An innovative type of surgery is making recovery faster and easier.
If you’ve got a pain in your hip, you’re not alone. Today, a person’s lifetime risk of developing osteoarthritis in the hip is 25 percent, according to a long-term study funded by the Centers for Disease Control and Prevention and the National Institutes of Health.
In large part, that’s because people are living longer and staying active longer, making osteoarthritis—a degeneration of joint cartilage and bone—more common. The American Association of Hip and Knee Surgeons says there is likely to be a need for 500,000 hip replacements each year by the year 2030.
Increasingly, the hip replacement surgery of choice is a newer type known as anterior approach hip replacement. While it may not be the answer for every patient, those who are able to have the anterior approach instead of more traditional forms of the surgery will experience less pain, a shorter recovery time and other advantages. Mark Ghobrial, DO, an orthopedic surgeon at Robert Wood Johnson University Hospital (RWJUH) Rahway, explains.
What makes a person choose hip replacement surgery?
Patients who are candidates tend to have moderate to severe arthritis in their hip, whether from osteoarthritis, rheumatoid arthritis or post-traumatic arthritis. We start with nonoperative, conservative treatments such as anti-inflammatory drugs, physical therapy, cortisone injections and use of a cane or walker.
But if pain continues to interfere with daily living activities—like walking, going up and down stairs, getting in and out of chairs and sleeping—even after these non-surgical remedies, patients may elect to proceed with surgical intervention.
What is different about the anterior approach compared with more traditional forms of hip replacement surgery?
The most common approach to the hip joint during surgery is what’s known as the posterior approach. It’s done from the back of the hip and involves cutting through the muscle in the buttocks. The anterior approach, as the name indicates, means that we make an incision down the front of the hip. It is a shorter incision—about three to five inches, compared to eight to 12 inches—and we don’t need to cut tendons or muscle. We can go in between muscles at a natural opening to get to the joint and replace it.
Because we don’t need to cut muscle with the anterior approach, patients have less pain, shorter hospital stays and a much quicker recovery time. The intact muscles also help hold the new joint in place, reducing the risk of hip dislocation.
In what cases would a patient not be eligible for the anterior approach to hip replacement?
In some cases, a patient’s skeletal structure or body type may make this approach difficult. Obesity can be a complicating factor. For select patients, I do the traditional posterior approach, or an approach from the side called the lateral approach.
Does the anterior approach require any special equipment?
At RWJUH Rahway, I use a specific table, known as a Hana table, to best position the patient for the anterior approach. The Hana table also makes it easier to use fluoroscopy, an interoperative X-ray, to make sure all the components of the joint replacement are positioned in the best way possible to match the patient’s anatomy.
It is a bit more technically challenging surgery to do, and requires specialized training in instrumentation. If a patient is interested in anterior approach hip replacement, I would advise him or her to find a surgeon who is well experienced in this type of surgery.
What is recovery like?
With other hip replacement approaches, a patient has to wait for wounds and tendons to heal before therapy can begin. With the anterior approach, the majority of patients spend one night in the hospital and do minimal to no physical therapy afterwards. Patients are basically able to get up and walk the next day, though they may still need a walker or cane.
To learn more about the joint replacement program at RWJUH Rahway, call 732.499.6346 or visit www.rwjbh.org/rahwayjointreplacement