With the anterior approach, the surgeon uses one small incision on the front (anterior) of your hip. This technique allows the surgeon to work between your muscles and tissues without detaching them from either the hip or thigh bones, sparing these tissues from trauma and a lengthy healing process. Keeping these muscles intact may also help prevent dislocations. Since the incision is in front, you’ll avoid the pain of sitting on the incision site.
The anterior approach is typically made possible with the use of a high-tech operating table that places the leg and pelvis in a stable position. This specially engineered table includes leg supports that allow the surgeon to adjust the operative leg during surgery with a great degree of control and precision. Surgeons who use this technique say this table is designed to help achieve excellent alignment and positioning of the implant. Rather than being positioned on their side or stomach, the patient is laid flat on his/her back, which minimizes tilting of the pelvis during the operation. The table also gives the surgeon excellent access to the femur, or thighbone, in order to position the stem of the implant effectively.
The procedure itself begins with the surgeon exposing the hip in a way that does not detach muscles or tendons from the bone – a key attribute of the anterior approach. The surgeon removes the diseased cup portion of the hip and replaces it with an implant. The surgeon then uses the specially designed table to rotate the operative leg so the foot points outward, extending toward the floor. This allows excellent access to the thigh bone, or femur, so the surgeon can replace the diseased portion of the bone with the stem implant. This is important since visibility is often limited due to smaller incisions.
Sometimes side-by-side TV screens are used to provide X-ray views of the operative hip and the patient’s opposite hip. This comparison gives the surgeon the information used to determine the best positioning for an effective, stable hip replacement implant. The combination of this X-ray imaging and the high-tech table allows the doctor to seek more precise control over the patient’s leg length as well.
The incision length, typically smaller than with standard surgery, varies according to a patient’s size, weight and other factors. The anterior approach lends itself to a relatively small incision because the hip joint is closest to the skin at the front of the hip. The muscle and fat layers are thinner than the muscle and fat tissue encountered when using other approaches on the side or rear of the thigh. While the smaller scar is a cosmetic advantage, surgeons say the actual size of the incision for each patient varies.
Another way that the anterior approach differs from some other techniques is with patient selection. Other minimally invasive techniques place more restrictions on patient selection. With other procedures, patients may need to be at their ideal bodyweight, for example. The anterior approach may make minimally invasive hip surgery possible for a wider range of patients, including larger, heavier patients. That’s because the anterior approach enters the body closer to the hip joint, with far less tissue between the skin and the bones of the hip, so more patients may be candidates.
Your doctor will tell you what restrictions you will have after surgery, and every surgeon has his or her own set of precautions for you to follow. Some surgeons who use the anterior approach place fewer restrictions in the days after surgery because the operation spares the major muscles of the thigh, allowing patients to get back to activities of daily living with fewer limitations.