Anterior Approach

The anterior approach involves reaching the hip joint through a natural gap in the muscles at the front of the leg.  It is a relatively new approach, and so long-term studies have yet to be carried out.  With that warning in mind, let's take at the advantages and disadvantages already known.

The term 'surgical approach' refers to the place on your hip that the surgeon uses to access your hip joint

Advantages of the Anterior Approach

Proponents of the frontal approach argue that: -

  • rehabilitation times are reduced as no muscle is detached from either the pelvis or the femur and the gluteal muscles, (which are the most important muscles involved in working the hip), are not cut
  • with fewer muscles being cut there is less chance of a dislocation following surgery 
  • there is less post-operative pain for the same reason
  • patients do not need to follow the usual course of hip precautions that lateral and posterior approach patients do
  • the incision used is usually smaller
  • it reduces hospital stay compared with the posterior approach
  • the approach allows the patient to mobilise quicker than other approaches do
  • the surgeon has a good view of the acetabulum (the pelvis side)

Disadvantages of the Anterior Approach

  • A special operating table is required to perform the operation with the patients legs attached to the table. The table is then turned to allow the prosthesis to be inserted. This makes it difficult for the surgeon to know how much force is being exerted during the procedure and as a result an increase in hip fractures have been reported to occur during the procedure.  It is technically demanding surgery

The HANA Operating Table

  • If the X-ray equipment (which is used to position the implant) is not itself positioned correctly there is an increased risk that the implant will not be sited correctly.
  • The surgeon has a good view of the acetabulum (pelvis) the same is not true of the femur
  • It is possible that damage may occur to surrounding nerves (particularly the cutaneous femoris lateralis nerve) during the insertion of the implant which may result in numbness but the surgeon can reduce this risk by moving the incision site away from the nerve.
  • More recently some surgeons have withdrawn from using the technique. Partly because a minimally invasive approach makes it harder for the surgeon to see and feel what he is doing, and partly because there are concerns about revision rates.
  • It is not suitable for all patients, particularly those that are very muscular or are obese and it is not suitable for some types of revision work
  • Finally, although the initial recovery period is quicker with the anterior approach, other patients soon catch up and after six weeks there is no difference in progress.

How Is It Done?

Surgery is easier to understand visually than verbally so here is a great little video of the procedure. Its graphical video not one of a live operation.

Learn more about:

Different types of Anesthetics
Different types of Hip Implants 
The debate around the Best Time for Hip Replacement Surgery

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