hip

DON’T FORGET:

  • Lead a healthy and active life.
  • In case of fever, throat inflammation, pulmonary inflammation or any infection, tell Dr Phong Tran that you have a hip implant.
  • Undergo regular general check-ups.

What are the complications and risks of having an anterior total hip replacement?

The complication rate following hip replacement surgery is very low.

However, it is important to always understand with potential complications (no matter how small the risk) when considering any operation.

The risks for a total hip replacement include:

  • Joint infection. Serious complications, such as joint infection, occur in fewer than 2% of patients.
  • Heart attack and Strokes. Major medical complications, such as heart attack or stroke, occur even less frequently.
  • Deep vein thrombosis (DVT) Blood clots in the leg veins or pelvis are the most common complication of hip replacement surgery. Dr Phong Tran may prescribe one or more measures to prevent blood clots from forming in your leg veins or, if they do form, measures to prevent them from becoming symptomatic. These measures may include special support hose, inflatable leg coverings, ankle pump exercises, and blood thinners.
  • Uneven legs. Leg-length inequality may occur or may become or seem worse after hip replacement. Dr Phong Tran will take this into account, in addition to other issues, including the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.
  • Dislocation
  • Wear and Tear. Over years, the hip prosthesis may wear out or loosen. This problem will likely be less common with newer materials and techniques. When the prosthesis wears, bone loss may occur because of the small particles produced at the wearing surface. This process is called osteolysis.
  • Revision surgery – having the operation done again.

Blood Clots | Deep Vein Thrombosis | DVT

One of the main risks of having a total hip replacement is a blood clot formation in the legs called a Deep Vein Thrombosis (DVT). The danger with a DVT is that it may move to your lungs and cause severe and sometimes life-threatening breathing problems called a Pulmonary Embolism (PE).

This threat is present anytime after your operation and last for several weeks after your surgery.

To reduce this risk as much as possible

Whilst in hospital, you will:

  • wear special compression stockings
  • be given daily injections of blood thinners called anticoagulants
  • walking and exercise everyday to help circulate your blood

Whilst at home

Look for the warning signs.

These include:

  • Pain in your calf

Warning signs that a blood clot has traveled to your lung include:

  • Shortness of breath
  • Chest pain, particularly with breathing

Notify Dr Phong Tran immediately if you develop any of these signs.

Preventing Infection

The most common causes of infection following hip replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your prosthesis.

Following your surgery, you may need to take antibiotics prior to dental work, including dental cleanings, or any surgical procedure that could allow bacteria to enter your bloodstream.

Warning signs of a possible hip replacement infection are:

  • Persistent fever (higher than 37.5°C orally)
  • Shaking chills
  • Increasing redness, tenderness, or swelling of the hip wound
  • Drainage from the hip wound
  • Increasing hip pain with both activity and rest

Notify Dr Phong Tran immediately if you develop any of these signs.

FAQ's

  • What are the important things to look for after a hip replacement?

    • Redness, swelling or warmth around the cut
    • Leakage from the cut
    • Fever and chills.
    • Severe knee pain that is not relieved by prescribed painkillers.
    • Sudden sharp pain and clicking or popping sound in the knee joint
    • Loss of control over leg movement
    • Loss of leg movement
  • Does Mr Tran perform metal on metal hip replacements?

    No. Mr Tran has never performed this operation because of the high revision rates associated with some of the metal on metal hip replacements.

    Also there is significant concern regarding the adverse health consequences of metal particles and metal ions.

    Reference

  • Does Mr Tran perform the Birmingham Hip Replacement?

    No. The Birmingham Hip replacement is a type of Metal on Metal Hip Replacement.

  • Will my hip replacement activate the metal detectors at airports?

    Some hip replacements may activate metal detectors at airports and some buildings.

    Patients have reported mixed experiences at airports. Most patients don’t find that they don’t set off metal detectors, but occasionally it can.

Australian National Joint Registry

References

  1. Abductor Tendons and Muscles Assessed at MR Imaging after Total Hip Arthroplasty in Asymptomatic and Symptomatic Patients. C. Pfirmann et al., Radiology 2005, 235: 969-976.
  2. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: COMPARISON BETWEEN THE DIRECT ANTERIOR APPROACH AND THE TRANSGLUTEAL APPROACHES. Bremer AK, Kalberer F, Pfirrmann CWA, Dora C, Journal of Bone and Joint Surgery – British Volume. 2011–July; 93-B:886-9.
  3. The Impact of Surgical Technique on Patient Reported Outcome Measures and Early Complications After Total Hip Arthroplasty. Sibia US, Turner TR, MacDonald JH, King PJ. J Arthroplasty. 2016 Nov