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Dr Anthony Spriggins Blog

Direct anterior approach to hip replacement

July 27, 2016 / Posted in Sportsmed News

Our hospital has peformed the first total knee replacement utilising the NAVIO surgical robot in Australia.

The direct anterior approach is gaining popularity in the orthopaedic profession for total hip replacement. The method is minimally invasive, reduces pain and improves mobility of the hip in the early post-operative stage.

While the direct anterior technique has recently gained momentum among orthopaedic surgeons, physiotherapists and patients, it is not a new approach and has long existed. It is an application of the Hueter approach first described in 1947.

The direct anterior route uses internervous and intermuscular planes, which lie between the muscles, to approach the capsule of the hip joint.

These planes are helpful as they can be utilised to access the joint without cutting any muscle.

The only structure at risk is a branch of the lateral cutaneous nerve of the thigh that provides some sensation over the side of the thigh.

Once access to the hip joint is obtained the procedural process of the hip replacement is the same regardless of the surgical approach.

The hip socket (acetabulum) needs visualisation and preparation, the head and neck of the thighbone (femur) need trimming, while the femoral shaft needs preparation.

Components of the new hip joint will also require accurate sizing, positioning and placement to achieve stable components in the correct position for a patient’s leg lengths and offset.

Once this is achieved, local anaesthetic is injected into the surrounding tissues and wound closure is performed.  After the operation a small patch of numbness may be present on the side of the thigh which is often transient.

Patients often stand and take their first steps on the day of surgery and are progressively more mobile over the next few days, with full weight able to be born on the hip at all times.

While the direct anterior approach restores function in the hip quicker and earlier, and decreases the need for pain relieving medication in the immediate weeks following, the outcome six months after surgery is the same as traditional methods.

The surgery is technically more difficult than other approaches, and so, in order for the operation to achieve the best results it requires a skilled, experienced, high volume surgeon who has received additional training to perform the approach, along with well-performing implants. In that case, complication rates are also similar to traditional approaches following surgery.

General risks of the direct anterior procedure are infection, deep vein thrombosis and difficulties with anaesthetic.

Specific to total hip replacement complications can include leg length inequality, fracture of the bone, hip dislocation and loosening of the implanted hip joint prosthesis. Complications are also more likely in patients suffering from obesity.

At SPORTSMED·SA we have a number of hip surgeons who specialise in the Direct Anterior Approach including Dr Spriggins and Dr Adrian Bauze.

For all appointments and enquiries with any of our hip specialists, please contact 08 8362 7788.