Direct Anterior Approach for Total Hip replacement - Mark Cvitanich
Arthritis of the hip joint results in damage and wear of the articular cartilage covering the hip joint surface leading to inflammation and severe pain in the hip. The end stage treatment of arthritis involves replacing the hip joint through surgery. Mark provides diagnosis and treatments for hip arthritis including anterior hip replacement surgery
The Direct Anterior Approach hip replacement is an approach that I utilise for my total hip replacements which is a good alternative to the traditional posterior or lateral approaches. These other approaches involve cutting the muscles surround the hip to access the joint.
In contrast, the direct anterior approach uses a muscle interval at the front of the joint so as to avoid the cutting of any muscles. Patients, therefore, experience less pain during the early postoperative period. The other major advantage is that patients do not need any postoperative precaution for posterior hip dislocation like using a highchair, high toilet seat or sleeping flat on the back for 6 weeks.
The surgery takes about an hour with either a spinal or a general anaesthetic. The surgery is done with you lying on your side not requiring the use of a special table.
We get you up immediately after the surgery. You will usually be up and walking within 90 mins of your surgery. Most patients will be discharged home the next day with the rest staying another night. You will be off crutches in the second week postoperatively. You can drive your car once off the crutches. You can sleep on your side immediately after surgery. A waterproof dressing covers the glued skin wound which allows showering immediately.
Benefits
- Advantages of the direct anterior approach include:-
- Smaller incision
- Short operative time
- Minimal blood loss
- Short stay in hospital
- Less postoperative pain
- Quicker mobilisation
- Fewer postoperative restrictions
- Lower dislocation risk
- Quicker return to driving/ work normal activities
Risks
No surgery is without risk. For a hip replacement, complications whilst unusual, can occur in about 2-3% of patients. The main complications to be aware of is infection which can occur early as a result of bacteria getting into the wound from your skin at the time of surgery. We minimise this risk by a strict sterile environment, special airflow in theatre and antibiotics around the time of surgery. Despite all efforts about 1% of patients will get an infection which may need further surgery to remove the implant and replace it with a new one to clear the infection. Dislocation is very uncommon and can usually be put back in place with sedation or a general anaesthesia. Recurrent dislocation may require further surgery to stabilise. Fracture can occur with any bone surgery and we have the gear available should this occur during the surgery. Deep vein thrombosis is very rare as we get you up so quickly and encourage lots of walking. I do put you on aspirin for 6 weeks postop. Some patients can get a temporary numb patch on the lower thigh from slight stretching a skin nerve during the surgery.
Handout
Rehab DAA Handout
