Anterior Approach Hip Replacement

For more information, see also Hip Replacement and Hip Resurfacing

What is the anterior approach ?

The anterior approach is a minimally invasive surgical technique used for total hip replacement where A/Prof Weinrauch can obtain access to the joint using intervals between muscle groups without the requirement for significant muscle detachment or splitting. For anterior approach procedures the incision is placed on the front and side of the upper thigh and the surgeon follows natural anatomic gaps between adjacent muscles to access the hip joint.

The anterior approach is also known as the Direct Anterior Approach (DAA), ASI (Anterior Supine Intermuscular) Approach, AMIS (Anterior Minimally Invasive Surgery) or the Heuter Approach. All of these procedures are identical or similar in many respects.

What are the advantages of the anterior approach ?

There are two main advantages.

Firstly, as muscle attachments and function are less compromised, people consistently rehabilitate quicker with a substantial reduction in pain and sweling, enabling an earlier return to functional activity.

Second, from a longer term perspective, anterior approach techniques also provide a much more stable hip replacement with a substantial reduction in the risk of dislocation. 

Does A/Prof Weinrauch perform the anterior approach ?

Yes. Anterior approach hip replacement offers a number of advantages in suitable patients. The anterior approach technique is not suited to every person nor to every procedure however.

Is a special traction table device required ?

No. My preference is to use Traction-Free Anterior Approach hip replacement techniques. In my opinion, the Traction-Free method allows greater accuracy in leg length restoration and better evaluation of muscle tension, joint range of motion and prosthetic stability as compared to when a traction table is used. In addition, anterior approach hip replacement procedures conducted with use of a traction table are associated with a higher risk of femoral fractures when compared to traction-free anterior hip replacemnet and other surgical approaches.

What is a typical recovery process?

Most people will be capable of walking on the same day of their surgery. You are permitted to place all your weight upon the operated hip when walking, however crutches are recommended for 2 weeks to assist in confidence and stability. Typically people will stay in hospital 2-3 nights after their procedure, however as people recover differently there are no "set number of days" allocated for your hospital stay - you can go earlier or stay longer depending on your progress.

Am I suitable for anterior approach hip replacement ?

While most people with hip arthritis requiring replacement are suitable for anterior approach techniques, there are some people with hip joints that are better suited to other surgical approaches. This may depend on a number of factors including bone shape, pattern of arthritis, implant design selected or the presence of significant obesity. Your suitability for anterior approach hip replacement will be determined by examination and evaluation of your hip prior to surgery.

What are the alternatives to anterior approach ?

Hip replacement procedures can be conducted using many different types of surgical approach, each of which has particular merits. For patients less suitable for anterior approach procedures I usually recommend a posterior approach. 

Regardless of the approach used, the outcomes after hip replacement surgery using modern surgical techniques and anaesthesia are excellent and rehabilitation consistently progresses in a safe and rapid manner. It is important to understand that posterior approach hip replacement is not necessarily "better" or "worse" - each surgical method has advantages and disadvantages depending on the the circumstances and note every person has the same requirements.

What are the disadvantages of the anterior approach ?

A patch of skin numbness below the skin incision on the outer aspect of the thigh below the incision is common, but is usually temporary.

Related publications

This information has been written by A/Prof Patrick Weinrauch for the purposes of patient education. The details provided are of general nature only and do not substitute for professional recommendations based an individual clinical assessment. © A/Prof Patrick Weinrauch. Brisbane Hip Clinic.