Direct Anterior Total Hip Replacement

What Is Direct Anterior Total Hip Replacement?

Direct Anterior Total Hip Replacement is a surgical procedure that aims to replace a damaged or arthritic hip joint with an artificial implant. The term "anterior" refers to the front of the body, and in this approach, the surgeon accesses the hip joint through the front of the hip, between the muscles, without cutting through any major muscle groups. 

Who Conditions are Suitable for Direct Anterior Total Hip Replacement?

Anyone who requires a total hip replacement. 

• Arthritis: The anterior approach may benefit patients with hip arthritis or degeneration. Arthritis may develop from previous trauma or accumulation of 'wear and tear' related to genetics or lifestyle factors.  Sometimes specific diseases may cause the arthritis such as avascular necrosis, hip dysplasia or inflammatory joint disease.

• Fracture: Displaced femoral neck fractures often do well with hip replacement.  Minimally displaced fractures can often be treated with fixation.  Decision to fix or replace depends on age, medical conditions and mobility.
  

Benefits of Direct Anterior Total Hip Replacement

Direct Anterior Total Hip Replacement offers several benefits compared to traditional hip replacement surgeries, including:

• Faster Recovery: Patients undergoing the direct anterior approach often experience a quicker recovery period. Since major muscles are not cut during surgery, there is less soft tissue damage, resulting in reduced pain and a faster return to normal activities.
• Shorter Hospital Stay: Many patients undergoing this procedure can expect a shorter hospital stay than traditional hip replacement. Some may even go home the same day as surgery, although this depends on individual factors and the surgeon's recommendations.
• Less Postoperative Pain: The minimally invasive procedure typically leads to less postoperative pain and discomfort. This can often be managed effectively with pain medications and physical therapy.
• Reduced Risk of Dislocation: The direct anterior approach may reduce the risk of hip dislocation, a potential complication of hip replacement surgery. This is because the technique preserves important hip structures.
• Smaller Incisions: Smaller incisions are used in this approach, resulting in better cosmetic outcomes and reduced scarring.

Preparation Before Direct Anterior Total Hip Replacement

Here are the steps to take before the procedure:

• Schedule a consultation with your orthopaedic surgeon to discuss your specific case. During this consultation, your surgeon will assess your hip joint's condition, overall health, and suitability for the procedure.
• Undergo a thorough medical evaluation, including blood tests, imaging (X-rays, MRI), and any other necessary diagnostic tests to ensure optimal health for surgery.
• Inform your surgeon about all your medications, including prescription, over-the-counter, and supplements. Some medicines may need to be adjusted or temporarily stopped before surgery.
•  If you have chronic medical conditions such as diabetes or hypertension, work with your healthcare team to ensure they are well-managed before surgery.
• If you smoke, consider quitting or at least reducing your smoking in the weeks leading up to surgery. Smoking can impair healing and increase the risk of complications.
• Your surgeon may recommend preoperative physical therapy to help improve your hip's strength and mobility. This can facilitate a smoother recovery.
• Prepare your home for your return after surgery. This may involve clearing clutter, installing safety rails, and arranging for assistance with daily tasks.
• Maintain a balanced diet to support healing. Consider discussing dietary guidelines with your surgeon or a nutritionist.
• Arrange for a support system to assist you during your recovery, including transportation to and from the hospital and help with daily activities.

Direct Anterior Total Hip Replacement Procedure

The surgical procedure itself involves several key steps:

• You will receive anaesthesia to ensure you are comfortable and pain-free during the procedure. Your surgeon and anesthetist will discuss the best anaesthesia option for you, including general anaesthesia and spinal anaesthesia.
• To access the hip joint, an anterior incision,  is made on the front of your hip, muscles and soft tissues are gently moved aside rather than cut through. This minimises muscle trauma.
• The damaged or arthritic parts of your hip joint are removed, and an artificial hip implant is inserted. This implant may have a combination of titanium, cross-linked polyethylene and surgical alloys.
• Dr Gifford utilises X-ray and Computer Software to determine the size and position of the implant.  The size of the implants are selected based on your skeleton and unique bone properties.  Critical elements that are considered with the computer software is Leg length, Offset and Rotation of the implants. 
• Once the implant is securely in place, the incision is closed with internal sutures which dissolve over time and a glue dressing.
• After the surgery, you will be monitored in a recovery room before being transferred to a hospital ward.

After a Direct Anterior Total Hip Replacement

Most patients stay in the hospital briefly, typically 1 to 4 days, depending on individual circumstances.

1. Pain management: You will receive pain medication as needed, and your medical team will work to keep you comfortable.  Pain medications include simple analgesia such as paracetamol and non-steroidal anti-inflammatories, and opioids such as Palexia and Endone or Targin.
2. Mobilisation: Moving after surgery is important for blood flow, independence, confidence and avoidance of complications.  The physiotherapists and nursing staff will assist you and graduate you through various forms of mobility assistance devices.  Most people discharge with elbow crutches.  You will need to show independence with bed and bathroom mobility, and use of stairs, prior to discharge.
3. Bladder and bowels: Its important that you can open your bowels and bladder prior to discharge.  Constipation is a very common problem for patients post operatively due to the combination of immobilisation, medications and pain.

Direct Anterior Total Hip Replacement Recovery Plan

Your surgeon and physical therapist will work with you to create a personalised recovery plan. Here are some key aspects of the recovery plan:

• Physical Therapy: Attend regular physical therapy sessions to improve hip strength, flexibility, and function.
• Medication: As your surgeon directs, continue taking prescribed medications, including pain relievers and prophylactic antibiotics.
• Mobility: Gradually increase your level of activity and mobility as guided by your medical team. If provided, follow any weight-bearing restrictions.
• Wound Care:  The dressing stays uninterrupted for 2 to 3 weeks.  Dr Gifford will remove at the first post-op visit.
• Lifestyle Adjustments: Make necessary adjustments to your daily routine and lifestyle, such as avoiding high-impact activities and following any dietary recommendations.
• Patience and Persistence: Recovery can take several weeks to months, and progress may vary from person to person. Be patient and persistent in your rehabilitation efforts.

Direct Anterior Total Hip Replacement Risks

While Direct Anterior Total Hip Replacement is generally safe and effective, like any surgical procedure, it carries some risks and potential complications. It's essential to be aware of these risks before undergoing surgery. Common risks and complications may include:

• Infection: There is a risk of infection at the surgical site or within the hip joint. This risk is mitigated through strict sterile techniques during surgery and antibiotic prophylaxis.
• Blood Clots: Blood clots can develop in the legs (deep vein thrombosis) or travel to the lungs (pulmonary embolism) after surgery. Measures such as blood thinners, compression stockings, and early mobilisation are used to reduce this risk.
• Nerve or Blood Vessel Damage: In rare cases, nerves or blood vessels near the surgical site may be injured during the procedure, leading to numbness, weakness, or bleeding.
• Dislocation: While the anterior approach can reduce the risk of dislocation, it is not eliminated.  There are no specific precautions with the anterior approach, just avoid falls!
• Implant Wear or Loosening: Over time, the artificial hip joint may experience wear or loosening, potentially requiring revision surgery.  Current implants used have a good history of survival and it is reasonable to expect a long use of the prothesis.
• Leg Length Discrepancy: In some cases, there may be a slight difference in leg length after surgery, although surgeons take measures to minimise this issue.
• Persistent Pain: While most patients experience pain relief, some may experience hip discomfort or pain after surgery.