Joel S. Buchalter, MD, FAAOS, FACS
Between 200,000 and 300,000 hip replacement surgeries are performed each year in the United States, sixty-five percent of them on people over the age of 65, according to the American Academy of Orthopaedic Surgeons. These procedures have been concentrated in older adults because many people put off the operation as long as possible, and because arthritis and other degenerative joint disorders become more severe as people grow older. Today, the number of younger people undergoing total hip replacement seems to be increasing, and the development of longer lasting prostheses and advances in surgical technique that reduce recovery time have persuaded more patients to avoid postponing the procedure.
One of the key surgical advances benefiting patients is the anterior hip replacement, a minimally invasive approach that reduces discomfort and simplifies and accelerates rehabilitation. The anterior approach to hip replacement allows the surgeon to reach the hip joint from the front of the hip instead of from the lateral (side) or the posterior (back) position. This way the hip can be replaced without detaching muscle from the pelvis or femur during surgery. The surgeon can simply work through the natural space between the muscles. The most important muscles for hip function are left undisturbed, thereby reducing recovery time.
Anterior hip replacement is made possible by a special, state-of-the-art surgical table known as the hana® table. The table allows hyperextension, adduction (movement to the mid-line) and external rotation of the hip to an extent not possible with conventional tables. This mobility enables the leg to be positioned for proper fit of all prosthetic components. The result is less pain, less scarring and a faster recovery. As opposed to conventional hip surgery, where the patient must take certain precautions after the operation, most patients after anterior hip replacement can walk with a cane to their first post-op visit and some even come in walking without the aid of a cane. Leaving the lateral and posterior soft tissues intact makes the hip immediately stable and also reduces the risk of dislocation.
The hana® table is essentially an infinitely adjustable positioning device. It also has a sterile robotic attachment that lifts the femur to make it accessible for the surgeon to place the femoral implant without interference from soft tissue. Additionally, the surgeon can view video images during the procedure to ensure precise fit and placement of all components.
Conventional lateral or posterior hip surgery typically requires strict post-surgical precautions. Most patients must limit hip motion for 6 to 8 weeks after surgery. They must not flex the hip more than 60 to 90 degrees, which complicates normal activities like sitting, putting on shoes or getting into a car. Climbing stairs may also be difficult during recovery. With anterior hip replacement, patients can bend the hip freely immediately after surgery and use the hip normally without cumbersome restrictions. Under supervision, they go up and down stairs before leaving the hospital. Patients are evaluated and treated by a physical therapist following surgery and may go home when able to walk with crutches or a walker and perform basic day to day activities. Discharge is generally 1 to 3 days after surgery depending on the patient’s degree of disability prior to surgery and overall capabilities.
Most patients who are candidates for traditional hip replacement surgery are also candidates for the anterior procedure. In fact, for patients who require bilateral hip replacement, it is even possible to do both hips in a single procedure. The patient undergoes a single surgery and anesthesia, a single hospital stay and a single rehabilitation period.
Anterior hip replacement with the hana® table minimizes disruption for patients. With conventional surgery, we generally see patients at their first office visit, two weeks after discharge, walking with a walker. With the new procedure performed on the hana® table, many patients are walking with only a cane and some are even walking without assistance.