Anterior hip replacement is a minimally invasive surgical procedure that replaces parts of the affected hip bones. The full recovery time for the direct anterior hip replacement is 12 weeks.
What is an Anterior Hip Replacement?
Total hip replacement surgery or total hip arthroplasty involves replacing both the femoral head and the acetabulum of the hip. There are 3 surgical techniques: anterior (front), posterior (back), and lateral (side).
The posterior hip replacement surgery is the most commonly used and received its name as “the traditional posterior approach.”
The anterior hip replacement surgery is a relatively new approach. It involves a small incision about 3 to 4 inches on the front of the hip while avoiding the incision of major muscles.
Anterior Hip Replacement Recovery Guide
Week 1:
- Pain Management:
- You will experience some pain and discomfort.
- Your healthcare provider will prescribe pain medication and anti-inflammatory medications if needed.
- Take it as directed.
- Physical Therapy:
- You’ll start physical therapy immediately to regain your new hip mobility and strengthen the muscles around the joint.
- The standard exercises at this stage are heel slides, hip abduction, knee extension, and arm exercises.
- Please take note of hip precautions.
- Weight-Bearing:
- How much weight you can put on your leg (weight-bearing status) is dependent on your surgeon.
- Most weight-bearing status is touchdown weight-bearing (only the toes of your foot touch the floor) or partial weight-bearing status (the complete front of your foot can touch the floor).
- Mobility:
- Use assistive devices like crutches or a walker as needed.
- Follow your surgeon’s instructions on weight-bearing and mobility.
- The patient can resume activities of daily living, such as showering, cooking, and getting around the house.
- Incision:
- Redness, swelling, bruising, or numbness around the incision at the hip joint is not abnormal.
- Hospital Stay:
- It varies depending on the patient’s medical history and overall comfort. Typically, the hospital stay is 1-2 days after the surgery.
Week 2-3:
- Reduced Pain: Hip pain should decrease; you may need fewer pain medications.
- Physical Therapy: Continue with therapy to improve your hip’s range of motion and strength.
- Weight-Bearing: Gradually increase weight-bearing as directed by your orthopedic surgeon.
- Driving: Consult your surgeon about when it’s safe to resume driving.
- Typically, after 7 days, the patient can start driving again if the hip is fully weight-bearing and has demonstrated good strength and mobility.
- Return to Work: You may discuss a return-to-work plan with your surgeon if your job is sedentary.
- For more physically demanding jobs, it might be several weeks or even months before you can return.
Week 4-6:
- Pain:
- Significantly less pain will be noted, along with decreased stillness and swelling.
- Physical Therapy:
- In therapy, the goals here may be walking without an assistive device, balance and coordination to return to normal daily activities, and overall strength and range of motion.
Week 7-12
- Physical Therapy:
- Depending on the patient’s condition, physical therapy may continue in an outpatient setting to increase strength and range and improve life quality.
- Return to Normal Activities:
- You can start returning to your usual activities. Please continue to avoid high-impact or strenuous exercises.
Activities After an Anterior Hip Replacement
Recommended Activities
- Stationary bike
- Croquet
- Ballroom dancing
- Golf
- Horseshoes
- Shooting
- Shuffleboard
- Swimming
- Doubles Tennis
- Walking
Activities Only With Professional Experience
- Low-impact aerobics
- Road biking
- Bowling
- Canoeing
- Hiking
- Horseback riding
- Cross-Country Skiing
Activities NOT Recommended
- High-impact aerobics
- Baseball/softball
- Basketball
- Football
- Gymnastics
- Handball
- Hockey
- Jogging
- Lacrosse
- Racquetball
- Squash
- Rock climbing
- Soccer
- Singles Tennis
- Volleyball
The list was provided by the book “Fundamental Orthopedic Management for the Physical Therapist Assistant” by Robert C. Manske.
Things You May Consider Buying After The Surgery
- Ice packs specifically designed for the hip
- A grabber tool kit to prevent you from bending down. Obey HIP PRECAUTIONS!
- An easy to access post surgery shorts
- Abduction Wedge Knee Separator to prevent crossing the legs past the midline
- A comfortable shoe that has a cushion to relieve hip pain. The Orthofeet shoes fit the criteria.
- Consider getting a raised toilet seat if you had a posterior hip replacement or the lateral approach to obey hip precautions.
- If you have a lot of swelling, consider getting some compression stockings.
Indications for Total Hip Replacement
Here are reasons why you would get a total hip replacement surgery. This list is provided by the Physical Therapy Clinical Handbook for PTAs.
- Osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis
- Severe hip pain with weight bearing and marked limitations of motion
- Non-union fracture, instability of hip, or deformity of the hip
- Bone tumors
- Failure of conservative interventions for hip osteoarthritis or rheumatoid arthritis
- Revision of a previous surgery
The first reason for getting a total hip replacement is arthritis. The American Academy of Orthopedic Surgeons suggests trying non-surgical means first, such as corticosteroid injections, physical therapy, and non-narcotic medications.
Is the Anterior Hip Replacement Approach Superior?
The choice of whether the anterior hip replacement approach is superior to other approaches, such as posterior or lateral, is a matter of ongoing debate and depends on several factors. Each approach has advantages and potential limitations, and what might be considered superior for one patient may not be the best choice for another.
The Surgery
According to Dr. Fernando, in his article “Direct Anterior Approach (Minimally Invasive) Total Hip Replacement,” he claims the anterior approach “results in quicker recovery, less pain, and more normal function after hip replacement. ”
In the anterior approach, the orthopedic surgeon can reach the ball and socket hip joint without detaching any tendons by moving muscles aside along their natural tissue planes. The procedure involves removing the ball and socket and then replacing it with an artificial one: metal, plastic, or ceramic. Since no hip muscles were cut, there are no hip precautions.
The posterior approach for a hip replacement involves making an incision in the back of the hip. Major muscles and tendons are being cut and require precautions:
- No hip flexion past 80 degrees to 90 degrees
- No hip adduction pas midline (past neutral)
- No internal rotation
The lateral approach for hip replacement involves making a cut on the side of the hip. The muscle mostly affected is the tensor fascia latae and the hip precautions are:
- Avoid hip flexion of more than 90 degrees
- No hip extension
- No hip extension with hip external rotation
- No combined motion of hip flexion, abduction, and external rotation
Recovery
The length of hospital stay is dependent on the patient’s comfort. It usually ranges from 1 to 2 days. No matter which surgical approach, it is the same. Here is a list of things to discharge a patient:
- Is the patient able to use the bathroom independently with an assistive device?
- Can the patient walk using an assistive device?
- What is the patient’s pain level?
- Is the patient able to transfer in and out of a car?
- Can the patient shower with assistance or independently?
- If the patient has stairs at home, is the patient able to enter in and out of the house?
The Outcome
According to the American Association of Hip and Knee Surgery, there is insufficient evidence to suggest that one approach is superior. Joseph D. Maratt, MD stated, “There was no statistically significant difference in dislocation risk, fracture rate, blood loss, hematoma formation, length of hospital stay or readmission.”
Regardless of the approach, total hip replacement surgery has a success rate of 95%.
The Takeaway
The anterior surgical approach to a total hip replacement is relatively new, but it’s hard to say it is better. The best method depends on the individual patient’s needs and the surgeon’s expertise.
It’s essential to have a thorough discussion with your orthopedic surgeon to determine the best approach for your specific case. Your surgeon will consider your unique circumstances, anatomy, and surgical goals to make the most informed decision regarding the approach to use for your hip replacement.
Throughout my years as a PTA, I’ve only had two patients with an anterior approach. The majority of my hip patients had the traditional posterior approach. That said, the two patients with the anterior hip replacement had less pain and faster recovery.
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References
- Moore , M. L., Brinkman, J. C., Pollock, J. R., Denkey, D. G., Makovicka, J. L., & Bingham, J. S. (2022, September 20). Patients are most interested in which hip … – arthroplasty Today. Patients are Most Interested in Which Hip Arthroplasty Approach? A 15-year Google Trends Analysis. https://www.arthroplastytoday.org/article/S2352-3441(22)00168-6/fulltext
- Fernando, N.D. (no date) Direct anterior approach (minimally invasive) total hip replacement, Direct Anterior Approach (Minimally Invasive) Total Hip Replacement. Available at: https://orthop.washington.edu/patient-care/articles/hip/direct-anterior-approach-minimally-invasive-total-hip-replacement.html (Accessed: 11 October 2023).
- Dreeben-Irimia, O. (2013) Physical therapy clinical handbook for PTAS. Burlington, MA: Jones & Bartlett Learning.
- Manske, R.C. (2016) Fundamental Orthopedic management for the physical therapist assistant. St. Louis , MO: Elsevier.
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