Dr. Baier has been utilizing the Anterior Total Hip Replacement approach (also called Direct Anterior Approach, DAA) successfully for over 4 years. He was the first surgeon to use this approach at Advocate Condell Hospital. He has noticed that patients tend to get on their feet quicker with the anterior approach compared to posterior approach. There is also less dislocations and leg length inequality with this approach.
Anterior Total Hip Replacement is a technique in which hip replacement surgery is performed through an alternative approach compared to conventional hip replacement surgery. Historically, hip replacement surgery was performed utilizing traditional posterior or lateral approaches. This necessitates that certain muscles or tendons are cut in order to access the hip joint and perform the surgery. Some of these small tendons that are cut assist in stabilizing the hip to prevent dislocations and don’t heal well when repaired.(See video for greater explanation)
The direct anterior approach, (AMIS – Anterior Minimally Invasive Surgery) utilizes a muscle interval in front of the hip joint in which muscles and tendons planes are split and separated. While one of the smaller muscles, the Piriformis, maybe released, the main anti-dislocation muscle, Obturator Externus, is preserved and not cut as in the posterior approach. Because exposure can be more challenging, special instruments and a custom operating table are used to assist in performing the surgery.
Patients who have undergone Anterior Total Hip Replacement surgery report that the post-operative pain and discomfort is markedly less than traditional approaches. There are no restrictions postoperatively with sitting in a low chair and no pillow is needed between the legs when sleeping at night. In addition, their recovery is expedited. Most patients are discharged from the hospital the day after surgery. In fact, the anterior hip replace can be performed as an outpatient surgery as long patient has proper support at home (See Outpatient Total Hips and Knees). Most patients are off any assistive devices (cane or walker) by 1-2 weeks after surgery.
The Anterior Total Hip Replacement is not applicable to all patients. Most patients who are undergoing Revision Total Hip Arthroplasty may be better served by more traditional approaches. Those patients who have severe hip deformities, such as from childhood diseases or from previous surgery, may not be candidates for the direct anterior approach. The surgery may take a little longer than the traditional surgery due to the exposure, but patients will not notice this since they are under anesthesia. There is also increase blood loss with this approach. It is rare, however, for patients to require any transfusions.
Studies show that patients with DAA make a quicker recovery at 2 weeks post-op than patients who had a traditional posterior approach. However, looking at patient strength and function, patients are equal at 6 months and 1 year post-op except those patients with posterior approach still have some weakness with external rotation of the leg.