Minimally Invasive Direct Anterior
Approach Hip Replacement, Sydney
Anterior approach total hip replacement is a minimally invasive hip surgery that does not cut muscles (muscle sparing) and provides for immediate post-operative mobilisation, return to home directly from hospital, and accelerated rehabilitation. Traditional ‘hip precautions’ from yesteryear are not required.
Anterior approach total hip replacement is combined with pre-operative dynamic hip analysis where CT scans and a set of dynamic pelvis X-rays are performed to assess the anatomic dimensions to ensure component positioning is matched to the patient’s functional analysis.
Dr. Robert Sew Hoy’s surgical technique has led to the development of the best direct anterior approach hip replacement Sydney residents can benefit from. Find out more by reading this comprehensive article.
How Anterior Hip Replacement Surgery Works
In the anaesthetic room of the operating theatre complex, the specialist anaesthetic doctor will discuss with you an anaesthetic plan that is based on safety and derived from your medical status.
In the operating theatre room, after the anaesthetic has been established, surgery is performed over the front of the hip with a surgical incision approximately 10cm in length. The anterior surgical approach is muscle sparing, meaning that it does not involve the cutting of muscles.
The biomedically engineered components replace the ‘ball and socket’ of the arthritic hip joint and are fitted firmly to the underlying bone. The new ‘ball and socket’ components carry decades of durability.
The ‘new socket’ is composed of a biocompatible titanium alloy acetabular component into which is placed a low friction material of either polyethylene or ceramic. The decision for polyethylene versus ceramic is primarily patient age determined.
The ‘new ball’ is composed of the low friction material of either ceramic or cobalt-chromium alloy that is mounted on a biocompatible titanium alloy femoral component that is inserted into the femoral canal.
The acetabular and femoral component insertion are guided by the dynamic hip analysis plan that was performed preoperatively. During surgery, X-rays are performed to ‘cross check’ that component orientation matches that of the pre-operative surgical plan.
Risks and Complications
Clinical protocols and pathways are followed that have been designed to reduce risk, but risk cannot unfortunately be reduced to zero. The vast majority of patients proceed through surgery along the expected path to recovery. It is important however to spend some time reading through the potential risks and complications, and to ask questions as they arise.
A list of the more important risks includes, but are not limited:
- Infection of the components and this is despite administering medication to prevent infection
- Blood clots (venous thromboembolism) despite administering medications to prevent blood clots.
- Fracture at the time of surgery.
- Component dislocation.
- Numbness around the surgical incision.
- Failure of the component to bond to the bone termed component loosening.
- Ending up with a difference in leg length of a few millimetres but this is usually not discernible.
The anterior approach total hip replacement surgical technique has less risk of dislocation and less risk of repeat surgery for component infection compared with the posterior and lateral surgical approaches.
Biomedical ceramic is an extremely durable material and importantly is bio-inert. Biomedical ceramic has been engineered to withstand extreme force but despite this, there is a low breakage rate. The ceramic ball has a breakage rate of perhaps 1 per 10,000 ceramic balls manufactured. The ceramic socket breakage rate is higher at perhaps 12-13 per 10,000 ceramic sockets manufactured. If a ceramic component breakage was to occur, then repeat surgery is required.
Postoperative Care and Rehabilitation
The anterior approach total hip replacement facilitates accelerated rehabilitation and this forms part of the enhanced recovery after surgery programme. The accelerated rehabilitation programme has the advantages of better clinical outcomes and less postoperative complications. The physiotherapist will assist in guiding the programme.
Recovery after an anterior approach total hip replacement permits a return to usual activities once comfort and confidence allow. The post-operative ‘hip precautions’ of yesteryear are not required.
Most patients will go home after 3-5 days in hospital but, for patients in their mid-70s and above, this may depend on whether there is someone home with them and whether there are only a couple of pre-existing medical conditions, or many pre-existing medical conditions. Prior to going home, patients need to prove their reasonable independence with regards to personal care, namely toileting, showering, dressing, walk safely with walking aids, and managing stairs.
A total hip replacement is classified as major surgery and the first few weeks after surgery can be physically and psychologically challenging. Take time to settle back into home, and work towards routine home activities. Post-operative soreness is to be expected and can be managed with pain-relieving medication. Tiredness can also be expected.
A waterproof dressing covers the surgical incision with dissolvable sutures. The dressing is shower proof, is changed only when required, and can be removed and left off 2 weeks after surgery. Thereafter, the surgical scar can be gently massaged with moisturising skin cream/bio-oil/vitamin E cream. The swelling in the thigh resolves slowly over 1 month.
Aim for a couple of short walks each day in the early stages, and build on this as the physiotherapy programme progresses. Return to your routine activities in and around home once comfort and confidence allow, and then work towards returning to your usual recreational activities, whether that be bush walking, gym-based fitness, tennis, golf, surfing, skiing etc., at your age appropriate level.
Why Choose Dr Robert Sew Hoy?
Dr. Robert Sew Hoy is an orthopaedic surgeon who specialises in treating knee and hip conditions. Dr. Hoy aims to provide safe and sound care for his patients. He proudly offers his services in two convenient locations in Sydney found here:
- Northern Beaches Hospital
Suite 20, Level 7, 105 Frenchs Forest Road, Frenchs Forest, NSW 2086 - The Mater Clinic
Suite 1.15, 3-9 Gillies Street, Wollstonecraft, NSW 2065
Do you have hip arthritis pain and are considering hip replacement surgery? Please contact Dr Robert Sew Hoy to arrange a consultation.
If you suffer from a knee or hip condition,
we can help you get back to life.
Pain and discomfort caused by orthopaedic conditions affect our patients negatively every day. Which is why we work so hard to provide relief for every one of our patients. Our team is highly trained in the diagnosis, treatment and management of all musculoskeletal conditions and injuries.
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