Direct Anterior Hip Replacement
Total hip replacement has become one of the most common - and safest - surgical procedures, with more than 300,000 performed annually in the United States alone. This is projected to double in the next 20 years, as more patients who suffer from progressively debilitating osteoarthritis seek to restore function, alleviate pain, and get back to living an active life.
Over the past 10 years, an increasing number of active patients have been benefitting from a more minimally invasive direct anterior approach hip replacement, which utilizes a small incision at the front of the hip to avoid muscle and tendon damage. This allows patients to return to normal daily activities shortly after surgery, with fewer restrictions and less risk of dislocation.
Dr. Adam Whatley has been performing direct anterior hip replacements since 2013. While he had great success with posterior and lateral approaches, he began investigating direct anterior replacement as demand grew in the Baton Rouge area. He trained extensively with noted surgeons, including Dr. Joel Matta, an early champion of the approach in North America.
Why Choose an Anterior Approach Hip Replacement
Regardless of the approach, hip replacements have about a 95% success rate in terms of improving pain, function and quality of life for up to 20 years.
- Using a lateral (side) or posterior (back) approach requires making an 8-12 inch incision and detaching muscles and tendons to replace the damaged joint. This can be more painful and prolong recovery for months.
- Direct anterior hip replacement utilizes a 3-4 inch incision to approach the joint from the front of the hip, and move muscles aside, along their natural tissue planes without detaching any tendons. This generally results in quicker recovery, less pain, less scarring, and a faster return to more normal function.
When it’s Time for Hip Replacement
The hip joint is made up of a ball (femoral head) at the upper end of the thigh bone, and rounded socket (acetabulum) in the pelvis. As arthritis causes the cartilage – which functions as a cushion – to wear away, bone rubs against bone, which can be extremely painful.
When severe arthritis starts significantly impeding function, it’s time to consider hip replacement.
Some of the most frequently reported symptoms include:
- Joint stiffness or swelling
- Difficulty walking, standing, and climbing stairs
- Discomfort sitting or lying down
- Difficulty bending, putting on shoes, or getting out of a chair
- Needing a cane, or other form of support, to get around
When symptoms no longer respond to non-invasive methods, such as anti-inflammatory medications or physical therapy, total hip replacement remains the most effective and reliable treatment.
Benefits of Anterior Hip Replacement
This minimally invasive procedure has several potential advantages:
- Minimal muscle trauma
- Less post-operative pain
- Quicker, easier recovery
- Less limping
- Reduced risk of hip dislocation
The direct anterior approach allows Dr. Whatley to place hip components in a more natural, anatomic fashion, without having to change the rotation of the socket. This greatly decreases the risk of dislocation and helps patients recover quicker with a more natural gait.
Specialized Equipment: Consistent Results
Dr. Whatley and his team use a special Hana Orthopedic Surgery Table, which positions a patient’s legs independently to provide ideal traction and mobility. X-rays taken during surgery help visualize placement to achieve virtually 100% accuracy.
This optimizes precision, accuracy, and the ability to see outcomes and make immediate adjustments in the operating room.
Recovery and Rehabilitation
Dr. Whatley generally completes direct anterior hip replacements in 1 hour.
Patients stay in the hospital overnight. They ease into physical therapy with weight bearing sessions the day of surgery, the morning after, and around lunchtime before going home. Patients continue walking, exercising at home, and working with a physical therapist as they progress.
A standard pain management regimen includes a narcotic for pain relief for about a week, Celebrex for inflammation, and Tylenol as needed.
After 2 weeks, most patients get around without an ambulatory assistance device; many report experiencing less pain the first day after surgery than they had before.
Activity after Hip Replacement
Post-operative activity levels are different for every patient. Traditionally, patients have had to take precautions to prevent dislocation after hip replacement surgery. This includes not crossing legs, not bending hips past a right angle, not turning feet excessively inward or outward, and sleeping with a pillow between their legs.
After a minimally invasive direct anterior hip replacement, most patients can safely move their hips immediately and bypass these cumbersome restrictions.
At 2 weeks, most active patients can, for example, practice their tennis swing, with a goal of returning to doubles (not singles), ease into golf with putting, chipping and pitching, or hunt using a ground blind (avoid climbing ladders and heavy lifting).
Patients are not permitted to drive while taking narcotics. After a left hip replacement, patients can typically start driving to physical therapy soon after surgery. Consult your physical therapist about driving after a right hip replacement. When resuming driving, Dr. Whatley recommends practicing in a field, abandoned road, or parking lot to gauge response time.
Patients with desk jobs can return to work in 2 weeks if they are able to drive safely. It may take 4-6 weeks to resume jobs with heavy lifting.
After a hip replacement, Dr. Whatley recommends avoiding running and jumping. Patients should take antibiotics before having dental work to minimize risk of infection.
Minimally Invasive, Direct Anterior Hip Replacement in Zachary, St. Francisville, and New Roads, LA
Dr. Adam N. Whatley is a board-certified orthopaedic surgeon with a fellowship in sports medicine from Harvard University’s Brigham and Women’s Hospital. He and his team at the Baton Rouge Orthopaedic Clinic are committed to utilizing the newest advances in orthopaedic care, including direct anterior total hip replacement and other minimally invasive procedures.