Total hip replacement has become one of the most common and most successful types of orthopedic surgeries. Nearly 500,000 hip replacement surgeries are done in the United States every year (AAOS). Recently, there is a lot of talk total hip replacement. More specifically, the surgical approaches utilized in total hip replacement. The surgical approach to the hip is how we get to the hip joint so we can replace it. There are basically three ways to get there:
- Anterior Approach
- Posterior Approach
- Lateral Approach
This means the surgeon will approach from the FRONT, BACK or MIDDLE. There are few things that differ in these approaches:
- WHERE the incision is made? The most obvious difference…Because you can see the incision, patients may fixate a bit on this. Ultimately, where you cut still leads the surgeon to the same destination.
- WHAT is happening below the incision?
- WHO is getting the new hip and WHO is performing your hip replacement?
Let’s break down the different surgical approaches:
1)The posterior approach (back) is performed with a patient lying on their side, and a surgical incision is made along the outside of the hip. This is described as a posterior approach because the actual hip joint is visualized from behind the thigh bone—which is the posterior aspect of the hip joint. This approach allows for good visualization of the hip joint, but the incision is typically longer and there will be some additional post-op precautions.
2) There is a lot of buzz in about the direct anterior approach (front) for hip replacement. Although media and marketing often make this approach sound like it was developed recently, this approach has been around for over 100 years. The direct anterior approach is performed with a patient lying on their back, and a surgical incision is made coming down the front of the thigh. The incision is typically shorter and there is less impact to the muscles and tendons. Chase Lobrano, MD says “I trained in my fellowship in the direct anterior approach, and I utilize this approach often. I do want my patients to understand that although the approach is often noted in media as minimally invasive, there is nothing minimally invasive about what I do… orthopedic surgery is invasive, but my goal is to help my patients recover at a good pace and to help them get their lives back on track. At the end of the day, if the direct anterior approach is the best option for my patient, I am confident and ready to get them on the road to recovery.”
3) A lateral or anterolateral approach (middle) is performed on the side of the hip joint. This surgical approach is often considered to be a balance between the anterior and posterior approaches. The lateral approach is far more common today. One of the alternative approaches that Steven Atchison, MD utilizes is the Direct Superior Approach, a muscle sparing technique, where a small incision is made at the upper side of the hip allowing the surgeon to avoid cutting the key muscle group including the IT band (or Iliotibial band) and the external rotators. “Hip Replacement is a great surgery with great outcomes. I utilize the direct superior approach and have had great success. Typically, my patients undergoing hip replacement come out of surgery and have near complete pain relief. They will typically get up and walk with the assistance of a physical therapist just a couple of hours after surgery. Most of patients spend one night in the hospital. It is important that patients keep moving and after a total hip replacement, you really need to get your walking shoes on and WALK. Inevitably, all my patients will hear the same thing from me ‘You get out what you put into this surgery.’ I can do the surgery, but it is up to you to do the work before and after surgery.” says Atchison.
We both agree that a hip replacement is a great surgical procedure offering patients relief from pain and positive long-term outcomes. At the end of the day, the best approach for you and your surgeon is the approach that is going to safely get the hip replacement in your hip in the best position with the least number of complications. If hip pain is interfering with you living the life you want, drop by clinic and let’s talk about what treatment options are best for you.
Steven Atchison, MD and Chase Lobrano, MD have clinics in Shreveport and Bossier City. To schedule an appointment with Dr. Atchsion or Dr. Lobrano, please call Orthopedic Specialists of Louisiana: (866) 759.9679